Borderline Personality Disorder Symptoms Research Articles

Negative affect and pain catastrophizing link borderline personality disorder to pain: Replicating and extending the borderline personality disorder-pain association.

Borderline personality disorder (BPD) is commonly comorbid with chronic pain and associated with pain symptoms and interference. BPD features are associated with negative affect, which is associated with pain catastrophizing and/or pain anxiety, and finally pain severity or interference. We extended models of the BPD-pain associations in a chronic pain sample (N = 202), highlighting the role of negative affect (depression and anxiety) and pain catastrophizing, and exploring the potential benefit of emotional suppression/distraction as a component of these associations. BPD symptoms were positively associated with pain severity, mediated by negative affect and pain catastrophizing, supporting a cognitive-affective pathway linking BPD to pain experiencing. There was only minor evidence for the benefit of incorporating emotional suppression/distraction into research or treatment on the BPD-pain association. We provide clinical implications based on targeting affective symptoms and catastrophizing among individuals with co-occurring chronic pain and BPD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negative Emotion (dys)regulation Predicts Distorted Time Perception: Preliminary Experimental Evidence and Implications for Psychopathology.

Accurate time perception is crucial to daily life but vulnerable to interference, particularly through negative affect, which dilates individuals' sense of time passing. Regulation strategies like rumination, and disorders like borderline personality disorder (BPD), are linked to time distortion, yet their interrelationships remain untested. We investigated whether rumination and BPD symptoms increase time dilation in negative affective states to understand the clinical implications of time distortion. In an online pilot study, we tested whether negative affect (NA) predicts subjective time perception and explored how rumination, BPD symptoms, and their interaction predicted time perception using a between-subjects online experimental mood induction. Adult participants (Ncombined = 760) were recruited from Prolific Academic and a large, Midwestern U.S. university. State NA and increased BPD features predicted increased time dilation. The role of trait-level rumination was nuanced, with individuals low in BPD symptoms and elevated trait rumination exhibiting reduced time dilation in response to NA. Conversely, those with elevated rumination and BPD symptoms reported increased time dilation in the neutral condition. Findings offer foundational evidence of NA and rumination's roles in time dilation for individuals across levels of BPD symptom endorsement. Subsequent replication and extension could flesh out these relationships and inform psychotherapeutic treatment targets.

Prediction of borderline personality disorder based on childhood trauma with the mediating role of experiential avoidance

IntroductionTraits of borderline personality disorder are important for the determination of the prognosis of mental illnesses and in evaluating risks of negativity as well as impulsivity. But, there is a lack of information about the distribution characteristics of borderline personality disorder traits and symptoms within clinical groups. The goal of the current study was to predict borderline personality disorder based on childhood trauma, using experiential avoidance as a mediator.MethodsAll male patients hospitalized in local psychiatric health centers with a diagnosis of borderline personality disorder comprised the statistical population of the current study. The number of 60 patients were selected by the purposeful sampling method. The questionnaire included the Childhood Trauma Questionnaire (CTQ), the Experiential Avoidance Questionnaire (AAQ-II), and the Borderline Personality Disorder Symptoms (BSL-23).Results and discussionThe results demonstrated that there is a considerable and positive relationship between childhood trauma and experiential avoidance (r = 0.711, p< 0.01). In the mediating model, childhood trauma had significant direct predictive effects on borderline personality disorder (β = 0.546, p< 0.01). Also, between childhood trauma and BPD, experienced avoidance acts as a moderating factor. (β = 0.304, p< 0.01).

