Borderline Personality Disorder Features Research Articles

Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: are there differences between men and women?

Emotional dysregulation is a core feature of borderline personality disorder (BPD); it is, for example, known to influence one’s ability to read other people’s facial expressions. We investigated behavioral and neurophysiological foundations of emotional face processing in individuals with BPD and in healthy controls, taking participants’ sex into account. 62 individuals with BPD (25 men, 37 women) and 49 healthy controls (20 men, 29 women) completed an emotion classification task with faces depicting blends of angry and happy expressions while the electroencephalogram was recorded. The cortical activity (late positive potential, P3/LPP) was evaluated using source modeling. Compared to healthy controls, individuals with BPD responded slower to happy but not to angry faces; further, they showed more anger ratings in happy but not in angry faces, especially in those with high ambiguity. Men had lower anger ratings than women and responded slower to angry but not happy faces. The P3/LPP was larger in healthy controls than in individuals with BPD, and larger in women than in men; moreover, women but not men produced enlarged P3/LPP responses to angry vs. happy faces. Sex did not interact with behavioral or P3/LPP-related differences between healthy controls and individuals with BPD. Together, BPD-related alterations in behavioral and P3/LPP correlates of emotional face processing exist in both men and women, supposedly without sex-related interactions. Results point to a general ‘negativity bias’ in women. Source modeling is well suited to investigate effects of participant and stimulus characteristics on the P3/LPP generators.

Decreased facial reactivity and mirroring in women with Borderline Personality Disorder - A facial electromyography study

Maladaptive interpersonal relationships are a core feature of Borderline Personality Disorder (BPD). Poor social communication including the capacity to convey one's emotional state non-verbally and to mirror others' facial expressions may be affected in BPD. 81 women with BPD and 38 female healthy controls (HCs) participated in an emotion recognition task. Facial activity of four muscles (zygomaticus major, levator labii superioris, orbicularis oculi, corrugator supercilii) was measured by electromyography (EMG) and participants rated their subjective emotional responses to dynamic facial expressions (happiness, fear, anger, sadness, disgust, surprise). Compared to HCs, patients with BPD overall showed lower EMG activity of facial muscles in response to dynamic facial expressions. Particularly, the BPD group showed less EMG activity to happy faces in the zygomaticus major, to disgusted faces in the levator labii superioris and to surprised faces in the corrugator supercilii compared to HCs. In contrast to HCs, patients with BPD reported stronger subjective emotional responses to all presented emotions but happiness. Decreased facial reactivity and mirroring along with increased stronger subjective responses to negative emotions of others' facial emotions is not in accordance with the facial feedback hypothesis and could trigger difficulties in social communication. Therapeutic approaches targeting non-verbal behavior in social communication may be a worthwhile element of psychotherapy in BPD. DRKS00009551. • Patients with BPD show decreased facial reactivity as measured by electromyography. • Patients with BPD show increased emotional response to negative emotions. • Patients with BPD show intact emotion recognition capacities. • Enhanced risk of misunderstandings, conflicts and negative evaluation by others.

Transdiagnostic Associations With Interpersonal and Affective Variability in Borderline Personality Pathology.

Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to quantify this variability in terms of the categorical BPD diagnosis, but evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. A sample of participants who met diagnostic criteria for BPD (n = 129) and healthy controls (n = 47) reported on their daily interactions during a 21-day AA protocol. Multilevel SEM was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of functioning. The authors found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea that BPD is best understood as general personality pathology.

The relation between Complex PTSD and Borderline Personality Disorder – a review of the literature

