Borderline personality disorder from the perspective of general personality functioning

Development and Validation of the Five-Factor Borderline Inventory-Super Short Form and Screener

The Five-Factor Borderline Inventory (FFBI) and FFBI-Short Form (FFBI-SF) are 120-item and 48-item measures that assess the underlying maladaptive personality traits of borderline personality disorder (BPD). The purpose of this study was to develop a super short form (FFBI-SSF) and an FFBI-Screener to facilitate the use of dimensional trait measures for BPD. Using item response theory analyses, the 48-item measure was reduced to 22 items using a large undergraduate sample (N = 1300) and then retested using a Mechanical Turk sample (N = 602), demonstrating strong replicability. IRT was again used to further reduce the measure from 22 items to four items to provide a brief screening tool. Correlations of the FFBI-SSF and Screener with measures of BPD-related variables were compared across five samples (N = 919, 204, 580, 281, and 488). Overall, the FFBI-SSF showed similar relations to the FFBI-SF at the full scale and domain-level scales, while the FFBI-screener demonstrated similar relations at the full scale level. This super short form and screener may best be used in large-scale research studies or as part of a screening tool in clinical settings.

Personality Disorders: Current Conceptualizations and Challenges

The personality disorders are said to be at the vanguard in the shift to a dimensional model of classification, as exemplified in the Alternative Model of Personality (AMPD) presented in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for emerging models and in the 11th edition of the International Classification of Diseases (ICD-11). Considered herein are some limitations and challenges. For the DSM-5 AMPD trait model, these include problematic placements, inadequate coverage, perceived complexity, and lack of cutoff points. For the DSM-5 AMPD Level of Personality Functioning (LPF), they include the complexity, the questionable presumption that the LPF defines the core of personality disorder, the presumption that the LPF identifies what is unique to the personality disorders, and the premise that the LPF is distinct from the maladaptive traits. Limitations and challenges of the ICD-11 model are the absence of lower-order facet scales and the fact that only the level of severity is required. This review suggests that the trait of depressivity belongs with negative affectivity and suspicion belongs within antagonism, that maladaptive traits from all 10 poles of the five domains should be provided, and that cutoff points based on social-occupational impairment and/or distress should be provided. The review summarizes research that questions whether the LPF represents the core of personality disorder, identifies what is unique to the personality disorders, and is distinct from maladaptive traits. Finally, the review suggests that the ICD-11 should require the assessment of the traits and include facet scales.

Using the HEXACO to explain the structure of borderline and psychopathic personality traits

Research has examined the use of basic personality traits in describing problematic personality traits, such as borderline and psychopathic traits. Specifically, the Honesty-Humility factor of the HEXACO model of personality appears to account for a large proportion of the variance in these traits. The purpose of the present study was to examine whether the HEXACO model would similarly predict borderline traits. As found in previous research, psychopathic traits were predicted by low Honesty-Humility, Emotionality, Agreeableness, and Conscientiousness, whereas borderline traits were found to be negatively related to eXtraversion and Conscientiousness but had a significantly positive relationship with Emotionality. As Emotionality appeared to be a differential predictor in this study, future research should further examine how Emotionality distinguishes between the various problematic personality traits, which may aid potential treatments/therapies.

Change in the Definition of Personality Disorder in Transition to ICD-11: A Look from Clinical and Developmental Perspectives