Emotion dysregulation, dissociation, and borderline personality disorder symptoms as correlates of maladaptive daydreaming in a general sample: the crucial role of experiential avoidance

Maladaptive daydreaming (MD) is defined as a long-hour fantasizing that disrupts the individual's daily functioning and enables an escape from unpleasant internal experiences. Previous studies indicate the significant role of daydreaming in emotion dysregulation. Considering the emotionality in people with borderline personality disorder (BPD), it can be assumed that MD functions as one of the strategies for coping with emotions in this group. The study aimed to explore the co-occurrence of MD with BPD symptoms. Additionally, the study will examine the role of BPD symptoms, experiential avoidance (EA), emotion dysregulation, and dissociation in the maintenance of MD. The sample included 167 adults (136 women, 28 men, 3 other/non-binary). MD symptoms correlated positively with BPD symptoms, dissociation, emotion dysregulation, and experiential avoidance. Two models explaining the symptoms of MD were compared. Model 1 did not include EA - after adding this variable, the fit of model 2 increased (SRMR = .095). EA predicted emotional dysregulation and dissociation, which in turn explained MD symptoms. The results allow for clinical cues for specialists and interventions focused on developing acceptance in treating MD and BPD symptoms.

An evaluation of measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition borderline personality disorder criteria across heterosexual, lesbian, gay, and bisexual adults.

There is a robust, yet poorly understood relationship between nonheterosexual orientation and borderline personality disorder (BPD), with lesbian, gay, and bisexual individuals evidencing greater BPD symptoms compared to heterosexual individuals. Recent evidence suggests possible psychometric bias in BPD diagnostic criteria leading to greater endorsement among sexual minority individuals, which hinders researchers' ability to make valid group comparisons. The present study utilized an epidemiological sample of 35,995 men and women to evaluate the extent of differential item functioning (DIF) among BPD criteria across sexual orientation groups using a multiple indicators multiple causes approach. All criteria except affective instability and emptiness indicated DIF for at least one sexual minority focal group, although both demonstrated DIF in sensitivity analyses. DIF was most consistently indicated for suicidality, efforts to avoid abandonment, and impulsivity. Contrary to predictions, DIF was mostly nonuniform with greater item discrimination for sexual minority groups compared to their heterosexual counterparts. Finally, all estimated effect sizes were small, suggesting that DIF was not practically meaningful and unlikely to impact the validity of group comparisons for BPD criteria across heterosexual and nonheterosexual men and women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Relationship Between Feelings of Emptiness and Self-Harm Among Thai Patients Exhibiting Borderline Personality Disorder Symptoms: The Mediating Role of the Inner Strengths

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson’s correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD.

Uncertain reflective functioning, anxious attachment, and cumulative impact of early relational trauma as predictors of severity in borderline personality disorder

ABSTRACT Background: The mentalization model of borderline personality disorder (BPD) utilizes a developmental psychopathology lens, emphasizing an unstable or reduced capacity to mentalize—stemming from early attachment disruptions and relational trauma—as the core feature of BPD. While the empirical evidence for the proposed intersections between mentalizing, attachment, and trauma and the development and manifestations of borderline personality is still limited, this knowledge is essential for developing effective assessments and interventions. Aim: To examine mentalizing, attachment, and early relational trauma as predictors of the severity of symptoms in BPD. Materials and Methods: The sample included 60 individuals diagnosed with BPD, aged 18–45 years, recruited from inpatient and outpatient services in a tertiary care mental health center. Participants completed measures of mentalizing (Reflective Functioning Questionnaire, Interpersonal Reactivity Index, and Reading the Mind in the Eyes test), attachment (Attachment Style Questionnaire), early relational trauma (Complex Trauma Questionnaire), and symptom severity (Borderline Symptom List). Results: The majority of the participants reported experiences of polyvictimization (93.3%) with the most common traumas being psychological abuse (93.3%), neglect (91.7%), and rejection (90.0%). Regression analyses revealed that uncertain reflective functioning, anxious attachment style, and the cumulative impact of trauma together predicted 53.1% of the variance in BPD symptom severity. Conclusion: Impaired mentalizing, characterized by inflexible understanding of mental states, is a critical target for therapeutic interventions in BPD. The significant role of anxious attachment and the necessity of assessing the perceived impact of traumatic experiences highlight the importance of trauma-informed and mentalization-based interventions for this vulnerable group.

Impulsive adolescents exhibit inefficient processing and a low decision threshold when decoding facial expressions of emotions.

