Gupta Nihit, Gupta Mayank, Madabushi Jayakrishna S, Zubiar Faiza
Psychiatry, University of West Virginia, Glen Dale, USA.
Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh , USA.
Cureus. 2023 Jun 12;15(6):e40295. doi: 10.7759/cureus.40295. eCollection 2023 Jun.
Borderline personality disorder (BPD) has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence. Various genetic, neurobiological, psychological, and social factors are implicated in the etiology of BPD. With emerging evidence on BPD development in adolescence, the review focused on recent literature to understand the role of psychosocial risk factors. The effects of adverse familial environment, physical, emotional, verbal, and sexual abuse, intergenerational transmission of psychopathological traits, maternal neglect and rejection, low socioeconomic status, bullying victimization, and dating violence were reviewed to understand their role in the development of BPD. BPD is a highly complex, serious, and enduring mental illness that has now been widely accepted to have symptoms that onset in early adolescence and could be diagnosed as early as age 12. BPD symptoms are stable, phenomenologically distinct from externalizing and internalizing disorders, and often present with co-occurring disorders, which during assessment could not explain impairments associated with BPD. New measures like the Difficulties in Emotion Regulation Scale (DERS), detailed developmental histories, understanding of psychosocial risks, shared decision-making, and psychoeducation could assist in early diagnosis and improvement of long-term outcomes. The implementation of evidence-based treatments is a challenge given higher costs and access to services; therefore, modifications in the treatment based on the core principles of these strategies should be considered. It is imperative to screen for psychosocial factors early in higher-risk groups. The assessment of familial factors, parental histories of psychopathologies, and histories of childhood abuse is important in context with impairing symptoms of clinical presentation and dimensional aspects of self-functioning. The role of family therapies, parental psychoeducation, and the integration of trauma-informed care approaches are important for clinical outcomes. Also, coordinated efforts with multiple stakeholders like school awareness programs, anti-bullying policies, legislation, and enforcement of existing laws might be instrumental in addressing issues related to victimization by peers.
边缘性人格障碍（BPD）在儿童晚期和青少年期的发展现象学知识方面取得了重大进展。BPD的病因涉及多种遗传、神经生物学、心理和社会因素。随着青春期BPD发展的新证据出现，本综述聚焦于近期文献，以了解心理社会风险因素的作用。回顾了不良家庭环境、身体、情感、言语和性虐待、精神病理特征的代际传递、母亲的忽视和拒绝、低社会经济地位、欺凌受害和约会暴力的影响，以了解它们在BPD发展中的作用。BPD是一种高度复杂、严重且持久的精神疾病，目前已被广泛认可其症状始于青春期早期，最早可在12岁时诊断。BPD症状稳定，在现象学上与外化和内化障碍不同，且常伴有共病，在评估过程中这些共病无法解释与BPD相关的损害。新的测量方法，如情绪调节困难量表（DERS）、详细的发育史、对心理社会风险的理解、共同决策和心理教育，有助于早期诊断和改善长期预后。鉴于成本较高和服务获取问题，实施循证治疗具有挑战性；因此，应考虑根据这些策略的核心原则对治疗进行调整。在高风险群体中尽早筛查心理社会因素至关重要。结合临床表现的损害症状和自我功能的维度方面，评估家庭因素、父母的精神病史和童年虐待史很重要。家庭治疗、父母心理教育以及创伤知情护理方法的整合对临床结果很重要。此外，与学校宣传项目、反欺凌政策、立法以及现有法律的执行等多个利益相关者的协调努力，可能有助于解决与同伴受害相关的问题。
