Borderline Features Research Articles

Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features

AbstractEmotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

Are Personality Traits Predictors of Police Misconduct?

AbstractSeveral forms of police misconduct exist, including the inappropriate use of a weapon, sexual misconduct, and racially offensive behaviors, and deserve more attention in the literature. More recent literature suggests that there may be personality predictors of misconduct. Specifically, aggression, having unstable relationships, a lack of empathy, thrill-seeking behavior, and poor impulse control, may contribute to officer misconduct. The current study examined a group of 642 first-year police officers through a series of mostly logistic regression analyses to determine if antisocial or borderline personality traits predict inappropriate use of a weapon, sexual misconduct, and racially offensive behavior using scales from the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2; the antisocial practices and the psychopathic deviance scales) and the Personality Assessment Inventory (PAI; the borderline and antisocial scales). Most of the hypotheses were not supported by the findings. Participants who had more antisocial traits, as assessed by MMPI-2, were less likely to be accused of racially offensive behavior. Officers who had more borderline characteristics, as assessed by the MMPI-2, were less likely to be accused of engagement in any misconduct, specifically sexual misconduct. However, participants who had more borderline traits, as assessed by the PAI, were more likely to engage in sexual misconduct, but less likely to engage in any misconduct overall. Demographic covariates also were found to be related to all three forms of misconduct.

B - 68 Executive Functioning Skills of Verbal and Emotional Intelligence and Borderline Personality Predict Posttraumatic Growth

Abstract Objective Research found a positive connection between emotional intelligence and both borderline personality and posttraumatic growth. Prior research has not examined the combination of emotional intelligence, borderline personality, and cognitive intelligence as predictors of posttraumatic growth (PTG); our research helped fill this gap. Method American adults (N = 402; M age = 38.7 years, SD = 13.0) were recruited from Prolific to complete an online survey including Shipley Institute of Living Scale-2, Assessing Emotions Scale, Posttraumatic Growth Inventory-Expanded, and screening questionnaire for DSM-5 Personality Disorders. PTG was measured in relation to any previous trauma. Participants reported being white (67.2%), African American/Black (9.7%), Asian/Asian American (9.7%), Hispanic/Latinx (9.0%), and other ethnicities (4.5%), and men (48.0%), women (47.8%), non-binary (1.5%), transgender men (1.2%) or women (0.5%), or other genders (0.9%). Results Hierarchical regression revealed that emotional and verbal intelligence significantly predicted PTG, F(2, 391) = 78.54, p < 0.001, adj. R2 = 0.28, 95% CI [0.20, 0.35]. Adding borderline characteristics to the model resulted in significantly greater prediction of PTG, F(3, 390) = 61.22, p < 0.001, F change p < 0.001, and explained 32% of the variance in PTG, adj. R2 = 0.32, 95% CI [0.24, 0.39]. Greater emotional intelligence (beta = 0.535), more borderline personality characteristics (beta = 0.189), and lower verbal reasoning (beta = −0.159) predicted more PTG. Conclusion Our findings suggest that executive functions and borderline characteristics play a complex role in the development of posttraumatic growth after trauma.

Pre-injury psychiatric history, subacute symptoms and personality traits predict social reintegration at 3-month post-mild traumatic brain injury

ABSTRACT Background The purpose of the study was to identify whether the presence of a pre-injury psychiatric history, subacute post-concussive symptoms (PCS) and personality traits were predictive of less favorable social reintegration for 3 months following a mild traumatic brain injury (mTBI). Method A total of 76 patients with mTBI were included, and the presence of a pre-injury psychiatric history was identified from the medical chart. One-month post-accident, these patients completed the Millon Multiaxial Clinical Inventory, 3rd Edition assessing personality traits and the Rivermead Post-Concussion Symptoms Questionnaire to measure subacute PCS. Social reintegration was measured using the Mayo-Portland Adaptability Inventory, 4th Edition at 3-month post-accident. Results The presence of pre-injury psychiatric history, high levels of subacute PCS and Cluster B personality traits such as histrionic and borderline features were significant predictors of social reintegration quality at 3-month post injury. Conclusion This study provides new insights on cluster B personality traits and its influence on recovery and social reintegration at 3-month post mTBI.

Borderline personality features in relationship to childhood trauma in unipolar depressive and bipolar disorders

BackgroundChildhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders. MethodsWe included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory). ResultsOn average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features. ConclusionGiven the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies.

