Developmental Pathways to Borderline Personality Disorder: Longitudinal Observational, Clinical, and Neural Predictors From Early Childhood to Young Adulthood

项目总结 交界性人格障碍(BPD)是导致残疾、负担和 死亡率上升。尽管自我障碍(RDoC社交过程系统： 对自我的感知和理解)和人际关系(RDoC社交过程系统： 隶属关系)功能起源于儿童早期，对其发育过程知之甚少 BPD的这些核心特征的精神病理学，而不是与之相关的精神障碍 通常先于BPD，并与BPD共同发展：严重抑郁障碍(MDD)。海流 提案将从早期建立人际关系和自我功能障碍的发展轨迹 童年期进入青壮年，考察与环境因素和 与异常神经回路的关系，以预测成年早期BPD的发病。在这 续订，我们利用17年前从以下位置收集的纵向数据(R01 MH090786) 348名幼儿因情绪失调而变得更富有。现在的年轻人(19-25岁)，36% 表现出BPD高于诊断阈值。这个样本提供了一个无与伦比的机会 了解BPD发病的特定发育前兆。丰富的表型，包括超过一个 十年的临床访谈、叙述、问卷、观察和重复的MRI和 EEG评估使其成为研究损伤的理想且高成本效益的数据集 在自我和人际功能方面导致BPD与MDD。在青年中收集新的数据 成人期包括对人际关系和自我功能的多方法评估 精神病学诊断面谈。我们的激励假设是，在情感的背景下 学龄前儿童的调节失调、同伴接纳和攻击性(人际功能障碍) 通过童年中期，与自我功能(不稳定、不连贯的自我价值和自我- 概念)，以独特地预测BPD在成年期发病，而不是MDD。我们会 检查：(1)这些结构的具体方面如何预期与成人BPD相关，如 与MDD的延续相反；(2)这些结构在哪些发展阶段 提供最具预测性的效用，包括特定环境因素的调节作用； 以及(3)评估这些结构的神经关联的预测和机制作用 预测BPD与MDD。调查结果将告知最佳时机和内容焦点(即， 特定的神经/行为自我和人际目标)新的早期干预预防 BPD在最早的发育期。这项纵向研究将能够确定 持续或恶化人际和自我功能障碍以及BPD发病的危险因素， 为制定BPD的预防策略提供了最佳起点。

PROJECT SUMMARY Borderline Personality Disorder (BPD) is a prominent contributor to disability, burden, and increased mortality. Although impairments in self (RDoC Systems for Social Processes: Perception and understanding of self) and interpersonal (RDoC Systems for Social Processes: Affiliation) functioning originate in early childhood, little is known about the developmental psychopathology of these core features in BPD, as opposed to a related psychiatric disorder that often precedes and co-develops with BPD: Major Depressive Disorder (MDD). The current proposal will establish developmental trajectories of interpersonal and self dysfunction from early childhood into young adulthood, examining interactions with environmental factors and associations with aberrant neural circuitry, to predict onset of BPD in early adulthood. In this renewal, we leverage 17 years of previously collected longitudinal data (R01 MH090786) from 348 young children enriched for emotional dysregulation. Now young adults (19-25 years), 36% exhibit BPD above diagnostic threshold. This sample offers an unparalleled opportunity to understand specific developmental precursors for BPD onset. Rich phenotyping, including over a decade of clinical interviews, narratives, questionnaires, observations, and repeated MRI and EEG assessments make this the ideal and highly cost-effective dataset to investigate impairments in self and interpersonal functioning that lead to BPD versus MDD. New data collection in young adulthood includes multi-method assessments of interpersonal and self functioning alongside psychiatric diagnostic interviews. Our motivating hypothesis is that in the context of emotion dysregulation, peer acceptance and aggression (interpersonal dysfunction) from preschool through middle childhood, interacts with self-functioning (unstable, incoherent self-worth and self- concept) in adolescence to uniquely predict BPD onset in adulthood versus MDD. We will examine: (1) how specific aspects of these constructs prospectively relate to adult BPD, as opposed to continuation of MDD; (2) during which developmental periods these constructs provide the most predictive utility, including the moderating effect of specific environmental factors; and (3) assess the predictive and mechanistic role of neural correlates of these constructs in forecasting BPD versus MDD. Findings will inform the optimal timing and content-focus (i.e., specific neural/behavioral self and interpersonal targets) of novel early-intervention for preventing BPD during the earliest developmental periods. This longitudinal research will be able to identify risk factors for the persistence or worsening of interpersonal and self dysfunction and BPD onset, offering the best starting point toward developing a prevention strategy for BPD.