Personality Disorder Research Research Articles

Creative Ecologies in Borderline Personality Disorder Research: Just What the Doctor Ordered

This article draws on the power of creative methods to call for a more collaborative, ecological approach to awareness, education, and research analysis of Borderline Personality Disorder (BPD). Drawing on affect theory and empirical research using a co-creation methodology, we advocate for the power of peer-directed support provision for those experiencing BPD. Through recognition and advocacy for this emerging area, the article advances the ways in which more holistic, ecological protocols can help shift research into BPD from a deficit-framed diagnostic approach to a more strengths-based agentic approach that recognizes the wider context and multiple factors beyond the individual.

Time to put aside the false dichotomy between personality disorders and psychotic symptoms.

Unlike internalizing and externalizing symptoms, psychotic symptoms (e.g., hallucinations, delusions) are manifestations of personality disorders (PDs) that are more controversial and poorly understood. This leaves clinicians with very little guidance for clinical practice, especially for diagnosis. What is more, most reviews have focused strictly on the links between psychotic symptoms and the categorically defined borderline PD, which contrasts with the growing movement that emphasizes a dimensional perspective (especially in psychology). Thus, the objectives of this critical review will be to (a) expose typical cases where PDs and psychotic symptoms might cooccur; (b) assess the state of scientific knowledge surrounding PD and psychotic symptoms; and (c) provide clinicians and researchers with recommendations to keep the field moving forward. We conclude that researchers and clinicians should move past the false "PD or psychosis" dichotomy since they often cooccur, avoid (as far as possible) making psychotic symptoms an exclusion criterion in PD research to enhance ecological validity, and consider dimensional PD diagnosis as a potential unifying solution to the dilemma posed by this cooccurrence.

Follow the money: Is borderline personality disorder research underfunded in Canada?

Follow the money: Is borderline personality disorder research underfunded in Canada?

Exploring ethnicity and personality disorder in a UK context: a scoping review of the literature

PurposeThe UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.Design/methodology/approachA scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.FindingsTen papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.Originality/valueThe shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

Associations of state or trait dissociation with severity of psychopathology in young people with borderline personality disorder

BackgroundState and trait dissociation are associated with borderline personality disorder (BPD) severity and severity of commonly co-occurring mental health symptoms. Although these distinct constructs do not consistently co-occur in experimental settings, they are frequently reported as the same construct, namely dissociation. This study aimed to investigate the co-occurrence of state and trait dissociation among young people with BPD and to examine whether state or trait dissociation were associated with symptom severity in this population.MethodsState dissociation was induced using a stressful behavioural task in a clinical sample of 51 young people (aged 15–25 years) with three or more BPD features. Diagnoses, state and trait dissociation, BPD severity and severity of posttraumatic stress disorder (PTSD), depressive, and stress symptoms were assessed by self-report or research interview.ResultsA chi-square test of independence showed a strong association between state and trait dissociation. Bonferroni corrected t-tests showed that state dissociation was significantly associated with PTSD symptom severity and likely associated with BPD severity and severity of depressive and stress symptoms. Trait dissociation was not associated with symptom severity or severity of BPD features.ConclusionsThese findings highlight the need to distinguish between state and trait dissociation in personality disorder research. They suggest that state dissociation might be an indicator of higher severity of psychopathology in young people with BPD.

Emotion Dysregulation in Personality Disorders.

This manuscript aims to take stock of emotion dysregulation and personality disorder (PD) research, review key findings, and highlight future directions. Most emotion dysregulation research in PDs has focused on borderline personality disorder (BPD). BPD is characterized by high baseline negative emotion and the use of maladaptive emotion regulation strategies, but several other emotion dysregulation components may not be pervasively evident in the disorder. Trends in the BPD field that add nuance to the study of emotion dysregulation suggest that BPD may involve problems in the flexible, contextually based selection/implementation of emotion regulation strategies, as well as the development of appropriate emotion regulatory goals. Furthermore, relational stressors may elicit and maintain emotion dysregulation in BPD. Less research has examined emotion dysregulation in other PDs, but several PDs may involve deficits in emotional processes (e.g., lower behavioral inhibition and resistance of emotion-related impulses), particularly in interpersonal contexts. Emotion dysregulation is a nuanced and contextual problem which, for some PDs, may be particularly nested within interpersonal contexts. The BPD field and the increasing nuance of the study of emotion dysregulation within it points to key future research directions for the broader PD field.