Childhood Physical Maltreatment and Borderline Personality Disorder Features in Adolescents: Mediating and Moderating Effects of Attachment Styles and Gender

ABSTRACT Childhood physical maltreatment may contribute to the onset of borderline personality disorder (BPD) features in adolescence; however, the mechanisms explaining this association warrant investigation. This study focused on insecure attachment styles as mediators in this relationship among a sample of adolescents. Analyses were also conducted to determine whether gender moderated the association between physical maltreatment and BPD features. The sample consisted of 529 Italian adolescents between 14 and 18 years (Mage = 16.48, SD = 1.37). Participants completed a survey including three self-report questionnaires: CTQ-SF, ASQ, and BPI. Physical abuse was related to BPD features through insecure-anxious and insecure-avoidant attachment styles, whereas physical neglect was associated with BPD features only through insecure-avoidant attachment. Gender moderated the pathway between physical maltreatment and BPD features so that boys who experienced childhood physical abuse and neglect reported more BPD features than girls. This study expanded our knowledge of the role of insecure attachment styles in the onset of BPD features among adolescents with early experiences of childhood physical maltreatment. This study also advances our understanding of potential gender differences in the childhood maltreatment-BPD features link in adolescents.

A Person × Environment approach to Borderline Personality Disorder features in young people: The role of life events, parental support, and self-esteem

Introduction: This study aimed at examining the concurrent associations between stressful life events and borderline personality disorder (BPD) features in a clinical sample of young people. The moderating role of parental support and self-esteem was investigated (i.e., stress buffering). In a subsample, short term changes in BPD features were examined at a 6-month follow-up. Method: The total sample consisted of 318 young people (ages 12-26). Regression analyses were conducted to examine the link between stressful events, parental support, self-esteem, and BPD features. Prospective regression analyses were conducted in a subsample (N = 138). Results: Results indicate that stressful life-events and (low) self-esteem were related to more BPD features at wave 1. However, these associations did not hold in the prospective analyses. Also, no support was found for a stress-buffering effect. Discussion: The discrepancy between the concurrent and the prospective findings suggest that stressful events and self-esteem may be intertwined with BPD features, rather than predictive of change in BPD features 6 months later.

Childhood maltreatment, peer victimization, borderline personality feature, suicidal risk in adolescents: Direct and indirect associations among developmental trajectories.

Childhood maltreatment, peer victimization, and borderline personality traits have all been shown to be linked to suicidal risk. However, there remains a need to illuminate the possible direct and indirect pathways among them from a developmental perspective that could serve as intervention targets. This study thus aimed to investigate the direct and indirect relationships among developmental trajectories of childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk in adolescents. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82) in junior middle schools completed self-report measures on three-time points across 1 year. Latent growth curve modeling was used to evaluate the direct and indirect relationships among the developmental trajectories of the aforementioned study variables. The developmental trajectories of childhood maltreatment, peer victimization, and borderline personality feature were positively and directly related to the developmental trajectory of suicidal risk; and the developmental trajectories of childhood maltreatment, peer victimization were indirectly related to the developmental trajectory of suicidal risk through the mediating effect of the developmental trajectory of borderline personality feature. The findings elucidated the direct and indirect longitudinal relationships among childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk, highlighting that interventions should target childhood maltreatment, peer victimization, and borderline personality feature to decrease suicidal risk in adolescents with a developmental perspective.

Dissociative Experiences, Borderline Personality Disorder Features, and Childhood Trauma: Generating Hypotheses from Data-Driven Network Analysis in an International Sample

ABSTRACT Dissociation is a multifaceted phenomenon that occurs in various mental disorders, including borderline personality disorder (BPD), but also in non-clinical populations. Severity of childhood trauma (abuse, neglect) plays an important role in the development of dissociation and BPD. However, the complex interplay of different dissociative symptoms, BPD features, and self-reported childhood trauma experiences is not yet fully understood. Graph-theoretical network analysis can help to better understand such multivariate interrelations. Objective: This study aimed to investigate associations between self-reported dissociation, BPD features, and childhood trauma experiences using a graph-theoretical approach. Data was collected online via international mental health platforms and research sites. N = 921 individuals (77.4% female) were included; 40% reported pathological levels of dissociation. Variables were assessed with established psychometric scales (Dissociative Experiences Scale; Personality Assessment Inventory Borderline Features Scale; Childhood Trauma Questionnaire) and analyzed within a partial correlation network. Positive bivariate correlations between all variables were found. When accounting for their mutual influence on each other, dissociation was predominantly connected to BPD features with effect sizes between rp = .028 and rp = .126, while still showing a slight unique relationship with physical neglect (rp = .044). Findings suggest close associations between dissociative experiences and BPD features. While childhood trauma plays an important role in the development of dissociation and BPD, its recall may not fully explain their current co-occurrence. Prospective studies are needed to shed more light on causal pathways to better understand which factors contribute to dissociation and its link to BPD (features).

