Measures Of Borderline Personality Disorder Research Articles

Prospective prediction of treatment outcomes in adolescents: A head-to-head comparison of alternative model for personality disorder versus borderline personality disorder.

Despite substantial evidence in support of the alternative model for personality disorder (AMPD) that has accumulated over the last decade, a gap remains in terms of head-to-head comparisons of the predictive power of Section II categorical diagnoses versus Section III AMPD diagnoses for clinical outcomes. The current study uses archival data from a naturalistic treatment outcome study in an adolescent psychiatric inpatient sample to compare the predictive power of the Section III AMPD (combined Criterion A and B assessment) versus Section II borderline personality disorder (BPD) in predicting treatment outcomes from admission to discharge. Outcomes in general psychiatric severity and emotion dysregulation were assessed in a sample of 59 adolescents (76.3% female, Mage = 15.27, SD = 1.17) at admission and at discharge on average about a month later. Results showed that, on average, predictive power of both AMPD measures and BPD were relatively modest. However, the AMPD, operationalized through combined measures of identity diffusion and maladaptive traits, was a stronger predictor of reduction in general psychiatric severity than a measure of BPD. The findings of the study add to a growing body of literature pointing to the advantages of Section III AMPD over Section II categorical diagnosis for clinical utility in predicting treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and Validation of the Five-Factor Borderline Inventory-Super Short Form and Screener.

The Five-Factor Borderline Inventory (FFBI) and FFBI-Short Form (FFBI-SF) are 120-item and 48-item measures that assess the underlying maladaptive personality traits of borderline personality disorder (BPD). The purpose of this study was to develop a super short form (FFBI-SSF) and an FFBI-Screener to facilitate the use of dimensional trait measures for BPD. Using item response theory analyses, the 48-item measure was reduced to 22 items using a large undergraduate sample (N = 1300) and then retested using a Mechanical Turk sample (N = 602), demonstrating strong replicability. IRT was again used to further reduce the measure from 22 items to four items to provide a brief screening tool. Correlations of the FFBI-SSF and Screener with measures of BPD-related variables were compared across five samples (N = 919, 204, 580, 281, and 488). Overall, the FFBI-SSF showed similar relations to the FFBI-SF at the full scale and domain-level scales, while the FFBI-screener demonstrated similar relations at the full scale level. This super short form and screener may best be used in large-scale research studies or as part of a screening tool in clinical settings.

Associations between different measures of personality pathology and resting-state autonomic function among adolescents.

Borderline personality disorder (BPD) has been associated with a reduced functional flexibility of the autonomic nervous system (ANS), indexed by decreased vagally mediated heart rate variability (vmHRV). Employing a comprehensive Section II-based assessment approach and a partial Section III-based assessment approach (including Criterion A of the alternative model of personality disorders [AMPD]), the present study investigates how different conceptualizations of personality disorders (PDs) according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition relate to ANS function. Using the BPD section of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II, a Section II-based assessment approach) and the Semistructured Interview for Personality Functioning DSM-5 (STiP-5.1, a Section III-based assessment approach), we conducted linear regression analyses to examine how categorical (BPD diagnosis) and dimensional (severity and domain) measures of PD are associated with ANS activity among adolescent psychiatric patients (N = 147, Mage = 15.25 years). Replicating earlier findings, analyses revealed a statistically significant positive association between the SCID-II measures of BPD and heart rate (HR), b = 0.43, t(59) = 3.57, p = .001, f = .57, as well as a statistically significant negative association between the SCID-II measures of BPD and vmHRV, b = -0.34, t(59) = -2.74, p = .008, f = .47. Neither the STiP-5.1 total score nor the subscales of the Level of Personality Functioning Scale (LPFS) were associated with HR or vmHRV. The present findings indicate that the SCID-II may capture features of PD that are more informative of variance in physiological function than the STiP-5.1. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Influence of Family Intervention on the Treatment of Adolescent Patients With Borderline Personality Disorder: A Literature Review.

