Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients

How changes in depression severity and borderline personality disorder intensity are linked - a cohort study of depressed patients with and without borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is often complicated by comorbid major depressive episodes (MDEs), which can occur as part of major depressive disorder (MDD) or bipolar disorder (BD). Such comorbidity is related to worse outcomes in both disorders. Subsyndromal features of BPD are also common in depression. However, studies of simultaneous changes in BPD and depression severities are scarce, and their interactions are poorly understood.

AIMS

Studying the associations between changes in BPD and depression symptoms over the course of an MDE.

METHODS

In a 6-month naturalistic cohort study of MDE/BPD, MDE/MDD, and MDE/BD patients (N = 95), we measured change in BPD features between baseline and six months with the Borderline Personality Disorder Severity Index (BPDSI), an interviewer-rated instrument quantifying recent temporal frequency of BPD symptoms. We examined changes in BPD severity and their correlation with depression severity and other clinical measures and compared these across patient groups.

RESULTS

There were significant reductions in BPD severity, both in number of positive BPD criteria (-0.35, sd 1.38, p = 0.01672) and in BPDSI scores (-4.23, SD 6.74, p < 0.001), reflecting mainly a reduction in temporal frequency of symptoms. These were similar in all diagnostic groups. In multivariate regression models, changes in depression severity independently associated with changes in symptoms in the BDSI. This relationship was strongest in MDE/BPD patients but was not found in MDD patients without BPD.

CONCLUSIONS

In the six-month follow-up, BPD features in MDE patients alleviated mainly by decreasing temporal symptom frequency and intensity. In BPD patients with comorbid MDE, changes in both conditions are strongly correlated.

Capturing Between- and Within-Person Variability of Borderline Traits in Youth from a Developmentally Sensitive Situational Judgment Perspective

The significance of early maladaptive traits for understanding the roots of borderline personality disorder (BPD) is increasingly endorsed. Given the interpersonal nature of BPD and fluctuations in phenotypic symptomatology, this study aims to test the assumption that a situation-contingent contextualized assessment of borderline traits is a viable avenue to more fully capture the way underlying traits are reflected in socioaffective behavior that occurs in age-relevant situations. We aimed to explore the extent to which the variability on these responses represents a meaningful construct for understanding the clinical richness of BPD. Toward this end, a contextualized measure of DSM-5 BPD traits was developed along a situational judgment test (SJT) format, allowing us to explore both between-person and within-person variability in a more economic format than repeated measurement does. Examination of the psychometric properties of the SJT revealed distinctive correlational patterns of the situation-based traits with symptom scales of a youth BPD measure, but also indicated that for certain traits consistency in trait level across different situations is more maladaptive, whereas for other traits a greater degree of variability in trait expression is more maladaptive. Overall, this work could set the stage for further research on the potential of SJTs for understanding personality vulnerabilities both at the dispositional and the dynamic level.

Associations Between Personality and Depressive Symptoms in an Adolescent Clinical Population: Consideration of Personality Stability

The study used trait-state-occasion TSO models to explore longitudinal personality stability in young adolescents with the onset of depressive symptoms and to quantify time-invariant and time-varying personality components in predicting the course of depressive symptoms. A total of 326 young clinical adolescents were recruited from high schools, and only 290 adolescents (112 boys; 178 girls) were followed up for 4 time points. Personality measures were implemented twice each year with an interval of 6 months, providing four assessment waves (T1 to T4); depression measures were administered at the initial stage (T1) and the third wave (T3), respectively. The results showed that five domains of personality in adolescents with depressive symptoms were largely characterized by the stable trait factor (65%-81%). The average autoregressive effects across the four waves were significant for all Big Five personality domains except openness. Moreover, excluding time-varying variance, conscientiousness, extraversion and agreeableness were negatively associated with T1 depressive symptoms; however, only the latter two domains retained significant relationships in the second year of intervention. An elevated level of neuroticism was consistently associated with higher levels of depressive symptoms over interventions. Trait factors of extraversion, agreeableness and neuroticism were associated with depressive symptoms in early adolsecnets, providing some implications for clinical practitioners.

