Mood and Reactivity in Borderline Personality Disorder

描述(由申请人提供)：这项研究的长期目标是确定以交界性人格障碍(BPD)为特征的极端情绪反应所涉及的具体机制，并将这些发现应用于开发和验证直接针对这些机制的心理社会和精神药理治疗。拟议研究的具体目的是确定患有BPD的个体在应对社交干扰时的生理和现象学反应的特征模式，并与两个健康对照组进行比较：1)气质匹配的对照组(在负面情绪和冲动的特质测量上的评分与BPD患者相似)；2)非气质匹配的对照组(在这些测量上的评分在平均范围内)。所有参与者都将通过结构化访谈接受DSM-IV轴I和II障碍的评估，然后将在三名评委面前参加包括演讲和言语算术任务的实验室压力范式。将在几个时间点采集唾液样本，以检测应激反应的两个生理维度：1)唾液皮质醇，反映边缘下丘脑-垂体-肾上腺轴的反应性；2)α-淀粉酶，反映自主神经(主要是交感神经系统)的激活。据预测，对实验室压力范式的反应：1)与两个对照组相比，BPD患者将表现出皮质醇和α-淀粉酶反应的增加，并较慢地恢复到基线水平；以及2)与两个对照组相比，BPD患者将报告更大的主观痛苦。据预测，与两个对照组相比，BPD患者将报告更多对他们在实验过程中与之互动的人的恶意看法。这项研究对公共卫生很重要，因为BPD是一种非常普遍、昂贵、痛苦、虚弱和致命的疾病，因此是一个严重的临床和公共卫生问题。对于患有BPD的人来说，环境中微妙和良性的事件会引起强烈的情绪反应，激活压力反应系统，并可能迅速螺旋式上升为危及生命和功能衰弱的行为。长期引发应激反应也会对健康造成严重后果，患有BPD的人经常使用医疗和精神卫生服务。了解BPD这些问题特征背后的生理和心理过程，对于开发旨在减轻精神疾病负担的治疗方法至关重要。

DESCRIPTION (provided by applicant): The long-term goal of this research is to identify the specific mechanisms involved in the extreme emotional reactivity that characterizes Borderline Personality Disorder (BPD) and to apply these findings to the development and validation of both psychosocial and psychopharmacological treatments that directly target these mechanisms. The specific aim of the proposed research is to identify the characteristic patterns of physiological and phenomenological reactions in response to social perturbation in individuals with BPD as compared to two healthy comparison groups: 1) a temperamentally matched comparison group (scoring similarly to BPD patients on trait measures of negative affect and impulsivity); and 2) a non-temperamentally matched comparison group (scoring in the average range on these measures). All participants will be assessed for DSM-IV Axis I and II disorders with structured interviews and then will participate in a laboratory stress paradigm involving a speech and a verbal arithmetic task in front of three judges. Saliva samples will be collected at several time points in order to examine two physiological dimensions of the stress response: 1) salivary cortisol, reflecting reactivity of the limbic hypothalamic-pituitary-adrenal axis; and 2) alpha-amylase, reflecting activation of the autonomic (primarily sympathetic) nervous system. It is predicted that in response to the laboratory stress paradigm: 1) BPD patients, compared to both comparison groups, will show increased cortisol and alpha-amylase responses and slower return to baseline levels; and 2) BPD patients, compared to both comparison groups, will report greater subjective distress. It is also predicted that, compared to both comparison groups, BPD patients will report more malevolent perceptions of those with whom they have interacted during the experimental procedures. This research is important to public health because BPD is a highly prevalent, costly, painful, debilitating, and deadly disorder, and thus represents a serious clinical and public health concern. For individuals with BPD, subtle and benign events in the environment can evoke intense emotional responses that activate the stress response system and may rapidly spiral into behaviors that are life threatening and functionally debilitating. There are also serious health consequences to chronic elicitation of the stress response, and individuals with BPD are frequent users of both medical and mental health services. Understanding the physiological and psychological processes underlying these problematic features of BPD is imperative to the development of treatments aimed at reducing the burden of mental illness.