Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5

Neurobiological correlates of personality dimensions in borderline personality disorder using graph analysis of functional connectivity

Borderline personality disorder (BPD) is is a type B personality disorder primarily characterized by a pattern of unstable interpersonal relationships, a distorted self-concept, and intense emotional reactions, associated with extreme and opposing mental and behavioral states, which coexist and lead to destructive behaviors such as self-harm, commonly recurring over time.. The Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition (PID-5) provides a dimensional assessment of maladaptive domains associated with personality disorders, improving the understanding of their complex clinical presentations. While altered brain functional connectivity (FC) has been reported in BPD, neurobiological-clinical correlations remain debated. This study explores the relationship between the personality dimensions of BPD and resting-state fMRI (rs-fMRI) FC. Twenty-eight patients with BPD (6M/22F, 23.7 ± 3.4 years) and twenty-eight matched healthy controls (6M/22F, 24.3 ± 2.8 years) underwent a psychiatric assessment, including the PID-5, and an MRI protocol including rs-fMRI. Functional data were analyzed via graph theory to derive network properties at global and nodal levels, which were correlated with the PID-5 subdomains. The results revealed impairments across all personality trait facets. Patients had lower global connectivity and compromised centrality of several limbic structures and frontotemporal regions. Significant correlations were found between separation insecurity and global efficiency (R = 0.60, adjusted-p = 0.035) and between depressivity and the degree of the left middle temporal gyrus (R = 0.69, adjusted-p = 0.023) in females. These findings suggest links between negative affectivity traits, in particular separation insecurity and depressivity, and specific brain network dysfunctions in BPD.

Assessing the prevalence of personality pathology in Australian psychiatric emergency care centres: A feasibility study

OBJECTIVES

To assess feasibility and acceptability of self-report measures in estimating prevalence of measurable personality disorder (PD) pathology in a Psychiatric Emergency Care Centre (PECC) unit.

METHOD

Patients meeting eligibility criteria admitted to an inner-city PECC unit were invited to complete the (1) Standardised Assessment of Personality - Abbreviated Scale (SAPAS), (2) Personality Inventory of DSM-5 Brief Form (PID-5-BF), and (3) Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF-2.0).

RESULTS

There were 24 participants - 80% of invited patients but only 51% of eligible patients and 21% of total PECC inpatients. Barriers to recruitment included: not meeting eligibility criteria, rapid discharge, and high workload. All participants completed the self-report measures. There was a very high prevalence of likely PD (87.5%) (SAPAS), personality trait dysfunction (87.5%) (PID-5-BF) and impaired personality functioning (91.7%) (LPFS-BF 2.0) but there was a low rate of agreement between discharge summary diagnoses and self-report measures.

CONCLUSIONS

Using self-report measures to assess PD pathology in a PECC unit was acceptable and may improve discharge summary diagnosis accuracy. Logistical challenges may limit this approach unless it can be embedded in routine care measures. Having accurate prevalence estimates would enable appropriate research, treatment and resourcing in PECCs.

Do PID-5 Trait Scores Predict Symptom Disorders? A Meta-analytic Review

The Personality Inventory for DSM-5 (PID-5) has become influential in the dimensional assessment of personality dysfunction. Though most studies have examined links between PID-5 trait domains and personality pathology, a number of investigations have assessed relationships between PID-5 scores and symptom disorders (e.g., depression, anxiety). We employed meta-analytic techniques to synthesize findings in this area, identifying 26 publications assessing associations between PID-5 scores and symptom disorders (N of effect sizes across the five trait domains = 260). PID-5 domain score effect sizes (rs) ranged from 0.20 for Antagonism to 0.35 for Negative Affect (all ps < .00001). Relationships between PID-5 scores and specific forms of psychopathology were generally consistent with expectations, with some unanticipated relationships as well. Findings confirm that the pathological personality traits assessed by the PID-5 predict symptom disorders as well as personality dysfunction, extending the heuristic value and clinical utility of the measure.

