背景:根据ICD-11,人格障碍(PD)是通过人格功能(PF)方面的自我和人际关系功能障碍的严重程度以及对特定适应不良人格特征表达的可选评估来定义的。此外,躯体形式障碍被躯体症状障碍(SSD)取代。本研究在未经选择的初级保健样本中使用SSD的新诊断标准来检查关联。PF,以及有和没有SSD的患者的适应不良特征。
方法:进行了匿名横断面研究。包括SSD-12(躯体症状障碍B标准量表-12)和PHQ-15(患者健康问卷-15)的问卷,使用LPFS-BF2.0(人格功能水平量表-简要表格)和PID-5BFM(DSM-5的改良人格量表-简要表格加)。用PF(一般因子参考)和人格特质(特定因子)计算双因子(S-1)模型,以估计PF之间的关联,特定的适应不良人格特质,SSD。使用Mann-WhitneyU检验计算SSD和非SSD患者之间的人格量表差异。
结果:共有624名患者参加了6个一般实践(平均年龄47岁;60.4%为女性)。SSD-12和PHQ-15与PF显著相关(γ=0.51;γ=0.48;p<0.001),负情感(γ=0.50;γ=0.38,p<0.001)和精神病性(γ=0.29;γ=0.28;p<0.010)。此外,SSD-12与去抑制(γ=-0.38;p&lt;0.010)和无刺激(γ=-0.16;p&lt;0.010)显着相关。SSD患者在所有量表中均表现出显着的PF受损和适应不良特征(p<0.001)。
结论:受损的PF解释了中度到大量的SSD症状和适应不良的人格特征负情感,精神病,去抑制,和anankastia显示出PF以外的特定关联。深入了解这些关系可能有助于改善SSD中的医患沟通和治疗。
BACKGROUND: According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD.
METHODS: An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale - Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 - Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test.
RESULTS: A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = -0.38; p < 0.010) and anankastia (γ = -0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001).
CONCLUSIONS: Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD.