Abstract
BackgroundThere have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles.MethodsA total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA).ResultsThe optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity.ConclusionsProfiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.
Highlights
There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; far, these works have yielded few consistent results
(2021) 8:4 (Continued from previous page). Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the Alternative Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Model for Personality Disorders (AMPD), as they were mainly distinguished by a continuum of severity and by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting
Results suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology
Summary
There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; far, these works have yielded few consistent results. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. Multiple endeavors have focused on trying to parse out the heterogeneity within borderline pathology by identifying patient subtypes. These efforts can be categorized as either “variable-centered” or “person-centered” [6]. The former approach has typically focused on DSM BPD criteria, using exploratory (EFA) and confirmatory (CFA) factor-analytic strategies in order to reduce the number of criteria to a few core dimensions. A factor-analytic study by Sharp et al [7] that included a bifactor analysis found that the nine DSM BPD criteria only loaded on a general personality pathology factor, suggesting that BPD criteria may represent core features of general PD severity instead of a discrete disorder
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