The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study.
The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study.
复制标题
DOI：
10.1176/ajp.2007.164.6.929
复制
发表时间：
2007-06
期刊：
影响因子：
--
通讯作者：
M. Zanarini;F. Frankenburg;D. B. Reich;K. Silk;J. Hudson;Lauren B. McSweeney
中科院分区：
文献类型：
--
作者：
M. Zanarini;F. Frankenburg;D. B. Reich;K. Silk;J. Hudson;Lauren B. McSweeney
目的探讨24例临界性人格障碍患者缓解时间的变化规律。方法对住院期间收集的362例人格障碍患者的边缘精神病理学进行评估，采用两次半结构访谈，证实其可靠性。在这些患者中，290名患者符合DSM-III-R标准以及修订的边缘人格障碍诊断访谈标准，72名患者符合DSM-III-R标准的另一种轴II障碍。超过85%的患者在五次不同的两年随访波中被面试者重新采访，而不是之前收集的所有信息。结果在临界性患者中，所研究的24种症状中有12种随着时间的推移呈现急剧下降的模式，在10年的随访中，只有不到15%的患者在基线时报告了这些症状。其他12种症状在随访期内显示出显著但不那么剧烈的下降模式。反映冲动的核心领域的症状(例如，自残和自杀努力)和积极尝试处理人际困难(例如，需求/权利问题和严重的治疗倒退)似乎解决得最快。相比之下，反映慢性焦虑症的情感症状(例如愤怒和孤独/空虚)以及反映遗弃和依赖问题的人际关系症状(例如对孤独的不容忍和反依赖问题)似乎最稳定。结论临界性人格障碍可能既有急性症状，又有更持久的症状。
OBJECTIVE The purpose of this study was to characterize the course of 24 symptoms of borderline personality disorder in terms of time to remission. METHOD The borderline psychopathology of 362 patients with personality disorders, all recruited during inpatient stays, was assessed using two semistructured interviews of proven reliability. Of these, 290 patients met DSM-III-R criteria as well as Revised Diagnostic Interview for Borderlines criteria for borderline personality disorder, and 72 met DSM-III-R criteria for another axis II disorder. Over 85% of the patients were reinterviewed at five distinct 2-year follow-up waves by interviewers blind to all previously collected information. RESULTS Among borderline patients, 12 of the 24 symptoms studied showed patterns of sharp decline over time and were reported at 10-year follow-up by less than 15% of the patients who reported them at baseline. The other 12 symptoms showed patterns of substantial but less dramatic decline over the follow-up period. Symptoms reflecting core areas of impulsivity (e.g., self-mutilation and suicide efforts) and active attempts to manage interpersonal difficulties (e.g., problems with demandingness/entitlement and serious treatment regressions) seemed to resolve the most quickly. In contrast, affective symptoms reflecting areas of chronic dysphoria (e.g., anger and loneliness/emptiness) and interpersonal symptoms reflecting abandonment and dependency issues (e.g., intolerance of aloneness and counterdependency problems) seemed to be the most stable. CONCLUSIONS The results suggest that borderline personality disorder may consist of both symptoms that are manifestations of acute illness and symptoms that represent more enduring aspects of the disorder.