Borderline Personality Disorder Symptoms Research Articles

Therapeutic and Preventive Interventions in Adolescents with Borderline Personality Disorder: Recent Findings, Current Challenges, and Future Directions.

Borderline personality disorder (BPD) has long suffered from overshadowing in adolescents and hopelessness from the psychiatrists themselves. Comprehensive guidelines for this age group are lacking. This narrative review aims to describe current recommendations for BPD and recent empirical evidence on effective treatments (both pharmacological and non-pharmacological) and preventive approaches. Innovative approaches, based on recent and original research on BPD adolescents, are also discussed. Very low-certainty evidence has supported that medication has a positive effect on core BPD symptoms in adolescents. Medication prescribed for suicidal crises or associated disorders should be included in a global therapeutic plan, including efficacy reassessment, treatment duration, and a security plan. The overall benefit of structured psychotherapy for adolescents with BPD (cognitive behavioral therapy, mentalization-based therapy, dialectic behavioral therapy, and group therapy) is more important for self-harm behaviors than other BPD symptoms. Their specific efficacy, although difficult to distinguish from the overall non-specific effect of integrative care. structured care of young BPD individuals should be based on the following principles: (1) setting the frame of care, including recognition of the diagnosis, and sharing information with patients and families about symptoms, prognosis, and putative psychological mechanisms involved; and (2) promoting comprehensive approaches, including both specific and non specific therapy, ecological interventions, community care, and preventive interventions in at-risk groups.

Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation

ABSTRACT Background: Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. Objective: Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. Method: 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. Results: Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (k 2=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. Conclusions: Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.

The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies.

Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods. A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects. Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive. Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.

Validation of the hyperbolic temperament questionnaire in Iran

ObjectiveBecause of the importance of the cross-cultural study of hyperbolic temperament in increasing knowledge related to borderline personality disorder (BPD), the present study was conducted to test the reliability, construct, criterion, and discriminant validity of the Hyperbolic Temperament Questionnaire (HTQ) in three Iranian samples.MethodsUsing a cross-sectional design, the HTQ 11-item version translated into Farsi was provided to three selected samples (total N = 558, 72% female, 18 to 77 years old with an average of 30.2 and a standard deviation of 10.3). The samples included non-personality disorder samples (n = 194), samples with BPD symptoms (n = 104), and samples with other personality disorder symptoms (n = 260). Data were collected using multiple validating measurements. Factor analysis was used to verify that the HTQ is unidimensional and correlations and regression models were used to examine its associations with other constructs.ResultsFactor analysis confirmed the single-factor structure of the HTQ in two non-personality disorder and BPD samples. The internal consistency of all items and the total scale were acceptable across the samples (α = 0.87 to 0.91). Positive correlations with maladaptive constructs such as negative affectivity and interpersonal sensitivity and negative correlations with adaptive constructs supported the criterion validity of HTQ. The HTQ was specifically related to borderline symptoms, even after controlling for similar constructs such as depression.ConclusionThe 11-item version of HTQ has acceptable reliability and validity in Iranian samples. Using this short tool for rapid screening of cases with BPD before common procedures such as clinical interviews helps to save diagnostic time and costs.

Prevalence rate trends of borderline personality disorder symptoms and self-injurious behaviors in college students from 2017 to 2021

The current study examines the prevalence rates of borderline personality disorder (BPD) symptoms and nonsuicidal self-injury (NSSI) behaviors amongst college students over a five-year period, including pre- and during the COVID pandemic. Online prescreener surveys were completed by undergraduate students (n = 12,756) attending a large Southern Plains University every semester from Spring of 2017 to Spring of 2021. The percentage of students with NSSI history and significant BPD symptoms were visualized by semester to examine trends over time. A series of logistic regressions and negative binomial regressions were conducted on NSSI history and BPD symptoms to examine whether the endorsement rates have been increasing over time and to compare before and during COVID pandemic. There was an increasing trend of NSSI rates and significant BPD symptoms over time for all sexes. Furthermore, there was a steeper increase in BPD symptoms specifically in female students over the last five years. Additionally, there was a significant increase in odds of elevated BPD symptoms and NSSI behaviors in the college students enrolled during the COVID pandemic compared with pre-COVID. Overall, there has been an increasing trend in BPD symptoms and NSSI rates over the last few years, including during the COVID pandemic.