IntroductionAdults diagnosed with Borderline Personality Disorder (BPD) likely have a history of psychological trauma. There has been research about the connection between Complex Post-Traumatic Stress Disorder (c-PTSD) and BPD.ObjectivesThis paper provides a review of the relationship between complex trauma and key features of BPD.MethodsReview of the literature from 2015 to present, using search engines such as Pubmed and Google Shoolar, using the following keywords: borderline personality disorder, complex post-traumatic stress disorder, traumaResultsTraumatic victimisation and compromised primary caregiving relationships have been hypothesized to be key aetiological factors in the subsequent development of BPD. c-PTSD was defined as a syndrome with symptoms of emotional dysregulation, dissociation somatisation and poor self-esteem, with distorted cognition about relationships, following traumatic interpersonal abuse. It was proposed as an alternative for understanding and treating people who had suffered prolonged and severe interpersonal trauma, many of whom were diagnosed with BPD. Although, the boundaries between c-PTSD and BPD remain vague. Currently, the main difference is the assumption that symptoms of c-PTSD are sequelae of exposure to traumatic stress, which is not inherent in the current DSM-5 definition of BPD. Furthermore, to date, the neurochemistry and neurostructural changes seen in c-PTSD, BPD and PTSD do not clearly differentiate the three conditions.ConclusionsBPD and PTSD are relatively distinct with regard to the precise qualitative definitions of their diagnostic features, but nevertheless have substantial potential overlap in their symptom criteria.DisclosureNo significant relationships.

Borderline personality features influence treatment response to suicide prevention

BackgroundSuicide is a notable risk for individuals with features of borderline personality disorder. Given the centrality of interpersonal difficulties in this disorder, we proposed that the negative interpersonal cognitions (perceived burdensomeness and thwarted belongingness) identified by the Interpersonal Theory of Suicide (IPTS) may explain the associations between suicidal ideation and borderline personality features. MethodParticipants were 322 suicidal youth (74% girls) aged 11–18 years (M, SD = 14.74, 1.6) in an intensive outpatient program in the southwest United States. Youth completed measures assessing borderline personality features at program entry, and suicidal ideation and IPTS variables at entry and exit. ResultsBorderline personality features did not moderate associations of IPTS variables and suicidal ideation. For the entire sample, changes in suicidal ideation from entry to discharge occurred in tandem with changes in perceived burdensomeness and depressive symptoms, but not thwarted belongingness. Youth with elevated borderline personality features entered with greater suicidal ideation, but improved more from treatment entry to exit. Regardless of level of borderline personality features, changes in negative interpersonal cognitions over treatment were associated with changes in suicidal ideation. LimitationsSelf-report measures and lack of sample diversity are study limitations. ConclusionsThis research highlights the clinical utility of the IPTS variables and the importance of promoting competence and interpersonal connectedness when treating this population. Findings indicate that the IPTS variables carry the same fundamental information for contributing to suicidal ideation, regardless of level of borderline personality features.

Dialectical Behavior Therapy for Adolescents: Treatment Outcomes in an Outpatient Community Setting

ABSTRACT The goal of this study was to evaluate the effectiveness of dialectical behavior therapy for adolescents (DBT-A) with borderline personality disorder (BPD) features under routine health-care conditions, particularly an urban hospital that primarily treats low income and ethnic minority individuals. Ninety-one adolescents (age 11–18) participated in at least one cycle of an outpatient DBT-A program, with the option to continue in additional cycles. The majority, 39% (N = 35), identified as Hispanic/Latinx, 29% (N = 27) as non-Hispanic White, and 20% (N = 18) as Black; 84% (N = 76) identified as female. Prior to beginning treatment, adolescents completed baseline assessments on BPD symptoms (BPD subscale of the Structured Clinical Interview for DSM-IV; Life Problems Inventory), lifetime history of suicidal and non-suicidal self-injurious behaviors (Lifetime-Suicide Attempt Self-Injury Interview), depression (Beck Depression Inventory), and higher level of care utilization. After each treatment cycle, participants completed these measures again; they and their caregivers also completed a DBT acceptability questionnaire (DBT-A Satisfaction Survey). Results yielded statistical and clinical significance, and reliable change (reduction) in suicidal behavior, non-suicidal self-injurious behavior, BPD symptoms (impulsivity, identity disturbance, interpersonal problems, and emotion dysregulation), depression, and service utilization (effect sizes ranging from medium to large) with high client satisfaction. These findings expand upon previous DBT-A effectiveness research by engaging a larger and more diverse sample with broader inclusion criteria that is consistent with outpatient community settings, reporting on the clinical significance of DBT-A, and assessing outcomes beyond one cycle of treatment.

Can you See and Hear How Bad I Feel Right Now? - Self-Injury and Suicidal Communication in Borderline Personality Disorder - A Secondary Analysis

Non-suicidal self-injurious behavior (NSSV) and suicide attempts are well-known features of borderline personality disorder; communicative behavior is poorly studied. Differences between patients with and without NSSV as well as differences in current suicide attempts regarding suicidal communication and NSSV were investigated.In a secondary analysis, data on current and anamnestic NSSV, suicide attempts, suicidal communication, and clinical symptomatology of 87 inpatients were studied.Patients with and without current NSSV did not differ in anamnestic but did differ in current suicide attempts and suicidal communication. In regard to the current inpatient stay, it was observed that patients with and without suicide attempts differed considerably in the variables NSSV (100 vs. 32.5 %) and suicidal communication (71.4 vs. 7.5 %).Current self-injury and suicidal communication are highly significant for risk assessment of current suicidality.

Do my emotions show or not? Problems with transparency estimation in women with borderline personality disorder features.

Transparency estimation, that is, estimating the extent to which one's mental states are observable to others, requires the simultaneous representation of the self and of others' perspective on the self. Individuals with borderline personality disorder (BPD) have difficulty integrating multiple perspectives when mentalizing, which may be reflected in impaired transparency estimation. A total of 62 participants high and low in BPD features watched emotionally evocative video clips and estimated the transparency of their emotional experience while facial expression coding software (FaceReader) quantified their objective transparency. Individuals high in BPD features showed a larger discrepancy between estimated and objective transparency than individuals low in BPD features, showing that they both over- and underestimated their transparency. Indeed, estimated transparency positively predicted objective transparency in individuals low in BPD features, but not in individuals high in BPD features. Moreover, the ability to estimate intraindividual variability in one's own objective transparency was moderated by self-reported arousal in the participants high in BPD features. Impairments in transparency estimation were correlated with self-report measures of borderline features, attachment, and mentalizing. In conclusion, we found that borderline features relate to a reduced capacity to estimate the extent to which one's own emotional states are observable to others. Although replication in clinical samples of BPD patients is needed, the present study provides evidence for problems in mentalizing the (embodied) self from another person's perspective in BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between borderline personality disorder features, early maladaptive schemas, and schema modes: A network analysis in a nonclinical sample

BackgroundBorderline Personality Disorder (BPD) is a heterogeneous personality disorder. Early Maladaptive Schemas (EMSs) and schema modes are two core concepts of schema theory that play an essential role in understanding BPD symptomatology. MethodsThis study aimed to model the complex associations between key BPD features (e.g., Affective Instability, Identity Problems, Negative Emotions, and Self-Harm), EMSs, and schema modes using network analysis in a sample of undergraduate students (n = 989). The Personality Assessment Inventory-Borderline subscale (PAI-BOR), the Young Schema Questionnaire-Short Form (YSQ-SF), and the Schema Mode Inventory (SMI) were used to assess the severity of BPD features, EMSs, and schema modes, respectively. ResultsThe schema modes were the most central nodes in the model, and the activated EMSs were related to BPD features through schema modes. Distinctive BPD features were also associated with specific schema modes. Interestingly, Affective Instability and Self-Harm features were directly associated with Impulsive Child mode. Identity Problems showed unique associations with the Abandonment schema, Vulnerable Child, and Punitive Parent modes. Finally, Negative Relations were also uniquely connected to the Angry Child mode. ConclusionsThe findings of this study can be helpful for clinicians and researchers to deepen their knowledge about BPD conceptualization.

Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents.

Although associations among borderline personality disorder (BPD), social rejection, and frontal EEG alpha asymmetry scores (FAA, a neural correlate of emotion regulation and approach-withdrawal motivations) have been explored in different studies, relatively little work has examined these relations during adolescence in the same study. We examined whether FAA moderated the relation between BPD features and rejection sensitivity following a validated social exclusion paradigm, Cyberball. A mixed, clinical-community sample of 64 adolescents (females = 62.5%; Mage = 14.45 years; SD = 1.6; range = 11-17 years) completed psychodiagnostic interviews and a self-report measure of BPD (Time 1). Approximately two weeks later (Time 2), participants completed a resting EEG recording followed by Cyberball. FAA moderated the relation between BPD features and overall feelings of rejection following Cyberball: individuals with greater relative left FAA had the highest and lowest feelings of social rejection depending on whether they had high and low BPD feature scores, respectively. Results remained after controlling for age, sex, gender, depression, and BPD diagnosis. These results suggest that FAA may moderate the relation between BPD features and social rejection, and that left frontal brain activity at rest may be differentially associated with those feelings in BPD. Findings are discussed in terms of the link between left frontal brain activity in the regulation and dysregulation of social approach behaviors, characteristic of BPD.

