The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age

The Stressful Personality: A Meta-Analytical Review of the Relation Between Personality and Stress

The current study presented the first meta-analytic review on the associations between the Big Five personality traits and stress measured under different conceptualizations (stressor exposure, psychological and physiological stress responses) using a total of 1,575 effect sizes drawn from 298 samples. Overall, neuroticism was found to be positively related to stress, whereas extraversion, agreeableness, conscientiousness, and openness were negatively linked to stress. When stress assessed under different conceptualizations was tested, only neuroticism, agreeableness, and conscientiousness were related to stressor exposure. All of the Big Five personality traits were significantly associated with psychological stress perception, whereas the five personality traits showed weak to null associations with physiological stress response. Further moderation analyses suggested that the associations between personality traits and stress under different conceptualizations were also contingent upon different characteristics of stress, sample, study design, and measures. The results supported the important role of personality traits in individual differences in stress.

Personality pathology predicts increased informant-reported, but not performance-based, cognitive decline: Findings from two samples

Research on the relationship between normal-range personality and cognitive aging has demonstrated consistent, modest effects. The current investigation increases our understanding of unhealthy cognitive aging by testing whether personality disorders (PDs), specifically borderline, avoidant, and obsessive-compulsive PDs, show prospective associations with the onset of cognitive problems. Interpersonal stressful life events and social support were expected to mediate these relationships. The current investigation used data from 2 longitudinal studies of older adulthood: the Alzheimer's disease Research Center cohort (ADRC, N = 434, Mage = 69.95, 56% women) and the St. Louis Personality and Aging Network study (SPAN, N = 1,058, Mage = 65.92, 54% women). The ADRC study administered a battery of neuropsychological tests to assess cognitive ability/memory. Borderline PD was measured with a composite from the NEO Five-Factor Inventory. The SPAN study administered self-, informant, and interview measures of the three PDs; a free-recall task; and an informant report measure of cognitive problems. Borderline PD features exhibited cross-sectional correlations with memory (ADRC: r = -.11; SPAN: all rs = -.08), general cognitive ability (ADRC: r = -.11), and informant-reported cognitive problems (rs ranged from .15 to .39). Most importantly, borderline PD features predicted an increase in informant-reported cognitive problems in SPAN participants (standardized bs = .13 and .15) over a 2-year period, but they did not predict a deterioration in the performance-based cognitive measures in either study. Avoidant and obsessive-compulsive PDs exhibited little association with cognitive aging. Neither interpersonal variable mediated any of these effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Examination of Stress Generation and Stress Exposure Models in Relation to Symptoms of Borderline Personality Disorder

Research examining life stress as a precipitant, co-occurrence, and consequence of psychopathology often has implications for two explanatory models: stress exposure, where stress causes symptoms, and stress generation, where symptoms cause stress. Preliminary evidence suggests that both processes are evident in borderline personality disorder (BPD). The present study examined 101 adults who self-reported at least three symptoms of BPD at prescreen, with 30% of the sample meeting full diagnostic criteria for BPD. Cross-lagged panel analyses were used to examine the relationships between BPD symptomatology and four forms of life stress. Stress exposure and stress generation were not supported for either form of chronic life stress. Results supported stress generation in both dependent and interpersonal episodic life stress, and stress exposure for interpersonal episodic life stress. These findings evidenced small effects only. Findings point to the impact of interpersonal stress on changes in symptomatology over time.

Black-White racial health disparities in inflammation and physical health: Cumulative stress, social isolation, and health behaviors

Black Americans have vastly increased odds and earlier onsets of stress- and age-related disease compared to White Americans. However, what contributes to these racial health disparities remains poorly understood. Using a sample of 1577 older adults (32.7% Black; ages 55-65 at baseline), we examined whether stress, health behaviors, social isolation, and inflammation are associated with racial disparities in self-reported physical health. A latent cumulative stress factor and unique stress-domain specific factors were modeled by applying bifactor confirmatory analysis to assessments across the lifespan (i.e., childhood maltreatment, trauma exposure, discrimination, stressful life events, and indices of socioeconomic status). Physical health, health behavior, and social isolation were assessed using self-report. Interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed from morning fasting serum samples; a z-scored inflammation index was formed across these 2 cytokines. A parallel serial mediational model tested whether race (i.e., Black/White) is indirectly associated with health through the following 3 independent pathways: (1) cumulative stress to preventative health behaviors (e.g., healthy eating) to inflammation, (2) cumulative stress to risky health behaviors (e.g., substance use) to inflammation; and (3) cumulative stress to social isolation to inflammation. There were significant indirect effects between race and self-reported physical health through cumulative stress, preventative health behaviors, and inflammation (B = -0.02, 95% CI: -0.05, -0.01). Specifically, Black Americans were exposed to greater cumulative stress, which was associated with reduced engagement in preventative health behaviors, which was, in turn, associated with greater inflammation and reduced physical health. A unique SES factor also indirectly linked race to physical health through preventative health behaviors. Cumulative stress exposure and unique aspects of socioeconomic status are indirectly associated with Black-White racial health disparities through behavioral (i.e., preventative health behavior) and biological (i.e., inflammation) factors. Culturally responsive evidence-based interventions that enhance engagement in preventative health behaviors are needed to directly confront health disparities. Ultimately, large scale anti-racist public policies that reduce cumulative stress burden (e.g., a living wage, universal healthcare) may best attenuate racial health disparities.

