Wyssen Andrea, Lerch Stefan, Reichl Corinna, Mürner-Lavanchy Ines, Sigrist Christine, Schär Selina, Cavelti Marialuisa, Koenig Julian, Kaess Michael
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Eur Child Adolesc Psychiatry. 2025 Mar;34(3):1183-1193. doi: 10.1007/s00787-024-02555-y. Epub 2024 Aug 16.
Borderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group.
边缘型人格障碍（BPD）在青少年中是一种既定的诊断，具有高共病率和心理社会功能损害。随着《精神疾病诊断与统计手册》第5版（DSM-5）中人格障碍替代模型（AMPD）的引入，人格功能通过人格功能水平量表（LPFS）进行操作化评估，该量表已被证明与人格病理学严重程度相关。本研究旨在探讨LPFS和BPD不同的心理病理学及心理社会相关因素。对总共526名青少年门诊和住院患者进行了STiP-5.1（LPFS）和《精神障碍诊断与统计手册》第二版（SCID-II）访谈。采用混合线性回归研究两次访谈与心理病理学及心理社会功能损害测量指标之间的关联。11.4%的患者达到两次访谈的诊断阈值，16.1%仅达到LPFS的诊断阈值，64.1%在两次访谈中均低于诊断阈值（无人格障碍）。仅符合BPD诊断标准的组比预期的大——符合BPD标准的患者中有8.4%未达到LPFS显著损害的标准。在同时表现出LPFS显著损害并符合BPD诊断的个体（LPFS + BPD）中发现负担最重。仅符合LPFS标准的组和仅符合BPD标准的组在风险行为和创伤经历方面存在差异，BPD组的患病率更高。研究结果证实了与BPD和LPFS相关的高心理病理学负担和心理社会功能损害。那些超过LPFS诊断阈值并伴有BPD诊断的患者表现出最大的残疾。并非所有符合正式BPD诊断的青少年在LPFS中都表现出临床上显著的损害，这可能指的是一个独特的诊断组。
