Interpersonal Functioning and Emotion in Borderline Personality

描述（由申请人提供）：本提案是一个修改后的竞争性续期申请，以扩展我们目前资助的项目，R 01 MH 056888，“边缘人格中的人际功能和情感”。“根据我们先前的研究结果，我们继续认为依恋理论是理解边缘型人格障碍（BPD）人际功能的最佳框架。在BPD中，焦虑、矛盾的依恋有一种独特的形式--经常对他人感到失望和愤怒，导致敌意退缩，随后是孤独和对分离的恐惧，产生新的接近和和解的尝试，直到下一次的挫折和失望。在这个自我挫败的循环中，关键的主题是（a）与愤怒作斗争，（B）无法与他人保持一致和舒适的人际距离。我们建议从二元的角度来研究这些过程，这是人格障碍研究的一个创新的新步骤。我们将从患者和浪漫伴侣的角度评估这些过程，因为我们早期的研究结果表明浪漫是BPD患者的高风险领域，与我们关于依恋机制的核心作用的假设一致。我们的主要目标是通过在多个层次上评估这些现象来提高我们对BPD中这些中心机制的理解。我们将使用三种方法（在不同的“粒度”级别和不同的时间尺度上）来实现这一点 objective.首先，我们将进行一个二元的实验室互动，涉及到一个目前棘手的和未解决的问题的关系的讨论。将使用特定情感编码系统（SPAFF）对情感和行为的相互作用进行编码，并记录外周心理生理学指标。第二，我们将使用一个二元的，生态瞬时评估（EMA）协议同时完成的参与者和合作伙伴为三个星期。最后，我们将对参与者（和伴侣）在过去一年中的25个最具情感意义的人物进行社交网络分析。我们的第一个具体目标是证明BPD患者（n = 55对）与其他PD患者（OPD，n = 55对）或无PD患者（n = 55对）相比，具有更高的平均愤怒水平，更大的愤怒变异性，以及依恋威胁和愤怒之间的更强关联。我们的第二个具体目标是证明BPD患者与其他PD或无PD患者相比，在人际距离方面表现出更大的变异性。我们的第三个具体目标是证明这些关于愤怒和人际距离的影响受到伴侣的特征和行为的调节，特别是他们自己的依恋焦虑。这项工作将以165对男女为样本，年龄在18岁至40岁之间。我们认为，结合二元评估（同时持续关注伴侣双方所处的更广泛的社交网络）是改进循证治疗的最佳途径，可以在日常交易的水平上解决人际功能。 公共卫生相关性：边缘型人格障碍（BPD）是一种严重的、使人衰弱的精神疾病。目前的治疗主要集中在个体患者，但我们相信，更广泛的人际环境（例如，二元评估和浪漫伴侣的纳入）可以确定新的干预目标，并提供更多的治疗效果。包括一个合作伙伴将使我们能够建立一个基础的证据，打开大门，以加强治疗干预的夫妇，其中一个或两个成员患有BPD。

DESCRIPTION (provided by applicant): This proposal is an amended competing renewal application to extend our currently funded project, R01 MH056888, "Interpersonal Functioning and Emotion in Borderline Personality." Based on our prior results, we continue to regard attachment theory as the best framework for understanding interpersonal functioning in borderline personality disorder (BPD) In BPD, anxious, ambivalent attachment takes a distinctive form- frequent disappointments and anger toward others lead to periods of hostile withdrawal, followed by loneliness and fears regarding separation, producing new attempts at approach and reconciliation, which continue until the next episode of frustration and disappointment. The key themes in this self-defeating cycle are (a) struggles with anger and (b) an inability to maintain a consistent and comfortable interpersonal distance from others. We propose to examine these processes from a dyadic perspective-an innovative, new step for research on personality disorders. We will assess these processes from the perspectives of both the patient and a romantic partner, given our earlier findings that romance is a high-risk domain for patients with BPD, consistent with our assumption about the central role of attachment mechanisms. The major objective is to enhance our understanding of these central mechanisms in BPD by assessing these phenomena at multiple levels of analysis. We will use three methods (at different levels of "granularity" and with different time scales) to achieve this objective. First, we will conduct a dyadic laboratory interaction involving a discussion of a currently troublesome and unresolved issue in the relationship. The interaction will be coded for both affect and behavior using the Specific Affect Coding System (SPAFF), and measures of peripheral psychophysiology will be recorded. Second, we will use a dyadic, ecological momentary assessment (EMA) protocol completed simultaneously by participant and partner for three weeks. Finally, we will include a social network analysis of the 25 most emotionally significant figures for the participant (and partner) during the past year. Our first specific aim s to document that patients with BPD (n = 55 dyads) have higher mean levels of anger, greater variability in anger, and a stronger association between threats to attachment and anger compared to patients with other PDs (OPD, n = 55 dyads) or no PD (n = 55 dyads). Our second specific aim is to document that patients with BPD display greater variability in interpersonal distance compared to patients with other PDs or no PD. Our third specific aim is to document that these effects regarding anger and interpersonal distance are moderated by the characteristics and behavior of partners, especially their own attachment anxiety. The work will be done with a total sample of 165 dyads consisting of men and women between the ages of 18 and 40. We believe that incorporating dyadic assessment (together with continued attention to the broader social networks in which both partners are embedded) is the best way forward to improved, evidence-based treatments that can address interpersonal functioning at the level of day-to-day transactions. PUBLIC HEALTH RELEVANCE: Borderline personality disorder (BPD) is a severe and debilitating psychiatric disorder. Current treatments focus primarily on the individual patient, bu we believe that a broader interpersonal context (exemplified by dyadic assessment and the inclusion of romantic partners) can identify new targets for intervention and provide more therapeutic impact. The inclusion of a partner will allow us to build a base of evidence that opens the door to enhanced treatment interventions for couples in which one or both members suffer from BPD.