Neuroticism and reward-related ventral striatum activity: Probing vulnerability to stress-related depression

Elevated neuroticism may confer vulnerability to the depressogenic effects of stressful life events (SLEs). However, the mechanisms underlying this susceptibility remain poorly understood. Accumulating evidence suggests that stress-related disruptions in neural reward processing might undergird links between stress and depression. Using data from the Saint Louis Personality and Aging Network (SPAN) study and Duke Neurogenetics Study (DNS), we examined whether neuroticism moderates links between stressful life events (SLE) and depression as well as SLEs and ventral striatum (VS) response to reward. In the longitudinal SPAN sample (n = 971 older adults), SLEs prospectively predicted future depressive symptoms, especially among those reporting elevated neuroticism, even after accounting for prior depressive symptoms and previous SLE exposure (NxSLE interaction: p = .016, ΔR² = 0.003). Cross-sectional analyses of the DNS, a young adult college sample with neuroimaging data, replicated this interaction (n = 1,343: NxSLE interaction: p = .019, ΔR² = 0.003) and provided evidence that neuroticism moderates the association between SLEs and reward-related VS response (n = 1,195, NxSLE: p = .017, ΔR² = 0.0048). Blunted left VS response to reward was associated with a lifetime depression diagnosis, r = -0.07, p = .02, but not current depressive symptoms, r = -0.003, p = .93. These data suggest that neuroticism may promote vulnerability to stress-related depression and that sensitivity to stress-related reductions in VS response may be a potential neural mechanism underlying vulnerability to clinically significant depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Unemployment and the Relationship between Borderline Personality Pathology and Health

Evidence suggests that employment may buffer against the negative health outcomes associated with borderline personality disorder (BPD). The purpose of the current analyses was to examine unemployment and the BPD-health relationship prospectively. Participants were 1,536 older adults in a longitudinal study of health and aging, with repeated measures of physical health, depressive symptoms, and life satisfaction. We measured BPD features using multiple sources at baseline, and used principal components analysis to obtain latent scores. Multilevel models indicated that unemployment experiences did not moderate the prospective relationship between BPD features and physical health or life satisfaction, but did strengthen the positive relationship between BPD features and depressive symptoms. These findings provide insight into mechanisms of recovery for individuals with BPD.

Dynamic associations between borderline personality disorder and stressful life events over five years in older adults

The time course of borderline personality disorder (BPD) is far more variable than traditionally assumed. Shifting environmental conditions are theorized to account, at least in part, for fluctuations in symptom presentation over time. In the present study, we evaluated the reciprocal influences of stressful life events and borderline pathology in a representative community sample of 1,630 older adults assessed 3 times over 5 years. An autoregressive cross-lagged model revealed strong, but imperfect, stability in symptoms of BPD over the study time frame. After adjusting for this continuity in BPD, the prospective effect of life stress on borderline pathology was virtually nil, contrary to expectations. On the other hand, borderline pathology was prospectively related to subsequent dependent event (i.e., stressors to which individuals may have contributed), but not independent event (i.e., fateful stressors), exposure. This pattern of associations was consistent with a stress generation effect. We conclude that stressful life events do not substantially redirect the trajectory of BPD in older adults, possibly owing to inertia of borderline pathology at this developmental stage. Instead, symptoms of BPD seem to promote stress exposure, thereby setting the stage for continued social impairment and comorbid psychiatric problems. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Processing of information about future life events in borderline personality disorder