Borderline personality disorder (BPD) is a widespread mental disorder linked to functional impairment and a high suicide rate. Adolescent BPD is now recognized as a reliable and valid diagnosis in psychiatric classification systems and national treatment guidelines. Family issues, such as parental underinvolvement or neglect, may affect the mentalization process and attachment styles. Thus, the family is crucial to understanding the etiology of BPD in adolescents. Family intervention was primarily used as a component of the psychotherapy strategy in the current treatment of BPD, including pharmacological and psychotherapy measures. The primary objective of this study is to review previous research on the effectiveness of family intervention in treating adolescents with BPD.Although there is currently little data, studies in this paper show that family intervention is a realistic treatment option for adolescents with BPD.

Borderline Personality Disorder (BPD) and Complex Posttraumatic Stress Disorder (CPTSD): A Network Analysis in a Highly Traumatized Clinical Sample

Whether complex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and disturbances in self-organization (DSO) are interconnected with BPD in a clinical sample of polytraumatized individuals (N = 330). Participants completed measures of life events, CPTSD, and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce, with "Affective Dysregulation" items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness from BPD. Implications for treatment are discussed.

Borderline personality disorder in adolescence: The role of narrative identity in the intrapsychic reasoning system.

Borderline personality disorder (BPD) manifests in adolescents, serving as a forerunner for later dysfunctionality and life constraints. BPD is characterized by multiple difficulties in understanding the self and others, and it has been implied that intrapsychic processes of reasoning might be the primary driver of these disturbances. In this study, we examined the role of narrative identity, the dynamic and evolving story people construct about their personal pasts, presents, and futures, as a potentially important but largely overlooked aspect of temporal reasoning within the intrapsychic system of adolescents with BPD features. A total of 174 American inpatient adolescents (Mage = 15.12 years, SD = 1.52) completed self-report measures of BPD upon hospital admission. Adolescents' narrative identity (i.e., themes/future wishes of agency and communion), mentalizing, and emotion dysregulation were assessed. Results showed that narrative identity (i.e., thwarted themes of agency and communion) was associated with lower mentalizing and higher emotional dysregulation capacities, supporting narrative identity's relation to other relevant aspects of intrapsychic processes of reasoning in BPD. Regression analyses showed that both higher levels of emotion dysregulation and more thwarted narrative themes of agency (but not mentalizing) were significantly associated with BPD features. Intriguingly, narrative identity (i.e., thwarted themes of agency) showed incremental validity in accounting for features of BPD, over and above emotion dysregulation. It is concluded that disturbances related to narrative identity might be a prominent component of the intrapsychic reasoning system in BPD and should be included in future work on the topic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Narrative identity in borderline personality disorder.

Borderline personality disorder (BPD) is a severe psychiatric condition that is associated with functional impairment and pathological traits. It has been argued that identity impairment is one of the core features of BPD, which can be manifested in different ways, including fragmented autobiographical narratives. Here, we considered both the traditional and modern conceptualizations of BPD to examine the relation between identity impairment, as operationalized through autobiographical memory, and features of BPD. We hypothesized that BPD features would be associated with higher levels of fragmentation in narrative identity, narrative intimacy, and narrative coherence in participants' autobiographical memory. To test this hypothesis, we recruited 298 university students who were administered a series of self-report measures of BPD and were asked to describe an autobiographical memory about a turning point in their lives. Narrative identity, but not narrative intimacy nor coherence, was the dominant predictor of BPD features. We discuss our findings in terms of how individuals with features of BPD struggle with many aspects of a distorted sense of self. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effectiveness of dialectical behavior therapy skills training group for adults with borderline personality disorder.

This study evaluated the effectiveness of the Dialectical Behavior Therapy Skills Training Group (DBT-ST) component of DBT. Participants (N = 114) attended an 18-20-week DBT-ST. The study utilized a quasi-experimental design with a within-persons control group for a measure of borderline personality disorder (BPD) symptoms (at referral), and emergency department (ED) presentations, and psychiatric bed-days (both assessed for 6 months pre- and post-intervention). Primary outcomes were the number of BPD symptoms, psychological distress, depression, rate of ED presentations, and psychiatric inpatient bed-days. After completing DBT-ST, participants had reduced BPD symptoms, psychological distress, and depression (p < 0.001). The waitlist control group showed no improvement in BPD symptoms (p = 0.085). The rate of ED presentations was reduced (p = 0.001). There was no reduction in psychiatric inpatient bed-days (p = 0.160), likely due to insufficient power. DBT-ST participation in addition to treatment-as-usual is an effective treatment for people with BPD.