MALADAPTIVE PARENTING AND PEER GROUP BULLYING AS PATHOLOGICAL PATHWAYS TO BORDERLINE PERSONALITY DISORDER SYMPTOMS IN EARLY ADULT: CASE REPORT

Introduction – Maladaptive experiences during adolescene have been consistently linked with borderline personality disorder. BPD is a serious mental illness characterized by pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Tthere was an interrelated relationship between parenting experiences and the development of BPD symptoms. Children who reported chronic bullying had a fivefold increase in the likelihood of developing BPD symptoms. Methods – Presented the case of patient, 20 years old young male with symptoms of borderline personality disorder turned out to have maladaptive parenting and history of became victim by peer group bullying since childhood. Data were taken from interviews and mental status examinations in psychiatric clinics, then a literature review was carried out. Results – The development of borderline personality disorder in adult linked with report of low care parenting, involves coldness, indifference, and rejection. BPD is also inevitable from hereditary risk factors. Discuss – There is a direct significant association between being victim of bullying and development of BPD. Empathy is one important aspect of social behavior that may not function in BPD. Atypical depressed patients with affective dysregulation first diagnosed with borderline personality disorder if do not meet the diagnostic criteria for bipolar disorder. Conclusion – Borderline personality disorder (BPD) is very prone to occur in young adults. Starting from affect dysregulation, inability to impulse control, unstable interpersonal relationships, and unstable self-image that begin to develop in children and adolescents when exposed to environmental risk factors. Risk factors that are very often influencing are family and peer group relationships. BPD is also an entry point for developing into bipolar disorder. Therefore, effective interventions should be targeted, early preventing the development of affect dysregulation in the development of the borderline personality disorder by reducing exposure to environmental risk factors. Keywords: borderline personality disorder, maladaptive parenting, bullying.

Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study.

This longitudinal study aimed to validate the biosocial theory of borderline personality disorder (BPD) by examining the transactional relationship between individual vulnerabilities and parental invalidation, and their links to BPD symptoms. We recruited a sample of 332 adolescents (mean age = 14.18 years; 58.3% female) residing in Singapore and administered self-report measures across three time-points (six months apart). Results from our path analytic model indicated that parental invalidation, impulsivity, and emotional vulnerability exhibited unique predictive associations with emotion dysregulation six months later. There was also a reciprocal prospective relationship between emotion regulation difficulties and BPD symptoms. Using random-intercepts cross-lagged panel models, we found partial evidence for a within-individual reciprocal relationship between parental invalidation and emotional vulnerability, and a unidirectional relationship of within-individual changes in impulsivity positively predicting changes in parental invalidation six months later. Overall, the study provided partial empirical support for the biosocial model in a Singaporean context.

Factors Associated with Treatment Response at 1-Year Follow-Up from a Residential Substance Use Disorder Programme for Young People Aged 16–24 Years

AbstractIdentifying correlates of treatment response may help to improve outcomes for adolescents and young people with substance use disorder (SUD). We assessed treatment response in an adolescent/young person-specific community-based residential SUD programme located in NSW, Australia. Participants (N = 100) were aged 16–24 years and recruited between 2018 and 2020 from a cohort study investigating treatment outcomes over time. We assessed treatment response using available data at 1-year follow-up (n = 24). Approximately one third (n = 9) of participants were classified as responders at 1-year follow-up (i.e. scoring below the clinical cut-off on the Brief Symptom Inventory Global Severity Index). At treatment entry, responders had higher levels of self-efficacy (d = 1.04), better functional status (d = 1.09), and less borderline personality disorder (BPD) symptoms (d = 1.26). Exploratory whole-sample analyses indicated over half of participants (56%) screened positively for a diagnosis of BPD at treatment entry, which was associated with more severe global psychiatric symptoms (d = .85), poorer functional status, (d = .76), lower self-efficacy (d = .73), higher substance use severity (d = .46), yet better cognitive functioning (d = .75). Findings suggest that comorbid BPD is common in this setting and may contribute to poorer outcomes for adolescents and young people with SUD.

The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

Introduction: Borderline personality disorder (BPD) affects approximately 1%-3% of the population. As the most common personality disorder, BPD features behavioural, emotional and social dysfunctions. It often co-occurs with self-harm, suicidal tendencies and substance abuse. To date, pharmacological treatment does not provide sufficient therapeutic effects. The aim of our study is to analyse the neurobiological, genetic and environmental components in the aetiopathogenesis of BPD and to collect data on the innovative use of lithium and naltrexone in the therapy of BPD. Methods: Basing on PubMed and Google Scholar databases using the following keywords: borderline, lithium, naltrexone for papers published from 1979 to 2022. Results: Difficult childhood, and emotional, sexual and physical abuse are the strongest predictors of BPD development. The core symptoms of BPD may be related to dysfunction of the serotonin, dopaminergic, endogenous system and opioid systems. Variation in 5-HTT, COMT, FKBP5 and oxytocin receptor genes may influence the course of BPD. Imaging studies have shown structural and functional abnormalities in the prefrontal cortex, amygdala and hippocampus. Lithium reduces impulsivity, aggression, suicidal tendencies and self-harm in BPD. Naltrexone may effectively reduce self-harm without suicidal tendencies, impulsivity, substance abuse and suicidality. Conclusions: No unified model has been developed to account for environmental, genetic and neurobiological components in the pathogenesis of BPD. Understanding the mechanisms is a crucial step towards personalising treatment. The use of lithium and naltrexone may have positive therapeutic effects. Randomised clinical trials are required to establish the efficacy and safety of both drugs in long-term treatment. Keywords: borderline, lithium, naltrexone

Effective therapeutic components in Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder.

