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Cavelti M, Lerch S, Ghinea D, Fischer-Waldschmidt G, Resch F, Koenig J, Kaess M. Heterogeneity of borderline personality disorder symptoms in help-seeking adolescents. Borderline Personal Disord Emot Dysregul 2021; 8:9. [PMID: 33722308 PMCID: PMC7958409 DOI: 10.1186/s40479-021-00147-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent structure of BPD in adolescents. METHODS Five-hundred and six outpatients aged 12 to 17 years with risk-taking and/or self-harming behavior were assessed at baseline and one-year follow-up. Latent class analysis (corresponding with the categorical approach), factor analysis (corresponding with the dimensional approach), and factor mixture models (allowing for both categorical and dimensional aspects) were applied to the DSM-IV BPD criteria. RESULTS The best fitting model distinguished between a majority class with high probabilities for all BPD criteria ("borderline group") and a minority class with high probabilities for the impulsivity and anger criteria only ("impulsive group"). Sex significantly affected latent class membership, and both a latent factor and age explained within-class variability. The borderline group primarily consisted of females, frequently reported adverse childhood experiences, scored high on the emotion dysregulation and inhibitedness personality traits, and was associated with internalizing psychopathology. In contrast, the impulsive group primarily consisted of males, scored high on the dissocial behavior personality trait, and was associated with externalizing psychopathology. After one year, the two groups showed similar clinical improvement. CONCLUSIONS The study provides evidence for two distinct subgroups of adolescents with BPD features that resemble the subtypes of the ICD-10 emotionally unstable personality disorder. More research is needed to further investigate the diagnostic stability of the two groups over time and potential differential treatment indications.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Stefan Lerch
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Denisa Ghinea
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland.
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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The CDA-BPD: retrofitting a traditional borderline personality questionnaire under the cognitive diagnosis model framework. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2021. [DOI: 10.1017/prp.2019.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To obtain rich information about the cognitive diagnosis of borderline personality disorder (BPD), this study attempted to retrofit a traditional borderline personality questionnaire so that the improved assessment (called CDA-BPD) could provide more diagnostic information. The retrofitting processes included the following steps: (1) applied an cognitive diagnosis model to analyze the psychometric characteristics of the traditional questionnaire; (2) under the guidance of cognitive diagnosis assessment (CDA), high-quality items were chosen to develop the CDA-BPD and tested on 1,097 subjects; (3) the quality of the CDA-BPD was evaluated; (4) the structure of the CDA-BPD was analyzed. Results indicated that: (1) the CDA-BPD had acceptable reliability and validity; (2) the CDA-BPD had sensitivity of 0.985 and specificity of 0.853 with area under curve (AUC) = 0.956; (3) the two structural factors of the traditional questionnaire were confirmed in the CDA-BPD; χ2 was 83.01 with df = 26, p < .0001, comparative fit index (CFI) = 0.97, root mean square error of approximation (RMSEA) = 0.045. It was concluded that the practice of retrofitting a traditional borderline personality assessment for cognitive diagnostic purpose was feasible. Most importantly, under the cognitive diagnosis model framework, CDA-BPD could simultaneously provide general-level information and the detailed symptom criteria-level information about the posterior probability of satisfying each symptom criterion in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5; American Psychiatric Association, 2013 ) for each individual, which gave further insight into tailoring individual-specific treatments for borderline personality disorder.
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Vine V, Victor SE, Mohr H, Byrd AL, Stepp SD. Adolescent suicide risk and experiences of dissociation in daily life. Psychiatry Res 2020; 287:112870. [PMID: 32171125 PMCID: PMC7983062 DOI: 10.1016/j.psychres.2020.112870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents' dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11-13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.
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Affiliation(s)
- Vera Vine
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Harmony Mohr
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Amy L Byrd
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Bayes AJ, Parker GB. Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria. Acta Psychiatr Scand 2020; 141:142-148. [PMID: 31758547 DOI: 10.1111/acps.13133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We sought to determine the differential diagnostic efficiency of all DSM-IV borderline personality disorder (BPD) criteria by studying a sample of those with BPD and a contrast group with a bipolar disorder (BP). METHOD Participants were clinically assessed and assigned diagnoses based on DSM criteria - with prevalence rates and diagnostic efficiency values calculated. RESULTS Fifty-three participants were assigned a BPD diagnosis, 83 a BP diagnosis, with comorbid participants excluded. The mean number of DSM BPD criteria assigned was 6.6 (SD = 1.0) in the BPD group and 1.9 (SD = 1.3) in the BP group. The most prevalent criterion in the BPD group was 'affective instability' (AI) (92.5%), with 'inappropriate anger' least endorsed (49%). The highest specificity criterion was 'abandonment fears', which displayed the greatest positive predictive value (PPV) = 0.9, and with AI offering the lowest specificity. 'Unstable relationships' had the highest overall negative predictive value (NPV) = 0.91. The highest percentage accuracy of classification was provided by 'identity disturbance' and 'abandonment fears' criteria, both 85%. CONCLUSION The transdiagnostic nature of 'affective instability' means it is less useful for diagnostic decisions, whereas 'abandonment fears' and 'identity disturbance' offer superior diagnostic efficiency in distinguishing BPD from BP.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - G B Parker
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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Abstract
