Model Of Borderline Personality Disorder Research Articles

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.

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.

Does trait mindfulness mediate the relationship between borderline personality symptoms and emotion dysregulation?

BackgroundEmotion dysregulation is core to many biopsychosocial models of Borderline Personality Disorder (BPD) and is often targeted as part of their associated psychological therapies. Several distinct specialist psychotherapies are thought to be effective for people diagnosed with BPD but it is unclear whether they share common change mechanisms. Some evidence suggests that Mindfulness Based Interventions improve competency in emotion regulation as well as trait mindfulness, which are both plausibly associated with good treatment outcomes. It is unclear whether the association between the severity of BPD symptoms and emotion dysregulation is mediated by trait mindfulness. Would improvement in trait mindfulness mediate an association between lower severity of BPD symptoms and fewer problems of emotion dysregulation?MethodsOne thousand and twelve participants completed online, single time-point, self-report questionnaires.ResultsAs predicted, the severity of BPD symptoms was significantly and positively associated with emotion dysregulation with a large effect size (r = .77). Trait mindfulness mediated this relationship as the 95% confidence interval for the indirect effect did not cross zero (size of direct effect = .48 and size of indirect effect = .29 [.25, .33].ConclusionsThe relationship between the severity of BPD symptoms and emotion dysregulation was confirmed in this dataset. As hypothesised, this relationship was mediated by trait mindfulness. Process measures of emotion dysregulation and mindfulness should be included in intervention studies for people diagnosed with BPD to understand if improvements in these factors are a universal occurrence with good response to treatment. Other process measures should also be explored to identify other factors involved in the relationship between BPD symptoms and emotion dysregulation.

False Memory and Borderline Personality Features

Borderline Personality Disorder (BPD) is a mental disorder characterized by significant impairment in intrapersonal and interpersonal functioning, as well as patterns of personality pathology. Memory deficits are not recognized as a core symptom of BPD, but individuals with BPD symptoms have long been suspected to have inaccurate perceptions, disturbed memory processes, and an increased tendency to develop false memories. In the present study, we examined whether there was an association between BPD features and the production of false memories in the Deese-Roediger-McDermott (DRM) paradigm—a laboratory-based procedure that is frequently used to investigate false memory. We also compared the traditional categorical BPD criteria (DSM-5 Section II) with the alternative model of personality disorders BPD criteria (DSM-5 Section III) in predicting memory performance. A total of 298 university students completed the McLean Screening Instrument for Borderline Personality Disorder, SCID-II Personality Questionnaire, Borderline Personality Disorder Impairment Scale, Personality Inventory for DSM-5, Beck Depression Inventory, Dissociative Experiences Scale, and Traumatic Life Events Questionnaire. Participants were also tested using both traditional DRM word lists as well as word lists that were specifically associated with BPD features. Using the traditional diagnosis of BPD, BPD features were correlated with higher false memory for positive information; in the alternative model of BPD, identity impairment and anxiousness were correlated with the overall false memory score. We also found that trauma and dissociation mediated the relation between BPD and false memory. These findings are discussed in terms of how the consequences of trauma, such as dissociation and identity disturbance, are associated with false memory. Whether false memory rates are higher in a clinical population of BPD patients than in non-clinical volunteers remains to be determined.

The predictive validity of the DSM-5 alternative model for borderline personality disorder: Associations with coping strategies, general distress, rumination, and suicidal ideation across one year.

The DSM-5 Alternative Model for Personality Disorders (AMPD) characterizes borderline personality disorder (BPD) in part as a constellation of maladaptive personality trait facets including emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk-taking, and hostility. Previous studies have supported the construct validity of AMPD-BPD; however, research examining its predictive validity in relation to theoretically and clinically relevant constructs remains needed. The present study investigates the longitudinal relationships between AMPD-BPD and general distress, rumination, and suicidal ideation, as well as adaptive and maladaptive coping targeted in Dialectical Behavior Therapy (DBT) in a sample of participants with elevated BPD symptomology. We also examined if dysfunctional coping skill use at 9-month follow-up explained the relationship between baseline BPD traits and outcomes at 1-year. There were significant correlations between baseline trait BPD with dysfunctional coping skill use at 9-month follow-up and psychological distress and rumination at 1-year follow-up. Dysfunctional skill use exhibited a significant indirect effect in the association between trait BPD and rumination after 1 year. The findings of this study support the construct validity of AMPD-BPD that can inform treatment and research.

