Dynamics Among Borderline Personality and Anxiety Features in Psychotherapy Outpatients: An Exploration of Nomothetic and Idiographic Patterns
Dynamics Among Borderline Personality and Anxiety Features in Psychotherapy Outpatients: An Exploration of Nomothetic and Idiographic Patterns
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DOI：
10.1037/per0000363
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发表时间：
2020-03-01
影响因子：
2.8
通讯作者：
Molenaar, Peter C. M.
中科院分区：
文献类型：
--
作者：
Ellison, William D.;Levy, Kenneth N.;Molenaar, Peter C. M.
边缘型人格障碍（BPD）涉及自我概念、情绪和行为的不稳定。然而，BPD症状之间以及这些症状与其他问题情绪体验之间的动态、纵向关系尚不清楚。目前还不清楚这些动态在人与人之间（包括跨诊断界限）是否相同，是否只针对BPD患者，还是个体化的。本研究使用生态瞬时评估和群体迭代多模型估计，这是一种新的、数据驱动的方法来识别群体时间序列数据的动态模式。本研究旨在探讨BPD的某些特征（愤怒、冲动和身份障碍）与焦虑相关经历之间的动态联系。42名被诊断为BPD的精神科门诊患者（n = 27）或患有焦虑症但未被诊断为BPD的患者（n = 15），在21天内每天6次评估他们的愤怒、身份障碍、冲动、焦虑、压力和平静状态，共提供4,699份调查。症状之间仅确定了1个适用于群体水平的动态联系，群体迭代多模型估计并未揭示具有不同症状动态的个体的稳定亚组。相反，这些动力因人而异。这些结果表明，这些BPD和焦虑症状之间的联系并不取决于诊断，而且在某种程度上是个体化的。案例的例子是用来说明在人的症状模型作为补充传统诊断信息的临床效用。
Borderline personality disorder (BPD) involves instability in self-concept, emotions, and behavior. However, the dynamic, longitudinal relations among BPD symptoms and between these symptoms and other problematic emotional experiences are poorly understood. It is also unclear whether these dynamics are the same across persons (including across diagnostic boundaries), specific to individuals with BPD, or idiographic. The current study uses ecological momentary assessment and group iterative multiple model estimation, a novel, data-driven approach to identifying dynamic patterns in time-series data at group. subgroup, and individual levels, to investigate the dynamic connections among select features of BPD (anger, impulsivity, and identity disturbance) and anxiety-related experiences. Forty-two psychiatric outpatients diagnosed with BPD (n = 27) or with an anxiety disorder, but not BPD (n = 15), rated their anger, identity disturbance, impulsivity, anxiety, stress, and calmness states 6 times per day for 21 days, providing a total of 4,699 surveys. Only 1 dynamic link between symptoms was identified that applied at the group level, and group iterative multiple model estimation did not reveal stable subgroups of individuals with distinct symptom dynamics. instead, these dynamics differed from individual to individual. These results suggest that connections among these BPD and anxiety symptoms do not depend on diagnosis and are somewhat idiographic. Case examples are used to illustrate the clinical utility of within-person symptom models as a supplement to traditional diagnostic information.