The status of borderline personality disorder (BPD) as a diagnostic category is a matter of continuing controversy. In the United States, BPD is one of the most frequent diagnoses of psychiatric inpatients, and a similar tendency emerges in Europe. Nearly all theoretical aspects of BPD have been questioned, including its very position as a personality disorder. In this article, we trace the evolution of the borderline concept from the beginning of the 20th century to the current psychometric research. We argue that the status of BPD is fraught with conceptual difficulties, including an unrecognized semantic drift of major phenomenological terms (e.g., identity), a lack of general principles for the distinction of BPD and the major psychiatric syndromes (e.g., schizophrenia spectrum disorders), and insufficient definitions of key nosological concepts. These difficulties illustrate general problems in today's psychiatry that require consideration.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
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Vanwoerden S, Leavitt J, Gallagher MW, Temple JR, Sharp C. Dating violence victimization and borderline personality pathology: Temporal associations from late adolescence to early adulthood. Personal Disord 2019; 10:132-142. [PMID: 30829527 DOI: 10.1037/per0000324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality pathology is a serious mental illness characterized by pervasive interpersonal deficits that onset during adolescence. Risk factors for borderline personality pathology include maladaptive interpersonal dynamics within attachment relationships. Given the shift toward emphasizing romantic relationships during adolescence as an important attachment relationship with implications for healthy development, the current study aimed to evaluate the longitudinal and reciprocal relations between victimization in dating relationships and borderline pathology in the transition from late adolescence to early adulthood. A large sample of high school daters (N = 818; 58% female; Mage = 16.10 years, SDage = .78) were recruited to complete annual assessments of borderline personality features and dating violence victimization across 5 years. Results of a cross-lagged panel model revealed that primarily among girls, borderline features predicted increased levels of relational, psychological, and physical violence, whereas psychological and sexual violence predicted greater borderline features. The current findings provide the first evidence of a longitudinal association between victimization and borderline pathology in adolescence and suggest, particularly among girls, that interventions for borderline features have important implications for reducing dating violence victimization among adolescents and young adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jeff R Temple
- Department of Obstetrics and Gynecology, University of Texas Medical Branch
| | - Carla Sharp
- Department of Psychology, University of Houston
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Vanwoerden S, Garey L, Ferguson T, Temple J, Sharp C. Borderline Personality Features Scale for Children-11: Measurement invariance over time and across gender in a community sample of adolescents. Psychol Assess 2019; 31:114-119. [PMID: 30080065 PMCID: PMC6312464 DOI: 10.1037/pas0000640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Borderline Personality Features Scale for Children (BPFS-C) was recently shortened using item response theory to an 11-item version that is optimal for use in epidemiological studies and repeated assessment over time. Only 1 study has examined invariance of the BPFS-C-11 items across gender and no study has done so over time. The present study employed a longitudinal design to address this gap by evaluating measurement invariance across gender and over time during the transition into adulthood in a diverse community-based sample of 755 adolescents (56% female). Results indicated measurement variance for items measuring personal relationships and impulsivity/recklessness, with females having a greater probability of endorsing items regarding relationship instability and males more likely to endorse impulsivity, despite an equal position on the latent trait. Overall, there was partial measurement invariance of a single dimension of borderline features between males and females and full longitudinal invariance of this factor through the transition into young adulthood. The current findings provide empirical evidence supporting the reliability of BPFS-C-11 scores as a measure of borderline pathology (BP) during late adolescence and early adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jeff Temple
- University of Texas Medical Branch, Galveston, TX, USA
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8
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Orme W, Bowersox L, Vanwoerden S, Fonagy P, Sharp C. The relation between epistemic trust and borderline pathology in an adolescent inpatient sample. Borderline Personal Disord Emot Dysregul 2019; 6:13. [PMID: 31485332 PMCID: PMC6712815 DOI: 10.1186/s40479-019-0110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/15/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Recent extensions of mentalization theory have included the hypothesis that a reduced capacity for epistemic trust in the context of attachment relationships may represent a core vulnerability for the development of borderline personality disorder (BPD). The first aim of the current study was to explore empirical relationships between epistemic trust and symptoms of BPD. The second aim was to explore the effect of epistemic trust on treatment response. METHODS Data were collected from 322 inpatient adolescents. The Inventory of Parent and Peer Attachment (IPPA) trust in mother and father subscales were used to approximate epistemic trust in the absence of a validated measure. A multimodal approach was used to measure BPD including self-report, parent-report, and interviewer ratings. Regression analyses were performed to explore the relationship between IPPA trust scores and measures of BPD. Mixed-design analyses of variance were conducted to evaluate whether self-reported parent trust at admission influenced progress in treatment. RESULTS As hypothesized, results indicated that reduced IPPA trust in parents correlated with BPD symptoms across various measures. Levels of IPPA trust in parents at admission did not moderate a reduction in BPD symptoms over the course of treatment. CONCLUSIONS This study provides support for the theoretical association between deficits in epistemic trust and BPD while also highlighting the need for a validated measure of epistemic trust. Although parent trust at admission did not moderate a reduction in BPD symptoms over the course of treatment, this result may suggest that progress in treatment, and perhaps the ability to cultivate trust in the treatment setting and providers, may not be overly determined by levels of parent trust.
