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

Key insights from studies on the stability of personality disorders in different age groups

While for decades, temporal stability has been conceived as a defining feature of personality disorders (PDs), cumulative findings appear to question the stability of PDs and PD symptoms over time. However, stability itself is a complex notion and findings are highly heterogenous. Building upon a literature search from a systematic review and meta-analysis, this narrative review aims to capture key findings in order to provide critical implications, both for clinical practice and future research. Taken together, this narrative review revealed that unlike previous assumptions, stability estimates in adolescence are comparable to stability estimates in adulthood and PDs and PD symptoms are not that stable. The extent of stability itself depends yet on various conceptual, methodological, environmental, and genetic factors. While findings were thus highly heterogenous, they all seem to converge in a notable trend towards symptomatic remission, except for high-risk-samples. This challenges the current understanding of PDs in terms of disorders and symptoms and argues instead in favor of the AMPD and ICD-11 reintroducing the idea of self and interpersonal functioning as the core feature of PDs.

Late Onset Personality Disorders in Mid-Life and Older Adults

There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.

Borderline personality disorder: associations with psychiatric disorders, somatic illnesses, trauma, and adverse behaviors

In one of the largest, most comprehensive studies on borderline personality disorder (BPD) to date, this article places into context associations between this diagnosis and (1) 16 different psychiatric disorders, (2) eight somatic illnesses, and (3) six trauma and adverse behaviors, e.g., violent crime victimization and self-harm. Second, it examines the sex differences in individuals with BPD and their siblings. A total of 1,969,839 Swedish individuals were identified from national registers. Cumulative incidence with 95% confidence intervals (CI) was evaluated after 5 years of follow-up from BPD diagnosis and compared with a matched cohort. Associations were estimated as hazard ratios (HR) with 95% CIs from Cox regression. 12,175 individuals were diagnosed with BPD (85.3% female). Individuals diagnosed with BPD had higher cumulative incidences and HRs for nearly all analyzed indicators, especially psychiatric disorders. Anxiety disorders were most common (cumulative incidence 95% CI 33.13% [31.48-34.73]). Other notable findings from Cox regressions include psychotic disorders (HR 95% CI 24.48 [23.14-25.90]), epilepsy (3.38 [3.08-3.70]), violent crime victimization (7.65 [7.25-8.06]), and self-harm (17.72 [17.27-18.19]). HRs in males and females with BPD had overlapping CIs for nearly all indicators. This indicates that a BPD diagnosis is a marker of vulnerability for negative events and poor physical and mental health similarly for both males and females. Having a sibling with BPD was associated with an increased risk for psychiatric disorders, trauma, and adverse behaviors but not somatic disorders. Clinical implications include the need for increased support for patients with BPD navigating the health care system.

Borderline personality disorder: stress reactivity or stress generation? A prospective dimensional study

BACKGROUND

Individuals diagnosed with borderline personality disorder (BPD) often describe their lives as stressful and unpredictable. However, it is unclear whether the adversity faced by those with BPD is a product of stress reactivity or stress generation. Here, we examined the dynamic, prospective associations between BPD and stressful life events over 3 years. Given the heterogeneity present in BPD, we sought to understand which empirically derived dimensions of this heterogeneous disorder explain stress reactivity v. stress generation.

METHODS

Participants included 355 individuals diagnosed with BPD and followed longitudinally at three annual assessments. Auto-regressive cross-lagged panel models were used to examine prospective associations between stressful life events and three latent dimensions implicated in BPD: negative affect, disinhibition, and antagonism.

RESULTS

Antagonism and disinhibition, but not negative affect, prospectively predicted dependent stressful life events (events the individual may have some role in). Evidence for decompensation under stress was more tenuous, with independent stressful life events (those presumably outside the individual's control) predicting increases in negative affect.

CONCLUSIONS

Our longitudinal study of a well-characterized clinical sample found more evidence for stress generation than for stress-induced decompensation in BPD. Stress generation in BPD is driven by externalizing dimensions: antagonism and disinhibition. These results highlight the utility of empirically derived dimensions for parsing heterogeneity present in BPD, leading to improvements in diagnostic evaluation, clinical prediction, and individualized approaches to treatment planning.