The Development of the Informant Five-Factor Borderline Inventory.

Borderline personality disorder (BPD) is one of the most studied personality disorders and is associated with significant outcomes such as suicide. Although BPD is represented in DSM-5 as a categorical diagnosis, it may be better characterized dimensionally, such as from the perspective of the five-factor model of general personality (FFM). The Five-Factor Borderline Inventory (FFBI) assesses BPD from the perspective of maladaptive variants of FFM traits. Previous research suggests that informant-reports may increase the validity of personality disorder assessment, providing additional information that may supplement self-report. Therefore, the current study developed an informant measure of the FFBI, Informant Five-Factor Borderline Inventory (IFFBI) and examined its convergent and discriminant validity compared with the self-report FFBI, FFM, and traditional measure of BPD. Overall, the IFFBI demonstrated good convergent validity and moderate discriminant validity with the FFBI, FFM, and other traditional measures of BPD.

Validity of A Web-based Measure of Borderline Personality Disorder: A Preliminary Study

ABSTRACT Purpose Early identification of borderline personality disorder (BPD) is important as timely interventions are beneficial and cost-effective. Unrecognized BPD not only results in suffering for individuals and their families, but also leads to considerable social costs. Although web-based measures have the potential to facilitate screening assessment of BPD for research and clinical purposes, little is known about whether the results of web-based measures of BPD are valid. This preliminary study aims to examine the validity of a web-based measure of BPD. Method We analyzed data from five independent samples (N = 828 in total). Results The web-based BPD measure had a consistent relationship with relevant variables, including trauma exposure, mental well-being, depression, post-traumatic stress, dissociation and psychotic features across samples. It was also strongly correlated with another BPD measure. The web-based BPD measure could discriminate between participants with and without BPD and the discrimination performance was excellent (area under the curve =.853). Discussion The initial findings suggest that the web-based BPD measure used in the present study is valid and may be helpful for research and screening purposes, although it should be followed up with a more comprehensive assessment in clinical settings. Implications are discussed. Given the limitations in this study, further studies are needed.

The moderating role of dissociation in the relation between borderline features and factors of self-injury in adolescents.

Self-injurious behaviours (SIB) occur frequently in individuals with borderline personality disorder (BPD). While multiple factors may explain the association between SIB and BPD, studies in adults have pointed to dissociation as factor worth considering. However, this relationship has not been examined in adolescents. The current study investigated the role of dissociation as a potential moderator between borderline features and SIB, with the expectation that this association would be stronger in the presence of dissociation. One hundred forty-four adolescent inpatients were compared on measures of BPD, non-suicidal self-injury (NSSI) and suicidal behaviour. The relationships between borderline features and self-injury outcomes were evaluated using linear and logistic regression with dissociation as a moderator. Borderline features and dissociation were found to be significantly associated with history of NSSI, history of suicide attempt, suicidal ideation (SI) intensity and SI severity. However, dissociation was a significant moderator only in the relationship between borderline features and SI intensity. Higher levels of dissociation were associated with more engagement with suicidal thoughts but did not necessarily contribute to SIB. Further research into differential patterns of association of self-injury in patients with BPD may investigate other models where dissociation may more strongly factor into outcomes. © 2020 John Wiley & Sons, Ltd.

A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder.

Risky sexual behavior (RSB) during adolescence increases risk for sexually transmitted diseases and teenage pregnancy. Youth with psychiatric diagnoses are more likely to engage in RSB, and borderline personality disorder (BPD) in adolescence may be particularly relevant to RSB. It is not yet clear whether adolescents with BPD engage in higher levels of RSB than adolescents with other psychiatric diagnoses. The present study examined RSB and correlates of RSB among adolescent inpatient females with and without BPD. One hundred twenty-three female adolescent inpatients (Mage = 15.15, 71.5% Caucasian, 40.6% BPD) completed an interview to assess BPD diagnosis and measures of BPD traits, RSB, attitudes and perceived norms related to RSB, and sexual self-efficacy. Results indicated no differences in RSB based on BPD diagnosis. However, the BPD group evidenced significantly lower self-efficacy to refuse sex, and riskier attitudes and perceived peer norms about sexual behavior than inpatient controls. When examined dimensionally using borderline traits and controlling for level of psychopathology, borderline traits were significantly related to lower self-efficacy to refuse sex. Results suggest that adolescent girls with BPD do not engage in higher levels of RSB than inpatient psychiatric controls; however, riskier attitudes and norms related to RSB, and particularly lower self-efficacy to refuse sex, may influence adolescent girls with BPD or BPD traits to engage in higher levels of RSB later in life and therefore present important preventative treatment targets. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relation between epistemic trust and borderline pathology in an adolescent inpatient sample