Borderline personality disorder (BPD) is a debilitating psychiatric illness whose symptoms frequently emerge during adolescence. Initial studies in adults suggest that the interpersonal difficulties common in BPD may emerge from disrupted processing of social and emotional stimuli. Less is known about these processes in adolescents with BPD symptoms, despite substantial changes in socioemotional processing during this developmental period. 86 adolescents and young adults with and without BPD symptoms completed an emotional interference task involving the identification of a facial emotion expression in the presence of a conflicting or congruent emotion word. We used hierarchical drift diffusion modeling to index speed of processing and decision boundary. Using Bayesian multilevel regression, we characterized age-related differences in facial emotion processing. We then examined whether BPD symptom dimensions were associated with facial emotion processing on this task. To determine the specificity of our effects, we analyzed behavioral data from a corresponding nonemotional interference task. Impulsivity, but not negative affectivity or interpersonal dysfunction, predicted inefficient processing when presented with conflicting negative emotional stimuli. Across both tasks, impulsivity in adolescents was further associated with a lower decision boundary. Impulsive adolescents were especially likely to make fast, but inaccurate decisions about another person's emotional state. Impulsive adolescents with BPD symptoms are prone to making errors when appraising facial expressions of emotions, which may potentiate or worsen interpersonal conflicts. Our findings highlight the role of lower-level social cognitive processes in interpersonal difficulties among vulnerable youth during a sensitive developmental window.

Physical Activity in young female outpatients with BORderline personality Disorder (PABORD): a study protocol for a randomized controlled trial (RCT)

BackgroundCurrent treatments for mental disorders, like pharmacotherapy or psychological approaches, do not lead to full remission in all individuals. Physical activity (PA) is effective at improving psycho-physical health in major depressive and anxiety disorders. However, the efficacy of PA as an adjunctive treatment for borderline personality disorder (BPD) has not been studied. To date, there are no approved pharmacological treatments for this severe condition and limited accessibility to effective psychotherapeutic interventions. This study tests the efficacy of a structured PA programme as an additional treatment for BPD outpatients.MethodsThe PABORD is a randomised controlled trial for female outpatients (18–40 years) with a BPD diagnosis. The intervention group (n = 32) will participate in a 12-week structured PA programme supervised by a sport medicine physician and preceded by three psychoeducation sessions on healthy eating habits. The control group (n = 32) will receive a 12-week psychoeducation programme on PA, diet, and health risks of a sedentary lifestyle for a total of 8 sessions. The study aims to determine if the PA intervention is superior to the control in reducing BPD symptoms. Secondary aims include improving PA levels and physical and psychological health. Assessments will be conducted at baseline, post-intervention, and 3 months post-intervention.DiscussionThe structured PA programme is expected to outperform the control group in terms of health and PA outcomes at the end of the intervention. Repeated assessments will also help to identify psychosocial factors that influence PA maintenance. Findings will support the potential widespread implementation of PA programmes for BPD treatment.Trial registrationClinicalTrials.gov NCT06461104. Registered on 6 June 2024 {2a}.

Implicit associations with non-suicidal self-injury: Examination in a clinical sample by borderline personality symptomatology.

We examine correlates and predictors for implicit associations with non-suicidal self-injury (NSSI) with the Self-Injury Implicit Association Test (SI-IAT) in a treatment-seeking sample. We also examine group differences in the SI-IAT among those with low/none, moderate and high/clinically significant borderline personality disorder (BPD) symptomatology in a treatment-seeking sample. Participants (N = 111; 58% female; 89% White; Mage = 30.25) completed the SI-IAT and self-report measures at two time points. Higher BPD symptom scores were significantly, positively correlated with implicit identification with NSSI, and predicted NSSI identity when controlling for depression indices, history of NSSI and other covariates. With Time 1 SI-IAT scores entered as a covariate, BPD scores no longer significantly predicted Time 2 SI-IAT scores. Individuals with moderate and high/clinically significant symptom counts of BPD had higher/stronger implicit associations with NSSI identity than those with no/low BPD symptoms. Individuals with symptoms of BPD may implicitly identify with NSSI more than other clinical groups; examination of implicit assessments in BPD in future research is needed to further explore implicit identification with NSSI in this patient group to further understand both cross-sectional and prospective relations.