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Affiliation(s)
- William Orme
- 1Baylor College of Medicine, The Menninger Clinic, Houston, Texas USA
| | - Lauren Bowersox
- 1Baylor College of Medicine, The Menninger Clinic, Houston, Texas USA
| | | | - Peter Fonagy
- 3Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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9
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Abstract
This commentary critically evaluates the usefulness of the standards employed by Gunderson et al. (2018) for theory evaluation and comparison and calls into question their adequacy, based both on the lack of scientific evidence supporting the assertions these standards imply and on the availability of alternative standard for theory evaluation and comparison. In so doing, the commentary calls for a redefinition of "borderlineness" as well as the use of standard criteria for theory evaluation and comparison.
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10
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Paggeot A, Huprich S. Measurement Invariance Between Genders on Two Measures of Borderline Personality Disorder. J Pers Disord 2018; 32:31-43. [PMID: 28513348 DOI: 10.1521/pedi_2017_31_284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gender bias in the diagnosis and assessment of borderline personality disorder (BPD) has been the subject of much controversy in the psychological research literature. Evidence regarding differential prevalence rates and diagnostic rates in clinical settings between genders has been mixed, and measurement bias is one potential explanation for these mixed findings. A total of 340 participants were recruited from a Midwestern university and four outpatient community mental health clinics. They were administered two structured clinical interviews for BPD that were then evaluated for measurement invariance. Both the SCID-II BPD scale and the PDI-IV BPD scale were found to be measurement invariant between genders. No significant differences were found on the SCID-II BPD scale in diagnosis or overall number of criteria endorsed. However, in the rates of endorsement of individual criteria, differences were found in the unstable relationships item.
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Affiliation(s)
- Amy Paggeot
- Eastern Michigan University, Ypsilanti, Michigan
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Rosenström T, Torvik FA, Ystrom E, Czajkowski NO, Gillespie NA, Aggen SH, Krueger RF, Kendler KS, Reichborn-Kjennerud T. Prediction of alcohol use disorder using personality disorder traits: a twin study. Addiction 2018; 113:15-24. [PMID: 28734091 PMCID: PMC5725242 DOI: 10.1111/add.13951] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/27/2017] [Accepted: 07/14/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS The DSM-IV personality disorders (PDs) are comorbid with alcohol use disorder (AUD) and with each other. It remains unclear which PD criteria are most likely to drive onset and recurrence of AUD and which are merely confounded with those criteria. We determine which individual PD criteria predict AUD and the degree of underlying genetic and/or environmental aetiology. DESIGN A prospective observational twin study. SETTING Norway 1999-2011. PARTICIPANTS A total of 2528 and 2275 Norwegian adult twins in waves 1 and 2 variable-selection analyses, and 2785 in biometric analyses. MEASUREMENTS DSM-IV PDs and their 80 criteria were assessed using a structured personal interview, and AUD using the World Health Organization's Composite International Diagnostic Interview. FINDINGS In a variable-selection analysis, two PD criteria were associated with AUD even after taking all the other criteria into account: criterion 8 of antisocial PD (childhood conduct disorder) and criterion 4 of borderline PD (self-damaging impulsive behaviours). Adjusting for each other, their respective odds ratios were 3.4 [confidence interval (CI) = 2.1-5.4] and 5.0 (CI = 3.3-7.7). Endorsement strength of the criteria was associated with AUD in a dose-response manner and they explained 5.5% of variation in AUD risk-more than the full diagnoses of antisocial and borderline PDs together (0.5%). The association between borderline criterion 4 and AUD 10 years later derived mainly from their overlapping genetic factors, whereas the association between antisocial criterion 8 and AUD 10 years later was due to both genetic and non-genetic factors. CONCLUSIONS Conduct disorder and self-harming impulsivity are the foremost risk traits for alcohol use disorder among the 80 personality disorder criteria of DSM-IV, predicting alcohol use disorder more effectively than personality disorder diagnoses. The twin-study analysis suggested that conduct disorder represents a joint genetic and developmental risk for alcohol use disorder and that impulsivity is a genetic risk.
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Affiliation(s)
- Tom Rosenström
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway,Correspondence:
| | - Fartein Ask Torvik
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychology, University of Oslo, Norway
| | - Eivind Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychology, University of Oslo, Norway,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Norway
| | - Nikolai Olavi Czajkowski
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychology, University of Oslo, Norway
| | - Nathan A. Gillespie
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H. Aggen
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Kenneth S Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Deparment of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Norway
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Tassi F, Ciucci E, Baroncelli A, Batani A. Callous-unemotional traits, borderline personality, and self-injury in gothic subculture. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2017. [DOI: 10.1080/17405629.2017.1320279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fulvio Tassi
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Enrica Ciucci
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Andrea Baroncelli
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Azzurra Batani
- Department of Education and Psychology, University of Florence, Florence, Italy
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13
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Ceylan V, Kose S, Akin E, Turkcapar MH. Normative data and factorial structure of the Turkish version of the Borderline Personality Questionnaire (Turkish BPQ). PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1298422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Vedat Ceylan
- Department of Psychology, H. Kalyoncu Universitesi, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, H. Kalyoncu Universitesi, Gaziantep, Turkey
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions (CNRA), Houston, TX, USA
| | - Ercan Akin
- Department of Psychology, H. Kalyoncu Universitesi, Gaziantep, Turkey
