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目的:探讨ADHD共患边缘型人格障碍(BPD)患者的冲动性特征及情绪调节策略在其中的影响。方法:纳入96例符合美国精神障碍诊断与统计手册第4版诊断标准的ADHD患者，其中48例共患BPD。采用Barratt冲动量表(BIS)及情绪调节困难量表(DERS)的冲动控制困难因子对冲动性特征进行评估，采用情绪调节问卷(ERQ)对情绪调节策略进行评估。结果:ADHD共患BPD组在BIS评估的认知、运动及非计划冲动上与ADHD未共患BPD组差异均无统计学意义(均P>0.05),ADHD共患BPD组DERS量表的冲动控制困难因子得分高于未共患BPD组(P<0.001),认知重评策略使用较ADHD未共患BPD组少(P<0.001)。认知重评在ADHD共患BPD与冲动控制困难间起到部分中介作用，效应量25.9%。结论:共患BPD的ADHD患者存在更高的情绪冲动性，较少使用情绪调节策略中的认知重评可能是ADHD共患BPD高冲动性的重要因素。
Abstract：Objective:To explore the impulsivity characteristics of patients with attention deficit hyperactivity disorder(ADHD) comorbid with borderline personality disorder(BPD) and the mediating role of emotion regulation strategies.Methods:A total of 96 patients with ADHD meeting the diagnostic criteria of the American Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV) were enrolled, 48 of whom had comorbid BPD.Impulsivity was assessed with the Barratt Impulse Scale(BIS) and the impulse control difficulty dimensions of Emotional Regulation Difficulty Scale(DERS).Emotion regulation strategies were evaluated with the Emotion Regulation Questionnaire(ERQ).Results:No significant differences were found between the ADHD with and without BPD group in cognitive impulsivity, motor impulsivity, or non-planning impulsivity as assessed with the BIS(Ps>0.05).However, the ADHD with BPD group showed higher scores on the DERS impulse control difficulty subscale(P<0.001) and less frequent use of cognitive reappraisal strategies(P<0.001).Cognitive reappraisal partially mediated the relationship between ADHD with BPD and impulse control difficulties, with an effect size of 25.9%.Conclusion:ADHD patients comorbid with BPD exhibit heightened emotional impulsivity, which might be partially mediated by reduced use of cognitive reappraisal.
[1] Karam RG,Breda V,Picon FA,et al.Persistence and remission of ADHD during adulthood:a 7-year clinical follow-up study[J].Psychol Med,2015,45(10):2045-2056.
[2] Philipsen A,Limberger MF,Lieb K,et al.Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder[J].Br J Psychiatry,2008,192(2):118-123.
[3] Fossati A,Novella L,Donati D,et al.History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder:a controlled study[J].Compr Psychiatry,2002,43(5):369-377.
[4] Nicastro R,Desseilles M,Prada P,et al.Subjective distress associated with adult ADHD:evaluation of a new self-report[J].Atten Defic Hyperact Disord,2018,10(1):77-86.
[5] Alvarez-Tomas I,Ruiz J,Guilera G,et al.Long-term clinical and functional course of borderline personality disorder:a meta-analysis of prospective studies[J].Eur Psychiatry,2019,56:75-83.doi:10.1016/j.eurpsy.2018.10.010
[6] Katzman MA,Bilkey TS,Chokka PR,et al.Adult ADHD and comorbid disorders:clinical implications of a dimensional approach[J].BMC Psychiatry,2017,17(1):302.doi:10.1186/s12888-017-1463-3
[7] Speranza M,Revah-Levy A,Cortese S,et al.ADHD in adolescents with borderline personality disorder[J].BMC Psychiatry,2011,11:158.doi:10.1186/1471-244X-11-158
[8] Stepp SD,Burke JD,Hipwell AE,et al.Trajectories of attention deficit hyperactivity disorder and oppositional defiant disorder symptoms as precursors of borderline personality disorder symptoms in adolescent girls[J].J Abnorm Child Psychol,2012,40(1):7-20.
[9] Ditrich I,Philipsen A,Matthies S.Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited-a review-update on common grounds and subtle distinctions[J].Borderline Personal Disord Emot Dysregul,2021,8(1):22.doi:10.1186/s40479-021-00162-w.
[10]储珺.反应抑制受损在边缘性人格障碍高冲动中的作用机制[D].长沙：中南大学，2022.
[11]Prada P,Hasler R,Baud P,et al.Distinguishing borderline personality disorder from adult attention deficit/hyperactivity disorder:a clinical and dimensional perspective[J].Psychiatry Res,2014,217(1-2):107-114.
[12]Lampe K,Konrad K,Kroener S,et al.Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder[J].Psychol Med,2007,37(12):1717-1729.
[13]Weinstein SM,Mermelstein RJ.Influences of mood variability,negative moods,and depression on adolescent cigarette smoking[J].Psychol Addict Behav,2013,27(4):1068-1078.
[14]Linhartova P,Sirucek 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.
[15]Bari A,Robbins TW.Inhibition and impulsivity:behavioral and neural basis of response control[J].Prog Neurobiol,2013,108:44-79.doi:10.1016/j.pneurobio.2013.06.005
[16]Qian Y,Chang W,He X,et al.Emotional dysregulation of ADHD in childhood predicts poor early-adulthood outcomes:a prospective follow up study[J].Res Dev Disabil,2016,59:428-436.doi:10.1016/j.ridd.2016.09.022
[17]Weiss NH,Tull MT,Viana AG,et al.Impulsive behaviors as an emotion regulation strategy:examining associations between PTSD,emotion dysregulation,and impulsive behaviors among substance dependent inpatients[J].J Anxiety Disord,2012,26(3):453-458.