Prospective self- and informant-personality associations with inflammation, health behaviors, and health indicators

OBJECTIVE

Personality influences many aspects of the health process. It is unclear to what extent self- and informant-reports of the Big Five offer incremental validity for the prediction of inflammatory biomarkers and whether inflammation provides a unique pathway between personality and indicators of physical health, independent of health behaviors.

METHOD

Using data from older adults (N = 1,630) enrolled in the St. Louis Personality and Aging Network study, we tested whether self- and informant-reported Big Five traits show unique associations with inflammation (IL-6, CRP, TNF-α). Further, we tested whether inflammation and health behaviors indirectly link personality to health-related quality of life, body mass index, and chronic disease burden using longitudinal mediation in a structural equation modeling framework.

RESULTS

Self-reports, informant-reports, and general trait factors of personality predicted future inflammatory biomarker levels (unstandardized regression coefficients ranged -.08 to .07 for self, -.13 to -.10 for informants, and -.16 to -.11 for general). Additionally, all assessment methods of personality were associated with the indicators of physical health through biomarker and health behavior pathways. Effects were primarily found for conscientiousness and neuroticism; IL-6 and CRP were the biomarkers with the most indirect effects; and indirect paths overall emerged more frequently through health behaviors, but this varied by outcome.

CONCLUSIONS

Self- and informant-reports provided unique predictive validity of inflammatory biomarkers. Findings highlight the benefits of using of multiple assessments of personality and the importance of examining multiple, distinct pathways by which personality might influence health to understand the mechanisms underlying this relationship more fully. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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).

Borderline personality disorder and ageing: myths and realities

PURPOSE OF REVIEW

Although mental health issues in ageing individuals have been receiving more attention, borderline personality disorder (BPD) in older adults and the elderly has been relatively neglected. This article aims to review the current state of knowledge about BPD in these age groups.

RECENT FINDINGS

Studies have consistently reported decreasing prevalence rates of BPD among ageing individuals. This may be attributed to the ageing process itself and/or different clinical features due to which meeting the diagnostic criteria for BPD becomes more difficult. Ageing individuals with BPD often present in a way that makes them look 'atypical' compared to younger individuals with the same condition. In particular, this pertains to somewhat attenuated and less overt manifestations of impulsivity. However, the basic pattern of overall symptoms instability continues to characterize ageing individuals with BPD, in addition to depressive symptoms, feeling of emptiness, anger, unstable interpersonal relationships, turbulent responses when needs are not met, various somatic complaints and other symptoms.

SUMMARY

Clinicians should be aware of different clinical features of BPD as patients get older. Diagnostic criteria for BPD may need to be revised to reflect this reality, allow accurate diagnosis and minimize the risk of overlooking BPD in ageing individuals.

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.

Perceived Characteristics of Life Events—Short-Term Changes in Prosociality and Empathy?

Post-traumatic growth can be understood as positive change in desirable personality traits after adverse life events. However, recent research questioned whether adversity is a relevant, necessary, and sufficient condition for change in desirable personality traits. Using five-wave longitudinal data, this study explored changes in the desirable personality traits prosociality and empathy before and after life events. We included all life events participants had experienced between the second and third assessment, that is, adverse, ambiguous, and positive events. Participants rated their life events on the Event Characteristics Questionnaire which assesses the individual perception of life events on nine continuous dimensions: challenge, emotional significance, extraordinariness, external control, impact, valence, social status change, predictability, and change in world views. We used multilevel growth curve models to explore changes in prosociality and empathy as a function of these event characteristics. Prosociality and empathy remained stable in the assessment period of 6 to 9 months after the reported life event, independently of whether the event had been perceived as adverse or not. We discuss our findings with respect to the inclusion of positive and ambiguous events as predictors of personality change and with respect to its theoretical implications for post-traumatic growth and personality development more broadly.

