Frequency of borderline personality disorder in patients with polycystic ovary syndrome and its relation with aggression

Yıl 2020, Cilt: 45 Sayı: 3, 1073 - 1079, 30.09.2020

Sema Baykara , Burkay Yakar , Faruk Kilinc , Sevda Korkmaz , Murad Atmaca

https://doi.org/10.17826/cumj.691630

Öz

Purpose: The aim of this study was to investigate the incidence of borderline personality disorder (BPD) and its relationship with aggression in patients with polycystic ovary syndrome (PCOS).
Materials and Methods: Eightyeight patients diagnosed with PCOS and met the study criteria were included in the study. The patients were interviewed by the psychiatrist after the endocrinological evaluations. Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV/Clinical Version (SCID-I/CV), sociodemographic data form, Borderline Personality Inventory (BPI), Buss-Perry Aggression Questionnaire (BPAQ) were applied.
Results: The mean age of the patients was 22.39 ± 3.41. 27.3% (n = 24) of patients was diagnosed with BPD. BPAQ subscale scores and BPAQ total scores increased as BPI score increased in all PCOS patients. Verbal aggression, anger subscales scores, and total BPAQ score increased as the BPI score increased in PCOS patients with BPD.
Conclusion: The results of the study show that PCOS is accompanied by high rates of comorbid BPD. The consistence of both diagnoses together resulted in significantly higher aggression scores than PCOS alone. Adding psychopharmacological and psychotherapeutic approaches to the treatment of PCOS patients, which may be effective in the treatment of BPD, may increase the success of the treatment.

Anahtar Kelimeler

polycystic ovary syndrome, borderline personality disorder

Polikistik over sendromu tanılı hastalarda borderline kişilik bozukluğu görülme sıklığı ve agresyon ile ilişkisi

Öz

Amaç: Bu çalışmada polikistik over sendromu (PCOS tanılı hastalarda) borderline kişilik bozukluğu (BKB) görülme sıklığı ve agresyon ile ilişkisinin incelenmesi amaçlandı.
Gereç ve Yöntem: PCOS tanılı hastalardan çalışma kriterlerini karşılayan 88 kişi çalışmaya dâhil edildi. Hastalar endokrinolojik değerlendirmelerden sonra psikiyatri uzmanı tarafından değerlendirildi. DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV I. Eksen Bozuklukları için yapılandırılmış Klinik Görüşme Çizelgesi Klinik Versiyonu (SCID-I/CV), sosyodemografik veri formu, Borderline Kişilik Envanteri (BKE), Buss-Perry Saldırganlık Ölçeği (BPSÖ) uygulandı.
Bulgular: Hastaların yaş ortalaması 22.39±3.41 idi ve %27,3’ü (n=24) BKB tanısı aldı. PCOS’lu hastalardan BKB olanlarda BPSÖ fiziksel saldırganlık, sözel saldırganlık, öfke, düşmanlık alt ölçek ve BPSÖ toplam puanları BKB olmayanlara göre anlamlı olarak yüksekti. Tüm PCOS’lularda BKE puanı arttıkça BPSÖ alt ölçek puanları ve BPSÖ toplam puanı artıyordu. BKB olan PCOS’lularda BKE puanı arttıkça BPSÖ sözel saldırganlık, öfke alt ölçek puanları ve toplam BPSÖ puanı artış gösterdi.
Sonuç: Çalışmanın sonuçları PCOS’ a yüksek oranlarda BKB ek tanısının eşlik ettiğini göstermektedir. Her iki tablonun bir arada olması, tek başına PCOS varlığına göre agresyon puanlarının anlamlı olarak daha yüksek olması ile sonuçlanmıştır. PCOS tanılı hastalarda tedaviye BKB tedavisinde etkili olabilen psikofarmakolojik ve psikoterapötik yaklaşımları eklemek tedavinin başarısını artırabilir.

