Between Borderline Personality Disorder Research Articles

Borderline Personality Features and Basic Psychological Needs during Adolescence

Objectives: Anchored in self-determination theory, this study investigates the associations between borderline personality disorder (BPD) features and basic psychological need frustration (BPNF) in adolescents. Methods: Participants (N = 270; M age = 15.3) assessed their own BPD features and BPNF through an online questionnaire. Results: Regression analyses revealed that frustrations of relatedness, autonomy, and competence were jointly and uniquely associated with more BPD features in adolescents, controlling for their gender and parents’ education. Implications: These results suggest the importance of taking BPNF into account to better understand the early signs of BPD among adolescents.

Borderline personality disorder and risk of atrial fibrillation: insights from a bidirectional Mendelian randomization study.

Atrial fibrillation (AF) is one of the most common form of arrhythmia. Previous studies have shown a link between AF and mental illness. However, the causal relationship between mental illness and AF remains unclear. The purpose of this study was to investigate the bidirectional causal relationship between borderline personality disorder (BPD) and AF. We used the bidirectional Two-sample Mendelian randomization (TSMR) method to evaluate the causal relationship between BPD and AF. Instrumental variables associated with BPD were derived from a genome-wide association study involving 214,816 Europeans (2,637 cases and 212,179 controls). We then obtained atrial fibrillation data from the GWAS meta-analysis (60,620 cases and 970,216 controls). The TSMR analyses were performed in five methods, namely fixed-effect inverse-variance weighted (IVW) method、random-effect IVW method, MR Egger regression method, Weighted median method and Simple mode method. Several sensitivity analyses are used to test the robustness of positive results. The fixed-effect inverse-variance weighted model [Odds ratio (OR), 1.033, 95% confidence interval (CI), 1.011-1.056, P = 0.0031], random-effect inverse-variance weighted model (OR, 1.033; 95%CI, 1.005-1.062; P = 0.0191) and Weighted median (OR, 1.034; 95%CI, 1.002-1.068; P = 0.0394) all showed that genetically predicted BPD was associated with an increased risk of AF. Sensitivity analysis using other MR Methods, including the MR-Egger intercept, MR-Presso method, and leave-one-out analyses, showed that the results were robust. In reverse MR analysis, there was no causal relationship of AF on BPD. Our study provides a causal relationship between BPD and AF. This means that patients with BPD should be monitored for the occurrence of AF. Early screening and proper management of BPD may show anti-arrhythmic benefits.

BPD Compass: Using a dimensional model of psychopathology to treat co-occurring borderline personality disorder and posttraumatic stress symptoms.

BPD Compass is a transdiagnostic psychotherapy that includes cognitive, behavioral, and mindfulness skills targeting the personality dimensions of negative affectivity, disinhibition, and antagonism. Given considerable symptom comorbidity and overlap in etiology between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD), this study investigated whether BPD Compass holds promise as an integrated approach to simultaneously treating co-occurring BPD features and PTSD symptoms. Participants included 84 trauma-exposed adults who participated in a two-phase clinical trial (Phase 1: randomized controlled trial of BPD Compass vs. waitlist [n = 43]; Phase 2: open trial of BPD Compass [n = 41]). Compared to waitlist, BPD Compass led to medium-to-large-sized, significant improvements in BPD features, βs = -.57 -.44, and facets of neuroticism, βs < -.55--.73, as well as small, nonsignificant improvements in self-reported, β = -.20, and clinician-rated PTSD symptom severity, β = -.19. During treatment, within-person improvements in PTSD symptoms predicted subsequent improvements in BPD features, β =.13, but not vice versa, β =.07. Within-person PTSD symptom reduction also predicted subsequent improvement in all personality dimensions, whereas only within-person improvement in despondence, β =.12, affective dysregulation, β =.11, and dissociative tendencies, β =.12, predicted PTSD symptom reductions. Findings offer preliminary support for the potential of BPD Compass to target BPD features and aspects of neuroticism and agreeableness among trauma-exposed adults. Moreover, PTSD symptom change predicting subsequent improvement in BPD features runs counter to current stage-based treatment models that emphasize BPD feature stabilization before engaging in trauma-focused therapy.