The recent body of research reveals fundamental limitations to the categorical concept of a personality disorder that has led researchers to adopt a new personality disorder concept. During the last decade DSM-5 and ICD-11 diagnostic classifications have accepted the dimensional view towards personality pathology. Despite the differences between the two classifications, the joint aspect of both models is the construct of Levels of personality functioning. The construct of personality functioning involves personality (dys)function in the self and interpersonal domains. This two-step conceptualization includes (a) impairments of self and interpersonal functioning, indicating general signs and severity of personality disorder, and (b) pathological personality traits, reflecting ‘stylistic’ differences in the expression of personality disorder. The new conceptualization of personality disorder reflects the innovative multi-theoretical integration of known, empirically-based personality assessment paradigms. The relationship between personality functioning and interpersonal, psychodynamic, and personological paradigms provides the theoretical integrity and empirically-based structure necessary to understand the overall severity of personality pathology. Many methods (interviews, self-assessment scales, and questionnaires) have already been developed for the assessment of personality functioning, and their development will be encouraged by the ICD-11 classification established in 2022. At present, only one instrument has been developed in Lithuania for assessing the level of personality functioning in young people aged 12–18 (Barkauskienė & Skabeikytė, 2020). The empirical data about the validity of this construct and its capability to differentiate between the normal and impaired personality in adults and adolescents provide promising results, but are still accumulating. Research suggests that adolescence is a stage in development when personality pathology can fully unfold and be validly confirmed, which opens up opportunities for early intervention. Although the dimensional personality disorder model needs to further prove its importance, there is already evidence that it is less stigmatizing and returns psychology and personality into the concept of a personality disorder. This review presents changes in the conceptualization of personality disorders by discussing them from both clinical and developmental perspectives and highlighting the results of key research in recent years.

The Role of Interactional Agreeableness in Responsive Treatments for Patients With Borderline Personality Disorder

It has been shown that agreeableness of patients with borderline personality disorder (BPD) had an impact on therapy process and outcome (Hirsh, Quilty, Bagby, & McMain, 2012). The goal of our study was to test whether agreeableness affects the therapeutic alliance and outcome assessed after brief treatment for BPD, and whether this link is moderated by therapist responsiveness. We compared two types of interventions (N = 60) in 10-session treatments (Kramer et al., 2014): a general psychiatric management (GPM)-based treatment and the same treatment supplemented with motive-oriented therapeutic relationship (MOTR), based on plan analysis case conceptualizations (PA; Caspar, 1995), as operationalization of therapist responsiveness. The results showed that there was a significant link between agreeableness and outcome for the GPM, but not for the MOTR. No links between agreeableness and the therapeutic alliance were found in both conditions. MOTR enables suppression of the influences of the patient's initial characteristics on the therapeutic results.

Borderline Personality Disorder: Associations Between Dimensional Personality Profiles and Self-Destructive Behaviors

Ongoing research is shifting towards a dimensional understanding of borderline personality disorder (BPD). Aim of this study was to identify personality profiles in BPD that are predictive of self-destructive behaviors. Personality traits were assessed (n = 130) according to the five-factor model of personality (i.e., Neuroticism, Extraversion, Openness to Experience, Agreeableness, Conscientiousness) and an additional factor called Risk Preference. Self-destructive behavior parameters such as non-suicidal self-injury (NSSI) and other borderline typical dyscontrolled behaviors (e.g., drug abuse) were assessed by self-report measures. Canonical correlation analyses demonstrated that Neuroticism, Extraversion, and Conscientiousness are predictors of NSSI. Further, Neuroticism, Agreeableness, and Risk Preference were associated with dyscontrolled behaviors. Our results add further support on personality-relevant self-destructive behaviors in BPD. A combined diagnostic assessment could offer clinically meaningful insights about the causes of self-destruction in BPD to expand current therapeutic repertoires.

Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample

Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.

Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex

INTRODUCTION

Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.

METHOD

Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.

RESULTS

BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.

CONCLUSIONS

This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

Interpersonal Dynamics in Personality and Personality Disorders

Clinical and basic personality psychologists interact less than they should, given their similar interests. In clinical personality psychology, available evidence supports a transition from the current categorical system to a hierarchical trait scheme for diagnosing the stable features of personality disorder. However, trait models do not capture the dynamic aspects of personality disorders as they have been described in the clinical literature, and thus miss a clinically critical feature of personality pathology. In contrast, basic personality psychologists have coalesced around a consensual structure of individual differences and become increasingly interested in the dynamic processes that underlie and contextualize traits. But trait psychology models are not sufficiently specific to characterize dynamic personality processes. In this paper, I filter clinical descriptions of personality disorders through the lens of interpersonal theory to specify a recursive within–situation interpersonal pattern of motives, affects, behaviours, and perceptions that could contribute to the stable between–situation patterns of maladaptive behaviour of historical interest to both basic and clinical personality psychologists. I suggest that this interpersonal model adds specificity to recent proposals regarding processes in the basic personality literature and has significant potential to advance research on personality dynamics. © 2018 European Association of Personality Psychology