Examining the Construct Validity of Borderline Personality Traits Using Familial Aggregation and Other External Validators

Numerous studies have questioned the reliability and validity of borderline personality disorder's (BPD) categorical conceptualization. DSM-5 Section III's alternative trait-based model of BPD may better capture borderline pathology, but aspects of its validity should be further established. Thus, the authors examined whether a latent BPD factor derived from Section III traits exhibits (1) familial aggregation among siblings and (2) association with constructs related to borderline pathology. The authors also tested whether gender moderated associations. A total of 498 community-recruited adults completed the Personality Inventory for DSM-5, a behavioral assessment of risk-taking, and reported their history of childhood maltreatment, substance use, nonsuicidal self-injury, and suicidal ideation. Familial aggregation was assessed among 232 sibling pairs. Siblings' BPD scores were significantly correlated and most external validators were significantly associated with BPD, with the exception of risk-taking. Results did not vary by gender. Findings further support the construct validity of Section III's BPD trait profile.

Prevalence of Personality Disorders Across Veteran Samples: A Meta-Analysis

Despite priorities around mental health, Veteran health care organizations have historically considered personality disorders to be preexisting conditions ineligible for disability benefits. However, growing evidence suggests potentially elevated prevalence of these disorders among military and Veteran samples and attests to implications of risk. The current study provides a meta-analytic review of literature on the prevalence of personality disorders in Veteran samples. Analysis of 27 unique samples, comprising 7,161 Veterans, suggests alarmingly high rates of Veteran personality disorders. Prevalence was highest for paranoid (23%) and borderline (21%) personality disorders and lowest for histrionic (0.8%) personality disorder. Rates were generally highest among Veterans experiencing substance use or elevated suicide risk and among studies establishing diagnoses through clinical interview (versus official medical record review). Results attest to the need for Veteran health care organizations to acknowledge personality disorders in this population, through both research and treatment, and to consider reclassifying personality disorders as potential "service-connected conditions."

The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.

Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences

BACKGROUND

Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation.

METHODS

N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected.

RESULTS

Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts.

CONCLUSIONS

The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.

Investigating the stress-related fluctuations of level of personality functioning: A critical review and agenda for future research

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) proposed a dimensional approach to the assessment of personality disorders (PDs). Both models dictate that the clinician first determines PD severity before assessing maladaptive traits, invoking the level of personality functioning (LPF) construct. We consider LPF a promising dimensional construct for translational research because of its clinical importance and conceptual overlap with the Research Domain Criteria (RDoC) Social Processes. We aim to identify biomarkers that co-vary with fluctuations in LPF in adulthood, ultimately to predict persistent decrease in LPF, associated with suicidality and morbidity. However, a theoretical framework to investigate stress-related oscillations in LPF is currently missing. In this article, we aim to fill this hiatus with a critical review about stress and LPF. First, we discuss acute stress and LPF. We briefly present the basics of the neurophysiological stress response and review the literature on momentary and daily fluctuations in LPF, both at a subjective and physiological level. Second, we review the effects of chronic stress on brain function and social behaviour and recapitulate the main findings from prospective cohort studies. This review underlies our suggestions for multimethod assessment of stress-related oscillations in LPF and our theoretical framework for future longitudinal studies, in particular studies using the experience sampling method (ESM).

Is personality stable in adolescence? Disentangling time-invariant and time-varying factors of personality in a trait-state-occasion model

This study applied trait-state-occasion (TSO) modelling to investigate the extent to which inter-individual differences in personality were accounted for by time-invariant and time-varying factors during adolescence. The participants were 753 high school students, and only 661 students were followed for 4 years. The mean age in the first year was 15.23 years and 52.8% were females. The results showed that the full TSO model had the best representation of adolescent personality, and the means of the proportions of variance explained by trait factors for the Big Five ranged between 56% and 83%, suggesting that inter-individual differences in personality are mainly accounted for by stable trait variance over the course of adolescence. Furthermore, the five dimensions of personality differed not only in the amounts of trait variance but also in the stability of time-varying factors. These findings have significant implications for personality research.

