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边缘型人格障碍症状特征行为学范式研究进展

  • 杨阳 ,
  • 仇剑崟
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  • 上海交通大学医学院附属精神卫生中心心理咨询门诊部,上海 200030
杨 阳(1999—),男,硕士生;电子信箱:1551517269@qq.com
仇剑崟,电子信箱:jianyin_qiu@163.com

收稿日期: 2024-06-06

  录用日期: 2024-07-18

  网络出版日期: 2024-11-28

基金资助

国家自然科学基金(82371555);上海市“科技创新行动计划”医学创新研究专项(21Y11905400)

Research progress in behavioral paradigms on the symptoms of borderline personality disorder

  • Yang YANG ,
  • Jianyin QIU
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  • Department of Psychological Counseling Clinic, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
QIU Jianyin, E-mail: jianyin_qiu@163.com.

Received date: 2024-06-06

  Accepted date: 2024-07-18

  Online published: 2024-11-28

Supported by

National Natural Science Foundation of China(82371555);Medical Innovation Research Special Project of Shanghai “Science and Technology Innovation Action Plan”(21Y11905400)

摘要

边缘型人格障碍(borderline personality disorder,BPD)是一种以情绪、自我意识以及人际关系不稳定为特点的人格障碍类型。它与其他精神障碍的共病率非常高,针对BPD症状的干预也可以为缓解其他共病障碍提供帮助,因此BPD成为研究最多的人格障碍之一。以往BPD症状特征主要采用量表测评,其结果容易受主观性和社会赞许性的影响。使用行为学范式对BPD症状的研究能够弥补该缺陷,较准确、客观地测量到相对真实的情境下BPD患者的外显和内隐模式。该文就人际关系不稳定性、情绪不稳定性、自我不稳定性和冲动性4个角度梳理了针对BPD症状特征的行为学研究范式及其进展,比较了不同行为学范式中的结果差异并提出研究可能的发展方向,以期扩大针对BPD患者行为学研究的规模及应用场景。行为学范式结合心理、物理或药物干预方法,以及功能性近红外光谱技术、眼动追踪技术、功能性磁共振成像、事件相关电位等测量方法,可以揭示BPD患者深层的认知和行为模式,增进研究者和精神卫生工作实践者对BPD的思考和理解。

本文引用格式

杨阳 , 仇剑崟 . 边缘型人格障碍症状特征行为学范式研究进展[J]. 上海交通大学学报(医学版), 2024 , 44(11) : 1447 -1453 . DOI: 10.3969/j.issn.1674-8115.2024.11.012

Abstract

Borderline personality disorder (BPD) is a type of personality disorder characterized by unstable emotion, self-consciousness and interpersonal relationships. Despite its high comorbidity with other mental disorders, interventions targeting BPD symptoms may aid in the treatment of the comorbid disorders, which makes BPD one of the most investigated personality disorders. Previously, BPD symptom features were mainly measured by standard scales, but the results of these scales would easily be affected by subjectivity or social desirability. One way to address this limitation is the application of behavioral paradigms, which can measure both explicit and implicit patterns of BPD patients in relatively true-to-life scenes more accurately and objectively. This article discusses behavioral paradigms related to four principal symptoms of BPD: interpersonal instability, emotional instability, identity disturbance and impulsivity, compares the differences in the results of these paradigms, and proposes possible directions for future BPD behavioral research, in order to achieve the enlargement of application of these paradigms. Combined with psychological, physical and pharmacal intervention, or other measurements such as functional near-infrared spectroscopy (fNIRS), eye tracking technology, functional magnetic resonance imaging (fMRI) or event-related potential (ERP), these paradigms would be able to uncover the inner cognitive and behavioral patterns of BPD patients, and improve the knowledge and understanding of researchers and mental health practitioners regarding BPD.