The Five-Factor Model Is a Competing Theory of Borderline Personality Disorder: Commentary on Gunderson et al

Gunderson, Fruzzetti, Unruh, and Choi-Kahn (2018) review four competing theories of borderline personality border (BPD). Regrettably, they did not acknowledge the theory that BPD is a maladaptive variant of Five-Factor Model general personality structure. This commentary indicates how the FFM of BPD addresses well, and does so empirically, the points of comparison, made by Gunderson et al.

Burnout, Depression, and Borderline Personality: A 1,163-Participant Study

We examined the association of burnout with borderline personality (BP) traits in a study of 1,163 educational staff (80.9% women; mean age: 42.96). Because burnout has been found to overlap with depression, parallel analyses of burnout and depression were conducted. Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, depressive symptoms with the PHQ-9, and BP traits with the Borderline Personality Questionnaire. Burnout was found to be associated with BP traits, controlling for neuroticism and history of depressive disorders. In women, burnout was linked to both the "affective insecurity" and the "impulsiveness" component of BP. In men, only the link between burnout and "affective insecurity" reached statistical significance. Compared to participants with "low" BP scores, participants with "high" BP scores reported more burnout symptoms, depressive symptoms, neuroticism, and occupational stress and less satisfaction with life. Disattenuated correlations between burnout and depression were close to 1, among both women (0.91) and men (0.94). The patterns of association of burnout and depression with the main study variables were similar, pointing to overlapping nomological networks. Burnout symptoms were only partly attributed to work by our participants. Our findings suggest that burnout is associated with BP traits through burnout-depression overlap.

Compelled to Risk: Does Sexual Compulsivity Explain the Connection Between Borderline Personality Disorder Features and Number of Sexual Partners?

Having more sexual partners increases the likelihood of new HIV infections among women. Women with more borderline personality disorder (BPD) features have been known to have greater numbers of sexual partners. However, the mechanisms linking BPD features with more sexual partners remain to be clarified. Sexual compulsivity (lack of control, increased distress over sexual behavior) may be one such explanatory factor, as it overlaps with BPD features (e.g., impulsivity, negative affectivity). The present study examined whether sexual compulsivity explained the relation of BPD features with number of sexual partners among a diverse sample of college females (N = 1,326). Results demonstrated a significant indirect effect of BPD features via sexual compulsivity on number of sexual partners. These findings support the relation between BPD features and sexual compulsivity and suggest sexual compulsivity as a target in the promotion of the sexual health of women with BPD who demonstrate risky sexual practices.

Interpersonal Problems and Their Relationship to Depression, Self-Esteem, and Malignant Self-Regard

DSM-5 Section III recommends that level of personality functioning be assessed. This requires an assessment of self and other representations. Malignant self-regard (MSR) is a way of assessing the level of functioning of those with a masochistic, self-defeating, depressive, or vulnerably narcissistic personality. In Study 1, 840 undergraduates were assessed for MSR, depressive symptoms, self-esteem, anaclitic and introjective depression, and interpersonal problems. MSR, self-esteem, depressive symptoms, and anaclitic and introjective depression were correlated with multiple dimensions of interpersonal problems, and MSR predicted the most variance in interpersonal scales measuring social inhibition, nonassertion, over-accommodation, and excessive self-sacrifice. MSR, anaclitic, and introjective depression predicted unique variance in six of the eight domains of interpersonal problems assessed. In Study 2, 68 undergraduates were provided positive or negative feedback. Consistent with theory, MSR predicted unique variance in state anxiety but not state anger. Results support the validity of the MSR construct.