Self-esteem instability might be more characteristic of borderline personality disorder than affective instability: Findings from an e-diary study with clinical and healthy controls.

Borderline personality disorder (BPD) is commonly characterized by pervasive instability. Affective instability, despite being a diagnostic criterion in the DSM-5, is commonly seen as a transdiagnostic feature, but recent studies have brought new attention to the importance of self-esteem instability as a potential defining feature of BPD. However, evidence is lacking regarding whether heightened self-esteem instability is a specific feature of BPD when patients with BPD are compared to clinical controls. Using ambulatory assessment, we examined self-esteem instability and affective instability in participants' daily lives. We assessed momentary self-esteem and affective state 12 times daily for 4 consecutive days in 71 patients with BPD, 121 patients with anxiety disorders (ADs), and 74 healthy controls (HCs). To determine group differences, we used established instability indices and analyzed multilevel models. Compared to HCs, patients with BPD and those with ADs exhibited heightened self-esteem instability and affective instability. Importantly, the clinical groups did not differ in affective instability, whereas self-esteem instability was significantly higher in patients with BPD than in those with ADs across all instability indices. Beyond the influence of mean self-esteem, patients with BPD had the highest general instability, the most frequent extreme changes, and the largest decreases in self-esteem, especially from high levels of self-esteem. Our results support previous findings on affective instability, which may constitute a transdiagnostic feature, and they provide the first evidence that heightened self-esteem instability is particularly prominent in BPD, underscoring the importance of self-esteem for the understanding of dysregulation in BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mentalizing in Adolescents With and Without Prominent Borderline Features: Validation of the Reflective Functioning Questionnaire for Youths (RFQY) and an Investigation of the Factor Structure of Hypo- and Hypermentalizing

The Reflective Functioning Questionnaire for Youths (RFQY) is a self-report measure of reflective functioning (RF) also referred to as mentalizing. Lower levels of RF are characteristic of a wide range of mental disorders and are especially relevant in the assessment of personality pathology. The goal of the current study is to examine the psychometric properties of a Danish translation of the RFQY and to corroborate previous research on the measure’s ability to differentiate between adolescents with and without borderline personality disorder (BPD) features. 889 adolescents were administered the RFQY and divided into three subsamples: a community sample (n = 644), a clinical non-personality disorder sample (n = 64), and a BPD sample (n = 181). Construct validity was examined through bivariate correlations between RFQY and a dimensional assessment of borderline personality features. Analysis of variance (ANOVA) supported the utility of the RFQY to discriminate between adolescents with and without BPD features. Moreover, a two-factor structure based on previous research of the adult version of the RFQ was examined. A series of exploratory and confirmatory factor analyses yielded a two-factor structure corroborating previous research. Implications for prevention, assessment, and treatment are discussed along with methodological limitations and suggestions for future research.

Potential mechanisms underlying sleep disturbance in young people with borderline personality disorder features: an exploratory study