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Akin E, Kose S, Ceylan V, Temel G, Turkcapar MH. Normative data and factorial structure of the Turkish version of the Borderline Evaluation of Severity over Time (BEST). PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1298421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions (CNRA), Houston, TX, USA
| | - Vedat Ceylan
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Gulizer Temel
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
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15
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Chun S, Harris A, Carrion M, Rojas E, Stark S, Lejuez C, Lechner WV, Bornovalova MA. A psychometric investigation of gender differences and common processes across borderline and antisocial personality disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:76-88. [PMID: 27808543 PMCID: PMC5217473 DOI: 10.1037/abn0000220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The comorbidity between borderline personality disorder (BPD) and antisocial personality disorder (ASPD) is well-established, and the 2 disorders share many similarities. However, there are also differences across disorders: most notably, BPD is diagnosed more frequently in women and ASPD in men. We investigated if (a) comorbidity between BPD and ASPD is attributable to 2 discrete disorders or the expression of common underlying processes, and (b) if the model of comorbidity is true across sex. Using a clinical sample of 1,400 drug users in residential substance abuse treatment, we tested 3 competing models to explore whether the comorbidity of ASPD and BPD should be represented by a single common factor, 2 correlated factors, or a bifactor structure involving a general and disorder-specific factors. Next, we tested whether our resulting model was meaningful by examining its relationship with criterion variables previously reported to be associated with BPD and ASPD. The bifactor model provided the best fit and was invariant across sex. Overall, the general factor of the bifactor model significantly accounted for a large percentage of the variance in criterion variables, whereas the BPD and AAB specific factors added little to the models. The association of the general and specific factor with all criterion variables was equal for men and women. Our results suggest common underlying vulnerability accounts for both the comorbidity between BPD and AAB (across sex), and this common vulnerability drives the association with other psychopathology and maladaptive behavior. This in turn has implications for diagnostic classification systems and treatment. (PsycINFO Database Record
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Affiliation(s)
- Seokjoon Chun
- University of South Florida, Department of Psychology
| | - Alexa Harris
- University of South Florida, Department of Psychology
| | | | | | - Stephen Stark
- University of South Florida, Department of Psychology
| | - Carl Lejuez
- University of Kansas, Department of Psychology
| | - William V. Lechner
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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16
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Dinsdale N, Mokkonen M, Crespi B. The ‘extreme female brain’: increased cognitive empathy as a dimension of psychopathology. EVOL HUM BEHAV 2016. [DOI: 10.1016/j.evolhumbehav.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Fossati A. Diagnosing Borderline Personality Disorder During Adolescence: A Review of the Published Literature. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Borderline personality disorder (BPD) is a debilitating disorder that occurs in approximately 1% to 3% of the general population. BPD is not only relatively prevalent; it is also associated with significant public health and security concerns. The clinical and social burden of adult BPD diagnosis has resulted in the desire for early diagnosis and the implementation of early intervention programs. A qualitative review of the scientific literature suggested that adolescence is a critical point for the early identification and therapeutic treatment of BPD. Although findings are far from conclusive, the inter-rater reliability and internal consistency of the Diagnostic and Statistical Manual of Mental Disorders symptom criteria for BPD during adolescence seem adequate. Recent studies based on a rigorous methodology of BPD assessment and large community samples reported prevalence rates for BPD diagnosis during adolescence that were less suspect than previous findings. A number of research studies addressed the construct validity of BPD in adolescents (i.e., whether a BPD diagnosis during adolescence actually measures what is intending to measure) and reported consistent relationships between BPD and associated areas of dysfunction and distress as evidence of the validity of the BPD diagnosis. Research evidence indicates that there is no single symptom that is predictive of later BPD diagnosis during adolescence; rather, a pattern of two to three selected BPD symptoms that are evident during adolescence seemed to be highly predictive of later BPD diagnosis, particularly when measures that were specifically designed to assess for BPD during adolescence were used as part of the assessment process.
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Affiliation(s)
- Andrea Fossati
- Department of Humanities, Libera Università Maria Ss. Assunta , Rome , Italy
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Sharp C, Kalpakci A. If It Looks Like a Duck and Quacks Like a Duck: Evaluating the Validity of Borderline Personality Disorder in Adolescents. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
The validity of borderline personality disorder (BPD) has been a topic of much controversy in psychiatry. Over the last two decades, a wealth of empirical work has challenged long-held concerns regarding the validity of adolescent BPD. However, this research has been conducted within a traditional approach to psychiatric nosology.
Objective:
In this article, we aim to evaluate the validity of adolescent BPD as guided by both the Robins and Guze criteria for the validity of psychiatric constructs and the new National Institute of Mental Health Research Domain Criteria (NIMH RDoC).
Method:
We used the five principles of the Robins and Guze approach to evaluate selected research from our own and other groups regarding the validity of adolescent BPD. These principles include clinical description studies, laboratory studies, studies that delimitate the disorder from other related syndromes, follow-up studies, and family studies.
Results:
Within the Robins and Guze criteria framework, evidence to date supports the validity of adolescent BPD to some extent. However, limitations of the research about the construct validity of adolescent BPD have also been identified, most notably regarding the delimitation of adolescent BPD from other disorders as well as a lack of longitudinal and family studies.
Conclusions:
Given these limitations and the limitations of the Robins and Guze approach to psychiatric nosology, we recommend exploring the potential of the National Institute of Mental Health Research Domain Criteria as a complement to previous work.