Borderline personality disorder: course and outcomes across the lifespan

This article presents an overview of the current literature on the course and outcomes of BPD. It begins with an overview of our changing understanding of BPD in terms of age of onset and prognosis over time. Recent research on clinical, functional and social recovery from BPD in youth and adult populations is then summarised. This is followed by an overview of contemporary prospective studies of adolescent BPD in community populations which seek to unravel complex pathways and the co-development of BPD symptoms and psychosocial problems. Studies of older populations are then described to shed light on how BPD manifests in middle to old age. The review concludes by bringing together these research strands to develop a picture of BPD across the lifespan and highlight areas for future research.

Age-related differences in borderline personality disorder symptom networks in a transdiagnostic sample

BACKGROUND

Naturalistic longitudinal studies of Borderline Personality Disorder (BPD) indicate that symptoms improve over time. In the present study, we applied network theory to the question of how BPD symptom networks may differ as a function of age.

METHODS

In a transdiagnostic sample of 5,212 patients presenting for acute psychiatric treatment, we administered a measure of BPD symptoms and then used a novel machine learning technique to test the hypothesis that symptom networks would significantly differ across the age of participants.

RESULTS

Results supported two significant differences in the BPD symptom network that emerged at age 46. In older participants, the relationships among symptoms of non-suicidal self-injury/suicide and emptiness was weaker, yet the relationship between anger and relationship problems was stronger. No differences emerged for relationships between all other symptoms.

LIMITATIONS

Given the cross-sectional nature of this study, the potential influence of cohort effects cannot be ruled out.

CONCLUSIONS

These findings support the utility of network theory for elucidating potential pathways by which the relationships between symptoms of BPD may differ as a function of age in treatment-seeking individuals. In parallel, results of this study support the highly central role of strong emotions in BPD regardless of age.

Borderline Personality Traits Are Not Correlated With Brain Structure in Two Large Samples

BACKGROUND

Borderline personality disorder is associated with severe psychiatric presentations and has been linked to variability in brain structure. Dimensional models of borderline personality traits (BPTs) have become influential; however, associations between BPTs and brain structure remain poorly understood.

METHODS

We tested whether BPTs are associated with regional cortical thickness, cortical surface area, and subcortical volumes (n = 152 brain structure metrics) in data from the Duke Neurogenetics Study (n = 1299) and Human Connectome Project (n = 1099). Positive control analyses tested whether BPTs are associated with related behaviors (e.g., suicidal thoughts and behaviors, psychiatric diagnoses) and experiences (e.g., adverse childhood experiences).

RESULTS

While BPTs were robustly associated with all positive control measures, they were not significantly associated with any brain structure metrics in the Duke Neurogenetics Study or Human Connectome Project, or in a meta-analysis of both samples. The strongest findings from the meta-analysis showed a positive association between BPTs and volumes of the left ventral diencephalon and thalamus (p values < .005 uncorrected, p values > .1 false discovery rate-corrected). Contrasting high and low BPT decile groups (n = 552) revealed no false discovery rate-significant associations with brain structure.

CONCLUSIONS

We find replicable evidence that BPTs are not associated with brain structure despite being correlated with independent behavioral measures. Prior reports linking brain morphology to borderline personality disorder may be driven by factors other than traits (e.g., severe presentations, comorbid conditions, severe childhood adversity, or medication) or reflect false positives. The etiology or consequences of BPTs may not be attributable to brain structure measured via magnetic resonance imaging. Future studies of BPTs will require much larger sample sizes to detect these very small effects.

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

The shift towards early intervention in borderline personality disorder (BPD) has introduced a clinical staging approach in the treatment for young persons with BPD. Complementary to staging is profiling: the identification of psychological, social and biological risk variables that may predict prognosis. The aim of this paper is to provide a risk profile for BPD by systematically reviewing literature on potential risk markers for poor prognosis for BPD. An extensive literature search revealed evidence for seven categories of risk factors: adverse childhood experiences, BPD symptom profile, associated mental disorders, personality impairments and traits, current interpersonal context, biological disposition and socio-demographics. Including these markers within the current staging approach, to compose individual risk profiles for poor BPD prognosis, may assist in personalizing treatment for young people with BPD and in refining research protocols for treatment outcome studies.