Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA.
Psychol Med. 2023 Aug;53(11):5177-5184. doi: 10.1017/S0033291722002197. Epub 2022 Jul 29.
Despite the significant psychosocial morbidity associated with borderline personality disorder (BPD), its underrecognition is a significant clinical problem. BPD is likely underdiagnosed, in part, because patients with BPD usually present with chief complaints associated with mood, anxiety, and substance use disorders. When patients with BPD do not exhibit self-harm behavior, we suspect that BPD is less likely to recognized. An important question is whether the absence of this criterion, which might attenuate the likelihood of recognizing and diagnosing the disorder, identifies a subgroup of patients with BPD who are 'less borderline' than patients with BPD who do not manifest this criterion.
Psychiatric outpatients were evaluated with a semi-structured diagnostic interview for DSM-IV BPD, 390 of whom were diagnosed with BPD. We compared the demographic and clinical characteristics of patients with BPD who do and do not engage in repeated suicidal and self-harm behavior.
Approximately half of the patients with BPD did not meet the suicidality/self-injury diagnostic criterion for the disorder. There were no differences between the patients who did and did not meet this criterion in occupational impairment, likelihood of receiving disability payments, impairment in social functioning, level of educational achievement, comorbid psychiatric disorders, history of childhood trauma, or severity of depression, anxiety, or anger upon presentation for treatment.
Repeated self-injurious and suicidal behavior is not synonymous with BPD. It is critical for clinicians to be aware that the absence of repeated self-injury and suicide threats/gestures or attempts does not rule out the diagnosis of BPD.
尽管边缘型人格障碍（BPD）与明显的心理社会发病率相关，但对其认识不足仍是一个重要的临床问题。BPD 可能诊断不足，部分原因是 BPD 患者通常以与心境、焦虑和物质使用障碍相关的主要症状就诊。当 BPD 患者没有表现出自伤行为时，我们怀疑 BPD 不太可能被识别。一个重要的问题是，是否缺少这一标准会降低识别和诊断该疾病的可能性，并确定一个比没有表现出这一标准的 BPD 患者“不那么边缘”的 BPD 患者亚组。
使用 DSM-IV BPD 的半结构式诊断访谈对精神科门诊患者进行评估，其中 390 名患者被诊断为 BPD。我们比较了有和没有反复自杀和自伤行为的 BPD 患者的人口统计学和临床特征。
大约一半的 BPD 患者不符合该疾病的自杀/自伤诊断标准。符合和不符合该标准的患者在职业障碍、获得残疾津贴的可能性、社会功能障碍程度、教育成就水平、共病精神障碍、童年创伤史或治疗时出现的抑郁、焦虑或愤怒严重程度方面均无差异。
反复的自伤和自杀行为与 BPD 并非同义。临床医生必须意识到，反复的自伤和自杀威胁/姿态或企图的缺失并不排除 BPD 的诊断。
