Refining Borderline Personality Disorder Using Flexible Latent Variable Modeling

描述（由候选人提供）：边缘型人格障碍（BPD）是一种复杂的精神疾病，与主观痛苦，生活质量差和慢性自杀有关，估计自杀完成率高达10%。由于BPD患者的攻击性、自杀和自伤行为，其治疗利用率显著高于情绪障碍或其他人格障碍患者，导致治疗费用显著增加。虽然这种疾病影响1-2%的人口，但BPD患者占所有门诊患者的10-20%和住院患者的15%。尽管与BPD相关的显著社会负担、主观痛苦和不良精神结局，但相对于其他形式的精神病理学，该表型尚未得到很好的理解。BPD的结构效度的提高在一定程度上受到了理论概念化和DSM诊断标准中所反映的相当大的异质性的阻碍。现有的诊断标准定义了一个有意义的，但分散的，结构和未来的研究工作将受到阻碍，如果患者选择单独使用这些标准。拟议的研究旨在通过探索其他临床和实验标志物来细化BPD表型，以及使用灵活的潜变量建模和统计模拟来阐明疾病的分类。这项工作将导致BPD的经验性分类，包括性状，亚型，或两者兼而有之，以及基于数据的阈值，用于识别临床显著的边界病理。这项研究有可能识别出更同质的BPD患者群体，这将提高未来实证工作的分辨率和可复制性。此外，澄清BPD患者之间的异质性将改善未来的治疗研究，因为临床策略可以更好地适应个体患者。具体目标是：1）使用Monte Carlo模拟方法评估现有分析方法解析BPD潜在结构的效率，2）使用整合连续和分类概念的混合潜变量模型阐明BPD内异质性，3）通过探索其他临床和实验标志物来细化BPD表型。这项拟议的研究将使用两个主要的流行病学数据集（国家科摩罗调查复制和国家酒精和相关疾病流行病学调查）和来自五项先前研究的616名参与者的大样本进行，其中约25%患有BPD。此外，将开发一种实验性的心理病理学排斥敏感性测量方法，并使用168名成年参与者的较小样本进行验证，该方法将被整合到分类模型中。我们预计DSM-IV BPD特征最好用一个连续的严重程度维度来描述，但疾病的亚型将根据其他标志物来识别，包括攻击性、不信任、专注依恋和排斥敏感性。将测试竞争维度、分类和综合模型。 公共卫生相关性：边缘型人格障碍（BPD）是一种复杂的精神疾病，与攻击性，自杀和自我伤害行为相关，通常需要长期强化治疗，导致治疗费用高昂。虽然这种疾病是不成比例地代表在住院和门诊设置相对于其在人群中的患病率，诊断患有这种疾病的患者是如此异质性，它一直难以确定其原因或设计有效的治疗方法。拟议的研究旨在使用复杂的统计模型和流行病学样本来完善BPD的流行概念，这将允许更好地对BPD进行分类，从而改善患者的治疗结果。

DESCRIPTION (provided by candidate): Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with subjective misery, poor quality of life, and chronic suicidality, with estimates of suicide completion as high as 10%. Because of aggressive, suicidal, and self-injurious behaviors, treatment utilization among BPD patients is significantly higher than patients with mood disorders or other personality disorders, resulting in significant treatment costs. Although this disorder affects 1-2% of the population, individuals with BPD account for 10-20% of all outpatients and 15% of inpatients. Despite the significant societal burden, subjective distress, and poor psychiatric outcomes associated with BPD, the phenotype is not well understood relative to other forms of psychopathology. Improving the construct validity of BPD has been impeded, in part, by the considerable heterogeneity reflected in theoretical conceptualizations and the DSM diagnostic criteria. Existing diagnostic criteria define a meaningful, but diffuse, construct and future research efforts will be impeded if patients are selected using these criteria alone. The proposed research seeks to refine the BPD phenotype by exploring additional clinical and experimental markers, as well as using flexible latent variable modeling and statistical simulation to clarify the classification of the disorder. This work will result in an empirically derived taxonomy of BPD consisting of traits, subtypes, or both, as well as data-based thresholds for identifying clinically significant borderline pathology. This research has the potential to identify more homogeneous groups of BPD patients, which will increase the resolving power and replicability of future empirical work. Additionally, clarifying the heterogeneity among BPD patients will improve future treatment research, as clinical strategies can be tailored better to individual patients. The specific aims are: 1) to assess the efficiency of extant analytic methods for resolving the latent structure of BPD using Monte Carlo simulation methods, 2) to clarify within-BPD heterogeneity using hybrid latent variable models that integrate continuous and categorical conceptions, and 3) to refine the BPD phenotype by exploring additional clinical and experimental markers. This proposed research will be conducted using two major epidemiological datasets (the National Comorbidity Survey Replication and the National Epidemiologic Survey on Alcohol and Related Conditions) and a large sample of 616 participants aggregated from five prior studies, approximately 25% of whom have BPD. In addition, an experimental psychopathology measure of rejection sensitivity will be developed and validated using a smaller sample of 168 adult participants, and this measure will be integrated into classification models. We expect that the DSM-IV BPD features are best described by a single continuous dimension of severity, but that subtypes of the disorder will be identified on the basis of additional markers, including aggression, mistrustfulness, preoccupied attachment, and rejection sensitivity. Competing dimensional, categorical, and integrative models will be tested. PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with aggressive, suicidal, and self-injurious behaviors that often require intensive long-term treatment, resulting in significant treatment costs. Although this disorder is disproportionately represented in inpatient and outpatient settings relative to its prevalence in the population, patients diagnosed with this condition are so heterogeneous that it has been difficult to identify its causes or to design effective treatments. The proposed research seeks to refine the prevailing conception of BPD using sophisticated statistical models and epidemiological samples, which will permit better classification of BPD, resulting in improved treatment outcomes for patients.