Borderline Personality Disorder Symptoms Research Articles

Investigating predictors of treatment response in Dialectical Behavior Therapy for borderline personality disorder using LASSO regression

Objective Prior studies of Dialectical Behavior Therapy (DBT) for borderline personality disorder (BPD) have yielded heterogeneous findings on what factors differentiate individuals with or without sufficient treatment response, highlighting the need for further research. Method We investigated a sample of 105 individuals with BPD receiving a 6-month course of DBT. Participants were categorized as sufficient or insufficient responders using clinical and statistical change indices (based on emotion dysregulation, BPD symptom severity, utilization of DBT skills, and functional impairment). Sociodemographic, clinical severity, and treatment process factors were tested as potential predictors of treatment response using a machine learning approach (LASSO regression). Results Two cross-validated LASSO regression models predicted treatment response (AUCs > .75). They suggested that higher homework completion rate, retention in treatment, and greater baseline severity were the most important predictors of DBT treatment response indicated by BPD symptom severity and utilization of DBT skills. Favorable effects of some aspects of therapeutic alliance during initial sessions were also found. Conclusions Future research may benefit from consolidating the criteria of treatment response, identifying clinically relevant variables, and testing the generalizability of findings to enhance knowledge of insufficient treatment response in DBT for BPD.

Are there underlying differences between sexually diverse and non-sexually diverse people diagnosed with Borderline Personality Disorder?

ABSTRACT Previous studies have demonstrated that people with Borderline Personality Disorder (BPD) are more likely to report a sexually diverse orientation (e.g gay, lesbian) than people with other or no psychiatric condition(s). Past literature has attempted to link the BPD symptoms of impulsivity (causing an increase in varied sexual behaviour) and identity disturbance (causing changes in sexual identity) to this overrepresentation. This however can be stigmatising and possibly suggest sexual diversity orientation as a pathology. To address this, the current study aimed to explore this overrepresentation in a more sensitive manner, and examine whether sexually diverse and non-sexually diverse people with BPD differ significantly in demographics, overall BPD symptomatology, identity disturbance, and impulsivity. An online survey was completed by 162 participants (152 cisgender female, 5 cisgender male, and 5 non-binary/third gender; mean age 33.01 years [SD = 9.44]); who self-reported receiving a diagnosis of BPD. Survey data included questions concerning demographics, respondents’ mental health (such as diagnoses, treatment status) and aspects of their sexuality (identity, attraction, relationship history), in addition to the measurement of BPD symptomatology (MSI-BPD), identity disturbance (SCIM), and impulsivity (UPPS-P). Survey data analysis suggested that sexually diverse individuals with BPD were younger than their non-sexually diverse (heterosexual) peers and were more likely to have changed their self-labelled sexual identity during the previous year. There were no significant differences in other demographic factors, BPD symptomatology, identity disturbance or impulsivity. The study clearly highlighted the challenges of using a single criterion to define sexual diversity, as the groups differed markedly according to whether classification was based on current and past relationship history, sexual attraction, or self-labelled sexual identity. The findings also suggest that BPD symptoms of identity disturbance and impulsivity may not explain the overrepresentation of sexual diversity in people diagnosed with BPD, and that further investigation is warranted.

Systems training for emotional predictability and problem solving in older adults with personality disorders: a pilot study.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults. The aim was to explore the outcome of STEPPS in older adults with personality disorders. In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning. Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen's d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen's d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning. The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.

Does the Augmentation of Trauma Informed Hatha Yoga Increase the Effect of Dialectical Behavior Therapy for Substance Use Disorders on Psychopathological Strain of Patients with Borderline Personality Disorder and Comorbid Substance Use Disorder? Results of a Quasi-Experimental Study