Personality and life events in a personality disorder sample

Individuals with a personality disorder (PD) tend to experience more negative life events (NLEs) than positive life events (PLEs). In community samples, the Five Factor Model of personality (FFM) predicts both positive and negative life events. The present research examined whether FFM normal personality traits were associated with positive and negative life events among individuals with 1 of 4 PDs: avoidant, borderline, schizotypal, and obsessive-compulsive, and tested whether associations between the FFM of personality and PLEs and NLEs were similar across the 4 PD groups and a control group. Among aggregated PDs, neuroticism was positively associated with NLEs, whereas extraversion, openness to experience, and conscientiousness were positively associated with PLEs. Comparisons of each PD group to a control group of individuals with a major depressive disorder indicated that the FFM traits operated similarly across clinical samples with and without PD. Our findings indicate that normal personality traits can be used to help understand the lives of individuals with PD. (PsycINFO Database Record

Childhood Precursors of Adult Borderline Personality Disorder Features: A Longitudinal Study

This study identifies childhood personality traits that are precursors of adult Borderline Personality Disorder (BPD) features. In a longitudinal study, childhood personality traits were assessed at age 11 (N = 100) using the California Child Q-set (CCQ: Block and Block, 1980). A number of these Q-items were found to be significantly correlated (p < 0.001) with a prototype-based measure of BPD features at age 23. Factor analysis of these Q-items suggested that they could be characterized by two underlying personality dimensions: Impulsivity and Nonconformity/Aggression. The findings thus provide evidence that childhood personality traits predict adult BPD features. Identifying such childhood precursors provides an opportunity for early intervention.

Comparing External Correlates of DSM-5 Section II and Section III Dimensional Trait Operationalizations of Borderline Personality Disorder

The current study evaluated the relative associations of the DSM-5 Section II operationalization of Borderline Personality Disorder (BPD) and dimensional traits included in a diagnosis of BPD in DSM-5 Section III with conceptually relevant external criterion variables. It is important to determine whether or not Section II BPD and constellation of Section III BPD traits have similar positions in the nomological network representing the BPD construct. Moreover, it is important to determine whether or not the trait-based Section III BPD diagnosis is an improvement upon the categorical Section II diagnosis in regard to its associations with external criteria. To evaluate this, we used two samples, a patient sample consisting of 145 psychiatric patients and a university sample consisting of 399 undergraduate students. We conducted a series of correlation and regression analyses in order to determine the relative associations of these two diagnostic methodologies with relevant external criteria. Correlation analyses did not favor either model, but indicated that both Section II and Section III BPD have associations with external criterion variables relevant to BPD. The regression analyses tended to favor the trait-based Section III model, supporting the construct validity and use of the trait profile for BPD in DSM-5 Section III. Generally, it was concluded that the Section II and Section III operationalizations have similar positions in a nomological network representing the BPD construct.

Momentary symptoms of borderline personality disorder as a product of trait personality and social context

Past studies identify Five Factor Model (FFM) domains that are characteristic of borderline personality disorder (BPD), including those associated with specific BPD symptoms, at a between-person level. The present study replicated these between-person associations and extended past research by assessing whether the FFM explains within-person variance in the manifestation of momentary BPD symptoms in the presence or absence of close social contact (CSC). We measured CSC and the BPD core symptoms negative affectivity, impulsivity, and interpersonal problems in 74 BPD patients and in a clinical control group of 40 depressed patients over the course of 28 days, 6 times a day. The FFM domains showed specificity in predicting momentary BPD symptoms and interacted with CSC in doing so. In particular, for BPD individuals only, momentary impulsivity and interpersonal problems were associated with higher neuroticism and extraversion and lower agreeableness, and these associations were especially strong in situations involving CSC. Negative affectivity was predicted by neuroticism for both groups of individuals, and this association was generally unaffected by CSC. Overall, experiencing CSC was positively associated with momentary BPD symptoms. Thus, both the FFM and CSC were associated with BPD patients' experience of symptoms in everyday life. Furthermore, specific FFM trait domains were particularly impactful in contexts where BPD symptoms are more likely to be manifested, providing further evidence that person-by-situation interactions are important for understanding BPD symptoms in the moment. (PsycINFO Database Record