Dimensional models of personality disorders: Challenges and opportunities.

Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.

Personality disorders research and social decontextualization: What it means to be a minoritized human.

Models of personality disorders have overwhelmingly developed in a socially decontextualized manner. Some historical models of personality pathology formally embraced the interactions between the individual and their environment. However, the field of personality disorder theory, research, and treatment has evolved in a manner that situates dysfunction within intraindividual deficiency processes. By doing so the field limits its applicability to populations that do not represent the norm in clinical psychological science (e.g., sexual/gender minority [SGM] persons for our purposes). Assumptions about personality disorders conflict with evidence-based ways of understanding psychosocial dysfunction among minoritized populations. Using research on SGM populations, and the detrimental impact of minority stress, we demonstrate how sociocultural context is inextricably linked to psychosocial functioning, which remains at odds with personality disorder theory and research. We first briefly review the historical roots of personality disorder theory; explore how sociocultural context is currently instantiated in official nosologies as the Diagnostic and Statistical Manual of Mental Disorders and the Psychodynamic Diagnostic Manual; and illustrate how intraindividual personality disorder conceptualization fails to align with the accepted understanding of how minority stress impacts the health of SGM populations. Finally, we end with a few recommendations for (a) future research on personality disorders and (b) clinical work with SGM individuals who might demonstrate behaviors typically associated with a personality disorder diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Moderation effects in personality disorder research.

Tests of statistical interactions (or tests of moderation effects) in personality disorder research are a common way for researchers to examine nuanced hypotheses relevant to personality pathology. However, the nature of statistical interactions makes them difficult to reliably detect in many research scenarios. The present study used a flexible, simulation-based approach to estimate statistical power to detect trait-by-trait interactions common to psychopathy research using the Triarchic model of Psychopathy and the Psychopathic Personality Inventory. Our results show that even above-average sample sizes in these literatures (e.g., N = 428) provide inadequate power to reliably detect trait-by-trait interactions, and the sample sizes needed to detect interaction effect sizes in realistic scenarios are extremely large, ranging from 1,300 to 5,200. The implications for trait-by-trait interactions in psychopathy are discussed, as well as how the present findings might generalize to other areas of personality disorder research. We provide recommendations for how to design research studies that can provide informative tests of interactions in personality disorder research, but also highlight that a more realistic option is to abandon the traditional approach when testing for interaction effects and adopt alternative approaches that may be more productive. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sampling methods in personality pathology research: Some data and recommendations.

The field of personality disorder research has grown since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, in 1980; with a notable evolution in the way that personality disorders are defined and operationalized. In evaluating this research, it is necessary to consider the range of sampling practices used. The goal of this study was to describe current sampling methods in personality disorder research and provide recommendations to guide sample design in future personality disorder research. To do this, we coded sampling practices described in recent empirical articles published in four journals that showcase research on personality disorders. We summarized aspects of sampling design including the combination of study question and sample characteristics (e.g., sample size, sample source, and use of screening), study design, and demographic representation of samples. Findings reveal a need for studies to better consider whether their samples are fit for purpose and to make explicit their target population and sampling frame, as well as the specific procedures (i.e., recruitment) used to carry out sampling. We also discuss issues that arise when attempting to capture low-base rate pathology, which is often associated with high comorbidity. We emphasize a process-oriented approach to developing a sampling strategy for personality disorders research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Experimental Paradigms in Personality Disorder Research: A Review of Covered RDoC Constructs, Methodological Issues, and Future Directions

Supplemental Material for Experimental Paradigms in Personality Disorder Research: A Review of Covered RDoC Constructs, Methodological Issues, and Future Directions

Supplemental Material for Factor Analysis in Personality Disorders Research: Modern Issues and Illustrations of Practical Recommendations

Supplemental Material for Factor Analysis in Personality Disorders Research: Modern Issues and Illustrations of Practical Recommendations

The registration continuum in personality disorder studies: Theory, rationale, and template.

