Precursors to Borderline and Antisocial Personality Disorders in Adolescence

边缘型人格障碍（BPD）和反社会型人格障碍（ASPD）是美国医疗保健和刑事司法系统面临的最严重，最复杂，最昂贵的公共卫生问题之一。这两种疾病开始出现在青春期，并与抑郁症，药物滥用，自伤，自杀企图，以及不良的社会，职业和学术成果的风险增加。1 -3，18-25此外，这两种疾病可能是特别有害的年轻女孩。据估计，社区中高达14%的青春期女孩符合BPD的标准，美国普通人群中多达10%的青春期女孩从事严重的反社会行为。4 - 6，15有必要确定可能导致这些疾病病因的特征，以最终帮助预防和干预工作。已经确定了BPD和ASPD共同的宽带风险因素，但对差异预测女孩出现这些疾病的特定前体知之甚少。人际关系困难是BPD和ASPD的核心特征，可能有助于其他特征的表现和延续，包括情感障碍和情绪依赖性冲动行为。基于证据表明，BPD和ASPD的特点可能是独特的人际模式，我已经开发了一个假设，即BPD和ASPD可能有定性不同的人际前体，是可识别的儿童时期和差异预测这些疾病的发展在青春期。该提案概述了一项旨在使用潜在生长建模方法对这一假设进行检验的研究，该研究对5-20岁的市中心女孩进行了纵向跟踪（匹兹堡女孩研究）。本研究的目的是：1）确定5-14岁儿童早期人际关系过程的独特发展轨迹，这些发展轨迹可能是青少年BPD和ASPD特征的前兆; 2）确定目标1中确定的人际关系前兆的预测效度，并确定他们对14-20岁BPD和ASPD特征发展的风险程度和时间。这个建议的核心假设是，在控制了BPD和ASPD的常见气质和环境儿童风险因素后，儿童时期的过敏/不一致的人际关系风格将赋予BPD发展的特定风险，而冷酷/侵略性的人际关系风格将赋予ASPD发展的特定风险。这项研究有可能描述和解释的发展轨迹BPD和ASPD的女孩在人格发展的关键时期，并确定这些疾病的发展和维护女孩的共同和特定的风险因素和前体。这些知识可用于制定针对这些特定过程的预防和治疗工作。这项研究响应NIMH战略计划的战略目标2（“绘制精神疾病轨迹以确定何时，何地以及如何干预”）。 公共卫生相关性：边缘型人格障碍（BPD）和反社会型人格障碍（ASPD）是慢性、衰弱和复杂的精神疾病，每年影响超过300万美国成年人，并与几种负面结果相关，包括高发病率和死亡率、治疗反应差以及社会、职业、和学术成果。1 -3有一个解决BPD和ASPD症状的发展过程的研究是一个关键的需求。拟议的研究旨在研究共同的和具体的人际前体发展的BPD和ASPD功能在青春期女孩使用潜在的增长建模方法，从而改善干预措施，目标是人际前体，并可能有更高的影响，在青春期比成年期。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD) are among the most serious, complex, and costly public health concerns facing the US healthcare and criminal justice systems. Both disorders begin to emerge by adolescence and are associated with increased risks for depression, substance abuse, self-injury, suicide attempts, and poor social, occupational, and academic outcomes.1-3, 18-25 In addition, both disorders may be particularly pernicious among young girls. Estimates suggest that up to 14% of adolescent girls in the community meet criteria for BPD, and as many as 10% of adolescent girls in the US general population engage in serious antisocial behavior.4-6,15 There is a need to identify features that might contribute to the etiology of these disorders to ultimately aid prevention and intervention efforts. Broadband risk factors that are common to both BPD and ASPD have been identified, 1 but the specific precursors that differentially predict the emergence of these disorders in girls are poorly understood. Interpersonal difficulties are core features of BPD and ASPD that may contribute to the manifestation and perpetuation of other features, including affective disturbance and mood-dependent, impulsive behaviors. Based on evidence suggesting that BPD and ASPD may be characterized by distinctive interpersonal patterns, I have developed the hypothesis that BPD and ASPD may have qualitatively different interpersonal precursors that are recognizable during childhood and that differentially predict the development of these disorders during adolescence. This proposal outlines a study designed to test this hypothesis using latent growth modeling methods in a large prospective study of inner-city girls followed longitudinally from ages 5-20 (the Pittsburgh Girls Study). The aims of this study are: 1) to identify distinctive developmental trajectories of early interpersonal processes from ages 5-14 that may function as precursors to BPD and ASPD features in adolescence; and 2) to determine the predictive validity of interpersonal precursors identified in Aim 1, and identify the magnitude and timing of the risk that they confer for the development of BPD and ASPD features from ages 14-20. The central hypothesis of this proposal is that, after controlling for common temperamental and environmental childhood risk factors for BPD and ASPD, a hypersensitive/inconsistent interpersonal style during childhood will confer specific risk for the development of BPD, and a callous/aggressive interpersonal style will impart specific risk for the development of ASPD. This study has the potential to describe and explain trajectories of development of BPD and ASPD in girls across critical periods of personality development and to identify the risk factors and precursors that are common and specific to the development and maintenance of these disorders in girls. This knowledge can be used to develop prevention and treatment efforts that target these specific processes. This research responds to Strategic Objective 2 of the NIMH Strategic Plan ("Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene"). PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD) are chronic, debilitating, and complex psychiatric conditions that affect more than 3 million US adults annually and are associated with several negative outcomes, including high rates of morbidity and mortality, poor treatment response, and poor social, occupational, and academic outcomes.1-3 There is a critical need for research that addresses the developmental course of BPD and ASPD symptoms. The proposed study seeks to examine the common and specific interpersonal precursors to the development of BPD and ASPD features in adolescent girls using latent growth modeling methods, resulting in improved intervention efforts that target interpersonal precursors and that may have a higher impact during adolescence than in adulthood.