Abstract
BackgroundThe borderline personality disorder (BPD) population is notably heterogeneous, and this has potentially important implications for intervention. Identifying distinct subtypes of patients may represent a first step in identifying which treatments work best for which individuals.MethodsA cluster-analysis on dimensional personality disorder (PD) features, as assessed with the SCID-II, was performed on a sample of carefully screened BPD patients (N = 187) referred for mentalization-based treatment. The optimal cluster solution was determined using multiple indices of fit. The validity of the clusters was explored by investigating their relationship with borderline pathology, symptom severity, interpersonal problems, quality of life, personality functioning, attachment, and trauma history, in addition to demographic and clinical features.ResultsA three-cluster solution was retained, which identified three clusters of BPD patients with distinct profiles. The largest cluster (n = 145) consisted of patients characterized by “core BPD” features, without marked elevations on other PD dimensions. A second “Extravert/externalizing” cluster of patients (n = 27) was characterized by high levels of histrionic, narcissistic, and antisocial features. A third, smaller “Schizotypal/paranoid” cluster (n = 15) consisted of patients with marked schizotypal and paranoid features. Patients in these clusters showed theoretically meaningful differences in terms of demographic and clinical features.ConclusionsThree meaningful subtypes of BPD patients were identified with distinct profiles. Differences were small, even when controlling for severity of PD pathology, suggesting a strong common factor underlying BPD. These results may represent a stepping stone toward research with larger samples aimed at replicating the findings and investigating differential trajectories of change, treatment outcomes, and treatment approaches for these subtypes.Trial registrationThe study was retrospectively registered 16 April 2010 in the Nederlands Trial Register, no. NTR2292.
Highlights
The borderline personality disorder (BPD) population is notably heterogeneous, and this has potentially important implications for intervention
The identification of meaningful subtypes is important given the growing interest in early detection and intervention in clinical staging models of BPD [13]. This may lead to improved theoretical frameworks and treatments that are tailored to the specific features and stage of problems presented by a particular BPD patient
The present study used a person-centered cluster-analytic approach to identify clusters of BPD patients based on comorbid PD dimensions, building on the study of Critchfield et al [32]. Based on these commonly available patient characteristics that are often used for treatment selection, we explore whether there are meaningful subgroups that differ based on their PD profiles
Summary
The borderline personality disorder (BPD) population is notably heterogeneous, and this has potentially important implications for intervention. Related research on possible differences in response and trajectories of change is hampered by the relative dearth of research on different subtypes of BPD patients [11]. The identification of meaningful subtypes is important given the growing interest in early detection and intervention in clinical staging models of BPD [13]. This may lead to improved theoretical frameworks and treatments that are tailored to the specific features and stage of problems presented by a particular BPD patient
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