Background: Borderline personality disorder (BPD) is one of the most common personality disorders among persons with substance use disorders (SUDs) and is characterized by severe clinical symptoms. The aim of this study was to investigate if the effect of dialectical behavior therapy for substance use disorders (DBT-S) inpatient treatment on psychopathological symptom load in patients suffering from both BPD and SUD can be augmented by weekly 60-min “Trauma Informed Hatha Yoga” sessions. Materials and Methods: Thirty-nine patients suffering from comorbid BPD and SUD were consecutively in time included in this quasi-experimental pilot study (first intervention then control group). In the intervention group, weekly Trauma Informed Hatha Yoga sessions were added to standard DBT-S for 8 weeks. The participants of the control group received standard DBT-S. All participants completed several self-report questionnaires to assess symptoms of depression, anxiety, symptoms of BPD, and their subjective stress perception at three points in time during the study course. Results: A repeated measures analysis of variance with patients’ psychopharmacological medication as covariate revealed a significant main effect of time for each of the psychometric scales (State and Trait Anxiety Inventory subscale for state anxiety [STAI-S] p = 0.001, Beck Depression Inventory [BDI] p < 0.001; Borderline Symptom List 23 [BSL] p = 0.036) indicating that the psychopathological symptom load of the patients was significantly lower at the end of the DBT-S therapy compared to the beginning in both study groups. Moreover, there was a significant interaction effect of group*time on the psychometric scales STAI-T (subscale for trait anxiety) sum score (p = 0.010) and the sum score of the Perceived Stress Scale (PSS) (p = 0.043). This was expressed by the fact that the participants of the intervention group showed a significant reduction of the STAI-T sum score as well as the sum score of the Perceived Stress Scale (PSS), while the control group did not. Due to the exploratory nature of this study, correction for multiple testing was omitted. Conclusion: Although they are very preliminary, our results suggest that practicing Trauma Informed Hatha Yoga on a regular basis in addition to DBT-S inpatient treatment seems to reduce the level of trait anxiety and perceived stress significantly more than DBT-S inpatient treatment alone. Nevertheless, the effectiveness of Trauma Informed Hatha Yoga in reducing trait anxiety and perceived stress in patients suffering from SUD und BPD must be tested in large randomized controlled trials.

Efficacy of Noninvasive Brain Stimulation on Borderline Personality Disorder Core Symptoms: A Systematic Review.

Although psychotherapy is the first-line treatment of borderline personality disorder (BPD), psychopharmacological agents have not been approved yet. Modulating brain functions with noninvasive brain stimulation (NIBS) interventions, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), may have a role in the treatment of BPD. In light of the limited knowledge available and the emerging interest in the possible role of NIBS as a therapeutic tool, the authors' main aim is to systematically review the literature on the effect of both rTMS and tDCS on BPD symptoms, specifically affective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual difficulties. The review process was conducted in accordance with PRISMA guidelines. The research methods were registered on PROSPERO (id code CRD42020209491). Eleven studies were included in the review. Despite the limited number of studies retrieved, preliminary data showed an improvement in all domains. Further studies are needed to understand potential long-term advantages of NIBS.

3.96 Identifying Preschool-Age Moderating Factors in the Development of Borderline Personality Disorder

Despite a growing literature on early childhood risk factors for borderline personality disorder (BPD), few studies have examined symptoms that may mitigate the effects of those risk factors. Here we examined whether 3 preschool-age characteristics—impulsivity, emotional lability, and initiative taking—moderated the relationship between known preschool-age risk factors and adolescent BPD symptoms.

Buffering Effect of Perseverance and Meditation on Depression among Medical Students Experiencing Negative Family Climate.

Background and objective: Thirty percent of Thai medical students experienced depression. Two of the crucial factors related to depression involved borderline personality disorder symptoms and adverse family experiences, while positive strengths were documented to prevent depression. This study aimed to investigate the role of perseverance and meditation on depression; Methods: Two hundred and forty−three medical student participants completed the following measurements: the core symptom index (CSI−D) to measure depression, the family climate questionnaire to measure family experience, the personality disorder questionnaire to measure borderline personality disorder symptoms, and the inner strength−based inventory to measure perseverance and meditation. In the analysis, depression served as an outcome, adverse family climate as a predictor and borderline personality disorder symptoms as a mediator. In contrast, perseverance and meditation were moderators in the mediation model. Mediation and moderation analysis using PROCESS was applied for testing the direct and indirect effects; Results: Among all, 49.38% were male, and the mean age was 22.76 years. Borderline personality disorder symptoms significantly mediated the relationship between adverse family climate and depression, B = 0.0608 (95%CI, 0.0301 to 0.1052). The variance explained by the mediation model was 43%. Meditation moderated the relationship between adverse family climate and borderline personality symptoms, whereas perseverance and meditation were found to be significant moderators for borderline personality disorder symptoms and depression. With two moderators in the mediation model, the indirect effect index was B = 0.0072 (95%CI, 0.0002 to 0.0160). The 49% of variances of depression were explained by the moderated mediation model; Conclusion: Borderline personality disorder symptoms are a crucial variable involving depression. Meditation practice has been demonstrated to be a buffer between negative family climate to borderline personality disorder symptoms and depressive symptoms, whereas perseverance buffers the effect of borderline personality disorder symptoms of depression. Further research on cultivating meditation and perseverance should be encouraged among those with negative family experiences.