Trait-based assessment of borderline personality disorder using the NEO Five-Factor Inventory: Phenotypic and genetic support

[Correction Notice: An Erratum for this article was reported in Vol 28(1) of Psychological Assessment (see record 2015-54029-001). The FFI-BPD values for Sample 3 in Table 2 should read 1.42 (0.44), 0.83.] The aim of the current study was to examine the reliability and validity of a trait-based assessment of borderline personality disorder (BPD) using the NEO Five-Factor Inventory. Correlations between the Five-Factor Inventory-BPD composite (FFI-BPD) and explicit measures of BPD were examined across 6 samples, including undergraduate, community, and clinical samples. The median correlation was .60, which was nearly identical to the correlation between measures of BPD and a BPD composite generated from the full Revised NEO Personality Inventory (i.e., NEO-BPD; r = .61). Correlations between FFI-BPD and relevant measures of psychiatric symptomatology and etiology (e.g., childhood abuse, drug use, depression, and personality disorders) were also examined and compared to those generated using explicit measures of BPD and NEO-BPD. As expected, the FFI-BPD composite correlated most strongly with measures associated with high levels of Neuroticism, such as depression, anxiety, and emotion dysregulation, and the pattern of correlations generated using the FFI-BPD was highly similar to those generated using explicit measures of BPD and NEO-BPD. Finally, genetic analyses estimated that FFI-BPD is 44% heritable, which is comparable to meta-analytic research examining genetics associated with BPD, and revealed that 71% of the genetic influences are shared between FFI-BPD and a self-report measure assessing BPD (Personality Assessment Inventory-Borderline subscale; Morey, 1991). Generally, these results support the use of FFI-BPD as a reasonable proxy for BPD, which has considerable implications, particularly for potential gene-finding efforts in large, epidemiological datasets that include the NEO FFI.

A Systematic Review of Personality Disorders and Health Outcomes

Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed.

Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder

BACKGROUND

Deficits in mindfulness-related capacities have been described in borderline personality disorder (BPD). However, little research has been conducted to explore which factors could explain these deficits. This study assesses the relationship between temperamental traits and childhood maltreatment with mindfulness in BPD.

METHODS

A total of 100 individuals diagnosed with BPD participated in the study. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ-SF), temperamental traits were assessed using the Zuckerman-Khulman Personality Questionnaire (ZKPQ), and mindfulness capabilities were evaluated with the Five Facet Mindfulness Questionnaire (FFMQ).

RESULTS

Hierarchical regression analyses were performed including only those CTQ-SF and ZKPQ subscales that showed simultaneous significant correlations with mindfulness facets. Results indicated that neuroticism and sexual abuse were predictors of acting with awareness; and neuroticism, impulsiveness and sexual abuse were significant predictors of non-judging. Temperamental traits did not have a moderator effect on the relationship between childhood sexual abuse and mindfulness facets.

CONCLUSIONS

These results provide preliminary evidence for the effects of temperamental traits and childhood trauma on mindfulness capabilities in BPD individuals. Further studies are needed to better clarify the impact of childhood traumatic experiences on mindfulness capabilities and to determine the causal relations between these variables.

Borderline Personality Features in Students: the Predicting Role of Schema, Emotion Regulation, Dissociative Experience and Suicidal Ideation

BACKGROUND

Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms.

OBJECTIVES

The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociative experiences and suicidal ideation among high school students in Shiraz City, Iran.