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Affiliation(s)
- Carla Sharp
- 1 University of Houston, The Menninger Clinic, Baylor College of Medicine , Texas , United States
| | - Allison Kalpakci
- 2 Developmental Psychopathology Lab, Dep. of Psychology, University of Houston , Texas , United States
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Hudson JI, Zanarini MC, Mitchell KS, Choi-Kain LW, Gunderson JG. The contribution of familial internalizing and externalizing liability factors to borderline personality disorder. Psychol Med 2014; 44:2397-2407. [PMID: 24406267 PMCID: PMC4090302 DOI: 10.1017/s0033291713003140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) frequently display co-morbid mental disorders. These disorders include 'internalizing' disorders (such as major depressive disorder and anxiety disorders) and 'externalizing' disorders (such as substance use disorders and antisocial personality disorder). It is hypothesized that these disorders may arise from latent 'internalizing' and 'externalizing' liability factors. Factor analytic studies suggest that internalizing and externalizing factors both contribute to BPD, but the extent to which such contributions are familial is unknown. METHOD Participants were 368 probands (132 with BPD; 134 without BPD; and 102 with major depressive disorder) and 885 siblings and parents of probands. Participants were administered the Diagnostic Interview for DSM-IV Personality Disorders, the Revised Diagnostic Interview for Borderlines, and the Structured Clinical Interview for DSM-IV. RESULTS On confirmatory factor analysis of within-person associations of disorders, BPD loaded moderately on internalizing (factor loading 0.53, S.E. = 0.10, p < 0.001) and externalizing latent variables (0.48, S.E. = 0.10, p < 0.001). Within-family associations were assessed using structural equation models of familial and non-familial factors for BPD, internalizing disorders, and externalizing disorders. In a Cholesky decomposition model, 84% (S.E. = 17%, p < 0.001) of the association of BPD with internalizing and externalizing factors was accounted for by familial contributions. CONCLUSIONS Familial internalizing and externalizing liability factors are both associated with, and therefore may mutually contribute to, BPD. These familial contributions account largely for the pattern of co-morbidity between BPD and internalizing and externalizing disorders.
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Affiliation(s)
- J I Hudson
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - M C Zanarini
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - K S Mitchell
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, Veterans Affairs,Boston Healthcare System and Boston University School of Medicine,Boston, MA,USA
| | - L W Choi-Kain
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - J G Gunderson
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
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Abstract
The heritability of borderline personality (BP) features has been established in multiple twin and family studies. Using data from the borderline subscale of the Personality Assessment Inventory Borderline Features Scale (PAI-BOR) collected in two Dutch cohorts (N=7125), the Netherlands Twin Register and The Netherlands Study of Depression and Anxiety, we show that heritability of the PAI-BOR total score using genome-wide single-nucleotide polymorphism (SNPs) is estimated at 23%, and that the genetic variance is substantially higher in affect instability items compared with the other three subscales of the PAI-BOR (42.7% vs non-significant estimates for self-harm, negative relations and identity problems). We present results from a first genome-wide association study of BP features, which shows a promising signal on chromosome 5 corresponding to SERINC5, a protein involved in myelination. Reduced myelination has been suggested as possibly having a role in the development of psychiatric disorders characterized by lack of social interaction. The signal was confirmed in a third independent Dutch cohort drawn from the Erasmus Rucphen Family study (N=1301). Our analyses were complemented by investigating the heterogeneity that was implied by the differences in genetic variance components in the four subscales of the PAI-BOR. These analyses show that the association of SNPs tagging SERINC5 differs substantially across the 24 items of the PAI-BOR. Further, using reverse regression we showed that the effects were present only in subjects with higher scores on the PAI-BOR. Taken together, these results suggest that future genome-wide analyses can benefit substantially by taking into account the phenotypic and genetic heterogeneity of BP features.
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Sharp C, Steinberg L, Temple J, Newlin E. An 11-item measure to assess borderline traits in adolescents: refinement of the BPFSC using IRT. Personal Disord 2014; 5:70-8. [PMID: 24588063 PMCID: PMC10754293 DOI: 10.1037/per0000057] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite historical concerns about the validity of the construct of borderline personality disorder (BPD) in adolescence, there is now general consensus that BPD in adolescence constitutes a valid and reliable diagnosis. Yet the development and refinement of measures to assess borderline traits in adolescents is in its infancy. Moreover, brief and easy-to-administer measures of borderline traits for use in large-scale studies do not exist. The aim of the current study was to evaluate the Borderline Personality Features Scale for Children (BPFSC; Crick, Murray-Close, & Woods, 2005) and develop a short version of the BPFSC through the use of item response theory (IRT) methods. BPFSC data from a community sample of 964 adolescents (mean age = 15.1 years, SD = .79; 55.9% female) were used to examine the factor structure of the BPFSC. The hypothesized 4-factor structure was not supported. The unidimensional IRT analysis showed instances of local dependence among item pairs and item responses that were not strongly related to the underlying construct. As a consequence, items were eliminated, creating a unidimensional 11-item brief BPFSC (the BPFSC-11). Next, evidence of construct validity of scores based on the shortened version was evaluated using a different sample of 371 inpatient adolescents. We demonstrated similar indices of construct validity as observed for the BPFSC total score with the BPFSC-11 scores and found evidence for good criterion validity. Use of the BPFSC-11 in clinical settings will reduce the burden on respondents without loss of information.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston
| | | | - Jeff Temple
- Department of Obstetrics & Gynecology, University of Texas Medical Branch Health
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22
