Integrating Process and Structure in Borderline Personality Disorder

描述（由申请人提供）：边缘型人格障碍（BPD）是一种严重的精神疾病，与严重的功能障碍和重大的社会成本相关。有两个重大问题阻碍了这些使人衰弱的疾病的成功诊断和治疗。首先是几乎完全缺乏关于实际症状表现、频率或严重程度的直接经验知识。临床诊断依赖于个体症状水平与正常频率和严重程度的比较，但对于正常或异常人群中症状表达的实际水平没有直接的经验知识。临床医生可获得数据的这种限制使得难以确定特定个体的症状是否符合诊断条件，是否正在得到有效治疗，或是否已降至健康水平。第二个重要的问题是，关于BPD背后的流程和相关问题的信息很少。如果不了解潜在的因果机制，就很难优化有效的BPD治疗。下面的研究计划是量身定制的，以同时解决这两个重大问题。在R01 MH70571，阶段1中，一种特别适合解决这些问题的创新方法被开发出来，并成功地应用于正常人格的研究。该方法有两个特点：(1)通过测量实际行为来描述和解释人格，而不是依靠回顾性问卷；(2)利用行为的可变性来识别人格的潜在机制。第一阶段验证了这一方法在获得关于人格的新见解和解释人格背后的机制方面的有效性。阶段2将使用这种方法来完成BPD的相同目标。第2阶段将测量实际症状，而不是依赖于回顾性报告，并利用这些症状的可变性来测试BPD的潜在机制。目的1是获得症状频率、严重程度和共现症的直接、经验性描述，以帮助诊断、治疗和终止决定。目的2是提出和测试BPD的几个理论机制。目的3是探讨人际知觉过程在应激源和症状中的作用。目标4是图表的轨迹和交易的症状频率，严重程度，和突发事件。与正常人格一样，边缘型人格障碍通常被认为是慢性的，无法治愈的。然而，这是一种严重的精神疾病，与严重的功能障碍、高昂的医疗费用和巨大的痛苦有关。找到治疗方法和降低这些费用的关键是找到一种方法来解开这种疾病的潜在机制。第一阶段展示了正常人格的这种方法；第二阶段将对边缘型人格障碍进行同样的治疗。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) is a serious mental illness, associated with severe functional impairment and significant costs to society. Two significant problems impede successful diagnosis and treatment of these debilitating disorders. First is an almost complete lack of direct, empirical knowledge about actual symptom expression, frequency, or severity. Clinical diagnosis relies on comparisons of individual's symptom levels to normal frequencies and severities, but there is no direct, empirical knowledge about actual levels of symptom expression in either a normal or abnormal population. This limitation in data availability to the clinician makes it difficult to determine whether a given individual's symptoms qualify for diagnosis, are being effectively treated, or are reduced to healthy levels. A second significant problem is that there is little information about the processes underlying BPD and associated problems. Without knowledge of the underlying causal mechanisms, it is difficult to optimize effective treatment of BPD. The following research proposal is tailored to simultaneously address both of these significant problems. In R01 MH70571, Stage 1, an innovative approach that is particularly suited to solving these problems was developed and successfully applied to the study of normal personality. This approach is characterized by two hallmarks: (1) measuring actual behavior to describe and explain personality, rather than relying on retrospective questionnaires; and (2) leveraging variability in behavior to identify the mechanisms underlying personality. Stage 1 verified the usefulness of this approach for arriving at new insights about personality and for explaining the mechanisms underlying personality. Stage 2 will use this approach to accomplish the same goals for BPD. Stage 2 will measure actual symptoms rather than rely on retrospective reports, and will leverage variability in those symptoms to test the mechanisms underlying BPD. Aim 1 is to obtain direct, empirical accounts of symptom frequencies, severities, and co-occurrences, to aid diagnosis, treatment, and termination decisions. Aim 2 is to propose and test several theoretical mechanisms for BPD. Aim 3 is to investigate the role of interpersonal perception processes in stressors and symptoms. Aim 4 is to chart trajectories and transactions of symptom frequencies, severities, and contingencies. Borderline Personality Disorder, like normal personality, is often considered chronic and untreatable. However, this is a serious mental illness, associated with severe functional impairment, high health-care costs, and significant suffering. The key to finding treatments and reducing these costs is to find an approach that unlocks the mechanism underlying the disorder. Stage 1 demonstrated such an approach for normal personality; Stage 2 will do the same for borderline personality disorder.