Assessing Measurement Consistency: A Study of the BPFSC Invariance Across Age and Sex in Romanian Adolescents.

The Borderline Personality Feature Scale for Children (BPFSC) is a widely used instrument and currently the only dimensional measure to investigate Borderline Personality features in children and adolescents. The present study aimed to investigate the factor structure and measurement invariance across age and sex in a community sample of 634 adolescents (mean age = 16.72, standard deviation = 1.31). To test for measurement invariance, we conducted multi-group confirmatory factor analysis (MG-CFA). Analysis showed residual invariance across age and sex. Based on the results, we conclude that BPFSC is a valid and reliable instrument to assess Borderline Personality features in adolescents. Implications for evidence-based assessment of Borderline Personality features in adolescence are discussed.

Development of the complex trauma screener: A brief measure of ICD-11 PTSD and complex PTSD

The purpose of this study was to develop the Complex Trauma Screener (CTS), a brief screener (seven items) of the ICD-11 trauma disorders that can be used in “quick-paced” facilities. We examined the factor structure of the CTS in two separate samples: civilian college students (N = 823) and military veterans (N = 130) who reported exposure to at least one traumatic event. Confirmatory factor analyses (CFAs) supported two highly-correlated factors (post-traumatic stress disorder [PTSD] and Disturbances in Self-Organization [DSO]) that loaded on the ICD-11-consistent items. The model fit indices indicated good to excellent model fit in both samples, and the internal consistencies for the scales were borderline to good (α = 0.68–0.86). Supplementary analyses supported the gender invariance of the CFA model in the civilian student sample, as well as convergent (with another trauma inventory) and discriminant validity (with borderline disorder features, depression, and mania) of the CTS in both samples. The CTS is, to our knowledge, the shortest instrument designed to measure the ICD-11 trauma disorders and is ideal for “fast-paced” facilities that have significant assessment time restraints. The CTS is, therefore, is a psychometrically-validated instrument that can help mental health professionals efficiently screen adults for ICD-11 trauma disorders.

Psychotropic medication use among adolescents participating in three randomized trials of DBT

BackgroundFrequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where pharmacological treatment has weak empirical support. There is a need for more clinical research into the frequency, type and rationale for pharmacological treatment in this group. In this secondary analysis of three randomized clinical trials of dialectical behaviour therapy for adolescents, we report on psychotropic medication use in the respective samples at the time of recruitment, compare use of psychotropic medication across trials and describe sample characteristics that may be associated with possible differences in psychotropic medication.FindingsTrials were conducted in Norway, the US and Spain (labelled the Oslo, US and Barcelona samples). At baseline, 86% of the Barcelona sample, 67% of the US sample and 12% of the Oslo sample were taking at least one psychotropic medication with antidepressants as the most frequent, followed by antipsychotics (72%, 22% and 1.3% respectively) and mood stabilizers (14.2%, 16.2% and 0%). In the Oslo sample there was a significant association between receiving a diagnosis of major depression and the likelihood of receiving antidepressants, but no such association was found in the Barcelona and US samples. The overall 7–8 times higher proportion of participants in the US and Barcelona samples treated with psychotropic medication could only partially be explained by differences between the samples in diagnostic profiles, symptom severity or level of dysfunction.ConclusionsHighly prevalent in use among suicidal and self-harming adolescents with borderline features, psychotropic medication was still very unevenly prescribed across trials, differences not explained by differences in sample characteristics suggesting that current treatment practices are not fully empirically supported. We call for continued medical education and increased availability of evidence-based psychosocial interventions.

Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization-based treatment for borderline personality disorder.

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly in treatment intensity: day hospital mentalization-based treatment (MBT-DH) and intensive outpatient mentalization-based treatment (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include the full intention-to-treat sample of the original trial of N= 114 randomized BPD patients (MBT-DH n= 70, MBT-IOP n= 44), who were assessed at baseline and subsequently every 6 up to 36 months after start of treatment. Outcomes were general symptom severity, borderline features, and interpersonal functioning. Clinical severity was examined in terms of severity of BPD, general symptom severity, comorbid symptom disorders, comorbid personality disorders, and cluster C personality features. None of the severity measures was related to treatment outcome or differentially predicted treatment outcome in MBT-DH and MBT-IOP, with the exception of a single moderating effect of co morbid symptom disorders on outcome in terms of BPD features, indicating less improvement in MBT-DH for patients with more symptom disorders. Overall, patients with varying levels of clinical severity benefited equally from MBT-DH and MBT-IOP, indicating that clinical severity may not be a useful criterion to differentiate in treatment intensity.

P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report

Abstract Introduction Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%. Clinical Case A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia. Conclusion The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.