The study aimed to examine the relative contribution to borderline personality disorder (BPD) symptom change of two potential effective therapeutic components in a manualized group psychotherapy (Systems Training for Emotional Predictability and Problem Solving; STEPPS): development of emotional/behavior regulation skills and group alliance. A repeated measures design assessed BPD symptom change over time, use of behavior and emotion regulation skills taught in STEPPS, and perceptions of global alliance within the group. Data were analyzed using hierarchical multiple regression. Additional qualitative feedback was analyzed using quantitative content analysis. Data were collected from 14 STEPPS groups across three NHS Trusts. Forty participants completed the study and were included in the final analysis. Self-reported skill acquisition throughout STEPPS treatment and satisfaction with intragroup relationships at the group midpoint were associated with improvement in BPD symptoms at the end of treatment, once symptoms at the start and mid-point of treatment had been controlled for. These two factors also emerged as the top two factors cited in qualitative feedback to explain subjective improvements observed as a result of STEPPS treatment. This is the first study to investigate and find support for acquisition of emotion and behavior regulation skills in STEPPS and satisfaction with intragroup relationships as potential effective therapeutic components in the treatment. Causal relationships cannot be concluded from this study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BPD compass: A randomized controlled trial of a short-term, personality-based treatment for borderline personality disorder.

Borderline personality disorder (BPD) is a heterogeneous condition that is particularly associated with three broad personality dimensions: neuroticism (i.e., high negative affectivity), agreeableness (i.e., low antagonism), and conscientiousness (i.e., low disinhibition). The purpose of the present study was to explore whether treatment with BPD Compass, a novel personality-based intervention for BPD, results in greater reductions in BPD symptoms, neuroticism, agreeableness, and conscientiousness compared to a waitlist control (WLC) condition. We also aimed to characterize within-treatment effects for participants assigned to the BPD Compass condition and evaluate patients' satisfaction with treatment. Participants (N = 51; Mage = 28.38; 83.3% female; 93.8% White; 54.2% sexual minority) meeting DSM-5 criteria for BPD were enrolled in a randomized controlled trial to evaluate the efficacy of BPD Compass. Patients were randomly assigned to receive 18 sessions of BPD Compass or complete an 18-week waiting period. BPD Compass led to larger reductions in BPD symptoms (assessor-rated [β = -0.47] and self-reported [β = -0.62]) and neuroticism (β = -0.37), but not agreeableness (β = 0.08) or conscientiousness (β = 0.10), compared to the WLC condition. Within the BPD Compass condition, pre- to posttreatment improvements in BPD symptoms, neuroticism, and conscientiousness were significant and large in magnitude (Hedges' gs: -1.38 to -1.08). Patients were highly satisfied with BPD Compass and generally perceived it to be an appropriate length. Thus, BPD Compass may be an accessible and useful complement to more specialty or intensive treatments for BPD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder

Stressful social situations like social exclusion are particularly challenging for patients with borderline personality disorder (BPD) and often lead to dysfunctional reactive behaviour of aggression and withdrawal. The autonomous signature of these core symptoms of BPD remains poorly understood. The present study investigated the parasympathetic response to social exclusion in women with BPD (n = 62) and healthy controls (HC; n = 87). In a between-subjects design, participants experienced objective social exclusion or overinclusion in the Cyberball task, a virtual ball-tossing game. Need threat scores served as individual measures of perceived exclusion and the resulting frustration of cognitive–emotional needs. Five-minute measurements of high-frequency heart rate variability (HF-HRV) at three time points (before, during, after Cyberball) indicated parasympathetic tone and regulation. We observed a trend towards lowered baseline HF-HRV in BPD vs. HC in line with previous findings. Interestingly, the parasympathetic response of patients with BPD to objective and perceived social exclusion fundamentally differed from HC: higher exclusion was associated with increased parasympathetic activation in HC, while this autonomic response was reversed and blunted in BPD. Our findings suggest that during social stress, the parasympathetic nervous system fails to display an adaptive regulation in patients with BPD, but not HC. Understanding the autonomous signature of the stress response in BPD allows the formulation of clinically relevant and biologically plausible interventions to counteract parasympathetic dysregulation in this clinical group.