BackgroundSleep disturbance is common among young people (15–25 years) with features of borderline personality disorder (BPD). However, the mechanisms underlying sleep disturbance in BPD remain unknown. Understanding these underlying processes is essential to guide the development of sleep-improvement interventions and to optimise their efficacy through identifying beneficial treatment targets. This exploratory study aimed to investigate potential underlying mechanisms to inform future hypotheses, research development, and provide insight into potential treatment targets to improve sleep in young people with BPD. This study explored the indirect roles of emotion regulation difficulties, depression, anxiety and stress in the relationship between BPD features and sleep disturbance in young people.MethodsSleep was measured subjectively (self-report questionnaires) and objectively (10 days wrist actigraphy) in 40 young people with BPD features and 38 healthy young people. Participants also completed the Difficulties in Emotion Regulation Scale and the Depression, Anxiety and Stress Scale.ResultsMediation analyses revealed that impulse control difficulties, limited emotion regulation strategies and anxiety indirectly affected the relationship between group (BPD vs. healthy) and subjective sleep disturbance in young people. Lack of emotional awareness and anxiety contributed to associations between group and objectively longer time in bed and bedtime variability, respectively.ConclusionsThese preliminary findings suggest that targeting emotional dysregulation (impulse control, strategies, emotional awareness) and anxiety might be beneficial for improving sleep in this population.

Dissociation of basolateral and central amygdala effective connectivity predicts the stability of emotion-related impulsivity in adolescents and emerging adults with borderline personality symptoms: a resting-state fMRI study.

Borderline personality disorder (BPD) is associated with altered activity in the prefrontal cortex (PFC) and amygdala, yet no studies have examined fronto-limbic circuitry in borderline adolescents and emerging adults. Here, we examined the contribution of fronto-limbic effective connectivity (EC) to the longitudinal stability of emotion-related impulsivity, a key feature of BPD, in symptomatic adolescents and young adults. We compared resting-state EC in 82 adolescents and emerging adults with and without clinically significant borderline symptoms (n BPD = 40, ages 13-30). Group-specific directed networks were estimated amongst fronto-limbic nodes including PFC, ventral striatum (VS), central amygdala (CeN), and basolateral amygdala (BLA). We examined the association of directed centrality metrics with initial levels and rates of change in emotion-related impulsivity symptoms over a one-year follow-up using latent growth curve models (LGCMs). In controls, ventromedial prefrontal cortex (vmPFC) and dorsal ACC had a directed influence on CeN and VS, respectively. In the BPD group, bilateral BLA had a directed influence on CeN, whereas in the healthy group CeN influenced BLA. LGCMs indicated that emotion-related impulsivity was stable across a one-year follow-up in the BPD group. Further, higher EC of R CeN to other regions in controls was associated with stronger within-person decreases in emotion-related impulsivity. Functional inputs from BLA and vmPFC appear to play competing roles in influencing CeN activity. In borderline adolescents and young adults, BLA may predominate over CeN activity, while in controls the ability of CeN to influence BLA activity predicted more rapid reductions in emotion-related impulsivity.

The prevalence of borderline personality features and borderline personality disorder during the perinatal period: a systematic review and meta-analysis.

Borderline personality disorder (BPD) is a psychiatric disorder marked by severe affective instability and poor interpersonal functioning. Existing literature has highlighted that individuals with BPD are at greater risk for a wide range of adverse physiological and psychosocial outcomes in the perinatal period compared to perinatal individuals without BPD. However, to date, no systematic review has addressed the prevalence of BPD and borderline personality features (BPF) in pregnant and postpartum individuals. A systematic review and meta-analysis was conducted by searching three databases (PubMed, PsycINFO, and Embase) on April 6th, 2021. Research articles and conference abstracts that evaluated BPF or BPD in pregnant, postpartum, or mixed perinatal populations were included. Sixteen publications were included in the systematic review (n = 14 research articles, n = 2 conference abstracts), seven of which were included in the meta-analysis. Among non-clinical samples, prevalence rates of BPF during pregnancy ranged from 6.9 to 26.7%, while rates of BPD across the perinatal period ranged from 0.7 to 1.7%. Among clinical samples, rates of BPF and BPD across the perinatal period spanned 9.7-34% and 2.0-35.2%, respectively. Results from the meta-analysis revealed that the pooled prevalence rate of BPD in clinical samples during the perinatal period is 14.0% (95% CI [7.0, 22.0]). Among clinical perinatal samples, there is a high prevalence of borderline personality pathology. This review highlights the need for appropriate validated screening methods to identify and treat BPD in the perinatal population.

Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder.

Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.

Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review.