Visually guided equivalence learning in borderline personality disorder

The hallmark symptoms of borderline personality disorder are maladaptive behavior and impulsive emotional reactions. However, the condition is occasionally associated with cognitive alterations. Recently, it has been found that the function of the basal ganglia and the hippocampi might also be affected. Hence, deterioration in learning and memory processes associated with these structures is expected. Thus, we sought to investigate visually guided associative learning, a type of conditioning associated with the basal ganglia and the hippocampi, in patients suffering from borderline personality disorder. In this study, the modified Rutgers Acquired Equivalence Test was used to assess associative learning in 23 patients and age-, sex-, and educational level-matched controls. The acquisition phase of the test, which is associated primarily with the frontostriatal loops, was altered in patients with borderline personality disorder: the patients exhibited poor performance in terms of building associations. However, the retrieval and generalization functions, which are primarily associated with the hippocampi and the medial temporal lobes, were not affected. These results corroborate that the basal ganglia are affected in borderline personality disorder. However, maintained retrieval and generalization do not support the assumption that the hippocampi are affected too.

The Association between Borderline Personality Disorder and Criminal Activity and Self-harm, Including Suicidal Behavior: A Systematic Review

Borderline Personality Disorder (BPD) is an extraordinarily complex and least-understood mental disorder. It is currently known that BPD is related to aggression and anger. However, fewer studies focused on the prevalence of BPD symptoms among criminal offenders and their association with crime. This systematic review act per Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. We searched PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Science Direct for appropriate studies and research. Screening of articles was performed based on relevance and inclusion and exclusion criteria. To check for bias, we used relevant quality appraisal tools. Initially, we found 10026 articles. After removing duplicates and irrelevant papers, we finalized 18 studies based on titles, abstracts, and reading entire articles. We excluded eight studies because of poor quality, and the remaining ten papers were included in this review. BPD was related to criminal activities and suicidal and non-suicidal acts. Adverse childhood experiences positively predicted self-injurious behavior. There is a positive linkage between BPD symptoms and general offense, Inter-Partner Violence (IPV), and Child Abuse Potential (CPA).

Online Sexual Activity among Iranian Clients with Borderline Personality Disorder and Its Correlation with Severity of Symptoms.

Objective: Clients with borderline personality disorder (BPD) often engage in high-risk sexual behaviors. Online sexual platforms convey abusive and harmful themes, especially for this group of sexually impulsive patients. We hypothesized a correlation between their online sexual activities and the severity of BPD symptoms. Method : Fifty clients with BPD who were referred to Iran psychiatric hospital and Tehran Psychiatric Institute in 2020 participated in this research. The Borderline Evaluation of Severity over Time (BEST) questionnaire was used to assess the severity of BPD symptoms, and the Internet Sex Screening Test (ISST) was used to evaluate online sexual behaviors. A psychiatric interview considered substance abuse and other confounding factors. Results: The mean ISST and BEST scores were 7.82 ± 5.74 and 41.7 ± 12.5, respectively. There was a positive and significant correlation between the severity of BPD symptoms and online sexual activities (P < 0.001, r = 0.480). There was also a significant relationship between online sexual activities and a history of substance abuse (P = 0.003, F = 25.06). Conclusion: Online sexual activity can harm clients with BPD who are more vulnerable to high-risk sexual behaviors. More severe borderline personality traits were associated with more online sexual activity, which underlines the importance of providing education about and managing such activities in clients with BPD.