Self-disgust in patients with borderline personality disorder. The associations with alexithymia, emotion dysregulation, and comorbid psychopathology

BackgroundSelf-disgust is a negative self-conscious emotion, which has been linked with borderline personality disorder (BPD). However, it has not yet been investigated in relation to both emotion dysregulation and alexithymia, which are recognized as crucial to BPD. Therefore, the aim of our study was to measure these variables and examine the possible mediational role of emotional alterations and comorbid anxiety and depression symptoms in shaping self-disgust in patients with BPD and healthy controls (HCs).MethodsIn total, the study included 100 inpatients with BPD and 104 HCs. Participants completed: the Self-Disgust Scale (SDS), Disgust Scale – Revised (DS-R), Toronto Alexithymia Scale (TAS-20), Emotion Dysregulation Scale short version (EDS-short), Borderline Personality Disorder Checklist (BPD Checklist), State-Trait Anxiety Inventory (STAI), and Center for Epidemiologic Studies Depression Scale (CESD-R).ResultsInpatients with BPD showed higher self-disgust, alexithymia, emotion dysregulation, core and comorbid symptoms levels, and lower disgust sensitivity. Alexithymia, emotion dysregulation, and trait anxiety partially mediated between BPD diagnosis and self-disgust. The relationship between the severity of BPD symptoms and self-disgust was fully mediated by alexithymia, emotion dysregulation, depressive symptoms, and trait anxiety.ConclusionsThe results of our study may imply the contribution of emotion dysregulation, alexithymia, and comorbid psychopathology to self-referenced disgust in BPD.

Negative urgency, distress tolerance, and symptoms of substance use, eating, and borderline personality disorders in treatment-seeking young people.

Negative urgency (NU) and distress tolerance (DT) are two similar yet distinct constructs with putative transdiagnostic relevance, particularly across psychopathology characterized by impulsivity (e.g., substance use disorders [SUD], eating disorders featuring binging and/or purging ED-B/P, and borderline personality disorder [BPD]). Yet, there remains a lack of research into NU and DT across SUD, ED-B/P, and BPD symptomatology in clinical populations. The present study sought to elucidate the transdiagnostic utility of NU and DT across impulsive-type psychology by examining the unique and interactive roles of NU and DT across SUD, ED-B/P, and BPD symptomatology within a treatment-seeking sample of young people. Participants (N = 385; 62.3% female; aged 16-25 years) were recruited from youth health services across Melbourne, Australia. Participants completed an online survey including self-report measures of NU and DT as well as SUD, ED-B/P, and BPD symptoms. Mixed effects logistic regression was used to explore unique and interactive associations of NU and DT with symptoms. Both NU (adjusted odds ratio [ORadj ] = 1.22; 95% confidence interval [CI] = [1.16, 1.28]) and global DT (ORadj = 0.59; 95% CI = [0.47, 0.74]) uniquely predicted symptoms. However, associations with global DT and most of its components differed across psychopathology types. No significant interactions between NU and DT in predicting symptoms were found. These results support the transdiagnostic utility of NU across SUD, ED-B/P, and BPD, while suggesting the role of DT across these disorders is more nuanced. These findings have important implications for NU and DT as potential intervention targets.

Supplemental Material for Effects of Borderline Personality Disorder Symptoms on Dialectical Behavior Therapy Outcomes for Eating Disorders

Supplemental Material for Effects of Borderline Personality Disorder Symptoms on Dialectical Behavior Therapy Outcomes for Eating Disorders

Prospective Impact of Borderline Personality Disorder Symptoms and Social Media Addiction on Coping and Health Related Outcomes During a Global Pandemic

Prospective Impact of Borderline Personality Disorder Symptoms and Social Media Addiction on Coping and Health Related Outcomes During a Global Pandemic

Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients.

Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.

Hurting the Grandiose Self: Examining Presence, Frequency, and Functions of Nonsuicidal Self-Injury in Pathological Narcissism.

The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (N = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (n = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with all interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.

Are you borderline or did you grow up without a racial identity? Black mixed-race identity disturbance and an unstable sense of self

This article draws on the lived experience of the author to discuss the Black mixed-raced experience of being diagnosed with borderline personality disorder (BPD), particularly in relation to the BPD symptom of troubled identities. This article argues that what psychiatry pathologises as a troubled identity within BPD is actually an everyday experience for a mixed-race person growing up between cultures. This article goes on to discuss Black mixed-race people’s identity through a lens of performativity, how this presents and is weaponised in psychiatry, and why it is important for psychiatry to understand Black mixed-race identities.