Abstract
Borderline Personality Disorder is a serious mental disease, classified in Cluster B of DSM IV-TR personality disorders. People with this syndrome presents an anamnesis of traumatic experiences and shows dissociative symptoms. Since not all subjects who have been victims of trauma develop a Borderline Personality Disorder, the emergence of this serious disease seems to have the fragility of character as a predisposing condition. Infect, numerous studies show that subjects positive for diagnosis of Borderline Personality Disorder had scores extremely high or extremely low to some temperamental dimensions (harm Avoidance and reward dependence) and character dimensions (cooperativeness and self directedness). In a sample of 602 subjects, who have had consecutive access to an Outpatient Mental Health Service, it was evaluated the presence of Borderline Personality Disorder using the semi-structured interview for the DSM IV-TR personality disorders. In this population we assessed the presence of dissociative symptoms with the Dissociative Experiences Scale and the personality traits with the Temperament and Character Inventory developed by Cloninger. To assess the weight and the predictive value of these psychopathological dimensions in relation to the Borderline Personality Disorder diagnosis, a neural network statistical model called “multilayer perceptron,” was implemented. This model was developed with a dichotomous dependent variable, consisting in the presence or absence of the diagnosis of borderline personality disorder and with five covariates. The first one is the taxonomic subscale of dissociative experience scale, the others are temperamental and characterial traits: Novelty-Seeking, Harm-Avoidance, Self-Directedness and Cooperativeness. The statistical model, that results satisfactory, showed a significance capacity (89%) to predict the presence of borderline personality disorder. Furthermore, the dissociative symptoms seem to have a greater influence than the character traits in the borderline personality disorder e disease. In conclusion, the results seem to indicate that to borderline personality disorder development, contribute both psychic factors, such as temperament and character traits, and environmental factors, such as traumatic events capable of producing dissociative symptoms. These factors interact in a nonlinear way in producing maladaptive behaviors typical of this disorder.
Highlights
Borderline Personality Disorder (BPD) is one of the major challenges for contemporary psychopathology as far as understanding its pathogenesis, clinical manifestations and treatment methods are considered
The present study aims to investigate the quality of the pathogenetic process by improving the ability to predict, in a single subject, the BPD on the basis of the evaluation instruments applicable in ordinary clinical contexts
Two types of assessment were used as input variables; on the one hand, measurements of the intensity of expression of the temperament and character traits that in the pertaining literature were systematically correlated with BPD, on the other the measurement of the intensity of the dissociative experiences
Summary
Borderline Personality Disorder (BPD) is one of the major challenges for contemporary psychopathology as far as understanding its pathogenesis, clinical manifestations and treatment methods are considered. From the analysis of current literature, an expression emerges that expresses the close relationship between traumatic events, dissociative phenomena and the dimensions of temperament and character in the genesis of BPD These relationships are clearly non-linear so that none of the phenomena described can be considered as the first or the essential etiologic mechanism. The question of the quality of the interaction between psychological and environmental processes is completely unrealistic at this stage; it is important to question how it proceeds and develops, what are the factors that enhance or inhibit it, and how and to what extent it is possible to predict the emergence of BPD following the collapse of individual resilience systems This last question is extremely relevant for the possibility of activating effective primary and secondary preventions interventions. This pattern of psychopathology is not universally accepted, it is an effective attempt to explain the non-linear relationships between the psychological phenomena underlying the pathogenetic mechanism of a disorder (Borsboom, 2017)
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