유병률, 공존 질환, 증상에 기초한 경계선 인격 장애, 외상후 스트레스 장애,복합성 외상후 스트레스 장애의 임상 양상 구분
Charicterist Clinical Features Between Post-Traumatic Stress Disorder, Complex Post-Traumatic Disorder and Borderline Personality Disorder Based On Prevalence, Comorbidity and Symptoms
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It is important for the therapist to differentiate between the symptoms of childhood trauma-related disorders, such as post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (cPTSD), and borderline personality disorder (BPD), and to evaluate whether these disorders coexist. Instead of the diagnosis of BPD with general stigma, the diagnosis of cPTSD without BPD has less stigma with a more accurate evaluation and treatment plan for patients. The relationship between PTSD, cPTSD/disturbance of self-organization (DSO), and BPD was evaluated in terms of prevalence, comorbidities, and clinical features. The comorbidity of BPD at diagnosis of cPTSD was higher than that of cPTSD at diagnosis of BPD. BPD symptoms tended to appear together with PTSD or cPTSD/DSO symptoms, rather than appearing separately, and in a subgroup with high severity of cPTSD. It suggested that the symptoms were more complex and aggravated during the transition from PTSD to cPTSD/DSO, and then followed by BPD after exposure to trauma. cPTSD/DSO symptoms were found to be distinct from PTSD and BPD symptoms; PTSD being fear-related intrusive memory, avoidance, and hypervigilance, and cPTSD/DSO being emotional numbness and emptiness, impaired self-perception, detachment from relationships, and BPD was characterized by emotional reactivity, impulsivity, emptiness, fear of abandonment, and a fragmented unstable sense of self. cPTSD/DSO was characterized by fear of getting close, avoidance, and unwillingness to make relationships, while BPD was characterized by intense, fleeting relational hostility and alternating excessive enmeshment in relationships. Cases with all BPD, PTSD, cPTSD/DSO symptoms were more strongly associated with accumulated more severe interpersonal trauma from childhood than those with cPTSD/DSO symptoms or PTSD without BPD symptoms.
Abstract
It is important for the therapist to differentiate between the symptoms of childhood trauma-related disorders, such as post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (cPTSD), and borderline personality disorder (BPD), and to evaluate whether these disorders coexist. Instead of the diagnosis of BPD with general stigma, the diagnosis of cPTSD without BPD has less stigma with a more accurate evaluation and treatment plan for patients. The relationship between PTSD, cPTSD/disturbance of self-organization (DSO), and BPD was evaluated in terms of prevalence, comorbidities, and clinical features. The comorbidity of BPD at diagnosis of cPTSD was higher than that of cPTSD at diagnosis of BPD. BPD symptoms tended to appear together with PTSD or cPTSD/DSO symptoms, rather than appearing separately, and in a subgroup with high severity of cPTSD. It suggested that the symptoms were more complex and aggravated during the transition from PTSD to cPTSD/DSO, and then followed by BPD after exposure to trauma. cPTSD/DSO symptoms were found to be distinct from PTSD and BPD symptoms; PTSD being fear-related intrusive memory, avoidance, and hypervigilance, and cPTSD/DSO being emotional numbness and emptiness, impaired self-perception, detachment from relationships, and BPD was characterized by emotional reactivity, impulsivity, emptiness, fear of abandonment, and a fragmented unstable sense of self. cPTSD/DSO was characterized by fear of getting close, avoidance, and unwillingness to make relationships, while BPD was characterized by intense, fleeting relational hostility and alternating excessive enmeshment in relationships. Cases with all BPD, PTSD, cPTSD/DSO symptoms were more strongly associated with accumulated more severe interpersonal trauma from childhood than those with cPTSD/DSO symptoms or PTSD without BPD symptoms.
