边缘型人格障碍患者在自尊降低之前会出现负性情感唤起增加，但抑郁症患者则不然：一种经验取样法。
Increases in negative affective arousal precede lower self-esteem in patients with borderline personality disorder but not in patients with depressive disorders: an experience sampling approach.
作者信息
Heekerens Johannes Bodo, Schulze Lars, Enge Juliane, Renneberg Babette, Roepke Stefan
机构信息
Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany.
出版信息
Borderline Personal Disord Emot Dysregul. 2023 Oct 3;10(1):29. doi: 10.1186/s40479-023-00229-w.
BACKGROUND
Instability in self-esteem and instability in affect are core features of borderline personality disorder (BPD). For decades, researchers and theorists have been interested in the temporal dynamics between these constructs. Some hypothesize that changes in affective states should precede changes in self-esteem (Linehan, Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993), while others suggest that changes in self-esteem should precede changes in affective states (Kernberg, Borderline conditions and pathological narcissism, 1975).
METHODS
In this study, we investigated the temporal relations between negative affective arousal states and current self-esteem in daily life. Patients with BPD (n = 42) or depressive disorders (DD; n = 40), and non-clinical controls (NCC; n = 40) were assessed every 15 min for 13 h.
RESULTS
As expected, dynamic structural equation modeling showed higher levels of average daily negative affective arousal and lower levels of average daily self-esteem in the BPD group compared with the NCC group, and scores in the DD group were in-between the BPD and the NCC groups. In line with predictions based on Linehan's (Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993) model of affective dysregulation in BPD, negative affective arousal (t) and subsequent self-esteem (t+ 1) were significantly linked only in the BPD group, implying that higher negative affective arousal is followed by lower current self-esteem in the next measurement (ca. 15 min later). Importantly, self-esteem (t) and subsequent negative affective arousal (t + 1) were not significantly related (Kernberg, Borderline conditions and pathological narcissism, 1975).
CONCLUSIONS
Our findings suggest close dynamic temporal relations between affective instability and self-esteem instability in BPD, which highlights the importance of providing patients with means to effectively modulate high negative affective arousal states.
背景
自尊不稳定和情感不稳定是边缘型人格障碍（BPD）的核心特征。几十年来，研究人员和理论家一直对这些构念之间的时间动态感兴趣。一些人假设情感状态的变化应该先于自尊的变化（Linehan，《边缘型人格障碍的认知行为治疗。精神障碍的诊断和治疗》，1993年），而另一些人则认为自尊的变化应该先于情感状态的变化（Kernberg，《边缘状况与病理性自恋》，1975年）。
方法
在本研究中，我们调查了日常生活中负面情感唤醒状态与当前自尊之间的时间关系。对42名边缘型人格障碍患者、40名抑郁症患者（DD）和40名非临床对照者（NCC）进行了为期13小时、每15分钟一次的评估。
结果
正如预期的那样，动态结构方程模型显示，与非临床对照者组相比，边缘型人格障碍组的每日平均负面情感唤醒水平更高，每日平均自尊水平更低，抑郁症患者组的得分介于边缘型人格障碍组和非临床对照者组之间。根据Linehan（《边缘型人格障碍的认知行为治疗。精神障碍的诊断和治疗》，1993年）的边缘型人格障碍情感失调模型所做的预测，负面情感唤醒（t）与随后的自尊（t + 1）仅在边缘型人格障碍组中显著相关，这意味着在下次测量（约15分钟后）中，较高的负面情感唤醒之后是较低的当前自尊。重要的是，自尊（t）与随后的负面情感唤醒（t + 1）没有显著相关性（Kernberg，《边缘状况与病理性自恋》，1975年）。
结论
我们的研究结果表明边缘型人格障碍中情感不稳定和自尊不稳定之间存在密切的动态时间关系，这凸显了为患者提供有效调节高负面情感唤醒状态方法的重要性。
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