Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands.
Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany.
Eur J Psychotraumatol. 2023;14(2):2263317. doi: 10.1080/20008066.2023.2263317. Epub 2023 Oct 17.
BACKGROUND: Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. OBJECTIVE: Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. METHOD: 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. RESULTS: Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. CONCLUSIONS: Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.
背景：边缘型人格障碍（BPD）是一种严重的精神障碍，其特征是情绪、自我形象和人际关系明显不稳定。童年期虐待经历是 BPD 的风险因素之一。虽然自伤和攻击行为经常发生，但并非每个患有该障碍的人都会表现出明显的失调行为。内隐症状，如羞耻、孤独和自我厌恶，往往更为普遍，并在临床缓解后持续存在。
目的：本研究旨在探讨 BPD 症状严重程度、童年期虐待与情绪调节困难之间的关系。我们进一步探讨了 BSL 是否可用于区分未来研究中内隐症状（内心紧张）和外显症状（失调行为）。
方法：187 名至少有轻度 BPD 症状的女性（65%被诊断为 BPD）完成了 BSL-23 及其 11 项补充（BSL-S）、童年创伤问卷（CTQ）和情绪调节困难量表（DERS）。参与者进一步接受半结构化临床访谈以评估 BPD 标准（国际人格障碍检查，IPDE）。采用多元模型和基于回归的自举分析来检验直接和间接效应。
结果：童年期创伤严重程度，尤其是情感虐待，正向预测 BPD 症状严重程度。通过情绪调节困难发现了显著的间接效应（=.56）。当探索与 BPD 标准（IPDE）的关联时，BSL-23 平均值与分离焦虑、身份和情绪问题、慢性空虚感、自杀意念和分离显著相关，而 BSL-S 与自我伤害冲动行为和愤怒爆发相关。
结论：这些发现补充了先前的研究，强调了童年期虐待和情绪调节困难在 BPD 中的作用。虽然我们的发现需要谨慎解释，但它们表明 BSL 可用于未来研究中区分 BPD 的内隐症状和行为表现。这种区分可能有助于加深对这种复杂异质障碍的理解。
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