Precursors to Borderline and Antisocial Personality Disorders in Adolescence

描述（由申请人提供）：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。这两种障碍在青春期开始出现，并与抑郁、药物滥用、自残、自杀企图以及社交、职业和学业成绩不佳的风险增加有关。此外，这两种疾病在年轻女孩中可能尤其有害。据估计，社区中高达14%的青春期女孩符合BPD的标准，美国总人口中多达10%的青春期女孩有严重的反社会行为。有必要确定可能有助于这些疾病病因的特征，以最终帮助预防和干预工作。BPD和反社会人格障碍共同的广泛危险因素已经被确定，但在女孩中不同地预测这些疾病出现的具体前兆却知之甚少。人际关系困难是BPD和反社会人格障碍的核心特征，它可能导致其他特征的表现和延续，包括情感障碍和情绪依赖、冲动行为。基于有证据表明BPD和ASPD可能以不同的人际模式为特征，我提出了一个假设，即BPD和ASPD可能有质的不同的人际关系前体，这些前体在童年时期是可识别的，并且不同地预测了青春期这些疾病的发展。本提案概述了一项研究，该研究旨在通过对5-20岁的市中心女孩进行纵向追踪的大型前瞻性研究（匹兹堡女孩研究）中使用潜在增长建模方法来验证这一假设。本研究的目的是：1)确定5-14岁早期人际交往过程的独特发展轨迹，这些发展轨迹可能是青春期BPD和反社会人格障碍特征的前兆；2)确定目标1中确定的人际关系前体的预测有效性，并确定它们对14-20岁之间BPD和ASPD特征发展的风险程度和时间。本研究的核心假设是，在控制了BPD和ASPD的常见气质和环境风险因素后，童年时期的敏感/不一致的人际关系风格会给BPD的发展带来特定的风险，而冷酷/激进的人际关系风格会给ASPD的发展带来特定的风险。这项研究有可能描述和解释女孩在人格发展的关键时期的BPD和ASPD的发展轨迹，并确定这些疾病在女孩中发展和维持的共同和特定的风险因素和前兆。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。这项研究回应了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”）。

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.