The role of thyroid function in borderline personality disorder and schizophrenia: a Mendelian Randomisation study

BackgroundGenome-wide association studies have reported a genetic overlap between borderline personality disorder (BPD) and schizophrenia (SCZ). Epidemiologically, the direction and causality of the association between thyroid function and risk of BPD and SCZ are unclear. We aim to test whether genetically predicted variations in TSH and FT4 levels or hypothyroidism are associated with the risk of BPD and SCZ.MethodsWe employed Mendelian Randomisation (MR) analyses using genetic instruments associated with TSH and FT4 levels as well as hypothyroidism to examine the effects of genetically predicted thyroid function on BPD and SCZ risk. Bidirectional MR analyses were employed to investigate a potential reverse causal association.ResultsGenetically predicted higher FT4 was not associated with the risk of BPD (OR: 1.18; P = 0.60, IVW) or the risk of SCZ (OR: 0.93; P = 0.19, IVW). Genetically predicted higher TSH was not associated with the risk of BPD (OR: 1.11; P = 0.51, IVW) or SCZ (OR: 0.98, P = 0.55, IVW). Genetically predicted hypothyroidism was not associated with BPD or SCZ. We found no evidence for a reverse causal effect between BPD or SCZ on thyroid function.ConclusionsWe report evidence for a null association between genetically predicted FT4, TSH or hypothyroidism with BPD or SCZ risk. There was no evidence for reverse causality.

Empathic accuracy of romantic partner negative affect is influenced by borderline personality symptoms.

The present study sought to examine the relation between borderline personality disorder (BPD) symptoms and empathic accuracy while improving on prior methodologies by using daily affect assessment in romantic partners. BPD symptoms were assessed in both members of 81 community couples who also reported on their own and their partner's negative and positive affect daily for 3 weeks. Data were analyzed using the Truth and Bias Model of Judgment, which allows the source of empathic accuracy to be parsed into partner affect (truth) and own affect (bias). Results provided evidence that individuals with higher BPD symptoms exhibited increased empathic accuracy for a partner's negative affect, particularly when partners also had higher BPD symptoms. The source of this accuracy stemmed more from bias forces than truth forces, indicating that participants' own affective states lead to more accurate judgments of partner affective state. The results suggest that this bias reduced the general tendency among participants to underestimate partner negative affect, thus leading to higher empathic accuracy. Overall, our results extend and provide support for previous research indicating that BPD symptoms are associated with heightened, not diminished, empathic accuracy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of comorbid ADHD on mortality in women with borderline personality disorder

BackgroundMany similarities exist between borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD), more so in women than in men. People with comorbid ADHD and BPD represent a subgroup of BPD patients with distinct symptom expression and, consequently, a different prognosis. We used Swedish national high quality registers to assess whether such comorbidity is related to increased mortality risk. The study focused on women with BPD because they are more likely than men to be clinically diagnosed with BPD and present a higher mortality risk, especially for unnatural causes of death, including suicide.FindingsIn a cohort of 15 847 women diagnosed with BPD a subsequent clinical diagnosis of ADHD did not influence the overall risk of mortality, including suicide.ConclusionsWomen with comorbid ADHD and BPD have a similar mortality risk as those only diagnosed with BPD.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020–5/24/2020 “first-wave”) and second (9/15/2020–3/1/2021 “second-wave”) wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

Examining Deviant Peer Association as a Moderator of the Relationship Between Borderline Personality Disorder Symptoms and Substance Use

Borderline personality disorder has been identified as a robust risk factor predicting substance use. There is a dearth of research examining how peer ties may condition this relationship. This study hypothesized that deviant peer association would amplify the relationship between Borderline personality disorder (BPD) symptoms and substance use. The Pathways to Desistance data were analyzed. Ordered logistic regression was used to analyze data. Results indicated that elevated levels of BPD symptoms predicted increased substance use frequency. Deviant peer association moderated the effects of BPD symptoms on marijuana use frequency and daily cigarette use. This moderation effect was in the opposite direction hypothesized, indicating that greater levels of deviant peer association dulled the effect on BPD symptoms on substance use. The unexpected effect indicated that youth reporting symptoms may be buffered against the impact of strain by having any peer relationships, even deviant ones.

The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness

BackgroundDespite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness. MethodsA U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months. ResultsResults revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time. LimitationsAll constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors. ConclusionsResults highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents.

The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. This is a cross-sectional, general population study evaluating adolescents (n=162, 61.3% female; ages 12-18, M=14.63, SD=1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b=-0.019, 95% CI=-0.0379 to -0.0002, p=.0476), but not other-mentalizing (b=0.027, 95% CI=0.000 to 0.053, p=.051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.