The reciprocal impacts of adversity and personality traits: A prospective longitudinal study of growth, change, and the power of personality

OBJECTIVE

We integrate the study of post-traumatic growth with personality science by examining the reciprocal effects of adversity and core personality traits. We implemented conceptual (i.e., incorporating personality traits into the study of adversity-related growth, examining trait-specific and configural personality change, and adopting a cumulative approach to adversity) and methodological (i.e., three-wave prospective design, assessing many life events, sampling from populations likely to experience adversity) innovations to advance the study of personality development and of the generality of adversity-related growth.

METHOD

A diverse sample (41% nonwhite, 48% low-income, 68% female, M_age  = 44, 30% diagnosed with Borderline Personality Disorder) participated in a three-wave prospective longitudinal study (N = 258-128 across waves). Participants completed a personality inventory and a battery of life-event surveys (including 105 events) at each wave.

RESULTS

Personality was generally stable from trait-specific and configural perspectives, and all traits were correlated with adversity. All traits, particularly Extraversion and Conscientiousness, predicted adversity. Adversity predicted increases in Emotionality and decreases in Agreeableness.

CONCLUSIONS

Although personality growth is not the typical response to adversity within a 3-year period, findings underscore the real-world impact of personality, and they provide some support for developmental theories emphasizing the effects of life events.

The relationship between childhood adversity and adult personality revealed by network analysis

BACKGROUND

Childhood adversity is known to influence personality development. Studies suggest that distinct types of childhood adversities have differential effects on personality dimensions. However, different types of adversity often co-occur, and personality dimensions are strongly interconnected.

OBJECTIVE

The aim of this study was to use a network approach to analyze the interrelationships between different types of childhood adversity and diverse personality dimensions integratively.

PARTICIPANTS AND SETTING

We used previously collected data on 142 alcohol dependent patients and 102 healthy controls.

METHODS

The participants completed the Interview for Traumatic Events in Childhood, the Parental Acceptance and Rejection Questionnaire and the Temperament and Character Inventory. Outcomes on the subscales of these instruments were included in the network analysis.

RESULTS

The resulting network showed strong connections between different types of childhood adversity, and between the different temperaments and characters of personality. Childhood adversity, mainly physical abuse and maternal rejection, was connected to most personality dimensions, except for reward dependence. Physical abuse showed the highest centrality measures, indicating a central, important role in the network.

CONCLUSIONS

These findings confirm that different types of childhood adverse experiences often co-occur, and suggest that specifically physical and emotional abuse, and maternal rejection might play a prominent role in shaping personality.

Perspectivas em Psicologia do Esporte e Saúde Mental sob a Pandemia de Covid-19

Resumo Este artigo objetiva compreender as relações entre saúde mental e prática esportiva, de exercício e/ou de atividade física no período afetado pela pandemia da Covid-19, especialmente no Brasil. Ancorado em duas perspectivas epistemologicamente diferentes em Psicologia, articula-se resultados oriundos de instrumentos objetivos de mensuração, bem como de experiências no registro do mundo-da-vida. Discute-se que tais práticas corporais são meios e fins da saúde, tanto pelos efeitos orgânicos benéficos previsíveis, segundo o estado da arte das ciências da atividade física, como pela expressão por excelência do engajamento no mundo com esquecimento de si. A partir do dispêndio de energia, controle da ansiedade e bem-estar delas resultantes, adotar uma regularidade de exercícios físicos no confinamento fornece ao praticante um critério ritual e metabólico auxiliar para o reestabelecimento de parâmetros de tempo e espaço em sua rotina. No entanto, tais atividades também apresentam seus riscos a depender do modo como são realizadas, o que se apresenta como desafio tanto para quem as vivencia quanto para os profissionais em Psicologia do Esporte, seja no âmbito do alto rendimento ou da prática recreativa. Entender as nuances do esporte e as particularidades desses indivíduos é fundamental para endereçar os cuidados adequados. Salienta-se que tal seara não se limita apenas às atividades marcadamente esportivas, envolvendo as mais diversas práticas corporais, culturais e de movimento.

The intergenerational transmission of childhood maltreatment: Nonspecificity of maltreatment type and associations with borderline personality pathology

One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10−4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.