Anahtar Kelimeler

Polikistik Over Sendromu, Sınırda Kişilik Bozukluğu, Agresyon

Kaynakça

• 1. Scaruffi E, Gambineri A, Cattaneo S, Turra J, Vettor R Mioni R. Personality and psychiatric disorders in women affected by polycystic ovary syndrome. Front Endocrinol (Lausanne). 2014;5:185.
• 2. Teede H, Deeks A Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.
• 3. Cesta CE, Månsson M, Palm C, Lichtenstein P, Iliadou AN Landén M. Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology. 2016;73:196-203.
• 4. Trent ME, Rich M, Austin SB Gordon CM. Quality of life in adolescent girls with polycystic ovary syndrome. Arch Pediatr Adolesc Med. 2002;156:556-60.
• 5. Sahingoz M, Uguz F, Gezginc K Korucu DG. Axis I and Axis II diagnoses in women with PCOS. Gen Hosp Psychiatry. 2013;35:508-11.
• 6. Weiner CL, Primeau M Ehrmann DA. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med. 2004;66:356-62.
• 7. Weber B, Lewicka S, Deuschle M, Colla M Heuser I. Testosterone, androstenedione and dihydrotestosterone concentrations are elevated in female patients with major depression. Psychoneuroendocrinology. 2000;25:765-71.
• 8. Barnard L, Ferriday D, Guenther N, Strauss B, Balen A Dye L. Quality of life and psychological well being in polycystic ovary syndrome. Hum Reprod. 2007;22:2279-86.
• 9. Tan S, Hahn S, Benson S, Janssen OE, Dietz T, Kimmig R, et al. Psychological implications of infertility in women with polycystic ovary syndrome. Hum Reprod. 2008;23:2064-71.
• 10. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, 2013.
• 11. American Psychiatric Association. Diagnostic criteria from DSM-IV-TR. American Psychiatric Association, Washington, D.C., 2000.
• 12. Evardone M, Alexander GM Morey LC. Hormones and borderline personality features. ‎Pers Individ Differ. 2008;44:278-87.
• 13. Grumm M von Collani G. Personality types and self-reported aggressiveness. ‎Pers Individ Differ. 2009;47:845-50.
• 14. Sharma TR. Polycystic ovarian syndrome and borderline personality disorder: 3 case reports and scientific review of literature. J Psychiatry. 2015;18:1-4.
• 15. Elsenbruch S, Hahn S, Kowalsky D, Offner AH, Schedlowski M, Mann K, et al. Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88:5801-07.
• 16. Himelein MJ Thatcher SS. Polycystic ovary syndrome and mental health: A review. Obstet Gynecol Surv. 2006;61:723-32.
• 17. Kahl KG, Bester M, Greggersen W, Rudolf S, Dibbelt L, Stoeckelhuber BM, et al. Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder. Psychosom Med. 2005;67:407-12.
• 18. Tan RY, Grigg J Kulkarni J. Borderline personality disorder and polycystic ovary syndrome: A review of the literature. Aust N Z J Psychiatry. 2018;52:117-28.
• 19. ESHRE TR Group A-SPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.
• 20. Zawadzski J. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic ovary syndrome 1992:39-50.
• 21. Riis P. Perspectives on the Fifth Revision of the Declaration of Helsinki. JAMA. 2000;284: 3045-46.
• 22. First MB. User's guide for the structured clinical interview for DSM-IV axis II personality disorders : SCID-II. American Psychiatric Press, Washington, DC, 1997.
• 23. Özkürkçügil A, Aydemir Ö, Yıldız M, Esen Danacı A Köroğlu IV E. DSM-IV Eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe’ye uyarlanması ve güvenilirlik çalışması. İlaç Tedavi Derg. 1999;12:233-6.
• 24. Leichsenring F. Development and first results of the Borderline Personality Inventory: A self-report instrument for assessing borderline personality organization. J Pers Assess. 1999;73:45-63.
• 25. Aydemir Ö, Demet MM, Danacı AE, Deveci A, Taşkın EO, Mızrak S, et al. Borderline kişilik envanterinin Türkçe’ye uyarlanması, güvenilirlik ve geçerliliği. Türkiye’de Psikiyatri. 2006;8:6-10.
• 26. Buss AH Perry M. The aggression questionnaire. J Pers Soc Psychol. 1992;63:452.
• 27. Andrews G, Henderson S Hall W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry. 2001;178:145-53.
• 28. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948-58.
• 29. Lenzenweger MF, Lane MC, Loranger AW Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62:553-564.
• 30. Quirk SE, Berk M, Pasco JA, Brennan-Olsen SL, Chanen AM, Koivumaa-Honkanen H, et al. The prevalence, age distribution and comorbidity of personality disorders in Australian women. Aust N Z J Psychiatry. 2017;51:141-50.
• 31. Trull TJ, Jahng S, Tomko RL, Wood PK Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 2010;24:412-26.
• 32. Roepke S, Ziegenhorn A, Kronsbein J, Merkl A, Bahri S, Lange J, et al. Incidence of polycystic ovaries and androgen serum levels in women with borderline personality disorder. J Psychiatr Res. 2010;44:847-52.
• 33. Jonard S Dewailly D. The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update. 2004;10:107-17.
• 34. Archer J. Testosterone and human aggression: an evaluation of the challenge hypothesis. Neurosci Biobehav Rev. 2006;30:319-45.
• 35. Benson S, Arck PC, Tan S, Hahn S, Mann K, Rifaie N, et al. Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology. 2009;34:727-35.
• 36. Lieb K, Rexhausen JE, Kahl KG, Schweiger U, Philipsen A, Hellhammer DH, et al. Increased diurnal salivary cortisol in women with borderline personality disorder. J Psychiatr Res. 2004;38:559-65.
• 37. Escobar-Morreale HF San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18:266-72.
• 38. Farrell K Antoni MH. Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertil Steril. 2010;94:1565-74.
• 39. Fulghesu AM, Villa P, Pavone V, Guido M, Apa R, Caruso A, et al. The impact of insulin secretion on the ovarian response to exogenous gonadotropins in polycystic ovary syndrome. J Clin Endocrinol Metab. 1997;82:644-48.
• 40. Archer J. The influence of testosterone on human aggression. Br J Psychol. 1991;82 ( Pt 1):1-28.
• 41. Rubinow DR Schmidt PJ. Androgens, brain, and behavior. Am J Psychiatry. 1996;153:974-84.
• 42. Ehrenkranz J, Bliss E Sheard MH. Plasma testosterone: correlation with aggressive behavior and social dominance in man. Psychosom Med. 1974;36:469-75.
• 43. Archer J, Graham-Kevan N Davies M. Testosterone and aggression: A reanalysis of Book, Starzyk, and Quinsey's (2001) study. Aggress Behav. 2005;10:241-61.
• 44. Book AS Quinsey VL. Re-examining the issues: A response to Archer et al. Aggress Behav. 2005;10:637-46.
• 45. Pajer K, Tabbah R, Gardner W, Rubin RT, Czambel RK Wang Y. Adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder. Psychoneuroendocrinology. 2006;31: 1245-56.
• 46. Dabbs J Hargrove MF. Age, testosterone, and behavior among female prison inmates. Psychosom Med. 1997;59:477-80.