Differences in mindfulness, rearing styles and emotion dysregulation between adolescents with borderline personality disorder features and a control group

Differences in mindfulness, rearing styles and emotion dysregulation between adolescents with borderline personality disorder features and a control group

The Utility of the Unified Protocol in Treating Borderline Features

The Utility of the Unified Protocol in Treating Borderline Features

Borderline personality disorder features are associated with inflexible social interpretations

BackgroundBorderline personality disorder (BPD) is thought to involve aberrant social learning, including impaired revision of social interpretations with new evidence (social interpretation inflexibility). However, this topic has received little empirical attention outside of specific literatures, such as moral inference or behavioral economics. Further, the contribution of comorbid depression to BPD-related interpretation inflexibility has not yet been assessed. MethodsIn two independent samples (Study 1: N = 213; Study 2: N = 210, oversampled for BPD features), we assessed the associations between BPD symptoms, depressive symptoms, and task-based measures of social interpretation flexibility. ResultsWe found that BPD symptoms, particularly volatility of identity and relationships, were associated with less revision of social interpretations with both positive and negative evidence. Meanwhile, depressive symptoms were associated with a pattern of less revision of social interpretations with positive versus negative information. LimitationsThe use of cross-sectional, crowd sourced samples limits causal interpretations. Translation to clinical populations should be assessed in future studies. ConclusionsResults suggest that inflexible social interpretations across valences may be feature of BPD-related pathology, and could be connected to symptoms involving volatility in social contexts. Future studies should investigate whether treatments geared toward increasing the flexibility of social interpretations are effective in treating BPD symptoms, especially those involving interpersonal difficulties.

Does self-compassion protect adolescents with non-suicidal self-injury from developing borderline features? A two-wave longitudinal study

Background: Adolescence is a vulnerable developmental stage for the onset of non-suicidal self-injury (NSSI) and borderline features, which are related psychological phenomena. Self-compassion reflects a sensitivity to own suffering and a motivation to relieve it, consisting of a more positive and beneficial self-to-self relationship. The aim of the present study was to test the effect of self-compassion between borderline features at baseline and six months with a sample of adolescents with a history of NSSI. Methods: At assessment wave one, participants were 139 Portuguese adolescents with an NSSI history (mean age = 15.52 years, SD = 0.87). Of these, 87 were re-assessed six months later (mean age = 15.46 years, SD = 0.86). Data were analysed through SPSS and PROCESS Macro. Results: The moderation model explained 56% of borderline features six months later, and the interaction between initial borderline features and the low and medium levels of self-compassion was significant. Youth with lower initial borderline features presented higher borderline features six months later if they had low self-compassion. Conclusions: These findings suggest that among adolescents with a history of NSSI, those with lower levels of self-compassion tend to exhibit higher borderline features in six-month when compared to their peers with higher levels of self-compassion. This observation emphasises the potential beneficial effect of self-compassion within this population.

Unpacking thep-factor. Associations Between Maladaptive Personality Traits and General Psychopathology in Female and Male Adolescents.

Adolescence is a period of rapid physical, psychological, and neural maturation that makes youth vulnerable to emerging psychopathology, highlighting the need for improved identification of psychopathology risk indicators. Recently, a higher-order latent psychopathology factor (p-factor) was identified that explains latent liability for psychopathology beyond internalizing and externalizing difficulties. However, recent proposals suggest reconceptualizing the p-factor model in terms ofimpairments in personality encompassing difficulties in both self-regulation (borderline features) and self-esteem (narcissistic features), but this remains untested. To address this, this study examined the p-factor structure and the contribution of borderline and narcissistic features using two cross-sectional data collections. In Study 1, 974 cisgender adolescents (63% assigned females at birth; age range: 13-19; Mage = 16.68,SD = 1.40) reported on internalizing and externalizing problems (YSR) to test via structural equation models (SEM) different theoretical models for adolescent psychopathology. In Study 2, 725 cisgender adolescents (64.5% assigned females at birth; age range: 13-19; Mage = 16.22,SD = 1.32) reported internalizing and externalizing problems (YSR), borderline personality features (BPFSC-11), and narcissistic personality traits (PNI), to explore, via SEM, thecontribution ofborderline and narcissistic traitsto the p-factor and accounting for gender differences.Results confirmed the utility of a bi-factor model in adolescence. Furthermore, findings highlighted the contribution of borderline features and narcissistic vulnerability to general psychopathology. The study provides the first evidence supporting a p-factor model reconceptualized in terms ofpersonality impairments encompassing difficulties in self-regulation and self-esteem in adolescents.

Borderline personality features are associated with worse perceptions of (but not compliance with) chronic pain treatment

ABSTRACT Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients’ negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features – both in general and by specific facets – predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features.