Components of Emotional Instability as Precursors of Borderline Personality

描述(由申请人提供)：边缘性人格障碍(BPD)是一种极其虚弱的疾病，75%的确诊患者有自杀行为，5%-10%的患者自杀。一旦出现这种疾病，就很难治疗，并给精神卫生系统带来巨大的负担。因此，迫切需要从青春期早期开始的纵向研究，以确定可以为预防和早期干预计划提供信息的BPD特征的先兆。发展理论认为，在父母养育行为无效的背景下，情绪不稳定(Ei)是BPD特征发展的基础，包括自杀和其他冲动行为、遗弃恐惧、关系波动和困难。 与身份形成有关。Ei被指定为消极情绪状态下的变异性维度， 情绪强度大，负面情绪发作后恢复缓慢。然而，EI组分的生物学基础及其对BPD特征的预测作用尚不清楚。了解父母养育行为和青少年EI如何随着时间的推移相互抑制或加剧，以及影响BPD特征的发展，对于识别临床上可改变的亲子交易至关重要。目的：目前的应用验证了关于EI的成分作为BPD特征的前驱以及这些特征的发展过程的假设。具体地说，我们将研究EI、BPD特征的组成部分之间的同时、预期、独特和共享的关联，以及在育儿环境中内部化和外部化的问题。因此，该建议还考察了父母对情绪的反应和青少年智力障碍之间的相互关联，以及父母对情绪的反应对BPD特征发展的潜在调节作用。方法：我们将使用一个多模式的、生态有效的青少年智力评估单元，以情感为重点的父母教育策略，以及亲子互动。我们将实时检查这些过程(使用生态瞬时评估方案、观察评级和自主反应性监测)，并在18个月内通过三次评估绘制它们的发展历程。我们将确定特定的EI成分如何与近邻的内化和外化问题(如抑郁、品行问题)相关，但我们认为这三个EI成分的组合形成了后续BPD特征的特定标记，特别是在有害的父母策略的背景下。将从精神科诊所招募11-13岁的青少年和主要照顾者(N=165个家庭；H50%为女孩)，并对青少年进行筛查，以确保我们对严重和临床显著水平的EI进行过多抽样。根据NIMH的战略优先事项，拟议的工作是确定谁面临最大风险以及如何干预弱势青年及其家庭的新的关键步骤。

DESCRIPTION (provided by applicant): Borderline personality disorder (BPD) is extremely debilitating, with 75% of diagnosed individuals engaging in suicidal behavior and 5-10% completing suicide. Once the disorder emerges, it is difficult to treat and places an enormous burden on mental health systems. Thus, longitudinal research that begins in early adolescence is urgently needed to identify precursors of BPD features that can inform prevention and early intervention programs. Developmental theory postulates that emotional instability (EI) in the context of invalidating parenting behaviors underlies the development of BPD features, including suicide and other impulsive behaviors, abandonment fears, relationship volatility, and difficulties with identity formation. EI is specified as dimensions of variability in negative affective states, intensity of affect, and slow recovery following the onset of negative affect. However, the biological underpinnings of EI components and their predictive utility for BPD features are not known. Understanding how parenting behaviors and youth EI dampen or exacerbate each other over time as well as influence the development of BPD features is essential for the identification of clinically modifiable parent-youth transactions. Aims: The current application tests hypotheses about components of EI as precursors of BPD features and the developmental course of these features. Specifically, we will examine concurrent, prospective, unique and shared associations between components of EI, BPD features, and internalizing and externalizing problems within the parenting context. Thus, the proposal also examines reciprocal associations between parental response to emotion and youth EI and the potential moderating role of parental response to emotion on the development of BPD features. Approach: We will use a multi-modal, ecologically valid assessment battery of EI in young adolescents, emotion-focused parenting strategies, and parent-youth interactions. We will examine these processes in real-time (using an ecological momentary assessment protocol, observational ratings, and autonomic reactivity monitoring) as well as chart the course of their development with three assessments over 18 months. We will determine how specific EI components are related to near-neighbor internalizing and externalizing problems (e.g., depression, conduct problems), but we propose that the combination of these three EI components form a specific marker of subsequent BPD features, especially in the context of deleterious parenting strategies. Youth aged 11-13 years and primary caretakers (N=165 families; H50% girls) will be recruited from psychiatric clinics, and adolescents will be screened to ensure that we oversample severe and clinically significant levels of EI. In accordance with NIMH strategic priorities, the proposed work is a novel and critical step to identify who is at greatest risk and how to intervene with vulnerable youth and their families.