The role of youths' cardiac autonomic balance and parental responses to youth emotion in vulnerability to borderline personality disorder development.

Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system response and parental responses to youth negative emotions on severity and exacerbation of youths' BPD features during the transition to adolescence. The sample consisted of 162 psychiatric youth (10-14 years; 47.2% female) and their parents. At baseline, youth and their parents completed a lab-based conflict discussion during which parasympathetic and sympathetic nervous system response were measured and indices of sympathetic-parasympathetic balance and coactivation/coinhibition were calculated. Youth also reported on supportive and non-supportive parental responses. At baseline and after 9 months, youth self-reported on their BPD features. Results demonstrated that shifting toward sympathetic dominance independently predicted exacerbation of BPD across 9 months. Additionally, fewer experiences of supportive parental responses and more non-supportive parental responses were associated with greater severity of BPD features in youth. This study highlights the role of autonomic response to parent-child conflict as well as the significance of parental responses to youth emotion for the development of BPD during this developmental window.

Emotion regulation strategies in borderline personality disorder: a meta-analysis

ABSTRACT Objectives Many theoretical models pinpoint emotional dysregulation not only as a symptom of borderline personality disorder (BPD) but also as a component in the development and maintenance of the disorder. In this meta-analysis, results from studies that examined the association between emotion regulation strategies and BPD symptoms were systematically analysed. Design A quantitative meta-analysis approach was used to systematically assess previous research studies and conduct subgroup and meta-regression analysis to test for theoretical, methodological and demographic moderating variables. Results Emotion regulation strategies are significantly and largely associated with BPD symptoms. Negative associations were found between BPD symptoms and acceptance (r = −.558), mindfulness (r = −.581) and reappraisal (r = −.303) and positive associations were found between BPD symptoms and avoidance (r = .528), distraction (r = .336), rumination (r = .551) and suppression (r = .449). As heterogeneity was high, moderating variables (clinical status, type of reporting, comorbidity control, type of population, mean age, percentage of females) were also investigated. Conclusion The findings highlight the need for active involvement of emotion regulation in explaining BPD psychopathology, as well as promoting interventions focused on individual emotion regulation strategies. KEY POINTS What is already known about this topic: (1) The biosocial model of BPD and dialectical behaviour therapy focuses on emotion dysregulation as a core characteristic of BPD. (2) Emotional dysregulation is a core feature of BPD and is strongly involved in the appearance and maintenance of BPD pathology. (3) Emotional regulation difficulties in BPD are also well reflected in the diagnostic criteria according to DSM-5 (APA, 2013). What this topic adds: (1) In the present review, acceptance and mindfulness are considered different emotion regulation strategies. (2) Problem solving is not seen as an emotion regulation strategy because it refers to meta-cognitive processes of dealing with emotions and does not target direct attempts to regulate emotions. (3) Psychological treatments that target the reduction of BPD associated symptoms should continue to focus on emotional dysregulation as a core component of BPD psychopathology.

The Pathogenesis of Borderline Personality Disorder: Evolution of Evidence and Treatment Implications for Two Prominent Models.

Since Stern first started his work in 1938, the field has recognized several empirically supported models of the etiology of borderline personality disorder (BPD). Two such models are the Tripartite Model of the Development of BPD and the Biosocial Development Model of BPD. The Tripartite Model of the Development of BPD suggests that it is a combination of a hyperbolic temperament, traumatic childhood experiences, and an event or series of events that trigger the onset of BPD. Whereas the Biosocial Development Model of BPD elaborates on the work of Linehan's Biosocial Theory. This model suggests a combination of an emotionally vulnerable temperament and an invalidating environment cause BPD. Over 70 years of research support these models. This article covers a detailed description of each of these models, the decades of research supporting these models, similarities, differences, treatment implications, the latest research, and future directions.

Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review.

ObjectiveRecent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.MethodsWe used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic–Pituitary–Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.ResultsThe evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.ConclusionThe biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.

Momentary borderline personality disorder symptoms in youth as a function of parental invalidation and youth-perceived support.

Parental invalidation is central to etiological models of borderline personality disorder (BPD). Previous studies relied on retrospective accounts or laboratory observations to examine these associations. There is a dearth of research assessing these constructs in daily life, and limited studies have tested the effect of parental invalidation on BPD symptoms during early adolescence, when BPD onsets. The current study took a dynamic approach to assess parents' validating and invalidating behavior and its effect on youths' BPD symptom expression in daily life, while accounting for parent-perceived helpfulness of these behaviors and youth-perceived support. A psychiatric sample of 162 early adolescents (age range = 10-14 years; 47% female) and their parent completed a four-day ecological momentary assessment study. Parents reported on the use of validating and invalidating (e.g. punishing and ignoring) behaviors during parent-child conflict, as well as perceived helpfulness of these behaviors. Youth reported on their BPD symptoms and perceived parental support. Multilevel models were used to test the between- and within-person effects of parents' validating and invalidating behaviors, parent-perceived helpfulness and youth-perceived support, and their interaction on youth's momentary expression of BPD symptoms. At the between-person level, invalidating behaviors, specifically punishing behaviors, were related to greater BPD symptoms in daily life, while ignoring behaviors were associated with fewer BPD symptoms. Youth-perceived support predicted fewer BPD symptoms. Results underscore the importance of parental invalidation for the expression of BPD symptoms in daily life and also highlight the importance of youth's subjective experience of parental support. Findings are discussed in terms of etiological and intervention models that emphasize a dyadic framework.

Validating a Dimensional Model of Borderline Personality Disorder Using Heritability and Other External Validators

Borderline personality disorder (BPD) is prevalent across clinical settings and is related to high treatment costs. Mounting evidence questions the reliability and validity of the categorical, DSM conceptualization of BPD. An alternative dimensional model of BPD derived from traits from the Personality Inventory for DSM-5 (PID-5) may have better psychometric properties than the traditional approach, but its relationship with external validators must be established. The present study assessed the validity of a PID5-derived model of BPD by examining its (a) heritability, given the strong influence of genetics on personality, and (b) association with constructs related to borderline pathology, including childhood maltreatment, alcohol and substance use, and risk-taking.

Temporal Bayesian Network modeling approach to evaluating the emotional cascade model of borderline personality disorder.

Theoretical models of personality disorders can be complex and multifaceted, making it difficult to validate such models in a comprehensive, empirical fashion. One such model of borderline personality disorder (BPD) is the emotional cascade model (Selby & Joiner, 2009), which has garnered empirical support in piecemeal fashion but has not been examined in a gestalt fashion. One way to test comprehensive models of personality pathology is with Temporal Bayesian Network (TBN) modeling, in which the relations between multiple subcomponents of a model can be specified and examined over a dynamic time frame, allowing for the modeling of positive feedback processes in addition to comprehensive model utility. In this study, we applied TBN modeling to examine the emotional cascade model in a sample of adolescents and young adults who actively self-injure, including those with BPD. TBN modeling was applied to ecological momentary assessment data provided via participant smartphone assessments for a period of 2 weeks. TBN analysis suggested that the emotional cascade model has considerable predictive utility, demonstrating substantial accuracy in predicting BPD diagnosis (with accuracy estimates around 90%) and momentary prediction of rumination, negative emotion, and dysregulated behaviors (with accuracy estimates consistently above 70% and reaching up to 100%, depending on the level of momentary prediction specificity). These findings provide support and validity to the notion that BPD may emerge from a dynamic interplay between emotional cascades and dysregulated behaviors. Implications of TBN modeling of BPD and personality disorders, in general, are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling

ABSTRACT Background: Despite concerns of conceptual similarity, increasing evidence supports the discriminant validity of Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD). However, all studies to date have assumed a categorical model of psychopathology. In contrast, dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology model (i.e. HiTOP model), recognise shared vulnerability across supposedly discrete disorders. Accounting for shared vulnerability between CPTSD and BPD symptoms may help to better reveal what is unique about these constructs. Objective: To identify the distinct and shared features of CPTSD and BPD via the application of dimensional modelling procedures. Method: Confirmatory bifactor and confirmatory factor analysis were employed to identify the optimal latent structure of CPTSD and BPD symptoms amongst a convenience sample of Israeli adults (N = 617). Additionally, structural equation modelling was used to identify risk factors associated with these constructs. Results: The latent structure of CPTSD and BPD symptoms was best explained by a bifactor model including one ‘general’ factor (i.e. vulnerability to all symptoms) and three ‘specific’ correlated factors (i.e. vulnerability to PTSD, DSO, and BPD symptoms, respectively). CPTSD symptoms were more readily distinguished from the general factor whereas BPD symptoms were not as easily distinguished from the general factor. CPTSD symptoms reflecting a negative self-concept and BPD symptoms reflecting an alternating self-concept were the most distinctive features of CPTSD and BPD relative to the general factor, respectively. Most of the risk factors were associated with the general vulnerability factor, consistent with the predictions of dimensional models of psychopathology regarding shared risk across supposedly distinct psychiatric constructs. Conclusion: Consistent with a dimensional model of psychopathology, CPTSD and BPD shared a common latent structure but were still distinguishable. CPTSD and BPD symptoms may be most effectively distinguished based on the phenomenology of self-concept symptoms.

Cognitive Conflict in Borderline Personality Disorder: A Study Protocol.

Borderline personality disorder (BPD) represents a severe mental condition that is usually characterized by distressing identity disturbances. Although most prevailing explanatory models and psychotherapy approaches consider and intervene on self-concept, they seem not to recognize or explore idiosyncratic cognitive conflicts that patients may experience. These conflicts, which have been conceptualized as “implicative dilemmas” and “dilemmatic constructs” by personal construct theorists, could be considered as key elements of the explanatory model for BPD to provide a better understanding of this disorder and possibly enhance the effectiveness of contemporary psychotherapeutic approaches. The current study (Identifier: NCT04498104) aims to examine the characteristics of the interpersonal cognitive system of a group of patients diagnosed with BPD, using the repertory grid technique, and to compare them with those of a community sample. We will test if BPD participants are more affected by cognitive conflicts than controls. Additionally, we will gauge the association between cognitive conflicts and symptom severity as well as their predictive capacity of treatment outcome. The obtained results will be a necessary step to determine if cognitive conflicts have a substantial role on the explanation of BPD. It could also help to consider the development of a conflict resolution intervention module for this disorder.

Preschool Age Predictors of Adolescent Borderline Personality Symptoms

Developmental models of borderline personality disorder (BPD) have highlighted the interplay of psychological variables (ie, impulsivity and emotional reactivity) with social risk factors, including invalidating parenting and childhood trauma. Prospective longitudinal studies have demonstrated the association of BPD with social, familial, and psychological antecedents. However, to date, few of these studies have studied the interaction of multiple risk domains and their potential manifestations in the preschool period. Participants were 170 children enrolled in a prospective longitudinal study of early childhood depression. Participants completed a baseline assessment between ages 3 and 6 years. Psychopathology, suicidality, and self-harm were assessed using a semistructured age-appropriate psychiatric interview before age 8 and self-report after age 8. BPD symptoms were assessed between ages 14 and 19 by self-report. Adverse childhood experiences (ACEs) and peer relationships were reported by parents. Maternal support was assessed using an observational measure between ages 3 and6. Preschool ACEs accounted for 14.9% of adolescent BPD symptom variance in a regression analysis. Controlling for gender and preschool ACEs, preschool and school-age externalizing symptoms, preschool internalizing symptoms, and low maternal support were significant predictors of BPD symptoms in multivariate analyses. Preschool and school-age suicidality composite scores significantly predicted BPD symptoms. These findings suggest that preschool factors may be early predictors of BPD symptoms. Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms. However, further research is needed to guide key factors for targeted early intervention.