Identifying moderating factors during the preschool period in the development of borderline personality disorder: a prospective longitudinal analysis

BackgroundDespite a growing literature detailing early childhood risk factors for borderline personality disorder (BPD), few studies have examined moderating factors that might mitigate or exacerbate the effects of those risk factors. The current study examined whether three preschool-age characteristics—impulsivity, emotional lability, and initiative-taking—moderated the relationship between known preschool-age risk factors and adolescent BPD symptoms.MethodsWe performed multilevel modeling analyses in a sample (n = 151) from the Preschool Depression Study, a prospective longitudinal study with assessments from preschool through adolescence. Preschool risk factors included adverse childhood experiences, internalizing symptoms, and externalizing symptoms measured with parent clinical interviews. Preschool moderating factors were assessed via parent report and observational coding of temperament and behavior. The Borderline Personality Features Scale for Children measured BPD symptoms in adolescence.ResultsWe found that observed initiative-taking moderated the relationship between preschool internalizing symptoms and adolescent BPD symptoms (b = 0.57, p = .011) and moderated the relationship between preschool externalizing symptoms and adolescent BPD symptoms (b = 1.42, p = .013). Greater initiative-taking was associated with lower BPD risk for children with high internalizing or externalizing symptoms. Conversely, for children with low internalizing or externalizing symptoms, greater initiative-taking was associated with increased BPD risk.ConclusionsWe identify a potential moderating factor in BPD development, offer novel targets for screening and intervention, and provide a framework for using early childhood observational assessments in BPD research. Our findings suggest the need for future research on early moderating factors in BPD development, which could inform early childhood interventions targeting those factors to mitigate the effects of potentially less malleable risk factors.

Borderline Personality Disorder Symptoms and Its Clinical Correlates among Chinese University Students: A Cross-Sectional Study.

Borderline personality disorder (BPD) is common among young adults. Related studies showed a wide range of prevalence among university students. Few studies regarding BPD symptoms and their correlations with different variables have been reported in the Chinese population. A cross-sectional, online survey was conducted on a sample of university students in China between November 2021 and January 2022. Sociodemographic questionnaires, the Screening Instrument for Borderline Personality Disorder (SI-Bord), the 18-item Experience in Close Relationships-Revised (ECR-R-18), the Meaning In Life Questionnaire (MLQ), the 10-item Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-9), the Rosenberg Self-Esteem Scale (RSES) and the Resilience Inventory (RI-9) were completed. Data were analyzed using Pearson’s correlation methods. Among 767 participants, mean age was 20.33 ± 1.495 years, and the majority were males (53.5%). According to the SI-Bord’s cut-off score >7, BPD symptoms were found in 17.5% of participants. Attachment anxiety, avoidance, depression, perceived stress, lack of meaning in life, resilience and self-esteem were significantly correlated with BPD symptoms with r’s of 0.473, 0.180, 0.451, 0.481, −0.148, −0.238 and −0.388, respectively (all p’s < 0.01). The prevalence of BPD symptoms is high among Chinese university students and significantly associated with mental health outcomes, suggesting that an early detection of BPD symptoms is necessary for this population.

What are we missing in dimensional models that might explain core dynamic processes in borderline personality disorder? Commentary on Miskewicz et al. (2022).

Comments on the original article by Miskewicz et al. (see record 2021-98114-001) regarding dimensional models that might explain core dynamic processes in borderline personality disorder. Miskewicz et al.'s findings provide strong evidence that although dynamic processes in borderline personality disorderare important, a trait-only model cannot fully explain core dynamic processes underlying symptom fluctuations as a function of context in borderline personality disorder (BPD). In fact, any single model is likely insufficient to explain BPD functioning in all its complexity. An important next step is to examine how traits and other theoretically and empirically informed constructs might synergistically (rather than merely independently) explain the dynamic expression of BPD symptoms in real-world contexts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The implications of borderline personality features for jail inmates' institutional misconduct and treatment-seeking.

Borderline personality disorder (BPD) is common in jails and prisons. In a sample of 506 jail inmates (30% female), we examined whether BPD symptoms assessed upon incarceration predict subsequent institutional misconduct and treatment-seeking. BPD features modestly predicted occurrence (vs. nonoccurrence) of institutional misconduct. Importantly, BPD did not predict the number of institutional misconduct incidents. That is, BPD was not associated with frequent, repeated difficulties in institutional adjustment. Consistent with previous research showing a relationship between BPD and past treatment-seeking in clinical and community samples, jail inmates' BPD features significantly predicted subsequent requests for treatment. Regarding specific types of treatment, the relationship held for substance abuse programs and forensic mental health services but not for psychoeducational services or support groups. There were very few moderators of the link between BPD and subsequent institutional misconduct and treatment-seeking. Most of the observed relationships held across sex, race, and age. Findings of the study indicate that jail staff and clinicians must learn to distinguish between initial adjustment problems and frequent misconduct among inmates high in BPD to facilitate their adjustment. The study further highlights the need for BPD-relevant treatments and services in jails. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Brief psychiatric treatment for borderline personality disorder as a first step of care: Adapting general psychiatric management to a 10-session intervention.

