具有边缘型人格障碍特质的青少年的母婴互动及早期生活虐待的影响。
Mother-child interactions in adolescents with borderline personality disorder traits and the impact of early life maltreatment.
作者信息
Williams Katharina, Fleck Leonie, Fuchs Anna, Koenig Julian, Kaess Michael
机构信息
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany.
Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
出版信息
Child Adolesc Psychiatry Ment Health. 2023 Aug 10;17(1):96. doi: 10.1186/s13034-023-00645-4.
BACKGROUND
Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships.
METHODS
The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case-control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored.
RESULTS
BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status.
DISCUSSION/CONCLUSION: Our data suggest a stronger focus on parent-child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.
背景
青少年边缘型人格障碍（BPD）的早期发现和干预已成为公共卫生的重点。理论模型强调社会互动和代际机制在该障碍发展中的作用，这表明需要更深入地研究照顾者与儿童的关系。
方法
本研究采用病例对照设计，调查了母亲与青少年的互动及其与青少年BPD特质的关联。对38名具有≥3种BPD特质的青少年患者及其母亲（BPD组）进行了调查，并与35对健康对照二元组（HC组）进行对比。在两次互动中，即有趣的一天计划和应激范式期间，使用互动行为编码手册（CIB）对母亲、青少年和二元组行为进行编码。还探讨了母亲和/或青少年早期生活虐待（ELM）对行为的额外影响。
结果
在两次互动中，BPD组的母亲、青少年和二元组行为质量均显著低于HC组。仅BPD特质就能预测母亲和青少年的行为，而二元组行为也受到青少年一般精神病理学的影响。对CIB子量表的探索性分析表明，与有趣的一天计划相比，HC组在应激期间增加了他们的互惠行为，而BPD组二元组则减少了这种行为。母亲的ELM在两组之间没有差异，也对行为没有任何影响。青少年的ELM与行为结果变量相关，但在临床状态的影响之外，并没有解释行为结果。
讨论/结论：我们的数据表明，在BPD特异性治疗中应更加强调亲子互动，以提高青少年BPD患者的长期治疗效果。需要进一步开展采用允许分析双向交易的研究设计（例如纵向设计、行为微观编码）的研究。
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