Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis

There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. The LCA revealed four distinct classes of individuals: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.

学界长期存在争议：当边缘型人格障碍（Borderline Personality Disorder, BPD）与创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）共病时，复杂性创伤后应激障碍（Complex Posttraumatic Stress Disorder, Complex PTSD）是否有别于边缘型人格障碍。为明确因童年创伤寻求治疗的女性所报告的症状模式，是否可归类为符合PTSD、复杂性创伤后应激障碍及BPD的诊断标准，本研究针对一项存档数据集开展了潜类别分析（Latent Class Analysis, LCA）。该数据集纳入了280名有童年创伤史的女性，这些女性均因参与PTSD相关临床试验接受入组评估。潜类别分析结果显示，可将被试划分为4个截然不同的类别：其一为低症状组，特征为所有症状的认可率均处于较低水平；其二为PTSD组，以PTSD症状显著升高为特征，但复杂性创伤后应激障碍与BPD的特征症状认可率较低；其三为复杂性创伤后应激障碍组，表现为PTSD症状与定义该障碍的自我组织症状水平均显著升高，但BPD症状水平偏低；其四为BPD组，以BPD症状为核心特征。研究发现，相较于复杂性创伤后应激障碍组，4项BPD症状可大幅提升被试归入BPD组的概率：竭力避免被遗弃、自我认知不稳定、不稳定且强烈的人际关系，以及冲动行为。本研究结果支持复杂性创伤后应激障碍与BPD存在显著区分的构念效度，明确了两类障碍的鉴别关键症状，可为临床鉴别诊断与治疗方案制定提供参考依据。