Zanarini M C, Williams A A, Lewis R E, Reich R B, Vera S C, Marino M F, Levin A, Yong L, Frankenburg F R
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02178, USA.
Am J Psychiatry. 1997 Aug;154(8):1101-6. doi: 10.1176/ajp.154.8.1101.
The purpose of this study was to assess a full range of pathological childhood experiences reported by patients with criteria-defined borderline personality disorder and comparison patients with other personality disorders.
The pathological childhood experiences reported by 467 inpatients with personality disorders were assessed by interviewers who used a semistructured research interview and were blind to clinical diagnosis.
Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18. The borderline patients were significantly more likely than the 109 patients with other personality disorders to report having been emotionally and physically abused by a caretaker and sexually abused by a noncaretaker. They were also significantly more likely to report having a caretaker withdraw from them emotionally, treat them inconsistently, deny their thoughts and feelings, place them in the role of a parent, and fail to provide them with needed protection. The borderline patients with a childhood history of sexual abuse were significantly more likely than those without such a history to report having experienced all but one of the types of abuse and neglect studied. When all significant risk factors were considered together, four were found to be significant predictors of a borderline diagnosis: female gender, sexual abuse by a male noncaretaker, emotional denial by a male caretaker, and inconsistent treatment by a female caretaker.
The results suggest that sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder and that other childhood experiences, particularly neglect by caretakers of both genders, represent significant risk factors.
本研究旨在评估符合标准定义的边缘型人格障碍患者以及其他人格障碍对照患者所报告的一系列童年病理性经历。
采用半结构化研究访谈对467名住院人格障碍患者所报告的童年病理性经历进行评估，访谈者对临床诊断不知情。
在358名边缘型人格障碍患者中，91%报告在18岁之前遭受过虐待，92%报告曾被忽视。边缘型人格障碍患者比109名其他人格障碍患者更有可能报告曾遭受照顾者的情感和身体虐待以及非照顾者的性虐待。他们也更有可能报告照顾者在情感上与他们疏离、对待他们不一致、否认他们的想法和感受、让他们承担父母的角色以及未能为他们提供所需的保护。有童年性虐待史的边缘型人格障碍患者比没有这种病史的患者更有可能报告经历了除一种之外的所有研究类型的虐待和忽视。当综合考虑所有显著的风险因素时，发现有四个因素是边缘型人格障碍诊断的显著预测因素：女性、男性非照顾者的性虐待、男性照顾者的情感否认以及女性照顾者的不一致对待。
结果表明，性虐待对于边缘型人格障碍的发展既非必要条件也非充分条件，其他童年经历，尤其是来自男女照顾者的忽视，是显著的风险因素。