Registration is a tool to increase the rigor of personality disorder research and its ability to reduce human suffering through improving people's lives. This article details the problems that exist without registrations, which revolve around a study's outcomes' dependence on the data rather than on the theory being tested. Registrations exist on a continuum underpinned by bipolar timing and unipolar disclosure dimensions, the latter of which poses myriad points of decisions for researchers to register. The registration process provides memory aids and guideposts for researchers through the course of a study, transparently maintains public trust in the scientific enterprise, and preserves the severity of the tests used in the study. This article provides a template for personality disorder researchers to consider and examples of how researchers can use registered flexibility to plan for contingencies that might arise during a study. It also addresses challenges in evaluating registrations and implementing registration in a research workflow. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contemporary methodological considerations for key issues in research on personality disorder development.

In the present article, we aim to contribute to further progress in the field of personality disorder (PD) development by highlighting several recent methodological innovations related to (a) the measurement of personality pathology, (b) the modeling of typical features of personality pathology, and (c) the assessment of processes that characterize PD development. For each of those issues, we discuss key points of attention and methodological strategies, illustrated with recent publications in the PD research field as potential resources for future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Experimental Manipulation of the BFI-2, IPIP-NEO-120, and the IPC-5.

Research assessing the relationship of the five-factor model (FFM) to personality disorder symptomatology has generally been confirmatory, with three exceptions. The exceptions have been failures to confirm associations of conscientiousness with the obsessive-compulsive personality disorder, agreeableness with dependent, and openness with schizotypal. Haigler and Widiger demonstrated empirically years ago that this was occurring because the predominant FFM measure at that time, the NEO Personality Inventory-Revised, does not include a sufficient representation of maladaptive variants of the respective FFM personality trait domains. Research since their study has continued to fail to confirm the FFM hypotheses, using other measures of the FFM. The current study extended the work of Haigler and Widiger by considering three additional FFM measures, the Big Five Inventory-2 (BFI-2), the International Item Pool-NEO-120 (IPIP-NEO-120), and the Inventory of Personal Characteristics-5 (IPC-5). Data were obtained from a community sample of adults with experience of mental health treatment. The results confirmed an improvement in the FFM-personality disorder relationships when the experimentally manipulated versions of the BFI-2, IPIP-NEO-120, and IPC-5 were used. The implications of the findings for existing and future FFM-personality disorder research are discussed.

Cluster B versus Cluster C Personality Disorders: A Comparison of Comorbidity, Suicidality, Traumatization and Global Functioning.

A general clinical assumption states that cluster B personality disorders (PDs) represent a more severe form of PD than cluster C PDs. Consequently, most PD research is centered on cluster B PDs (especially borderline PD). Yet, prevalence ratings of cluster C PDs exceed those of cluster B PDs. In this explorative, cross-sectional study, we compared cluster B and C PD patients (N = 94) on a wide range of clinically-relevant severity measures, including comorbidity, suicidality, (childhood) traumatization and global functioning. Results showed that, although cluster B PD patients suffered more often from substance use disorders and lifetime suicide attempts, no difference could be established between groups for all other severity measures, including trauma variables. In our study, we additionally included a group of combined cluster B and C PDs, who were largely similar to both other groups. Although our study is insufficiently powered to claim a significant non-difference, these findings emphasize that high rates of comorbidity, suicidality, childhood traumatization and functional impairment apply to both cluster B and C patients. As such, our findings encourage more research into cluster C PDs, ultimately leading to more evidence-based treatments for this prevalent patient group. In addition, the high level of traumatization across groups calls for a routine trauma screening, especially since PD treatment may benefit from concurrent trauma treatment.