The considerable demand versus supply gap of evidence-based treatments for borderline personality disorder (BPD) indicates the need for modular steps of care to tailor fit between individual patients' needs along the trajectory of their clinical course and effective interventions. These trajectories may or may not include lengthy specialized psychotherapies. Good psychiatric management (GPM) for BPD is being practiced by an increasing number of mental health professionals as a basic starting block of mental health services in the community. It remains an open question what duration of GPM is optimal, what the content of a shortened version of GPM may be, and how such brief treatment may be integrated into larger long-term treatment plans for patients with BPD. The present practice review elaborated on a brief version of GPM, addressed its conceptual background and the notion of stepped care in the treatment of BPD, and discussed the clinical tasks and contents of brief psychiatric management in 10 sessions (or lasting 4 months). It also summarized the moderate evidence base of brief forms of GPM: 2 randomized controlled trials of 10-session GPM, and 1 randomized controlled trial of a 6-session GPM psychoeducational group, have found medium-to-large effects in reducing BPD symptoms. Finally, this review offered 2 clinical vignettes of patients either stepping up or down the intensity of their treatment to illustrate how to implement brief GPM and suggested open avenues for future development and clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The roles of personality traits and close social contact in the expression of momentary borderline personality disorder symptoms in daily life.

Dimensional models of personality, such as the five-factor model (FFM), have demonstrated strong coherence with the presentation of personality disorders, including borderline personality disorder (BPD). Given that select personality trait elevations have been linked to impairments in multiple life domains across diagnostic groups, we sought to replicate findings from a previous investigation of the utility of the FFM in predicting BPD-relevant outcomes (i.e., negative affect intensity and instability, impulsivity, and interpersonal disagreements) in the daily lives of those with BPD (Hepp et al., 2016) and community participants. As interpersonal context is instrumental in determining the strength of effects observed in studies examining individuals with BPD, we utilized ecological momentary assessment across 3 weeks (6 times daily; ntotal = 15,889) to test whether close social contact (CSC) would moderate the effects of personality on momentary outcomes. Overall, results suggest that CSC is an important moderator between the effects of personality and daily life outcomes for individuals with BPD (N = 56), but not for community individuals (N = 60). For individuals with BPD, CSC may function as both a protective buffer and a risk factor, depending on outcome. For example, CSC attenuates experience of negative affect intensity for individuals with elevated neuroticism, but CSC may predict more frequent disagreements for individuals who report lower agreeableness. We replicated approximately half of the original study's findings, and results support that FFM personality is predictive of BPD-relevant outcomes broadly. However, interpersonal context is key to understanding these relationships for individuals with BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Where are the active ingredients for borderline personality disorder? The importance of heightened triggers, two arguments for traits, and two arguments for Criterion A.

We are grateful that insightful experts took the time to comment on our article, and we find their comments both elucidating and advancing. In response to the commentaries, we consider 3 possible locations for the active ingredients producing borderline personality disorder symptoms. First, we offer a more optimistic case that the active ingredients may be in Personality Inventory for DSM-5 traits because of the important role of heightened trigger frequency in accounting for elevated symptoms (with some caveats). Second, we support the commenters' arguments that active ingredients may be in dysfunction in the self and in relationships, as in Criterion A. Third, we offer an argument that the active ingredients may be in normal traits, but that the conception and measurement of normal traits need to be updated in light of the connection between normal traits and personality disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Amygdala response predicts clinical symptom reduction in patients with borderline personality disorder: A pilot fMRI study.