PATIENTS AND METHODS

In this descriptive correlational study, 300 students (150 boys and 150 girls) were selected from the high schools in Shiraz, Iran, using the multi-stage random sampling. Data were collected using some instruments including borderline personality feature scale for children, young schema questionnaire-short form, difficulties in emotion-regulation scale (DERS), dissociative experience scale and beck suicide ideation scale. Data were analyzed using the Pearson correlation coefficient and multivariate regression analysis.

RESULTS

The results showed a significant positive correlation between schema, emotion regulation, dissociative experiences and suicide ideation with borderline personality features. Moreover, the results of multivariate regression analysis suggested that among the studied variables, schema was the most effective predicting variable of borderline features (P < 0.001).

CONCLUSIONS

The findings of this study are in accordance with findings from previous studies, and generally show a meaningful association between schema, emotion regulation, dissociative experiences, and suicide ideation with borderline personality features.

Development of a Short Form of the Five-Factor Borderline Inventory

The Five-Factor Borderline Inventory (FFBI) is a 120-item dimensional measure of borderline personality disorder (BPD) that was developed from the description of BPD from the perspective of the Five-Factor Model. The FFBI includes 12 subscales and 1 total score. The current study created a short form of the FFBI (FFBI-SF) using item response theory analyses based on an undergraduate student sample that completed the FFBI. Based on the results, the final FFBI-SF included 48 items, with 4 items per subscale. The construct validity of the short form was compared with the original FFBI in five additional samples. The FFBI-SF showed strong convergence with other BPD scales and comparable convergent and discriminant validity with the FFM compared with the FFBI. The correlational profiles generated by the total score and subscales were highly convergent. Results of the current study suggest that the FFBI-SF may be an accessible and useful assessment tool of BPD.

Interpersonal assessment of borderline personality disorder: preliminary findings

We examined the reliability and validity of scores on an interpersonal measure of borderline personality disorder (BPD). Ratings on the Interpersonal Measure of Borderline Personality Disorder (IM-B) were based on nonverbal behaviors and interpersonal interactions occurring during clinical interviews with 276 adults. Scores on the IM-B exhibited good reliability. IM-B scores also displayed expected patterns of associations with scores on other measures of BPD, as well as with scores on measures of affective dysfunction, interpersonal pathology, and behavioral impairment associated with BPD, including indexes of maladaptive emotion regulation, interpersonal sensitivity, and self-harm. The pattern of associations for IM-B scores was quite similar to what would be expected for a dimensional measure of BPD symptoms. Scores on the IM-B were also associated with symptoms of disorders generally comorbid with BPD. Finally, IM-B scores contributed incrementally to the prediction of interpersonal dysfunction and suicidal ideation and behavior. Discussion focuses on implications for the assessment of BPD.

The impact of childhood temperament on the development of borderline personality disorder symptoms over the course of adolescence

BACKGROUND

The purpose of this study was to characterize the development of BPD symptoms across adolescence by evaluating the fit of several latent variable growth models to annual assessments of symptoms obtained from girls when they were ages 14 through 19 years. After determining the best fitting model, we examined prospective associations between the temperament dimensions of emotionality, activity, low sociability, and shyness and BPD symptom development.

METHODS

We utilized longitudinal data from the Pittsburgh Girls Study; one of the few large-scale, prospective studies of girls (N = 2,450) in the United States. Parent- and teacher-reports of girls' temperament were collected at Wave 1, when girls were ages 5-8 years. Child-reports of BPD symptoms were collected annually beginning at age 14 through 19 years.

RESULTS

We found that a free curve slope intercept model provided the best model fit, with the course of BPD symptoms characterized by a large component of inter-individual stability and a smaller component representing within-individual changes across adolescence. Symptoms appeared to peak by age 15, decline through age 18, and remain steady between ages 18 and 19 years. Both parent- and teacher-reports of temperament emotionality, activity, low sociability, and shyness predicted the developmental course of symptoms.