Factors affecting participant recruitment and retention in borderline personality disorder research: a feasibility study

BackgroundPrevious studies have shown that stigma is a major barrier to participation in psychiatric research and that individuals who participate in psychiatric research may differ clinically and demographically from non-participants. However, few studies have explored research recruitment and retention challenges in the context of personality disorders.AimTo provide an analysis of the factors affecting participant recruitment and retention in a study of borderline personality disorder among general psychiatric inpatients.MethodsAdult inpatients in a tertiary psychiatric hospital were approached about participating in a cross-sectional study of borderline personality disorder. Recruitment rates, retention rates, and reasons for declining participation or withdrawing from the study were collected. Demographic characteristics were compared between participants and non-participants and between patients who remained in the study and those who withdrew.ResultsA total of 71 participants were recruited into the study between January 2018 and March 2020. Recruitment and retention rates were 45% and 70%, respectively. Lack of interest was the most commonly cited reason for non-participation, followed by scheduling conflicts and concerns regarding mental/physical well-being. Age and sex were not predictors of study participation or retention.ConclusionsMore research is needed to explore patients’ perspectives and attitudes towards borderline personality disorder diagnosis and research, determine effects of different recruitment strategies, and identify clinical predictors of recruitment and retention in personality disorder research.

The Safety-Oriented Personality Style or Phobicentric Psychopathology: A Cross-National Replication Study

Our replication study embarked on in the Middle East, used an Arabic translation of the original research tool, the Safety-Oriented Personality Style or Phobicentric Psychopathology Individual Questionnaire (SOPS/PCPIQ) that was employed in the North American study, which could identify adults with more serious chronic anxiety. SOPS/PCP, described as dimensional and neurobiologically-based is the hypothesized construct from which SOPS/PCPIQ is derived. SOPS/PCP, a brand-new formulation, arose serendipitously from clinical observations and followed in the new tradition of attempting to avoid characterizing personality disorder in the categorical and non-theoretical style of the previously influential Diagnostic Statistical Manual of Mental Disorders. The present study is intended to produce results that confirm that SOPS/PCP may be experienced outside North America. The results supported the hypotheses that the Arabic version of the SOPS/PCPIQ would demonstrate adequate reliability and validity. They further showed that individuals with a history of trauma exposure scored significantly higher than the other subjects. As such, the similar results from this Arabic study to those from Canada and the United States showed that this cross-national study successfully replicated the original North American findings. Discussion addresses the potential role of this study’s psychopathology to provide meaningful contribution to the recognition and reduction of global anxiety disorder and help change the current direction of personality disorder research.

Emotion Dysregulation and Early Trauma in Borderline Personality Disorder: An Exploratory Study.

Background:Borderline personality disorder (BPD) research is in its nascent stage in India though studies have estimated its prevalence in psychiatric conditions. Trauma experiences and emotion regulation difficulties are well documented in BPD in the international literature. Thus, it is imperative to examine the role of trauma experiences and their relation to emotion dysregulation in BPD in the Indian context.Materials and Methods:This study used both self-report and semistructured interview data from 34 adults with BPD who presented for outpatient or inpatient psychiatric treatment and compared them with a gender-matched control group. The tools used were the International Personality Disorder Examination, Kessler-10, Early Trauma Inventory Self Report-Short Form, modified-Positive And Negative Affect Scale, Cognitive Emotion Regulation Questionnaire, and Difficulties in Emotion Regulation Scale (DERS).Results:The BPD group reported higher negative affect, increased use of maladaptive emotion regulation strategies and a deficit of adaptive strategies, after depression scores were controlled for. General abuse, physical punishment, and emotional abuse were significantly higher in the BPD group. The high occurrence of childhood emotional abuse and negative affect in BPD patients emerged as a major correlate accounting for 68.4% of the variance in DERS scores.Conclusions:Although we obtained results similar to the western literature on BPD pathology, sociocultural factors such as family and economic conditions, cultural differences in symptom expression of BPD, and treatment forms used in India warrant further research.

Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example.

Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.