Borderline personality disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches

Starting from the general concept of “borderline”, the present work focuses on the essential aspects of personality disorder that define the clinical and diagnostic contexts, laying the foundations for a correct differential diagnosis, without neglecting the neural characteristics developed by the scientific community. A new classification model of borderline personality disorder, based on five levels, is proposed. The discussion ends with the best suggested therapeutic approaches.

Diffusion tensor imaging in borderline personality disorder showing prefrontal white matter alterations

Borderline personality disorder (BPD) has repeatedly been linked to alterations in fronto-limbic dysfunction. In this study, we tested the hypothesis of disturbed structural connectivity in underlying fibre tracts and their relation to symptom profiles. We analysed diffusion tensor imaging (DTI) data from 18 female BPD patients and 38 female healthy controls. Group comparisons showed significant (p < .05, FDR adjusted) increase of radial diffusivity (RD) in the right frontal lobe, including the uncinate fasciculus, anterior thalamic radiation, and inferior fronto-occipital fasciculus, as well as overall apparent diffusion coefficient (ADC) increases in the anterior and posterior internal capsule. Symptom correlations, based on the BSL-95 questionnaires, within the BPD sample showed significant negative correlations of dysphoria with ADC the left and right anterior thalamic radiation, and positive correlations of fractional anisotropy with self-perception scores in the right superior corona radiata. While our findings add to the fronto-limbic dysfunction model of BPD, they provide additional evidence of links to its affective core pathology, particularly frontotemporal and fronto-thalamic systems.

Hypersensitivity or hyperreactivity? an experimental investigation in borderline personality disorder

Objective: Starting from the controversial results showed by empirical research on Linehan’s Biosocial model of Borderline Personality Disorder (BPD), this study aims to empirically evaluate Linehan’s conceptualization of emotional hypersensitivity and hyperreactivity, as well as to investigate the role of pre-existing emotional states in BPD altered physiological responsivity. Methods: We asked 24 participants (BPD = 12; Healthy Controls = 12) to complete a self-reported questionnaire (Positive and Negative Affect Schedule) in order to assess their pre-task affective state. Subsequently, 36 emotional pictures from four valence categories (i.e. erotic, negative, positive, neutral) were administered while assessing participants self-reported and electrodermal responses. Results: BPD patients showed higher levels of pre-task negative affectivity as well as an enhanced physiological response to neutral stimuli. No main BPD group effect was found for the physiological data. Moreover, pre-task negative affectivity levels were exclusively related to physiological responses among BPD subjects. Discussion: Our findings supported the hypersensitivity hypothesis operationalized as an enhanced responsiveness to non-emotional cues. Hyperreactivity assumption was not supported. Conversely, our study revealed heightened physiological responses in relation to pre-existent negative emotional states in BPD. We discussed our results in the context of the putative pathological processes underlying BPD.

Supplemental Material for Temporal Bayesian Network Modeling Approach to Evaluating the Emotional Cascade Model of Borderline Personality Disorder

Supplemental Material for Temporal Bayesian Network Modeling Approach to Evaluating the Emotional Cascade Model of Borderline Personality Disorder

Keep the Change: Embracing Variability as a Path to Richer Theoretical Models of Borderline Personality Disorder

Keep the Change: Embracing Variability as a Path to Richer Theoretical Models of Borderline Personality Disorder