Bemmouna Doha, Weiner Luisa
Faculté de Psychologie, Université de Strasbourg, Strasbourg, France.
Département de Psychiatrie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
Front Psychiatry. 2023 Sep 29;14:1238116. doi: 10.3389/fpsyt.2023.1238116. eCollection 2023.
Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.
情绪调节障碍（ED）是自闭症谱系障碍（ASC）中普遍存在的一种跨诊断性难题。重要的是，最近的研究表明，ED与自我伤害和自杀行为有关。先前关于ASC中ED病因的模型主要关注与ASC特征相关的生物学因素，如感官敏感性、灵活性差和对变化的敏感性。然而，尽管心理社会因素似乎在ASC中ED的出现中也起作用（例如，童年期虐待和伪装），但缺乏一个综合模型来概念化自闭症患者中与ED相关的生物社会因素。莱因汉的生物社会模型（1993）是边缘性人格障碍（BPD）中ED的主要病因模型之一。它将ED概念化为源于儿童预先存在的情绪易感性与无效的发育环境之间的相互作用。除了其临床相关性外，莱因汉的模型还收集了实证证据，支持其在BPD和其他精神疾病中的相关性。尽管ASC和BPD是两种不同的诊断，但由于它们可能都存在ED，莱因汉的生物社会模型可能有助于理解ASC中ED的发展。因此，本文旨在对莱因汉的模型进行应用和扩展，以概念化ASC中的ED。为此，我们从发展的角度对ASC中ED及其潜在因素的文献进行了叙述性综述。为了研究应用于自闭症患者ED的生物社会模型的相关性，我们关注以下数据：（i）与生物社会模型相关的ASC中ED及其行为相关性；（ii）ASC中ED的潜在生物学和心理社会相关性；（iii）ASC和BPD中的重叠难题。最后，为了评估该模型的相关性，我们将其应用于一名患有ED和自杀行为的自闭症女性的案例。我们的综述以及对一名自闭症女性案例的应用表明，ASC中的ED包含了BPD框架中概念化的与生物和心理社会风险因素相关的因素，尽管在这两个领域中可能涉及ASC特有的因素。