Borderline personality disorder (BPD) is a prevalent, devastating, and heterogeneous psychiatric disorder. Treatment success is highly variable within this patient group. A cognitive neuroscientific approach to BPD might contribute to precision psychiatry by identifying neurocognitive factors that predict who will benefit from a specific treatment. Here, we build on observations that BPD is accompanied by the enhanced impact of the aversive effect on behavior and abnormal neural signaling in the amygdala. We assessed whether BPD is accompanied by abnormal aversive regulation of instrumental behavior and associated neural signaling, in a manner that is predictive of symptom reduction after therapy. We tested a clinical sample of 15 female patients with BPD, awaiting dialectical behavior therapy (DBT), and 16 matched healthy controls using fMRI and an aversive Pavlovian-to-instrumental transfer (PIT) task that assesses how instrumental behaviors are influenced by aversive Pavlovian stimuli. Patients were assessed 1 year after the start of DBT to quantify changes in BPD symptom severity. At baseline, behavioral aversive PIT and associated neural signaling did not differ between groups. However, the BOLD signal in the amygdala measured during aversive PIT was associated with symptom reduction at 1-year follow-up: higher PIT-related aversive amygdala signaling before treatment was associated with reduced clinical improvement at follow-up. Thus, within the evaluated group of BPD patients, the BOLD signal in the amygdala before treatment was related to clinical symptom reduction 1 year after the start of treatment. The results suggest that less PIT-related responsiveness of the amygdala increases the chances of treatment success. We note that the relatively small sample size is a limitation of this study and that replication is warranted.

Borderline personality disorder symptoms in individuals with eating disorder: Association with severity, psychological distress, and psychosocial function.

We aimed to determine the prevalence of borderline personality disorder (BPD) symptoms in a sample of eating disorder (ED) outpatients and assess how BPD symptoms correlate with severity, distress, and function. A total of 119 individuals were assessed and divided into high BPD symptoms (H-BPD) and low BPD symptoms (L-BPD) using a cut-off score of seven on the McLean Screening for Borderline Personality Disorder (MSI-BPD). Groups were compared on ED diagnosis, age at ED onset, age at assessment, illness duration, body mass index (BMI), ED symptomatology, psychological distress, and psychosocial function. Correlation analyses were performed to assess the relationship between BPD symptoms and these variables. The 45.4% of the participants scored ≥7 on the MSI-BPD, indicating a diagnosis of BPD. There were no differences between the H-BPD (N = 54) and L-BPD (N = 65) groups on age at onset, age at assessment, duration of illness, BMI, or proportion of ED diagnosis. The H-BPD group reported significantly higher ED symptomatology, psychological distress, and poorer psychosocial functioning. MSI-BPD scores were positively associated with these variables. This study suggests a high prevalence of BPD symptoms within outpatients seeking ED treatment, and use of a brief screening instrument for BPD in this group may contribute to a greater understanding of the patient.

Personal agency and borderline personality disorder: a longitudinal study of outcomes

BackgroundLow personal agency is the concept of attributing successes and failures to external factors rather than personal characteristics. Previous research supported links between low personal agency and symptoms of borderline personality disorder (BPD). The present research followed patients in an outpatient dialectical behavioural therapy (DBT) group from intake to 12 months follow up to examine the impact of personal agency on outcome.MethodsPatients (N = 57, age 18–72, 91.5% female) were assessed at intake, after three months of DBT treatment, and 12 months follow up on measures of symptoms and personal agency. Three separate measures were used to assess treatment outcomes: the BPD Checklist, the Personality Inventory for DSM-5 (PID-5), and the Mental Health Inventory (MHI-5).ResultsMixed model analyses found BPD symptoms significantly reduced as a result of DBT treatment and were maintained at follow-up. However, 47% of participants continued to meet BPD criteria 12 months later, despite treatment. Regression analyses indicated that low personal agency at intake was associated with higher BPD symptom severity at post-treatment and 12 month follow up. In addition, low personal agency at intake was associated with greater levels of negative affectivity at post-treatment. Personal agency did not relate to levels of depression and anxiety.ConclusionsDespite the reductions in BPD symptomology, personal agency did not significantly change over time. Those with lower agency at intake continued to do more poorly at follow up. We speculate that poor outcomes may be contributed to by patients' lack of engagement in recovery due to poor agency and an external locus of control. As such, therapeutic approaches, like DBT, may require additional strategies to appropriately target low personal agency. Further research is needed to understand if other treatment protocols may facilitate positive change in personal agency.