Abstract
BackgroundThough the heterogeneous expression of symptoms of borderline personality disorder (BPD) is well-known, it is far from fully understood. Hybrid models combining dimensional and categorical ways of diagnosing BPD have been suggested to better handle this heterogeneity, but more research is needed. The aim of this study was to identify potential clusters in BPD, and evaluate if these clusters differed in diagnostic composition, severity, psychiatric symptoms, emotion regulation and control, or sociodemographic features.MethodsClusters were based on personality traits measured with the Swedish universities Scales of Personality (SSP) in 141 psychiatric patients diagnosed with BPD. Hierarchical cluster analysis was performed using Ward’s method. We used one-way analysis of variance to explore the different clusters’ properties. Effect sizes were calculated using partial eta squared.ResultsWe found three distinct clusters: the lower psychopathology cluster (N = 67), the externalizing cluster (N = 28), and the internalizing cluster (N = 46). The clusters differed regarding trait composition, severity, and emotion regulation and control.ConclusionsOur findings support hybrid models for diagnosing BPD by showing that clusters differed in terms of both severity (lower and higher psychopathology) and personality traits/style (internalizing and externalizing). Assessment of personality traits may be a feasible way to differentiate between clusters. In the future, this knowledge might be used to personalize treatment.
Highlights
Borderline personality disorder (BPD) is a heterogeneous disorder [1]
Instruments Swedish universities scales of personality The Swedish universities Scales of Personality (SSP) is a self-rating scale that measures stable personality traits based on biological theories related to psychopathologies [24]
Cluster analysis The three-cluster solution was superior to the others since it demonstrated distinct psychopathology between the clusters, differentiating them from each other
Summary
Borderline personality disorder (BPD) is a heterogeneous disorder [1]. A person needs to fulfill only five out of nine diagnostic criteria to get a diagnosis. Several researchers have based their clusters on personality disorder ratings [2, 6,7,8,9,10,11,12] Others have based their analyses on emotional regulation strategies [13], intrapersonal problem inventories [14, 15], suicidal behavior [16], or a variety of demographic and psychological variables [17]. One of the most common is the presence of an internalizing/inhibited cluster characterized by depressed mood, fear, and avoidance, and an externalizing/disinhibited cluster related to disinhibition and impulsivity [2, 10, 11, 13, 14] Another recurring characteristic is the presence of clusters that differ in symptom severity or function [2, 10, 11, 13]. The aim of this study was to identify potential clusters in BPD, and evaluate if these clusters differed in diagnostic composition, severity, psychiatric symptoms, emotion regulation and control, or sociodemographic features
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