Borderline personality disorder features are associated with inflexible social interpretations

BACKGROUND

Borderline personality disorder (BPD) is thought to involve aberrant social learning, including impaired revision of social interpretations with new evidence (social interpretation inflexibility). However, this topic has received little empirical attention outside of specific literatures, such as moral inference or behavioral economics. Further, the contribution of comorbid depression to BPD-related interpretation inflexibility has not yet been assessed.

METHODS

In two independent samples (Study 1: N = 213; Study 2: N = 210, oversampled for BPD features), we assessed the associations between BPD symptoms, depressive symptoms, and task-based measures of social interpretation flexibility.

RESULTS

We found that BPD symptoms, particularly volatility of identity and relationships, were associated with less revision of social interpretations with both positive and negative evidence. Meanwhile, depressive symptoms were associated with a pattern of less revision of social interpretations with positive versus negative information.

LIMITATIONS

The use of cross-sectional, crowdsourced samples limits causal interpretations. Translation to clinical populations should be assessed in future studies.

CONCLUSIONS

Results suggest that inflexible social interpretations across valences may be a feature of BPD-related pathology, and could be connected to symptoms involving volatility in social contexts. Future studies should investigate whether treatments geared toward increasing the flexibility of social interpretations are effective in treating BPD symptoms, especially those involving interpersonal difficulties.

Clinical cut scores for the Persian version of the personality inventory for DSM-5

BACKGROUND

The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups.

METHODS

Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests.

RESULTS

All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status.

CONCLUSION

Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care

OBJECTIVE

To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design.

METHOD

Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout.

RESULTS

N = 1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions.

CONCLUSION

The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.

miR-124-3p target genes identify globus pallidus role in suicide ideation recovery in borderline personality disorder

Borderline personality disorder (BPD) is characterized by patterns of unstable affect, unstable interpersonal relationships, and chronic suicidal tendencies. Research on the genetics, epigenetics, and brain function of BPD is lacking. MicroRNA-124-3p (miR-124-3p) was recently identified in a Genome-Wide Association Study as likely associated with BPD. Here, we identified the anatomical brain expression of genes likely modulated by miR-124-3p and compared morphometry in those brain regions in BPD inpatients vs. controls matched for psychiatric comorbidities. We isolated lists of targets likely modulated by miR-124-3p from TargetScan (v 8.0) by their preferentially conserved targeting (Aggregate PCT > 0.99, see Supplementary Table 1). We applied Process Genes List (PGL) to identify regions of interest associated with the co-expression of miR-124-3p target genes. We compared the gray matter volume of the top region of interest co-expressing those genes between BPD inpatients (n = 111, 46% female) and psychiatric controls (n = 111, 54% female) at The Menninger Clinic in Houston, Texas. We then correlated personality measures, suicidal ideation intensity, and recovery from suicidal ideation with volumetrics. Gene targets of miR-124-3p were significantly co-expressed in the left Globus Pallidus (GP), which was smaller in BPD than in psychiatric controls. Smaller GP volume was negatively correlated with agreeableness and with recovery from suicidal ideation post-treatment. In BPD, GP volume may be reduced through miR-124-3p regulation and suppression of its target genes. Importantly, we identified that a reduction of the GP in BPD could serve as a potential biomarker for recovery from suicidal ideation.

Acute suicidal affective disturbance and borderline personality disorder symptoms: Distinct yet correlated constructs

OBJECTIVE

Acute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD).

METHODS

We estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms.

RESULTS

Our estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators.

CONCLUSIONS

Our findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs.

Maladaptive personality traits in patients with recent-onset psychosis: A case-control study using the Personality Inventory for the DSM-5 (PID-5)

BACKGROUND

The relationship between maladaptive personality traits and psychotic disorders in the early stages of disease has not been thoroughly investigated, even though it is essential for developing prevention and early intervention strategies.