Borderline Personality Disorder (BPD) is associated with negative self-images. However, it has remained underexplored whether BPD patients hold negative views of their personal future. When receiving information about possible future live events, healthy participants tend to update their estimates more toward desirable than toward undesirable information. Here, we test whether BPD patients (n=21) process information about their future in a more negative fashion than healthy controls (n=79). Participants rated their probability of experiencing 45 adverse life events-before and after receiving statistical information about the average probability of these events. BPD patients first estimated their probability of experiencing negative life events higher than healthy controls. However, after receiving information about the life events the estimates of two groups did not differ. Both groups updated their estimates more toward desirable than toward undesirable information. Thus, our findings suggest a nuanced picture. At the outset, BPD patients appear pessimistic but they might be able to overcome their pessimism when provided with relevant information. Taken together, BPD patients were initially more pessimistic about their personal future than healthy controls. Both groups showed positively biased updating without evidence for differences in BPD patients.

Dispositional negativity: An integrative psychological and neurobiological perspective

Dispositional negativity-the propensity to experience and express more frequent, intense, or enduring negative affect-is a fundamental dimension of childhood temperament and adult personality. Elevated levels of dispositional negativity can have profound consequences for health, wealth, and happiness, drawing the attention of clinicians, researchers, and policymakers. Here, we highlight recent advances in our understanding of the psychological and neurobiological processes linking stable individual differences in dispositional negativity to momentary emotional states. Self-report data suggest that 3 key pathways-increased stressor reactivity, tonic increases in negative affect, and increased stressor exposure-explain most of the heightened negative affect that characterizes individuals with a more negative disposition. Of these 3 pathways, tonically elevated, indiscriminate negative affect appears to be most central to daily life and most relevant to the development of psychopathology. New behavioral and biological data provide insights into the neural systems underlying these 3 pathways and motivate the hypothesis that seemingly "tonic" increases in negative affect may actually reflect increased reactivity to stressors that are remote, uncertain, or diffuse. Research focused on humans, monkeys, and rodents suggests that this indiscriminate negative affect reflects trait-like variation in the activity and connectivity of several key brain regions, including the central extended amygdala and parts of the prefrontal cortex. Collectively, these observations provide an integrative psychobiological framework for understanding the dynamic cascade of processes that bind emotional traits to emotional states and, ultimately, to emotional disorders and other kinds of adverse outcomes. (PsycINFO Database Record

Personality Predicts Health Declines Through Stressful Life Events During Late Mid-Life

Personality predicts the occurrence of dependent stressful life events (SLE; i.e., events reliant, at least in part, on an individual's behavior). This process, termed stress generation, contributes to psychiatric outcomes, but its role in physical health is unknown. Data were included from 998 participants (aged 55-64) in the St. Louis Personality and Aging Network (SPAN) study. Assessments occurred every 6 months for 18 months. Neuroticism, impulsivity, and agreeableness were measured with the Revised NEO Personality Inventory. Dependent (e.g., divorce) and independent (e.g., family death) SLE occurring within 6 months following baseline were assessed with the List of Threatening Experiences and confirmed by interviews. Health problems occurring within a year after SLE were the outcome. Analyses examined whether neuroticism, impulsivity, and agreeableness indirectly predict the onset of new health problems through exposure to dependent SLE. Each personality trait was associated with dependent, but not independent, SLE. Only dependent SLE predicted new health problems. Each personality trait indirectly predicted the onset of new health problems through dependent SLE. Findings suggest that personality-driven stress generation influences physical health during late mid-life. Addressing personality in interventions may reduce the occurrence of SLE, in turn decreasing health risks.

Borderline personality pathology and insomnia symptoms in community-dwelling older adults

Prior research has associated BPD with sleep problems, but the relationship has been explored primarily in small clinical samples of younger adults. Findings from our lab have demonstrated that borderline symptoms remain present in later middle age and are associated with several negative life outcomes. A representative community sample of older adults (N = 633, Mage  = 62.3) was obtained from the St Louis area, and interviewer-reports, self-reports, and informant-reports of personality pathology were completed along with an insomnia symptoms questionnaire. Cross-sectional analyses revealed that symptoms from all 10 DSM-IV personality disorders were significantly correlated with insomnia symptoms. However, after statistically controlling for major depression, body-mass index, race and gender, only borderline personality pathology remained significantly associated with insomnia symptoms. Our results demonstrate that in addition to other negative health outcomes, borderline personality pathology is uniquely associated with sleep problems in later middle-aged adults in the community.