The phenomenon of “emptiness” in modern psychiatry

The article analyses a new psychopathological phenomenon of “emptiness” for classical psychiatry, which is compared with clinical manifestations of emptiness, boredom, apathy, and melancholy. A conclusion is made about the uniqueness of this symptom is drawn. The relationship between the phenomenon of “emptiness” and other diagnostically significant symptoms of borderline personality disorder (BPD) is examined, as is its influence on suicidal and self-harming behavior. It is argued that “emptiness” reflects the mechanism of dissociative depersonalization, and that the wide representation of dissociative symptoms within BPD in conjunction with the “emptiness” phenomenon makes it promising to consider BPD and its individual symptoms a “new hysteria”.

Compulsive buying disorder: Conceptualization based on addictive, impulsive, and obsessive-compulsive features and comorbidity

BackgroundThis study sought to examine the conceptualization of compulsive buying disorder in a sample of adults drawn from the community and its associated mental health correlates. MethodsAn online survey of “Personality, Mental Health, and Well-Being” was distributed to 300 adults aged 18–75 years. The survey measured a range of behaviors, such as buying behavior, alcohol and drug use, impulse control disorders, and dimensional constructs of impulsivity and obsessive-compulsiveness. ResultsA total of 294 participants (54.7% female) completed the survey and were included in the analysis. The overall frequency of probable compulsive buying disorder was 5.4% (n = 16). Compared to adults without compulsive buying disorder, those with probable compulsive buying disorder were significantly less likely to identify as heterosexual and were significantly more likely to endorse attention-deficit hyperactivity disorder, drug use problems, symptoms of borderline personality disorder, binge eating disorder, and had higher levels of compulsivity plus impulsivity. ConclusionCompulsive buying disorder appears to be fairly common in adults and appears to have symptom or diagnostic overlap with obsessive-compulsive problems, addictive disorders, and impulse control disorders. Findings highlight the need for careful clinical screening to identify often overlooked comorbidities and treat them on an individual patient basis, as well as the need to conduct high-quality clinical trials for compulsive buying disorder itself and to explore its presentation longitudinally at large scale.

Contextual-compassion training for borderline personality disorder with long lasting symptoms: a randomized clinical trial

Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.

Effect of metacognitive interpersonal therapy on brain structural connectivity in borderline personality disorder: Results from the CLIMAMITHE randomized clinical trial

BackgroundRecently, we showed that Metacognitive Interpersonal Therapy (MIT) is effective in improving clinical symptoms in borderline personality disorder (BPD). Here, we investigated whether the effect of MIT on clinical features is associated to microstructural changes in brain circuits supporting core BPD symptoms. MethodsForty-seven BPD were randomized to MIT or structured clinical management, and underwent a clinical assessment and diffusion-weighted imaging before and after the intervention. Fractional anisotropy (FA), mean, radial, and axial diffusivities maps were computed using FSL toolbox. Microstructural changes were assessed (i) voxel-wise, with tract based spatial statistics (TBSS) and (ii) ROI-wise, in the triple network system (default mode, salience, and executive control networks). The effect of MIT on brain microstructure was assessed with paired tests using FSL PALM (voxel-wise), Linear Mixed-Effect Models or Generalized Linear Mixed Models (ROI-wise). Associations between microstructural and clinical changes were explored with linear regression (voxel-wise) and correlations (ROI-wise). ResultsThe voxel-wise analysis showed that MIT was associated with increased FA in the bilateral thalamic radiation and left associative tracts (p < .050, family-wise error rate corrected). At network system level, MIT increased FA and both interventions reduced AD in the executive control network (p = .05, uncorrected). LimitationsThe DTI metrics can't clarify the nature of axonal changes. ConclusionsOur results indicate that MIT modulates brain structural connectivity in circuits related to associative and executive control functions. These microstructural changes may denote activity-dependent plasticity, possibly representing a neurobiological mechanism underlying MIT effects. Trial registrationClinicalTrials.govNCT02370316 (https://clinicaltrials.gov/study/NCT02370316).