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Reichborn-Kjennerud T, Ystrom E, Neale MC, Aggen SH, Mazzeo SE, Knudsen GP, Tambs K, Czajkowski NO, Kendler KS. Structure of genetic and environmental risk factors for symptoms of DSM-IV borderline personality disorder. JAMA Psychiatry 2013; 70:1206-14. [PMID: 24048243 PMCID: PMC3927987 DOI: 10.1001/jamapsychiatry.2013.1944] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Previous studies have indicated that the psychopathological dimensions of borderline personality disorder (BPD) are influenced by a unitary liability factor. However, to our knowledge, the underlying etiological nature of the individual criteria for BPD as defined by the DSM-IV has not been explored. OBJECTIVE To determine the structure of genetic and environmental risk factors for the symptoms of BPD. DESIGN, SETTING, AND PARTICIPANTS Multivariate twin study with BPD criteria assessed by personal interview within a general community setting. Participants included 2794 young adults from the Norwegian Institute of Public Health Twin Panel. MAIN OUTCOMES AND MEASURES The 9 criteria for BPD assessed by the Structured Interview for DSM-IV Personality. RESULTS A common pathway model dominated by 1 highly heritable (55%) general BPD factor that strongly influenced all 9 BPD criteria (standardized path coefficients, 0.53-0.79) fit the data best. The model also included 2 additional common liability factors, mainly influencing criteria reflecting the affective and interpersonal dimensions. Both of these were mostly influenced by environmental liability factors (heritability, 29.3% and 2.2%). With 1 exception (criterion 2, unstable and intense relationships), the specific criteria were strongly influenced by environmental factors. Five of the 9 criterion-specific genetic effects were either 0 or negligible. CONCLUSIONS AND RELEVANCE These results indicate that most of the genetic effects on the individual BPD criteria derive from 1 highly heritable general BPD factor, whereas the environmental influences were mostly criterion specific.
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Affiliation(s)
- Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo 2Institute of Psychiatry, University of Oslo, Oslo, Norway
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Conway C, Hammen C, Brennan PA. A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: implications for DSM-5. J Pers Disord 2012; 26:793-803. [PMID: 23013346 PMCID: PMC3460547 DOI: 10.1521/pedi.2012.26.5.793] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) scheduled for publication in 2013, researchers continue to debate the optimal classification of borderline personality disorder (BPD). Much of the discussion has focused on the relative merits of dimensional versus categorical classification schemes for BPD. Advances in statistical technologies have made it possible to adjudicate between continuous and categorical models of BPD using quantitative methods, yet no prior studies have attempted such a comparison. The current study directly compares the fit of dimensional, categorical, and hybrid models of BPD in a large community sample (N = 700) of young adults at risk for psychopathology due to elevated rates of maternal depression. BPD symptoms were assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Latent class, latent trait, and factor mixture models of SCID-II symptoms were estimated, and a latent trait model provided superior fit to the data, supporting a dimensional conceptualization of borderline pathology. The nosological implications of these results are discussed with respect to a "hybrid" model of BPD diagnosis currently under consideration for DSM-5.
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Affiliation(s)
- Christopher Conway
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Evren C, Cınar O, Evren B. Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Compr Psychiatry 2012; 53:854-9. [PMID: 22225788 DOI: 10.1016/j.comppsych.2011.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/13/2011] [Accepted: 11/28/2011] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate possible interactions between severity of borderline personality features (BPFs), dissociative experiences, and alexithymia among substance-dependent men while controlling for their current age, depression, and anxiety. Participants were 200 substance-dependent men consecutively admitted to a dependency treatment unit. The Borderline Personality Inventory, the Toronto Alexithymia Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory were administered to all participants. Severity of negative affect, alexithymia, dissociative experiences, and BPF were correlated with each other. Being younger, severity of dissociative experiences, difficulty in identifying feelings, depression, and trait anxiety predicted the severity of BPF in linear regression analysis. These findings suggest that alexithymia and dissociative experiences may be a way of coping with depression and chronic anxiety, but they also seem to be related to the severity of BPF independent of the negative affect and from each other.
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Affiliation(s)
- Cuneyt Evren
- Bakirkoy State Hospital for Mental Health and Neurological Disorders, Alcohol and Drug Research, Treatment and Training Center, Istanbul, Turkey.
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Sharp C, Ha C, Michonski J, Venta A, Carbone C. Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients. Compr Psychiatry 2012; 53:765-74. [PMID: 22300904 DOI: 10.1016/j.comppsych.2011.12.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/01/2011] [Accepted: 12/13/2011] [Indexed: 02/07/2023] Open
Abstract
Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist. The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD) [Zanarini, 2003] is a promising interview-based measure of adolescent BPD. Currently, no studies have explicitly been designed to examine the psychometric properties of the CI-BPD. The aim of the current study was to examine various psychometric properties of the CI-BPD in an inpatient sample of adolescents (n = 245). A confirmatory factor analytic approach was used to examine the internal factor structure of the 9 CI-BPD items. In addition, internal consistency, interrater reliability, convergent validity (with clinician diagnosis and 2 questionnaire-based measures of BPD), and concurrent validity (with Axis I psychopathology and deliberate self-harm) were examined. Similar to several adult studies, the confirmatory factor analytic results supported a unidimensional factor structure for the CI-BPD, indicating that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria on which the CI-BPD is based constitute a coherent combination of traits and symptoms even in adolescents. In addition, other validity criteria were excellent. Taken together, the current study provides strong evidence for the validity of the CI-BPD for use in adolescents.
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Affiliation(s)
- Carla Sharp
- University of Houston, Houston, TX 77004, USA.