[18]Miles SR,Sharp C,Tharp AT,et al.Emotion dysregulation as an underlying mechanism of impulsive aggression:reviewing empirical data to inform treatments for veterans who perpetrate violence[J].Aggression Viol Behav,2017,34:147-153.doi:10.1016/j.avb.2017.01.017
[19]Waite EE,Defontes C,Weiss NH,et al.Borderline personality disorder and multidimensional impulsivity:the roles of positive and negative emotion dysregulation[J].J Affect Disord,2024,344:635-643.doi:10.1016/j.jad.2023.10.030
[20]李献云，费立鹏，徐东，等.Barratt冲动性量表中文修订版在社区和大学人群中应用的信效度[J].中国心理卫生杂志，2011,25(8):610-615.
[21]王力，柳恒超，杜卫，等.情绪调节困难量表在中国人群中的初步测试[J].中国健康心理学杂志，2007,15(4):336-340.
[22]Association AP.Diagnostic and statistical manual of mental disorders(DSM-IV)[Z].Arlington,VA,US:American Psychiatric Publishing,Inc,1994:886.
[23]Conners CK,Epstein J,Johnson D.Conners′ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) [G].NY:Multi-Health Systems,Inc,2001:1-36.
[24]龚耀先，蔡太生.中国修订韦氏儿童智力量表手[M].长沙：湖南地图出版社，1993:237-238.
[25]First MB,Gibbon M,Spitzer RL,et al.Structured clinical interview for DSM-IV axis II personality disorders[M].Washington,DC:American Psychiatric Press,1997.
[26]Su YE,Wang H,Geng YG,et al.Parent ratings of ADHD symptoms in Chinese urban schoolchildren:assessment with the Chinese ADHD Rating Scale-IV:Home Version[J].J Atten Disord,2015,19(12):1022-1033.
[27]王力，柳恒超，李中权，等.情绪调节问卷中文版的信效度研究[J].中国健康心理学杂志，2007,15(6):503-505.
[28]O′Malley GK,Mchugh L,Mac GN,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.doi:10.1016/j.eurpsy.2015.09.012
[29]Speranza M,Revah-Levy A,Cortese S,et al.ADHD in adolescents with borderline personality disorder[J].BMC Psychiatry,2011,11:158.doi:10.1186/1471-244X-11-158
[30]Krause-Utz A,Sobanski E,Alm B,et al.Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity disorder:an exploratory study[J].J Nerv Ment Dis,2013,201(2):116-123.
[31]Evenden JL.Varieties of impulsivity[J].Psychopharmacology (Berl),1999,146(4):348-361.
[32]Gross JJ,John OP.Individual differences in two emotion regulation processes:implications for affect,relationships,and well-being[J].J Pers Soc Psychol,2003,85(2):348-362.
[33]Gross JJ.Emotion regulation:Current status and future prospects[J].Psychol Inquiry,2015,26(1):1-26.
[34]Liu Q,Chen W,Preece DA,et al.Emotion dysregulation in adults with ADHD:the role of cognitive reappraisal and expressive suppression[J].J Affect Disord,2022,319:267-276.doi:10.1016/j.jad.2022.09.058
[35]Materna L,Wiesner CD,Shushakova A,et al.Adult patients with ADHD differ from healthy controls in implicit,but not explicit,emotion regulation[J].J Psychiatry Neurosci,2019,44(5):340-349.
[36]Bodalski EA,Knouse LE.Kovalev D,et al.Adult ADHD,emotion dysregulation,and functional outcomes:examining the role of emotion regulation strategies[J].J Psychopathol Behav Assess,2019,41:81-92.https://doi.org/10.1007/s10862-018-9695-1
[37]Beblo T,Pastuszak A,Griepenstroh J,et al.Self-reported emotional dysregulation but no impairment of emotional intelligence in borderline personality disorder:an explorative study[J].J Nerv Ment Dis,2010,198(5):385-388.
[38]Krause-Utz A,Walther JC,Lis S,et al.Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder:the role of comorbid posttraumatic stress disorder and dissociation[J].Psychol Med,2019,49(11):1810-1821.
[39]Carvalho Fernando S,Beblo T,Schlosser N,et al.The impact of self-reported childhood trauma on emotion regulation in borderline personality disorder and major depression[J].J Trauma Dissociation,2014,15(4):384-401.
[40]Denny BT,Lopez RB,Wu-Chung EL,et al.Training in cognitive reappraisal normalizes whole-brain indices of emotion regulation in borderline personality disorder[J].Biol Psychiatry Cogn Neurosci Neuroimaging,2024,9(8):819-826.
基本信息:
中图分类号:R749.91
引用信息:
[1]常卫利,李海梅,潘美蓉,等.ADHD共患边缘型人格障碍患者冲动性特征及其与情绪调节策略的关系[J].中国心理卫生杂志,2025,39(12):1013-1018.
基金信息:
首都卫生发展科研专项(CFH:2024-2-4114); 北京市科技新星计划(20220484061、20230484444); 国家自然科学基金(82271575); 北京大学临床医学+X青年专项(中央高校基本科研业务费,PKU2023LCXQ043); 北京市卫健委第三批研究型病房项目