BackgroundRecent extensions of mentalization theory have included the hypothesis that a reduced capacity for epistemic trust in the context of attachment relationships may represent a core vulnerability for the development of borderline personality disorder (BPD). The first aim of the current study was to explore empirical relationships between epistemic trust and symptoms of BPD. The second aim was to explore the effect of epistemic trust on treatment response.MethodsData were collected from 322 inpatient adolescents. The Inventory of Parent and Peer Attachment (IPPA) trust in mother and father subscales were used to approximate epistemic trust in the absence of a validated measure. A multimodal approach was used to measure BPD including self-report, parent-report, and interviewer ratings. Regression analyses were performed to explore the relationship between IPPA trust scores and measures of BPD. Mixed-design analyses of variance were conducted to evaluate whether self-reported parent trust at admission influenced progress in treatment.ResultsAs hypothesized, results indicated that reduced IPPA trust in parents correlated with BPD symptoms across various measures. Levels of IPPA trust in parents at admission did not moderate a reduction in BPD symptoms over the course of treatment.ConclusionsThis study provides support for the theoretical association between deficits in epistemic trust and BPD while also highlighting the need for a validated measure of epistemic trust. Although parent trust at admission did not moderate a reduction in BPD symptoms over the course of treatment, this result may suggest that progress in treatment, and perhaps the ability to cultivate trust in the treatment setting and providers, may not be overly determined by levels of parent trust.

The Italian version of the Reflective Functioning Questionnaire: Validity data for adults and its association with severity of borderline personality disorder.

IntroductionImpairments in the ability to understand others and the self in terms of internal mental states (reflective functioning [RF] or mentalizing) are thought to play a key role in the development of borderline personality disorder (BPD). The first aim of this study was to validate the Italian version of the Reflective Functioning Questionnaire (RFQ), a brief self-report measure of RF, by examining its factor structure with Principal Component Analyses (PCA), and correlations with constructs that should be theoretically related to RF. In addition, we investigated whether the RFQ could empirically distinguish between healthy controls and carefully diagnosed BPD patients using Research Operating Curve methods, and was related to severity of borderline pathology as measured with the Shedler–Westen Assessment Procedure (SWAP), an observer-rated measure of BPD pathology.MethodsAn Italian translation of the RFQ was administered to a sample of 154 healthy controls and a clinical sample of 59 BPD patients diagnosed with the Structured Clinical Interview for DSM-IV Axis II disorders. Clinical severity of BPD was assessed with the SWAP. Normal controls completed self-report inventories of constructs related to RF (mindfulness, empathy, Theory of Mind, alexithymia, and autistic traits).ResultsPCA confirmed the a priori factor structure in the Italian translation of the RFQ, showing two subscales that measure certainty and uncertainty about mental states, with satisfactory reliability and construct validity. These dimensions also distinguished BPD patients from healthy controls (p < 0.05). ROC analyses showed that the uncertainty subscale discriminated BPD patients from healthy individuals (area under the curve = 78%, cut of 4.5 points, sensitivity = 73%, specificity = 68%). Within the patient group, regression analyses showed uncertainty about mental states to have a significant unique contribution in predicting BPD severity (p < 0.05), explaining 12% of the variance.ConclusionsResults largely supported the reliability and validity of the Italian version of the RFQ. These findings also provide further evidence for the role of impairments in mentalizing and reinforce the rationale for offering mentalization-based interventions to individuals with this disorder.

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants.

Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group. A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week. A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships. This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.

Borderline personality disorder and mental health care utilization: The role of self-harm.

