Brodsky B S, Cloitre M, Dulit R A
Department of Psychology, Cornell University Medical Center, New York, USA.
Am J Psychiatry. 1995 Dec;152(12):1788-92. doi: 10.1176/ajp.152.12.1788.
This study sought to document the prevalence of dissociative experiences in adult female inpatients with borderline personality disorder and to explore the relationship between dissociation, self-mutilation, and childhood abuse history.
A treatment history interview, the Dissociative Experiences Scale, the Sexual Experiences Questionnaire, and the Hamilton Depression Rating Scale were administered to 60 consecutively admitted female inpatients with borderline personality disorder as diagnosed by the Structured Clinical Interview for DSM-III-R Personality Disorders.
Fifty percent of the subjects had a score of 15 or more on the Dissociative Experiences Scale, indicating pathological levels of dissociation. Fifty-two percent reported a history of self-mutilation, and 60% reported a history of childhood physical and/or sexual abuse. The subjects who dissociated were more likely than those who did not to self-mutilate and to report childhood abuse. They also had higher levels of current depressive symptoms and psychiatric treatment. Multiple regression analysis demonstrated that each of these variables predicted dissociation when each of the others was controlled for, and that self-mutilation was the most powerful predictor of dissociation.
Female inpatients with borderline personality disorder who dissociate may represent a sizable subgroup of patients with the disorder who are at especially high risk for self-mutilation, childhood abuse, depression, and utilization of psychiatric treatment. The strong correlation between dissociation and self-mutilation independent of childhood abuse history should alert clinicians to address these symptoms first while exercising caution in attributing them to a history of abuse.
本研究旨在记录成年女性边缘型人格障碍住院患者分离体验的发生率，并探讨分离、自我伤害行为与童年期受虐史之间的关系。
对60例连续入院的女性边缘型人格障碍患者进行治疗史访谈、分离体验量表、性经历问卷及汉密尔顿抑郁量表评定，这些患者均由DSM-III-R人格障碍的结构化临床访谈确诊。
50%的受试者分离体验量表得分在15分及以上，表明存在病理性分离。52%的受试者报告有自我伤害行为史，60%的受试者报告有童年期身体和/或性虐待史。有分离体验的受试者比无分离体验的受试者更易出现自我伤害行为且更易报告童年期受虐史。她们目前的抑郁症状水平及接受精神科治疗的频率也更高。多元回归分析显示，当控制其他变量时，这些变量中的每一个都可预测分离体验，且自我伤害行为是分离体验最有力的预测因素。
有分离体验的女性边缘型人格障碍住院患者可能是该障碍患者中的一个相当大的亚组，她们在自我伤害、童年期受虐、抑郁及接受精神科治疗方面风险尤其高。分离体验与自我伤害行为之间的强相关性独立于童年期受虐史，这应提醒临床医生在谨慎将这些症状归因于受虐史的同时，应首先处理这些症状。