A hypermentalizing impairment, or tendency to overattribute mental states to others, has been identified among individuals with borderline personality disorder. However, associations between hypermentalizing and other disorders call into question the specificity of this impairment to borderline personality disorder. This study aimed to evaluate the relative strength of the association between hypermentalizing and borderline personality disorder compared with other disorders and to assess the impact of moderators on the relationship between hypermentalizing and psychopathology. The authors conducted a meta-analysis of 36 studies (N=4,188 people) to investigate the relative strength of the association between hypermentalizing and borderline personality disorder, compared with other disorders, and to assess the impact of moderators on this relationship. The Movie for the Assessment of Social Cognition, an ecologically valid experimental instrument, was used to measure hypermentalizing. Results indicated support for an association between psychopathology and hypermentalizing (r=0.24, 95% confidence interval [CI]=0.17 to 0.31), but the association was not significantly stronger for borderline personality disorder (r=0.26, 95% CI=0.12 to 0.39) than for other disorders (r=0.24, 95% CI=0.14 to 0.33). Neither age nor gender significantly moderated the association between psychopathology and hypermentalizing. Hypermentalizing may be related to psychopathology in general rather than borderline personality disorder in particular. The findings are discussed in view of the possibility that features of borderline personality disorder associated with other psychopathology may explain the overall association between psychopathology and hypermentalizing. Clinical implications for mentalization-based treatment and concerns that the measurement used for hypermentalization may be too narrow and not representative of variations in functioning across cultures and race-ethnicity also are discussed.

Trauma and Outcomes of Mentalization-Based Therapy for Individuals With Borderline Personality Disorder.

Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP). All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment. Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP. Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.

Exploring screening for borderline personality disorder in pediatric inpatients with psychiatric Illness

Borderline Personality Disorder (BPD) is a severe psychiatric illness associated with poor personal and interpersonal functioning. Screening for BPD in adolescents and provision of specialized treatment may improve life circumstances in vocations and relationships. The purpose of this study was to determine the number of pediatric inpatients who would screen positive for BPD with a self-rating measure, and to compare their personal and interpersonal characteristics with youth who did not screen positive. A survey with self-report measures was administered to patients to screen for BPD. The mean age of the sample was 15 years and 71% identified as female gender. Of 109 patients 72 (66%) screened positive for BPD while only eight (7%) patients were diagnosed by psychiatrists with BPD or features of BPD. There were no statistically significant differences between those who scored positive versus negative for BPD in age, gender, or avoidant anxiety. There were statistically significant differences in anxious attachment, distress, clinical symptoms, problematic use of electronic devices, considered suicide, past trauma and prior suspensions from school. This exploration in pediatric inpatients suggests that many of these patients may be at risk for a diagnosis of BPD later in life and may benefit from early identification and specialized intervention.

Risky Sexual Behavior Profiles in Youth: Associations With Borderline Personality Features.

Adolescence and young adulthood are peak periods for risky sexual behaviors (RSB) and borderline personality disorder (BPD) features. RSB is a major public health concern and adolescents with BPD may be particularly vulnerable to RSB, but this is understudied. The aim of this study was to identify distinct RSB profiles in youth and determine whether a specific profile was associated with BPD features. Participants were 220 adolescents and young adults (age 14–21) recruited from the community. To identify groups of adolescents and young adults who engage in similar RSB, a latent profile analysis (LPA) was conducted on sexually active youth (57%). Next ANOVA was used to identify how profiles differed in terms RSB dimensions and BPD features. We identified three distinct RSB profiles: (1) a Low RSB profile that was manifested by the majority (77.7%) of youth; (2) an Unprotected Sex in Relationships profile (13.3%) and; (3) an Impulsive Sex Outside Relationships profile (12%) which was manifested by youth with significantly higher BPD features. The findings shed light on the difficulties youth with BPD manifest around integrating sexuality, intimacy, fidelity, and love. This contrasts with the majority of youth who are sexually active in the context of relationships and engage in little or no RSB. The findings have important clinical implications. Adolescent sexuality is frequently in the blind spot of clinicians. To address the elevated risk of RSB in adolescents with BPD, interventions are needed to help adolescents navigate this period and improve their understanding of the reasons for RSB while addressing difficulties in establishing sexual and attachment relationships.