Evidence needed to compare definitions of personality pathology: commentary on "a postmortem and future look at the personality disorders in DSM-5"

Comments on the original article by Widiger (see record 2013-45025-016). As Widiger notes, it is important to compare competing systems for the measurement of personality disorders (PD) using empirical data. The current author comments that classification systems are not right or wrong; they are simply more or less useful. What kind of evidence is needed for these comparisons? Clearly the relevant data will cover a wide range of topics, from basic descriptive information to behavior genetics and treatment outcome data. The current author makes three recommendations regarding studies of this sort. First, evidence regarding the presence of personality pathology should come from all sources, not simply self-report instruments. Second, investigators should study community samples as well as samples composed exclusively of patients who are receiving treatment. The third point is that investigators who compare diagnostic models should consider longitudinal evidence collected across all phases of the life span.

Symptoms of borderline personality disorder predict interpersonal (but not independent) stressful life events in a community sample of older adults

Individuals with borderline personality disorder (BPD) often experience stressful life events at a higher frequency than those without BPD. It is less clear what specific types of events are involved in this effect, and it has not been determined whether some features of BPD are more important than others in accounting for this effect. The latter issue is important in light of the heterogeneous nature of this diagnostic construct. These issues were examined in a large, representative community sample of men and women, ages 55-64. Ten Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, Washington, DC, American Psychiatric Association, 2000) personality disorders were assessed at baseline using the Structured Interview for DSM-IV Personality: SIDP-IV (B. Pfohl, N. Blum, & M. Zimmerman, 1997, Washington, DC, American Psychiatric Press). Life events were measured at three sequential assessments following baseline at 6-month (N = 1,294), 12-month (N = 1,070), and 18-month (N = 837) follow-ups. Stressful life events were identified using a self-report questionnaire (LTE-Q; List of Threatening Experiences Questionnaire: A subset of prescribed life events with considerable long-term contextual threat by T. Brugha, C. Bebbington, P. Tennant, and J. Hurry, 1985, Psychological Medicine, Vol. 15, pp. 189-194.) followed by a telephone interview. Only borderline personality pathology was related to an increase in the frequency of interpersonal stressful life events. Three specific symptoms of BPD were largely responsible for this connection: unstable interpersonal relationships, impulsivity, and chronic feelings of emptiness (negative association). Symptoms of avoidant and schizoid personality disorders were associated with a reduced number of stressful life events that are considered to be outside a person's control (e.g., serious illness, injury, or death of a loved one). None of the personality disorders predicted an increase in the number of stressful financial events (e.g., major financial crisis). These findings suggest that, as individuals approach later life, certain features of BPD continue to serve as important risk factors for stressful life events of an interpersonal nature.

The enduring impact of maladaptive personality traits on relationship quality and health in later life

Over the past 5 years, the St. Louis Personality and Aging Network (SPAN) has been collecting data on personality in later life with an emphasis on maladaptive personality, social integration, and health outcomes in a representative sample of 1,630 adults aged 55-64 living in the St. Louis area. This program has confirmed the importance of considering both the normal range of personality and in particular the role of maladaptive traits in order to understand individuals' relationships, life events, and health outcomes. In the current article, we discuss the explanatory benefits of considering maladaptive traits or traits associated with personality disorders when discussing the role of personality in social and health outcomes, with an emphasis on adults in middle to later life, and integrate these findings into the greater literature.

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports

This report is concerned with the prevalence of symptoms of specific personality disorders in a representative community sample and draws attention to the importance of different sources of diagnostic information. We recruited a sample of 1,630 people between the ages of 55 and 64 to participate in a study regarding personality and health. Using careful recruitment methods, our participation rate was 43 %. Participants completed the SIDP-IV interview as well as a questionnaire (self-report MAPP). Informants completed the same questionnaire (informant MAPP), describing the participant's maladaptive personality characteristics. According to the diagnostic interview, 7 % of participants met criteria for exactly one PD, 1 % met criteria for 2 or 3 PDs, and 2 % met criteria for PD NOS (defined as 10 or more miscellaneous criteria). Avoidant and obsessive compulsive PDs were the most common types. Correlations between the three sources of information indicated significant agreement among these measurement methods, but they are not redundant. In comparison to interview and self-report data, informants reported more symptoms of personality pathology (except for avoidant PD). Symptoms of personality pathology are continuously distributed, and subthreshold features may have an important impact on health and social adjustment. In this community sample, rates of co-morbidity among PDs and the proportion of PDNOS diagnoses are substantially lower than reported from clinical samples. Future research must evaluate the validity of diagnostic thresholds and competing sources of diagnostic information in relation to important life outcomes.