The identification of a risk profile for young people with borderline personality pathology: a review of recent literature

The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

Developmental trajectories of anger and sadness dysregulation in childhood differentially predict later borderline symptoms

Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.

Understanding the development of bipolar disorder and borderline personality disorder in young people: a meta-review of systematic reviews

BACKGROUND

There is ongoing debate on the nosological position of bipolar disorder (BD) and borderline personality disorder (BPD). Identifying the unique and shared risks, developmental pathways, and symptoms in emerging BD and BPD could help the field refine aetiological hypotheses and improve the prediction of the onset of these disorders. This study aimed to: (a) systematically synthesise the available evidence from systematic reviews (SRs) and meta-analyses (MAs) concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD; (b) identify the main differences and common features between the two disorders to characterise their complex interplay and, (c) highlight remaining evidence gaps.

METHODS

Data sources were; PubMed, PsychINFO, Embase, Cochrane, CINAHL, Medline, ISI Web of Science. Overlap of included SRs/MAs was assessed using the corrected covered area process. The methodological quality of each included SR and MA was assessed using the AMSTAR.

RESULTS

22 SRs and MAs involving 249 prospective studies met eligibility criteria. Results demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament were common predisposing factors across both disorders. There are also distinct factors specific to emerging BD or BPD.

CONCLUSIONS

Prospective studies are required to increase our understanding of the development of BD and BPD onset and their complex interplay by concurrently examining multiple measures in BD and BPD at-risk populations.

Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap.

METHODS

Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI.

RESULTS

NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender.

LIMITATIONS

Cross-sectional design through self-report assessment.

CONCLUSIONS

Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.

From emotional intelligence to suicidality: a mediation analysis in patients with borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is a serious mental illness with a high suicidality rate between 40 and 85%. However, little is known concerning psychosocial risk and protective factors associated with suicidal behaviors in this clinical group. The main focus of the present study was on examining the relationship of emotional intelligence (EI) with suicidal behaviors and its mediators (e.g., depression, self-esteem, addiction potential, and disorder severity) among patients with BPD.

METHODS

In this cross-sectional study, a total of 220 participants (including 110 patients with BPD and 110 healthy controls) in Zahedan, Iran, were examined using clinical interviewing and self-report measures of EI, suicidal behaviors, depression, self-esteem, addiction potential, and BPD symptom severity. The data were analyzed using SPSS v25.0 software at the significance level of p < 0.05.

RESULTS

Our preliminary analysis showed higher levels of EI, depression, and self-esteem in the BPD group in comparison to healthy controls (p < 0.001). Furthermore, our findings showed that higher levels of addiction potential, BPD symptom severity, and depression and lower levels of self-esteem and EI were likely to be related to suicidal behaviors of the BPD group. Our results also supported the overall hypothesis that addiction potential, depression, BPD symptom severity, and self-esteem had a mediating role in the impact of EI on suicidal behaviors in the BPD group.

CONCLUSIONS

According to these findings, we have come to believe that training EI possibly plays a directly and/or indirectly potential preventive and therapeutic role in suicidal behaviors among patients with BPD. However, further longitudinal studies must be carried out to clarify the cause and effect relationship between EI, depression, self-esteem, addiction potential, BPD symptom severity, and suicidal behaviors.

Clinical Staging as a Novel Approach for Selecting Psychological Treatment Levels for Older Adults with Borderline Personality Disorder

OBJECTIVES

In this paper, a novel approach is presented for selecting psychological treatment levels for older adults with borderline personality disorder (BPD). BPD tends to be a lifelong disorder persisting into old age, with a specific presentation of BPD symptoms in later life, which is illustrated by three different clinical cases.

METHODS

Recently, a clinical staging and health management model for BPD was presented to assist in selecting appropriate treatment approaches.

RESULTS

We combined this clinical staging model for BPD across the lifespan with psychotherapeutic treatment levels for older adults with personality disorders.

CONCLUSIONS

This may allow for a more accurate treatment selection for older adults with BPD and was applied to the three clinical cases. Finally, implications for research and clinical practice are discussed.

Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents

The recent development of a dimensional view toward personality disorder opens up the field of personality research based on the constructs of personality functioning (Criterion A) and maladaptive personality traits (Criterion B) as core components of personality pathology. However, little is known about the roles of these aspects in relation to borderline personality features during adolescence. The current study aimed at exploring the associations of Criterion A and B and their contribution in predicting borderline personality features in adolescence. A sample of 568 adolescents aged 11-17 (M = 14.38, SD = 1.57; 42.4% males) from different backgrounds (community-based, psychiatric inpatients, and youth forensic care) completed a set of questionnaires among which were measures of personality functioning, maladaptive personality traits, and borderline personality features. The findings reveal that Criterion A and B are strongly interrelated and both are significant in predicting borderline personality features in adolescents. Further, the results showed the incremental value of Criterion A beyond the level of underlying psychopathology and maladaptive personality traits suggesting the distinctive function of Criterion A to capture the features of borderline personality. These findings extend the knowledge about the dimensional aspects of personality pathology in adolescence. The implications in relation to the new personality disorder model in the ICD-11 are highlighted.

A systematic review of the factors associated with the course of borderline personality disorder symptoms in adolescence

BACKGROUND

Research on personality pathology in adolescence has accelerated during the last decade. Among all of the personality disorders, there is strong support for the validity of borderline personality disorder (BPD) diagnosis in adolescence with comparable stability as seen in adulthood. Researchers have put much effort in the analysis of the developmental pathways and etiology of the disorder and currently are relocating their attention to the identification of the possible risk factors associated with the course of BPD symptoms during adolescence. The risk profile provided in previous systematic reviews did not address the possible development and course of BPD features across time. Having this in mind, the purpose of this systematic review is to identify the factors that are associated with the course of BPD symptoms during adolescence.

METHODS

Electronic databases were systematically searched for prospective longitudinal studies with at least two assessments of BPD as an outcome of the examined risk factors. A total number of 14 articles from the period of almost 40 years were identified as fitting the eligibility criteria.

CONCLUSIONS

Factors associated with the course of BPD symptoms include childhood temperament, comorbid psychopathology, and current interpersonal experiences. The current review adds up to the knowledge base about factors that are associated with the persistence or worsening of BPD symptoms in adolescence, describing the factors congruent to different developmental periods.

Future directions in personality pathology development research from a trainee perspective: Suggestions for theory, methodology, and practice

Research on personality disorder (PD) development has received increased attention in the last two decades, spurring reconceptualization in theoretical models of etiology, use of advanced methods, and development of effective treatments. The current manuscript briefly reviews the state of the field and proposes avenues of new research on the development of personality pathology in theoretical, methodological, and clinical veins. We identify the need to adopt a unifying and comprehensive theory to describe PD development across the lifespan, novel statistical methods to complement traditional methods relied on thus far, and the adoption of developmentally sensitive interventions that are disseminated to professionals and trainees alike. These directions for future research aim to augment prevention efforts to reduce the burden of PDs earlier in life.

Barriers to care for adolescents with borderline personality disorder

Intervention for borderline personality disorder (BPD) in adolescence is crucial as early onset of the disorder predicts more severe course, and intervention 'late' in the course of the disorder is associated with more negative outcomes. In spite of this, access to services is poor. This is because several unique barriers to accessing care exist for adolescents with BPD. In this article we highlight key barriers to care for adolescents with BPD utilizing a conceptual model for understanding health care access that emphasizes the interaction between patient and health care system characteristics. We conclude with proposed recommendations to address these identified barriers.