Chronotype, sleep quality, impulsivity and aggression in patients with borderline personality disorder and healthy controls

ABSTRACT Impulsivity, aggression, and suicide are the major clinical symptoms of borderline personality disorder (BPD). Although previous studies indicated poor sleep quality and its relationship with clinical symptoms in patients with BPD, chronotype, an important sleep parameter, was not investigated in these patients. This study aimed to analyze chronotype and its relationship with clinical symptoms in patients with BPD. Participants in this study consisted of 68 BPD patients and 65 healthy controls. Subjective sleep characteristics, impulsivity, aggression, suicide probability, and chronotype were assessed using the Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale, Buss-Perry Aggression Scale (BPAQ), Suicide Probability Scale, and Morningness – Eveningness Questionnaire, respectively. PSQI total and subscale scores subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime drowsiness were significantly higher in the BPD group (p < 0.001). There was a positive correlation between the PSQI total score and the BPAQ total score (r = 0.268, p = 0.027). The rate of evening type was significantly higher in the control group (p = 0.004). Suicide attempts and the subscale of suicide probability hopelessness, suicidal ideation, and negative self-evaluation scores were significantly higher in evening type BPD patients. (p = 0.017, p = 0.009, p = 0.001, p = 0.047). Sleep quality is associated with aggression, and the eveningness chronotype is associated with suicide. It may be useful to focus on sleep problems in treating BPD patients.

Mediation models of the interaction between Internet gaming disorder and psychological pain and symptoms of anxiety, depression, and borderline personality disorder

Introduction: The prevalence of Internet gaming disorder (IGD) ranges from approximately 2% to 27.5% in the world population and 5.5% in the Polish population. Research findings indicate that IGD may be associated with depression, ADHD, anxiety, autism spectrum, and aggressive behaviours. However, there is a lack of research on the relationship between IGD and borderline personality disorder and psychological pain (psychache). The aim of this study is to examine the relationships between IGD and symptoms of anxiety, depression, psychological pain, borderline personality disorder and determining the role of psychological pain as a mediator of the above-mentioned links.; Methods: A sample of Polish gamers (n=201) was assessed using clinical scales (HADS, IGD-20, BPD Checklist) to evaluate the severity of depression, anxiety, IGD, and borderline personality symptoms. Additionally, the psychological pain scale was administered to assess relationship with IGD via mediation models. Results: Regression analysis in a mediation model revealed that IGD significantly predicted anxiety and depression, while borderline personality disorder was a significant predictor of IGD. Moreover, a bidirectional relationship between IGD and psychological pain had been demonstrated–IGD was a significant predictor of psychological pain and vice versa. Psychological pain also mediated the relationship between IGD and anxiety and depression, as well as the relationship between borderline personality symptoms and IGD. Conclusions: In the diagnostic and therapeutic process of people suffering from IGD, the co-occurrence of IGD with psychological pain, depression, anxiety and borderline personality disorder should be considered. Further scientific exploration is required to assess the associations between IGD and clinical variables and psychological pain.

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. ClinicalTrial.gov, identifier NCT05023447.

Capturing the experience of borderline personality disorder symptoms in the daily lives of women with eating disorders.

Capturing the experience of borderline personality disorder symptoms in the daily lives of women with eating disorders.

Supplemental Material for Capturing the Experience of Borderline Personality Disorder Symptoms in the Daily Lives of Women With Eating Disorders

Supplemental Material for Capturing the Experience of Borderline Personality Disorder Symptoms in the Daily Lives of Women With Eating Disorders

Perceived Parental Criticism Exacerbate Symptoms of Borderline Personality Disorder Ameliorated by Self-Control in Young Adults

Perceived Parental Criticism Exacerbate Symptoms of Borderline Personality Disorder Ameliorated by Self-Control in Young Adults