The current study examined the associations for borderline personality disorder (BPD) and a specific trait of the disorder, self-harm, with mental health care utilization. Our sample consisted of 145 psychiatric inpatients who completed 3 measures of BPD (Personality Diagnostic Questionnaire-4 [PDQ-4], McLean Screening Inventory for borderline personality disorder [MSI-BPD], Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire [SCID-II-PQ]) and the Self-Harm Inventory (SHI). In relationship to mental health care utilization, the correlation for the SHI was significantly larger than those for the PDQ-4, MSI-BPD, or SCID-II-PQ. Thus, self-harm was significantly better at detecting mental health care utilization than was the overall BPD construct, which indicates that some of the more severe manifestations of the disorder are the most predictive of impairment in functioning. These findings also call into question whether BPD (and by extension, personality pathology in general) is most useful in these symptom constellations as opposed to focusing on specific maladaptive traits. (PsycINFO Database Record

The Five Factor Borderline Inventory: Behavioral outcomes across time.

The Five-Factor Borderline Inventory Short Form (FFBI-SF) is a 48-item dimensional measure of borderline personality disorder (BPD) that was developed from the Five-factor model (FFM). Previous research has examined the relationships of the FFBI-SF to the FFM and BPD. The purpose of the current study was to investigate the relationship of FFBI-SF scales with behavioral outcomes, such as self-injury, physical fights, panic symptoms, promiscuous sex, theft, attempted suicide, reckless driving, and binge eating. A potential advantage of the FFBI-SF, relative to other measures of BPD, is the provision of subscales, which provides a more precise and differentiated assessment. In the current study, the predictive validity of the FFBI-SF in relation to various impulsive behaviors was investigated across a 2-month time period. Additional comparisons were also made with respect to a more traditional measure of borderline personality disorder and an assessment of the normal range of the FFM. Undergraduate students in psychology courses (T1 = 938, T2 = 284, T3 = 163) and workers from Amazon Mechanical Turk (T1 = 215, T2 = 167, T3 = 157) were administered personality measures and a measure of impulsive behaviors across 3 time points. The results are discussed with respect to the comparative validity of the FFBI-SF, relative to traditional measures of borderline personality disorder and the FFM. Overall, the study provided evidence that the FFBI-SF is able to predict specific maladaptive behaviors over time and therefore may be useful in clinical and research settings. (PsycINFO Database Record

Parent-adolescent concordance on the Revised Diagnostic Interview for Borderlines (DIB-R) and the Childhood Interview for Borderline Personality Disorder (CI-BPD).

While the degree of concordance between parent and adolescent self-report of internalizing and externalizing pathology is well studied, virtually nothing is known about concordance in borderline pathology and the implication of parent-adolescent discrepancies for outcomes. The present study aimed to (1) examine discrepancies between parents and adolescents on two interview-based measures of borderline personality disorder (BPD)-the Revised Diagnostic Interview for Borderlines (DIB-R22 ) and the Childhood Interview for Borderline Personality Disorder (CI-BPD23 ); and (2) investigate the implications of discrepancies for clinical outcomes. Diagnostic concordance on the DIB-R and CI-BPD showed rates of 82% and 94% respectively, with lower concordance demonstrated for dimensionally scored variables. Standardized difference scores between adolescent and parent reports on both borderline measures were significantly correlated with few interview-based axis I diagnoses as reported by parents, but not adolescents themselves. Implications regarding the use of each measure for the assessment and diagnosis of borderline personality disorder are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Callous-unemotional traits, borderline personality, and self-injury in gothic subculture

The present study investigates individual characteristics of a sample of young adults from gothic subculture, in terms of personality traits (i.e., borderline personality and callous-unemotional traits), prevalence and functions of non-suicidal self-injury behaviours (i.e., internal emotion regulation, external emotion regulation, social influence, and sensation seeking). Fifty-one young adults (28 girls and 23 boys, mean age = 26.20, SD = 4.61) were recruited at a gothic meeting in Italy. They completed self-report questionnaires related to self-injury behaviours and self-injury functions, along with measures of borderline personality disorder and callous-unemotional traits. The results indicated that nearly 65% of the participants reported having committed self-injury at least once. Moreover, both bivariate and multivariate analyses indicated that self-injury behaviours were related to borderline personality and internal emotion regulation function. Lastly, association between considered personality traits and self-injury functions were investigated. Overall, results indicated that in gothic subculture self-injury has the function of regulating emotion to maintain the integrity of the Self and is related to the perception of a traumatic reality in which derealization coexists with extreme self-directed aggression.