CONCLUSIONS

BPD symptoms in adolescence reflect trait-like differences between youth with less within-person variability across time. Childhood temperament dimensions of emotionality, activity, low sociability, and shyness predict adolescent BPD symptom development. Parent- and teacher-informants provide unique information about the course of BPD symptoms, underscoring the utility of collecting child assessments using multiple informants.

Associations between changes in normal personality traits and borderline personality disorder symptoms over 16 years

There has been significant movement toward conceptualizing borderline personality disorder (BPD) with normal personality traits. However, 1 critical assumption underlying this transition, that longitudinal trajectories of BPD symptoms and normal traits track together, has not been tested. We evaluated the prospective longitudinal associations of changes in Five-Factor Model traits and BPD symptoms over the course of 16 years using parallel process latent growth curve models in 362 patients with BPD (n = 290) or other PDs (n = 72). Moderate to strong cross-sectional and longitudinal associations were observed between BPD symptoms and Neuroticism, Extraversion, Agreeableness, and Conscientiousness. This study is the first to demonstrate a longitudinal link between changes in BPD symptoms and changes in traits over an extended interval in a clinical sample. These findings imply that changes in BPD symptoms occur in concert with changes in normal traits, and support the proposed transition to conceptualizing BPD, at least in part, with trait dimensions.

Comparing the Personality Disorder Interview for DSM-IV (PDI-IV) and SCID-II borderline personality disorder scales: an item-response theory analysis

One-hundred sixty-nine psychiatric outpatients and 171 undergraduate students were assessed with the Personality Disorder Interview-IV (PDI-IV; Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995) and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) for borderline personality disorder (BPD). Eighty individuals met PDI-IV BPD criteria, whereas 34 met SCID-II BPD criteria. Dimensional ratings of both measures were highly intercorrelated (rs = .78, .75), and item-level interrater reliability fell in the good to excellent range. An item-response theory analysis was performed to investigate whether properties of the items from each interview could help understand these differences. The limited agreement seemed to be explained by differences in the response options across the two interviews. We found that suicidal behavior was among the most discriminating criteria on both instruments, whereas dissociation and difficulty controlling anger had the 2 lowest alpha parameter values. Finally, those meeting BPD criteria on both interviews had higher levels of anxiety, depression, and more impairments in object relations than those meeting criteria on just the PDI-IV. These findings suggest that the choice of measure has a notable effect on the obtained diagnostic prevalence and the level of BPD severity that is detected.

Effects of serotonin-2A receptor binding and gender on personality traits and suicidal behavior in borderline personality disorder

Impulsivity and aggressiveness are personality traits associated with a vulnerability to suicidal behavior. Behavioral expression of these traits differs by gender and has been related to central serotonergic function. We assessed the relationships between serotonin-2A receptor function, gender, and personality traits in borderline personality disorder (BPD), a disorder characterized by impulsive-aggression and recurrent suicidal behavior. Participants, who included 33 BPD patients and 27 healthy controls (HC), were assessed for Axis I and II disorders with the Structured Clinical Interview for DSM-IV and the International Personality Disorders Examination, and with the Diagnostic Interview for Borderline Patients-Revised for BPD. Depressed mood, impulsivity, aggression, and temperament were assessed with standardized measures. Positron emission tomography with [(18)F]altanserin as ligand and arterial blood sampling was used to determine the binding potentials (BPND) of serotonin-2A receptors in 11 regions of interest. Data were analyzed using Logan graphical analysis, controlling for age and non-specific binding. Among BPD subjects, aggression, Cluster B co-morbidity, antisocial PD, and childhood abuse were each related to altanserin binding. BPND values predicted impulsivity and aggression in BPD females (but not BPD males), and in HC males (but not HC females.) Altanserin binding was greater in BPD females than males in every contrast, but it did not discriminate suicide attempters from non-attempters. Region-specific differences in serotonin-2A receptor binding related to diagnosis and gender predicted clinical expression of aggression and impulsivity. Vulnerability to suicidal behavior in BPD may be related to serotonin-2A binding through expression of personality risk factors.

