Components of Emotional Instability as Precursors of Borderline Personality

描述（由申请人提供）：边缘型人格障碍（BPD）是非常衰弱的，75%的诊断个体从事自杀行为，5-10%完成自杀。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负担。因此，迫切需要从青春期早期开始的纵向研究，以确定BPD特征的前兆，从而为预防和早期干预计划提供信息。发展理论认为，在父母行为无效的背景下，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 身份形成。EI被指定为消极情感状态的可变性维度， 影响的强度，以及负面影响开始后的缓慢恢复。然而，EI组分的生物学基础及其对BPD特征的预测效用尚不清楚。了解如何养育行为和青年EI抑制或加剧对方随着时间的推移，以及影响BPD功能的发展是必不可少的识别临床修改的父母-青年交易。目的：目前的应用程序测试的假设的成分的EI作为前兆的BPD功能和这些功能的发展过程。具体来说，我们将研究并发，前瞻性，独特的和共享的关联组件的EI，BPD功能，和内在和外在的问题在养育环境。因此，该建议还探讨了父母的情绪反应和青年EI和潜在的调节作用，父母的情绪反应对BPD功能的发展之间的相互关联。方法：我们将使用一个多模式的，生态有效的评估电池的EI在年轻的青少年，情绪为重点的养育策略，和父母与青少年的互动。我们将实时检查这些过程（使用生态瞬时评估协议，观察评级和自主反应监测），并在18个月内通过三次评估绘制其发展过程。我们将确定特定的EI组件如何与近邻内化和外化问题相关（例如，抑郁症，行为问题），但我们认为，这三个EI组件的组合形成了一个特定的标志，随后的BPD功能，特别是在有害的父母的战略。将从精神病诊所招募11-13岁的青少年和主要照顾者（N=165个家庭; H50%女孩），并对青少年进行筛选，以确保我们对严重和临床显著水平的EI进行过采样。根据NIMH的战略优先事项，拟议的工作是一个新的和关键的步骤，以确定谁是最大的风险，以及如何干预弱势青年及其家庭。

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.