Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System.
Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System.
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DOI：
10.1017/s0033291718001253
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发表时间：
2018-09
影响因子：
6.9
通讯作者：
Girdler SS
中科院分区：
文献类型：
--
作者：
Eisenlohr-Moul TA;Schmalenberger KM;Owens SA;Peters JR;Dawson DN;Girdler SS
患有交界性人格障碍(BPD)的人患有一系列迅速变化的情绪、人际关系和行为症状。月经周期可能导致患有这种疾病的女性症状不稳定。15名患有BPD且没有痛经的健康、未服用药物的女性在35天内报告了每天的症状。用尿黄体生成素(LH)和唾液孕酮(P4)确定排卵和周期。使用(1)多水平模型中的阶段对比和(2)卡罗莱纳经前评估评分系统(C-PASS)来评估症状的周期性恶化，C-PASS是一种用于评估对症状的临床显著周期效应的方案。大多数症状表现为黄体中期恶化，围绝经期高峰期，以及卵泡期或排卵期症状缓解。后期与以人为中心的孕酮的相关性显示与大多数症状呈负相关。抑郁症状表现出一种意想不到的延迟模式，在排卵期和黄体中期观察到症状的基线水平，并在围孕期和卵泡期观察到恶化。大多数参与者符合临床显著(=30%)症状恶化的C-PASS标准。所有参与者都符合BPD的情绪不稳定标准，没有参与者符合DSM-5的经前焦虑症(PMDD)标准。患有BPD的女性可能会增加围绝经期情绪症状恶化的风险。需要进行细粒度激素测量的纵向研究和激素实验，以确定BPD围绝经期恶化的病理生理学。
Individuals with borderline personality disorder (BPD) suffer from a constellation of rapidly shifting emotional, interpersonal, and behavioral symptoms. The menstrual cycle may contribute to symptom instability among females with this disorder. Fifteen healthy, unmedicated females with BPD and without dysmenorrhea reported daily symptoms across 35 days. Urine luteinizing hormone (LH) and salivary progesterone (P4) were used to confirm ovulation and cycle phase. Cyclical worsening of symptoms was evaluated using (1) phase contrasts in multilevel models and (2) the Carolina Premenstrual Assessment Scoring System (C-PASS), a protocol for evaluating clinically significant cycle effects on symptoms. Most symptoms demonstrated midluteal worsening, a perimenstrual peak, and resolution of symptoms in the follicular or ovulatory phase. Post-hoc correlations with person-centered progesterone revealed negative correlations with most symptoms. Depressive symptoms showed an unexpected delayed pattern in which baseline levels of symptoms were observed in the ovulatory and midluteal phases, and exacerbations were observed during both the perimenstrual and follicular phases. The majority of participants met C-PASS criteria for clinically significant (>=30%) symptom exacerbation. All participants met the emotional instability criterion of BPD, and no participant met DSM-5 criteria for premenstrual dysphoric disorder (PMDD). Females with BPD may be at elevated risk for perimenstrual worsening of emotional symptoms. Longitudinal studies with fine-grained hormonal measurement as well as hormonal experiments are needed to determine the pathophysiology of perimenstrual exacerbation in BPD.