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Aggen SH, Kendler KS, Kubarych TS, Neale MC. Differential age and sex effects in the assessment of major depression: a population-based twin item analysis of the DSM criteria. Twin Res Hum Genet 2012; 14:524-38. [PMID: 22506308 DOI: 10.1375/twin.14.6.524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A twin item factor analytic model was developed to test for the presence of noninvariant age, sex, and age by sex interaction effects on the individual DSM-III-R criteria for major depression (MD). Based on 1-year reports, six of the nine MD criteria and duration requirement were found to have covariate factor loading and/or threshold effects that significantly deviated from their corresponding factor level expectations. A significant age effect was found for the binary duration variable factor loading. The 'loss of interest', 'weight problems' and 'psychomotor problems' criteria all displayed forms of threshold only effects. 'Depressed mood', 'fatigue', and 'feeling worthless' had more complex patterns that included both factor loading and threshold effects. A significant factor age by sex interaction effect indicating an increasing female mean difference with age was found to be largely associated with the presence of differential threshold covariate effects. Disagreement between estimated factor scores and DSM-derived affected vs. unaffected classification was approximately 1.3%. Status on the duration requirement was found to be the one feature common to all discrepancies. The MD criteria set provided maximum information for calibrating MD factor scores in the scale region where discrepancies occurred. The dimensional modeling results are discussed in the broader context of epidemiological research and clinical assessment of major depression.
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Affiliation(s)
- Steven H Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0126, USA.
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Bachrach N, Croon MA, Bekker MHJ. Factor structure of self-reported clinical disorders and personality disorders: a review of the existing literature and a factor analytical study. J Clin Psychol 2012; 68:645-60. [PMID: 22467345 DOI: 10.1002/jclp.21841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this research is to add to the current understanding of the latent factor structure of personality disorders by performing a review of the existing literature (Study 1) and a factor analytical study on the factor structure and the relationship between self-reported Axis I and Axis II psychopathology (Study 2). DESIGN The current research (Study 2) is cross-sectional and multicenter. RESULTS We found support for the assumption that the borderline personality disorder is a multidimensional construct. Second, we found evidence for a single-factor structure of the narcissistic, dependent as well as the avoidant personality disorder. Third, we found support for the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) distinction between Axis I and Axis II, Axis I psychopathology being explained by the factor neuroticism and Axis II disorders to be further subdivided into the higher order factors of internalizing and externalizing pathology. CONCLUSIONS An adaptation to the current DSM-IV borderline personality criteria should be made, while various findings show that the borderline construct is multidimensional. Second, deletion of the dependent and narcissistic personality in the DSM-V might be unjust. Third, Axis I psychopathology can be explained by the factor neuroticism, and Axis II disorders should be further subdivided into the higher order factors of internalizing and externalizing pathology.
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Fonseca-Pedrero E, Paino M, Lemos-Giráldez S, Sierra-Baigrie S, González MPGP, Bobes J, Muňiz J. Borderline personality traits in nonclinical young adults. J Pers Disord 2011; 25:542-56. [PMID: 21838568 DOI: 10.1521/pedi.2011.25.4.542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The main purpose of this study was to explore the dimensionality of the borderline personality disorder in nonclinical young adults by means of the Borderline Personality Questionnaire (BPQ; Poreh et al., 2006). We also studied the phenotypic expression of the borderline personality traits as a function of participants' gender and age, and the relationship between BPQ subscales and measures of depressive symptoms, anxiety, stress, hallucinatory predisposition, and paranoid ideation. The sample comprised 809 young adults, 562 (69.5%) were women, with a mean age of 20.2 years (SD = 2.9). The results indicate that the BPQ self-report has adequate psychometric properties. The levels of internal consistency for the BPQ subscales ranged between .78 and .93. Analysis of the internal structure of the BPQ subscales yielded a one-dimensional solution. In contrast, second-order principal components analysis at the item level yielded a five-dimensional solution. Likewise, statistically significant differences in the mean scores of the borderline personality traits as a function of participants' gender and age were found. The BPQ subscales correlated significantly with measures of depression, anxiety, stress, paranoid ideation, and hallucinatory predisposition. These results help to improve our understanding of the dimensional structure of the borderline personality in the general population. Future research should continue to identify participants who are at risk for the development of borderline personality disorder and facilitating the development of early detection and prevention programs.
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Røysamb E, Kendler KS, Tambs K, Orstavik RE, Neale MC, Aggen SH, Torgersen S, Reichborn-Kjennerud T. The joint structure of DSM-IV Axis I and Axis II disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:198-209. [PMID: 21319931 DOI: 10.1037/a0021660] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.
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Affiliation(s)
- Espen Røysamb
- Norwegian Institute of Public Health and University of Oslo, Norway.
