Silk K R, Lee S, Hill E M, Lohr N E
Department of Psychiatry, University of Michigan, Ann Arbor, USA.
Am J Psychiatry. 1995 Jul;152(7):1059-64. doi: 10.1176/ajp.152.7.1059.
This study explored the relationship of specific symptoms of borderline personality disorder to dimensions of severity of sexual abuse experiences in childhood.
A group of 41 patients with borderline personality disorder who retrospectively reported a childhood history of sexual abuse on the Familial Experiences Interview were studied. Six items from the Diagnostic Interview for Borderline Patients (DIB) were chosen on the basis of their univariate (chi-square) association with a sexual abuse severity scale that was developed by the authors and their research team. These six DIB items were each modeled in a logistic regression. Predictor variables were the most severe experience within each of three dimensions of sexual abuse: 1) perpetrator (sexual abuse by a parent), 2) duration (sexual abuse that was ongoing), and 3) type (sexual abuse that involved penetration).
The severity dimension that was most frequently found to be a significant predictor of the sum of the six DIB items as well as the total scaled DIB score was the duration dimension. Ongoing sexual abuse predicted parasuicidal behavior as well.
Ongoing sexual abuse may be a strong determinant of specific aspects of the disordered interpersonal behavior and functioning found in patients with borderline personality disorder. The expectation that the world is an empty, malevolent place may have some of its roots in the repetition of sexual abuse experiences in childhood. This expectation of malevolence among patients with borderline personality disorder may manifest itself in psychotherapy through regressive and distancing behavior.
本研究探讨了边缘型人格障碍的特定症状与童年期性虐待经历严重程度维度之间的关系。
对一组41名边缘型人格障碍患者进行了研究，这些患者在家族经历访谈中回顾性报告了童年期性虐待史。根据边缘型人格障碍诊断访谈（DIB）中的六个项目与作者及其研究团队编制的性虐待严重程度量表的单变量（卡方）关联，选取了这六个项目。这六个DIB项目分别进行逻辑回归建模。预测变量为性虐待三个维度中每个维度最严重的经历：1）施虐者（父母性虐待），2）持续时间（持续性虐待），3）类型（涉及插入的性虐待）。
最常被发现是六个DIB项目总和以及DIB总量表得分显著预测因素的严重程度维度是持续时间维度。持续性虐待也预测了准自杀行为。
持续性虐待可能是边缘型人格障碍患者人际行为紊乱和功能障碍特定方面的一个重要决定因素。认为世界是一个空虚、恶意之地的预期可能部分源于童年期性虐待经历的重复。边缘型人格障碍患者的这种恶意预期可能在心理治疗中通过退行和疏远行为表现出来。