参考文献

1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders (fifth edition)[M]. Arlington, VA: American Psychiatric Association, 2013.
2 LIEB K, ZANARINI M C, SCHMAHL C, et al. Borderline personality disorder[J]. Lancet, 2004, 364(9432): 453-461.
3 LEICHSENRING F, HEIM N, LEWEKE F, et al. Borderline personality disorder[J]. JAMA, 2023, 329(8): 670-679.
4 QADEER SHAH A, PRASAD D, CAROPRESO L, et al. The comorbidity between borderline personality disorder (BPD) and generalized anxiety disorder (GAD): a systematic review and meta-analysis[J]. J Psychiatr Res, 2023, 164: 304-314.
5 TOMKO R L, TRULL T J, WOOD P K, et al. Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning[J]. J Pers Disord, 2014, 28(5): 734-750.
6 SHAH R, ZANARINI M C. Comorbidity of borderline personality disorder: current status and future directions[J]. Psychiatr Clin North Am, 2018, 41(4): 583-593.
7 DENNING D M, CIOTTI V, GIOIA A, et al. Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders[J]. Personal Disord, 2024, 15(2): 146-156.
8 ZEIFMAN R J, LANDY M S H, LIEBMAN R E, et al. Optimizing treatment for comorbid borderline personality disorder and posttraumatic stress disorder: a systematic review of psychotherapeutic approaches and treatment efficacy[J]. Clin Psychol Rev, 2021, 86: 102030.
9 PASCUAL J C, ARIAS L, SOLER J. Pharmacological management of borderline personality disorder and common comorbidities[J]. CNS Drugs, 2023, 37(6): 489-497.
10 SANTANGELO P S, KOENIG J, FUNKE V, et al. Ecological momentary assessment of affective and interpersonal instability in adolescent non-suicidal self-injury[J]. J Abnorm Child Psychol, 2017, 45(7): 1429-1438.
11 BERENSON K R, JOHNSON J C, ZHAO F H, et al. Borderline personality features and integration of positive and negative thoughts about significant others[J]. Personal Disord, 2018, 9(5): 447-457.
12 BOZZATELLO P, BLUA C, MARIN G, et al. Group interpersonal psychotherapy (IPT-G) for borderline personality disorder: a randomized controlled study[J]. J Psychiatr Res, 2023, 168: 157-164.
13 SHARP C, VENTA A, MCLAREN V. Interpersonal trust in adolescents with borderline personality disorder: comparisons with healthy and psychiatric controls[J]. J Pers Disord, 2023, 37(5): 475-489.
14 FERTUCK E A, JEKAL A, SONG I, et al. Enhanced ‘Reading the Mind in the Eyes’ in borderline personality disorder compared to healthy controls[J]. Psychol Med, 2009, 39(12): 1979-1988.
15 K?L?? F, DEMIRDA? A, I??K ü, et al. Empathy, alexithymia, and theory of mind in borderline personality disorder[J]. J Nerv Ment Dis, 2020, 208(9): 736-741.
16 CYRKOT T, SZCZEPANOWSKI R, JANKOWIAK-SIUDA K, et al. Mindreading and metacognition patterns in patients with borderline personality disorder: experimental study[J]. Eur Arch Psychiatry Clin Neurosci, 2021, 271(6): 1159-1168.
17 NéMETH N, PéTERFALVI á, CZéH B, et al. Examining the relationship between executive functions and mentalizing abilities of patients with borderline personality disorder[J]. Front Psychol, 2020, 11: 1583.
18 BERENSON K R, DOCHAT C, MARTIN C G, et al. Identification of mental states and interpersonal functioning in borderline personality disorder[J]. Personal Disord, 2018, 9(2): 172-181.
19 THOME J, LIEBKE L, BUNGERT M, et al. Confidence in facial emotion recognition in borderline personality disorder[J]. Personal Disord, 2016, 7(2): 159-168.
20 WINGENFELD K, RULLKOETTER N, MENSEBACH C, et al. Neural correlates of the individual emotional Stroop in borderline personality disorder[J]. Psychoneuroendocrinology, 2009, 34(4): 571-586.
21 SINKE C, WOLLMER M A, KNEER J, et al. Interaction between behavioral inhibition and emotional processing in borderline personality disorder using a pictorial emotional go/no-go paradigm[J]. Psychiatry Res, 2017, 256: 286-289.
22 HYNIEWSKA S, D?BROWSKA J, MAKOWSKA I, et al. The borderline bias in explicit emotion interpretation[J]. Front Psychol, 2021, 12: 733742.
23 KLEINDIENST N, HAUSCHILD S, LIEBKE L, et al. A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted borderline personality disorder[J]. Borderline Personal Disord Emot Dysregul, 2019, 6: 17.