METHODS

The five domains and the 25 facets of the Personality Inventory for DSM-5 (PID-5) were compared between 102 patients with recent-onset psychosis (ROP) and 116 community subjects (C) with a general linear model including age and sex in the analyses. In addition, multiple linear regression models were used to identify which factors associated with the PID-5 domains in ROP, and correlation analyses were used to explore the relationship between personality traits.

RESULTS

Patients with ROP, compared to C, exhibited higher scores in four out of the five domains with medium effect sizes (Cohen's f² ≥ 0.15) in two of them: negative affect (NA, p = 0.013, f² = 0.04), detachment (DET, p < 0.001, f² = 0.15), disinhibition (DIS, p < 0.001, f² = 0.14) and psychoticism (PSY, p < 0.001, f² = 0.16). Significant group differences were observed in 15 of the 25 facets and the largest effects were observed in the facets of withdrawal (p ≤ 0.001, f² = 0.20), irresponsibility (p < 0.001, f² = 0.23) and unusual beliefs (p = 0.001, f² = 0.22). Interestingly, being on antidepressants and high scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were associated with high scores of NA, antagonism (ANT) and PSY.

CONCLUSIONS

Maladaptive personality traits were prominent in persons with ROP. These findings suggest that personality traits might play a role in vulnerability to psychosis and highlight the importance of evaluating personality in the early stages of psychosis.

Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study

BACKGROUND

Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits.

METHODS

A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed.

RESULTS

Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R² = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69).

CONCLUSIONS

Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.

The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review

BACKGROUND

Given the role digital technologies are likely to play in the future of mental health care, there is a need for a comprehensive appraisal of the current state and validity (ie, screening or diagnostic accuracy) of digital mental health assessments.

OBJECTIVE

The aim of this review is to explore the current state and validity of question-and-answer-based digital tools for diagnosing and screening psychiatric conditions in adults.

METHODS

This systematic review was based on the Population, Intervention, Comparison, and Outcome framework and was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2021. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening or diagnostic accuracy of the included tools were conducted. Risk of bias and applicability were assessed using the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2.

RESULTS

A total of 28 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder, major depressive disorder, and any depressive disorder. Most of the studies used digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening or diagnostic accuracy (sensitivity=0.32-1.00, specificity=0.37-1.00, area under the receiver operating characteristic curve=0.57-0.98) and a high risk of bias for most of the included studies.

CONCLUSIONS

The field of digital mental health tools is in its early stages, and high-quality evidence is lacking.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25382.

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.

In light of the DSM-5 dimensional model of personality: Borderline personality disorder at the crossroads with the bipolar spectrum

BACKGROUND

State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms.

METHODS

A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed.

RESULTS

The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis.

LIMITATIONS

The small size of the samples; a lack of data from participants' previous clinical history.

CONCLUSIONS

Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.

The Personality Inventory for DSM-5: Psychometric Evidence of Validity and Reliability-Updates

OBJECTIVE

To perform a systematic review of the literature on the psychometric characteristics of different versions of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and to integrate the current findings with those of previous reviews by Al Dajani and colleagues (2015) and Watters and Bagby (2018).

METHODS

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. PubMed, PsycINFO, SciELO, Web of Science, and LILACS were searched using two keywords: personality AND DSM-5. Studies published from 2015 to 2018 were included.

RESULTS

Sixty-four new studies were evaluated. The PID-5-self-report form (SRF) was concluded to have a factorial structure consisting of five factors and 25 facets, as well as excellent indicators of internal consistency, test-retest reliability, and convergent validity with different personality instruments and with other clinical constructs. The form also has predictive and discriminative potential, warranting further exploration in studies with samples of personality disorders in relation to different parameters and not only the diagnostic algorithm of DSM-5 Section III. The brief and informant versions, although less studied, also showed good psychometric indicators, comparable to the original version.