참고문헌 (30)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders. 4th ed" (1994), American Psychiatric Association
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders. 5th ed" (2013), American Psychiatric Association
- Brewin CR, "A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD", Clin Psychol Rev, 58, pp.1~15 (2017)
- Cloitre M, "Evidence for proposed ICD-11 PTSD and complex PTSD : a latent profile analysis", Eur J Psychotraumatol, 4, pp.20706~ (2013)
- Cloitre M, "Distinguishing PTSD, complex PTSD, and borderline personality disorder : a latent class analysis", Eur J Psychotraumatol, 5, pp.25097~ (2014)
- Doering S, "Borderline personality disorder in patients with medical illness : a review of assessment, prevalence, and treatment options", Psychosom Med, 81, pp.584~594 (2019)
- Ford JD, "Commentary on the special section on complex PTSD : still going strong after all these years", J Trauma Stress, 32, pp.877~880 (2019)
- Ford JD, "Complex PTSD, affect dysregulation, and borderline personality disorder", Borderline Personal Disord Emot Dysregul, 1, pp.9~ (2014)
- Ford JD, "Complex PTSD and borderline personality disorder", Borderline Personal Disord Emot Dysregul, 8, pp.16~ (2021)
- Frías Á, "Comorbidity between post-traumatic stress disorder and borderline personality disorder : a review", Psychopathology, 48, pp.1~10 (2015)
- Frost R, "Distinguishing complex PTSD from borderline personality disorder among individuals with a history of sexual trauma : a latent class analysis", Eur J Trauma Dissoc, 4, pp.100080~ (2020)
- Greene T, "Prevalence, detection and correlates of PTSD in the primary care setting : a systematic review", J Clin Psychol Med Settings, 23, pp.160~180 (2016)
- Harford TC, "Borderline personality disorder and violence toward self and others : a national study", J Pers Disord, 33, pp.653~670 (2019)
- Herman JL, "Complex PTSD : a syndrome in survivors of prolonged and repeated trauma", J Trauma Stress, 5, pp.377~391 (1992)
- Hyland P, "Examining the discriminant validity of complex posttraumatic stress disorder and borderline personality disorder symptoms : results from a United Kingdom population sample", J Trauma Stress, 32, pp.855~863 (2019)
- Jowett S, "Multiple and interpersonal trauma are risk factors for both post-traumatic stress disorder and borderline personality disorder : a systematic review on the traumatic backgrounds and clinical characteristics of comorbid post-traumatic stress disorder", borderline personality disorder groups versus single-disorder groups, 2020, pp.93, 621~638
- Jowett S, "Differentiating symptom profiles of ICD-11 PTSD, complex PTSD, and borderline personality disorder : a latent class analysis in a multiply traumatized sample", Personal Disord, 11, pp.36~45 (2020)
- Kessler RC, "Trauma and PTSD in the WHO world mental health surveys", Eur J Psychotraumatol, 8(sup5), pp.1353383~ (2017)
- Knefel M, "The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective", J Anxiety Disord, 43, pp.70~78 (2016)
- Kulkarni J, "Complex PTSD-a better description for borderline personality disorder?", Australas Psychiatry, 25, pp.333~335 (2017)
- Linehan MM, "Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder : a randomized clinical trial and component analysis", JAMA Psychiatry, 72, pp.475~482 (2015)
- Møller L, "Traumatic experiences, ICD-11 PTSD, ICD-11 complex PTSD, and the overlap with ICD-10 diagnoses", Acta Psychiatr Scand, 141, pp.421~431 (2020)
- Porter C, "Childhood adversity and borderline personality disorder : a metaanalysis", Acta Psychiatr Scand, 141, pp.6~20 (2020)
- Roth S, "Complex PTSD in victims exposed to sexual and physical abuse : results from the DSM-IV field trial for posttraumatic stress disorder", J Trauma Stress, 10, pp.539~555 (1997)
- Scheiderer EM, "The comorbidity of borderline personality disorder and posttraumatic stress disorder : revisiting the prevalence and associations in a general population sample", Borderline Personal Disord Emot Dysregul, 2, pp.11~ (2015)
- Stein DJ, "DSM-5 and ICD-11 definitions of posttraumatic stress disorder : investigating"narrow"and"broad"approaches", Depress Anxiety, 31, pp.494~505 (2014)
- van Dijke A, "Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder", Eur J Psychotraumatol, 9, pp.1400878~ (2018)
- International classification of diseases 11th revision (ICD-11), "World Health Organization", World Health Organisation, ~ (2018)
- Wolf EJ, "ICD-11 complex PTSD in US national and veteran samples : prevalence and structural associations with PTSD", Clin Psychol Sci, 3, pp.215~229 (2015)
- Zanarini MC, "The 10-year course of PTSD in borderline patients and axis II comparison subjects", Acta Psychiatr Scand, 124, pp.349~356 (2011)