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Kendler KS, Myers J, Reichborn-Kjennerud T. Borderline personality disorder traits and their relationship with dimensions of normative personality: a web-based cohort and twin study. Acta Psychiatr Scand 2011; 123:349-59. [PMID: 21198457 PMCID: PMC3081883 DOI: 10.1111/j.1600-0447.2010.01653.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the structure of genetic and environmental risk factors for four dimensions of borderline personality disorder (BPD) and to understand the source of resemblance of these dimensions and normal personality. METHOD A web-based sample (n = 44,112 including 542 twin pairs) completed items from 4 scales of the Dimensional Assessment of Personality Pathology Basic Questionnaire and the Big Five Inventory. RESULTS A one-factor common pathway model best fits the 4 BPD scales producing a highly heritable latent liability (heritability = 60%) and strong loadings on all 4 dimensions. Affective instability had the lowest trait-specific genetic loading, suggesting that it was a core feature of BPD. A complex pattern of genetic and environmental associations was found between the big five personality traits and BPD dimensions. The strongest genetic correlations with the BPD traits were generally seen for neuroticism (positive), followed by conscientiousness and agreeableness, both negative. CONCLUSION In the general population, these four BPD dimensions reflect one underlying highly heritable factor. The association between normative personality and dimensions of BPD is complex with high degrees of genetic correlation.
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Affiliation(s)
- K. S. Kendler
- Virginia Institute of Psychiatric and Behavioral Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA, Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA, Department of Human and Molecular Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
| | - J. Myers
- Virginia Institute of Psychiatric and Behavioral Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA, Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
| | - T. Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, University of Oslo, Oslo, Norway, Institute of Psychiatry, University of Oslo, Oslo, Norway, Department of Epidemiology, Columbia University, New York, NY, USA
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Meares R, Gerull F, Stevenson J, Korner A. Is self disturbance the core of borderline personality disorder? An outcome study of borderline personality factors. Aust N Z J Psychiatry 2011; 45:214-22. [PMID: 21438747 DOI: 10.3109/00048674.2010.551280] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECT To determine which constellation of clinical features constitutes the core of borderline personality disorder (BPD). METHOD The criterion of endurance was used to identify the constellation of features which are most basic, or core, in borderline personality disorder. Two sets of constellations of DSM-III features were tested, each consisting of three groupings. The first set of constellations was constructed according to Clarkin's factor analysis; the second was theoretically derived. Broadly speaking, the three groupings concerned 'self', 'emotional regulation', and 'impulse'. Changes of these constellations were charted over one year in a comparison of the effect of treatment by the Conversational Model (n = 29) with treatment as usual (n = 31). In addition, measures of typical depression (Zung) were scored before and after the treatment period. The changes in the constellations were considered in relation to authoritative opinion. RESULTS The changes in the two sets of constellations were similar. In the treatment as usual (TAU) group, 'self' endured unchanged, while 'emotional regulation' and 'impulse' improved. In the Conversational Model cohort, 'self' improved, 'emotional regulation' improved more greatly than the TAU group, while 'impulse' improved but not more than the treatment as usual group. Depression scores were not particularly associated with any grouping. CONCLUSIONS A group of features including self/identity disturbance, emptiness and fear of abandonment may be at the core of BPD. Correlations between the three groupings and Zung scores favoured the view that the core affect is not typical depression. Rather, the central state may be 'painful incoherence'. It is suggested that the findings have implications for the refinement and elaboration of treatment methods in borderline personality disorder.
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Affiliation(s)
- Russell Meares
- Department of Psychological Medicine, University of Sydney, Australia.
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Doran N, Aldridge A, Roesch S, Myers M. Factor Structure and Invariance of the Behavioral Undercontrol Questionnaire. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2011. [DOI: 10.1027/1015-5759/a000060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The construct of behavioral undercontrol is often assessed as a potential risk factor in studies of health-risk behaviors, but few studies have examined psychometric properties of measures of behavioral undercontrol. The present study tested the factor structure of the Behavioral Undercontrol Questionnaire (BUQ), a 20-item self-report measure, across gender and racial/ethnic groups, using a college sample (N = 648). We hypothesized that the factor structure would vary by both gender and race/ethnicity. A single-factor solution was identified and confirmed within each group. However, analyses yielded differences across gender and racial/ethnic groups. Findings support the overall validity of the BUQ, but also suggest that caution should be exercised in making comparisons across gender and racial/ethnic groups. These data also highlight the importance of assessing the psychometric properties of measures of behavioral undercontrol and other externalizing constructs.
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Affiliation(s)
- Neal Doran
- University of California, San Diego, CA, USA
| | | | | | - Mark Myers
- University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Singh D, McMain S, Zucker KJ. Gender identity and sexual orientation in women with borderline personality disorder. J Sex Med 2010; 8:447-54. [PMID: 21054794 DOI: 10.1111/j.1743-6109.2010.02086.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) (and earlier editions), a disturbance in "identity" is one of the defining features of borderline personality disorder (BPD). Gender identity, a person's sense of self as a male or a female, constitutes an important aspect of identity formation, but this construct has rarely been examined in patients with BPD. AIMS In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD. MAIN OUTCOME MEASURES We used a validated dimensional measure of gender dysphoria. Recalled gender identity and gender role behavior from childhood was also assessed with a validated dimensional measure, and current sexual orientation was assessed by two self-report measures. METHODS A consecutive series of 100 clinic-referred women (mean age, 34 years) with BPD participated in the study. The women were diagnosed with BPD using the International Personality Disorder Exam-BPD Section. RESULTS None of the women with BPD met the criterion for caseness on the dimensional measure of gender dysphoria. Women who self-reported either a bisexual or a homosexual sexual orientation had a significantly higher score on the dimensional measure of gender dysphoria than the women who self-reported a heterosexual sexual orientation, and they also recalled significantly more cross-gender behavior during childhood. Results were compared with a previous study on a diagnostically heterogeneous group of women with other clinical problems. CONCLUSION The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed.
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Affiliation(s)
- Devita Singh
- Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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