24 SAVAGE M, LENZENWEGER M F. The impact of social exclusion on “Reading the Mind in the Eyes” performance in relation to borderline personality disorder features[J]. J Pers Disord, 2018, 32(1): 109-130.
25 DE MEULEMEESTER C, LOWYCK B, BOETS B, et al. Do my emotions show or not? Problems with transparency estimation in women with borderline personality disorder features[J]. Personal Disord, 2022, 13(3): 288-299.
26 MEULEMEESTER C, LOWYCK B, BOETS B, et al. “Feeling invisible”: individuals with borderline personality disorder underestimate the transparency of their emotions[J]. J Pers Disord, 2023, 37(2): 213-232.
27 GRAUMANN L, CHO A B, KULAKOVA E, et al. Impact of social exclusion on empathy in women with borderline personality disorder[J]. Eur Arch Psychiatry Clin Neurosci, 2023, 273(4): 865-874.
28 REINHARD M A, PADBERG F, DEWALD-KAUFMANN J, et al. Sequential social exclusion in a novel cyberball paradigm leads to reduced behavioral repair and plasma oxytocin in borderline personality disorder[J]. J Pers Disord, 2022, 36(1): 99-115.
29 G?TTLICH M, WESTERMAIR A L, BEYER F, et al. Neural basis of shame and guilt experience in women with borderline personality disorder[J]. Eur Arch Psychiatry Clin Neurosci, 2020, 270(8): 979-992.
30 VAN ZUTPHEN L, SIEP N, JACOB G A, et al. Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder[J]. J Psychiatry Neurosci, 2018, 43(1): 37-47.
31 FUCHS T. Fragmented selves: temporality and identity in borderline personality disorder[J]. Psychopathology, 2007, 40(6): 379-387.
32 WINTER D, STEEB L, HERBERT C, et al. Lower self-positivity and its association with self-esteem in women with borderline personality disorder[J]. Behav Res Ther, 2018, 109: 84-93.
33 KORN C W, LA ROSéE L, HEEKEREN H R, et al. Social feedback processing in borderline personality disorder[J]. Psychol Med, 2016, 46(3): 575-587.
34 FORSTER S D, BEBLO T, POHL S, et al. Self-referential processing and perspective taking in patients with a borderline personality disorder[J]. J Psychiatr Res, 2021, 140: 87-94.
35 VAN SCHIE C C, WHITING L, GRENYER B F S. How negative self-views may interfere with building positive relationships: an experimental analogue of identity dysfunction in borderline personality disorder[J]. PLoS One, 2024, 19(3): e0301196.
36 LINEHAN M. Cognitive-behavioral treatment of borderline personality disorder[M]. New York: Guilford Press, 1993.
37 HOCHHAUSEN N M, LORENZ A R, NEWMAN J P. Specifying the impulsivity of female inmates with borderline personality disorder[J]. J Abnorm Psychol, 2002, 111(3): 495-501.
38 WOLF R C, THOMANN P A, SAMBATARO F, et al. Orbitofrontal cortex and impulsivity in borderline personality disorder: an MRI study of baseline brain perfusion[J]. Eur Arch Psychiatry Clin Neurosci, 2012, 262(8): 677-685.
39 LAWRENCE K A, ALLEN J S, CHANEN A M. Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress[J]. J Pers Disord, 2010, 24(6): 786-799.
40 JACOB G A, GUTZ L, BADER K, et al. Impulsivity in borderline personality disorder: impairment in self-report measures, but not behavioral inhibition[J]. Psychopathology, 2010, 43(3): 180-188.
41 MACPHERSON L, MAGIDSON J F, REYNOLDS E K, et al. Changes in sensation seeking and risk-taking propensity predict increases in alcohol use among early adolescents[J]. Alcohol Clin Exp Res, 2010, 34(8): 1400-1408.
42 O′MALLEY G K, MCHUGH L, MAC GIOLLABHUI N, et al. Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors[J]. Eur Psychiatry, 2016, 31: 29-36.
43 LINHARTOVá P, ?IR??EK J, EJOVA A, et al. Dimensions of impulsivity in healthy people, patients with borderline personality disorder, and patients with attention-deficit/hyperactivity disorder[J]. J Atten Disord, 2021, 25(4): 584-595.
44 WAITE E E, DEFONTES C, WEISS N H, et al. Borderline personality disorder and multidimensional impulsivity: the roles of positive and negative emotion dysregulation[J]. J Affect Disord, 2024, 344: 635-643.
45 COFFEY S F, SCHUMACHER J A, BASCHNAGEL J S, et al. Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders[J]. Personal Disord, 2011, 2(2): 128-141.
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