CONCLUSIONS

The PID-5 showed psychometric suitability for use in different cultures and contexts. The form's use in clinical practice and as a means of operationalizing the diagnostic evaluation of the DSM-5 dimensional model is promising and should be encouraged.

Lifetime and prospective associations among personality trait domains and suicide-related behaviors in patients with severe mental illness

BACKGROUND

Despite extensive research and clinical efforts, the suicide rate in the United States continues to rise, driving the need for more research to identify latent factors that increase risk for suicide and to guide treatment decision-making.

METHODS

The current study examined a large cohort (N = 1,219) of high-risk psychiatric inpatients to explore associations between personality traits and suicide-related variables measured retrospectively (lifetime history prior to hospital admission) and prospectively (at discharge and 12-month follow-up).

RESULTS

Lifetime suicide-related behavior (SRB: combination of ideational severity, aborted, interrupted, actual attempts, and non-suicidal self-injury) was associated with age (younger), gender (female), and elevated scores on the Personality Inventory for DSM-5 (PID-5) negative affectivity, borderline trait composite score, and five-factor model traits of conscientiousness and neuroticism. Patients who manifested persistent suicidal ideation throughout a 6-8 week inpatient treatment (n = 162; 16.9%) tended to be younger, female, and to have elevated PID-5 borderline trait composite scores. Twelve-month post-discharge SRB was predicted by elevated PID-5 borderline trait composite scores.

LIMITATIONS

Personality traits accounted for a small amount of variance in the overall model, thus limiting prediction based on individual traits.

CONCLUSIONS

This large sample of high-risk inpatients with longitudinal outcomes provides a rare assessment of proximal personality traits in predicting lifetime SRB, persistent suicidal ideation observed during the course of a 6-8-week intensive inpatient treatment, and SRB outcomes within 12 months after discharge from hospitalization. Personality traits should be included in future attempts to create predictive algorithms that include relevant biological data (neuroimaging, genetic, microbiome).

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

PURPOSE OF REVIEW

Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD.

RECENT FINDINGS

A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.

Dependency, mood instability, and inconsequence traits for discriminating borderline personality disorder

INTRODUCTION

Borderline personality disorder (BPD) is one of the most widely studied personality disorders (PDs). It recurrently shows traits of emotional lability, anxiety, separation insecurity, depressiveness, impulsiveness, risk exposure, and hostility, mainly affecting the domains of negative affectivity and antagonism.

OBJECTIVES

To investigate the most discriminant dimensions of the Dimensional Clinical Personality Inventory (Inventário Dimensional Clínico da Personalidade 2 [IDCP-2]) to distinguish people diagnosed with BPD from people without this diagnosis.

METHODS

A total of 305 participants were included in this study: psychiatric outpatients diagnosed with BPD (n = 30), psychiatric outpatients diagnosed with other PDs (n = 75), and a community sample (n = 200). BPD traits were assessed using the dependency, mood instability, and inconsequence dimensions of the IDCP-2.

RESULTS

Analysis of variance (ANOVA) comparisons indicated highest mean measures in the BPD group, and mood instability factors were the most discriminant ones when considering all groups. Applying the multiple regression analysis, we found an adjusted r 2 = 0.50, and hopelessness was the most predictive measure (β = 0.32; t = 6.19; p < 0.001).

CONCLUSIONS

We found discriminatory capacity for factors of all dimensions, although at different levels, and more consistent results to discriminate the BPD group from the community sample.

Differentiating bipolar disorder from borderline personality disorder: Diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5

BACKGROUND

Confusion abounds when differentiating the diagnoses of bipolar disorder (BD) from borderline personality disorder (BPD). This study explored the relative clinical utility of affective instability and self-report personality trait measures for accurate identification of BD and BPD.

METHODS

Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of self-report measures. Inpatients with research-confirmed diagnoses of BD (n = 341) or BPD (n = 381) completed the Difficulty in Emotion Regulation Scale (DERS) and Personality Inventory for DSM-5 (PID-5).