Evaluating borderline personality disorder traits in the context of an intimate partner violence intervention programme

ABSTRACT Research has demonstrated a clear association between Borderline Personality Disorder (BPD) and Intimate Partner Violence (IPV) perpetration, but an association with IPV intervention programme drop-out and recidivism has not been directly examined. In the current study, we examined associations between self-reported BPD symptomology and self-reported IPV perpetration variables, IPV intervention programme outcome, and recidivism. An additional goal was to compare traditional DSM-5 BPD with the Alternative DSM-5 Model for Personality Disorders (AMPD) dimensional trait perspective. For this purpose, we used archival data of 531 men in a court-ordered group IPV intervention programme. Results indicated that IPV offenders with BPD symptomology were of increased risk for failing to complete IPV treatment and were more likely re-offend in a one year follow up period, thus providing further support for the relevance of personality pathology in relation to IPV treatment success. Overall both ‘traditional’ BPD and AMPD BPD-relevant trait dimensions were shown to be approximately equally associated with self-report IPV variables, IPV treatment outcomes, and recidivism, with minor advantages for each BPD model for different outcome variables. Regardless of perspective, our findings indicate that BPD symptoms and traits are important for clinicians to consider in the treatment and risk assessment of IPV offenders.

Comorbid early psychosis and borderline personality disorder: Conceptualizing clinical overlap, etiology, and treatment.

Despite substantial efforts aimed at the detection and intervention for early symptoms of mental illness, there is relatively limited research on the clinical overlap between borderline personality disorder (BPD) and early psychosis, for example, clinical high risk (CHR) for psychosis, in young people. We present a narrative review of the clinical overlap between BPD and psychosis spectrum symptoms. Both conditions have unstable temporal course, and both are marked by functional impairment, increased suicide risk, and higher rates of psychiatric inpatient services. We then review evidence-based treatments for psychosis and BPD, emphasizing treatments for early presentations of these symptoms and initial research considering treatments for the overlap. Psychotherapies with the strongest empirical support include cognitive behavioral models, with BPD showing limited response to adjunctive pharmacotherapy. We end by discussing specific recommendations for future research, including longitudinal studies to determine the predictors of the course of illness and the development of treatments to target comorbid BPD and CHR symptoms.

The overlap between complex posttraumatic stress disorder and borderline personality disorder

IntroductionResearch has shown the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (cPTSD), pointing out the overlapping nature and expression of both conditions. In order to understand their differences and similarities, we present a case of a 22-years-old patient with a history of repeated sexual trauma throughout all her adolescence, whose diagnose was changed from BPD to cPTSD after she was admitted in an acute inpatient mental health unit.ObjectivesTo gather the similarities between borderline personality disorder and complex posttraumatic stress disorder.MethodsA narrative review of the literature through the presentation of a case. Articles were chosen based on its clinical relevance.ResultscPTSD merges the clinical features and symptoms of PTSD with affect dysregulation, negative self-perception, unstable relationships and somatization, also present in BPD. Furthermore, BPD is known to frequently have a traumatic etiology.ConclusionsIt is not always simple to draw a clear line between cPTSD and BPD conditions. However, each diagnosis may have a different impact on patient understanding and treatment.DisclosureNo significant relationships.

Facial and Vocal Expressions During Clinical Interviews Suggest an Emotional Modulation Paradox in Borderline Personality Disorder: An Explorative Study.

Videotape recordings obtained during an initial and conventional psychiatric interview were used to assess possible emotional differences in facial expressions and acoustic parameters of the voice between Borderline Personality Disorder (BPD) female patients and matched controls. The incidence of seven basic emotion expressions, emotional valence, heart rate, and vocal frequency (f0), and intensity (dB) of the discourse adjectives and interjections were determined through the application of computational software to the visual (FaceReader) and sound (PRAAT) tracks of the videotape recordings. The extensive data obtained were analyzed by three statistical strategies: linear multilevel modeling, correlation matrices, and exploratory network analysis. In comparison with healthy controls, BPD patients express a third less sadness and show a higher number of positive correlations (14 vs. 8) and a cluster of related nodes among the prosodic parameters and the facial expressions of anger, disgust, and contempt. In contrast, control subjects showed negative or null correlations between such facial expressions and prosodic parameters. It seems feasible that BPD patients restrain the facial expression of specific emotions in an attempt to achieve social acceptance. Moreover, the confluence of prosodic and facial expressions of negative emotions reflects a sympathetic activation which is opposed to the social engagement system. Such BPD imbalance reflects an emotional alteration and a dysfunctional behavioral strategy that may constitute a useful biobehavioral indicator of the severity and clinical course of the disorder. This face/voice/heart rate emotional expression assessment (EMEX) may be used in the search for reliable biobehavioral correlates of other psychopathological conditions.