RESULTS

The total score for DERS evidenced relatively poor accuracy for differentiating the disorders (AUC = 0.72, SE = 0.02, p < .0001), while subscales of affective instability measures yielded fair discrimination (AUC range = 0.70-0.59). The PID-5 BPD algorithm (consisting of emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC = 0.83, SE = 0.04, p < .0001) with a good balance of specificity (SP = 0.79) and sensitivity (SN = 0.77).

CONCLUSION

Findings support the use of the PID-5 algorithm for differentiating BD from BPD. Furthermore, findings support the accuracy of the DSM-5 alternative model Criteria B trait constellation for differentiating these two disorders with overlapping features.

Evaluation of DSM-5 and ICD-11 personality traits using the Personality Inventory for DSM-5 (PID-5) in a Brazilian sample of psychiatric inpatients

OBJECTIVE

The objective of this study was to test if the Personality Inventory for DSM-5 (PID-5) is an adequate instrument to evaluate psychiatric inpatients' pathological personality traits.

METHODS

Inpatients (n = 130; mean age: 38.5 years; 62.3% female; 63.9% single) answered the PID-5 after clinical improvement of their psychiatric symptoms. The mean scores of the DSM-5 personality domains, facets and profiles, and ICD-11 domain traits were compared with the mean scores of a Brazilian normative sample (n = 656). We investigated the diagnostic performance of the scales to identify individuals with and without psychopathology.

RESULTS

The final sample included mainly diagnoses of mood disorders. Except for Antagonism and Disinhibition, all DSM-5 personality domains and most facets as well as almost all DSM-5 personality disorder profiles (except Narcissist) and ICD-11 trait domains (except Detachment and Dissociality) of the inpatients presented high differences compared with the normative sample. In general, the PID-5 scales presented a high negative predictive value and a low positive predictive value to identify individuals with severe psychopathology.

DISCUSSION

This study found high scores of pathological personality traits in a sample of Brazilian psychiatric inpatients. The PID-5 may be a promising instrument to measure pathological personality traits among psychiatric inpatients. Methodological and sample size limitations may have influenced the results. © 2018 John Wiley & Sons, Ltd.

A Life Span Perspective on Borderline Personality Disorder

PURPOSE OF REVIEW

To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research.

RECENT FINDINGS

BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.

Examining the role of borderline personality traits in the relationship between major depression and nonsuicidal self-injury

BACKGROUND

Depression and borderline personality disorder (BPD) are highly comorbid conditions that are both associated with nonsuicidal self-injury (NSSI).

AIMS

The purpose of this study was to determine if depression is associated with NSSI after controlling for BPD traits. A distinction was made between NSSI for emotional regulation and NSSI for interpersonal motives.

METHOD

Logistic regression analyses were conducted on cross-sectional data from a general population sample of 7370 adults who completed the 2007 Adult Psychiatric Morbidity Survey. Depressive symptoms were assessed with the revised Clinical Interview Schedule. NSSI and motives for NSSI were also assessed during clinical interviews. BPD traits were assessed with the participant-completed Structured Clinical Interview for DSM-IV Axis II Personality Disorders.

RESULTS

Participants in a major depressive episode were more likely to have engaged in emotional-regulation NSSI and interpersonal NSSI than participants without depression. After controlling for BPD traits depression remained associated with emotional-regulation NSSI, whereas the association with interpersonal NSSI became nonsignificant. There were statistically significant relationships between depression and both types of NSSI occurring indirectly through BPD traits.

CONCLUSIONS

BPD traits account for a significant portion of the cross-sectional relationship between depression and past NSSI that varies in size depending on the motive for NSSI. People with depression are more likely to have engaged in NSSI for emotional regulation even in the absence of prominent BPD traits. In contrast, BPD traits may be more prominent in people with depression who have engaged in interpersonal NSSI.