“Imperfect Love”: The Effect of Borderline Personality Disorder Symptoms and Relationship Commitment on Relationship Satisfaction

This study aimed to determine the connection between borderline personality disorder (BPD) symptom-endorsement and relationship satisfaction. Individuals in romantic relationships often report higher levels of overall life satisfaction and functioning. However, the experience of emotional distress or disability may impair one’s ability to benefit from the protective effects of a romantic dyad. Therefore, understanding the impact that individual mental health may have on perceptions of satisfaction in romantic relationships may be of importance. Additionally, the role that relationship type, such as committed vs. non-committed relationships, can have on assessments of satisfaction for individuals who experience BPD symptoms is of interest. 433 participants self-reported their experiences with BPD symptoms using the Borderline Symptoms List 23 [1] and relationship type (committed vs. non-committed). The Relationship Satisfaction Assessment [2]was completed to determine individuals’ happiness and fulfillment within their interpersonal relationships. Findings indicated that endorsement of BPD symptoms had a significant negative association with self-reported relationship satisfaction. Relationship type was also a significant indicator of relationship satisfaction. Thus, those in committed relationships reported higher levels of overall satisfaction than those in non-committed relationships. This research suggests that both the experience of certain mental health issues and commitment to a relationship may determine overall feelings of fulfillment in romantic relationships. Additional research is necessary to replicate and explore the impact of this association.

Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems

Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use problems (i.e., prescription opioid misuse, apprehension about prescription opioid use, and opioid cravings) through motives for opioid use (i.e., coping, enhancement, social, and conformity motives) among 68 patients endorsing prescription opioid misuse in a residential correctional substance use disorder (SUD) treatment facility. Participants completed measures of BPD pathology, motives for opioid use, and opioid use problems. Findings revealed significant indirect relations of BPD pathology to opioid misuse through coping and enhancement motives, apprehension about opioid use through coping, enhancement, and social motives, and opioid cravings through coping motives within this SUD sample. Results illustrate the relevance of both emotion- and interpersonal-related motives for opioid use to opioid use problems among patients with BPD pathology in SUD treatment.

Beyond the Categorical Distinction Between Borderline Personality Disorder and Bipolar II Disorder Through the Identification of Personality Traits Profiles

BackgroundThe relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them.MethodsFive-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample.ResultsA three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters’ boundaries did not match the categorical diagnosis.ConclusionsOur sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.

The Impact of Impulsivity and Emotional Dysregulation on Comorbid Bipolar Disorder and Borderline Personality Disorder.

The symptomatic overlap between borderline personality disorder (BPD) and bipolar disorder (BD) is a topic of scientific and academic debates. Emotional dysregulation and impulsivity are common features of both disorders. Several studies have shown that both BPD and BD lie on a spectrum; others have suggested that they are separate entities that coexist. BPD is characterized by impulsive and dangerous behaviors such as driving recklessly, inappropriate sexual behavior, eating disorders, and substance abuse. BD, during a manic episode, is known for their impulsive and risk-taking behavior like hypersexuality, excessive spending, and substance abuse. The current literature review aims to provide an overview of the impact of impulsivity and emotional dysregulation on comorbid bipolar disorder and borderline personality disorder. Our study results showed that patients with comorbid BPD and BD struggle with impulsive actions and have difficulty controlling their emotions. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Patients with comorbid BPD and BD struggle with severe psychosocial morbidity and an increased risk of suicide. In patients with only one disease, misdiagnosis is a common phenomenon due to the overlapping symptoms of BPD and BD.

Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study.

Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. Twenty-two patients with BPD; 22 patients with BIP-II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen-GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP-II only, there was a significant positive correlation between DIDF and GBB total score. In BIP-II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP-II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.

The roles of emotion regulation difficulties and impulsivity in the associations between borderline personality disorder symptoms and frequency of nonprescription sedative use and prescription sedative/opioid misuse

Despite evidence of a strong relationship between borderline personality disorder (BPD) and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = 0.04, 95% CI [0.003, 0.09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = 0.05, 95% CI [0.01, 0.11], and negative urgency, ab = 0.03, 95% CI [0.002, 0.07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.