Dimensional models of personality: the five-factor model and the DSM-5

It is evident that the classification of personality disorder is shifting toward a dimensional trait model and, more specifically, the five-factor model (FFM). The purpose of this paper is to provide an overview of the FFM of personality disorder. It will begin with a description of this dimensional model of normal and abnormal personality functioning, followed by a comparison with a proposal for future revisions to DSM-5 and a discussion of its potential advantages as an integrative hierarchical model of normal and abnormal personality structure.

Exploring the interaction between childhood maltreatment and temperamental traits on the severity of borderline personality disorder

BACKGROUND

Childhood maltreatment and temperamental traits play a role in the development of Borderline Personality Disorder (BPD). The aim of the present study was to assess the involvement and the interrelationship of both factors in the clinical severity of BPD.

METHOD

The self-reported history of childhood trauma, psychobiological temperamental traits, and severity of BPD symptoms were evaluated in 130 subjects with BPD.

RESULTS

Approximately 70% of the sample reported some form of abuse or neglect. Childhood maltreatment inversely correlated with sociability, but no correlation was observed with the other temperamental traits. The regression model showed that neuroticism-anxiety and aggression-hostility traits, as well as emotional abuse, were risk factors independently associated with the severity of BPD. Sexual abuse was not associated with the severity of the disorder. Finally, the interaction between high neuroticism-anxiety traits and the presence of severe emotional abuse was associated with BPD severity.

CONCLUSION

These results suggest that the interaction between temperamental traits and childhood emotional abuse has an influence not only on the development but also on the severity of BPD. Further studies are needed to identify more biological and environmental factors associated with the severity of the disorder.

A further validation of the Minnesota Borderline Personality Disorder Scale

Previous research indicates that borderline personality disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of 429 female twins. The MBPD correlated strongly with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) screener for BPD and moderately with external correlates. Moreover, the MBPD and SCID-II screener exhibited very similar patterns of external correlations. Additionally, results indicated that the genetic and environmental influences on MBPD overlap with the genetic and environmental influences on the SCID-II screener, which suggests that these scales are measuring the same construct. These data provide further evidence for the construct validity of the MBPD.

On the relationship between retrospective childhood ADHD symptoms and adult BPD features: the mediating role of action-oriented personality traits

A number of studies have reported data suggestive of a significant association between ADHD and BPD, nevertheless, the nature of this relation has not been fully understood yet. In our study, we tried to evaluate if the relationship between retrospectively assessed ADHD symptoms and adult BPD features could mediated by selected temperament/personality traits. Four hundred forty-seven in- and outpatients consecutively admitted to the Clinical Psychology and Psychotherapy Unit of the Scientific Institute H San Raffaele of Milan, Italy, were administered the Italian versions of the following instruments: Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II), Wender Utah Rating Scale (WURS), Temperament and Character Inventory-Revised (TCI-R), Barratt Impulsiveness Scale-11 (BIS-11), and Aggression Questionnaire (AQ). Our mediation analyses showed that the combination of impulsivity, aggression, novelty seeking, and juvenile conduct problems completely mediate the relationship between retrospectively assessed ADHD symptoms and current BPD features.

Integrating normal and abnormal personality structure: the Five-Factor Model

It is evident that the conceptualization, diagnosis, and classification of personality disorder (PD) is shifting toward a dimensional model. The purpose of this special issue of Journal of Personality is to indicate how the Five-Factor Model (FFM) can provide a useful and meaningful basis for an integration of the description and classification of both normal and abnormal personality functioning. This introductory article discusses its empirical support and the potential advantages of understanding personality disorders, including those included within the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and likely future PDs from the dimensional perspective of the FFM.

Five-Factor Model personality disorder prototypes: a review of their development, validity, and comparison to alternative approaches

In this article, the development of Five-Factor Model (FFM) personality disorder (PD) prototypes for the assessment of DSM-IV PDs are reviewed, as well as subsequent procedures for scoring individuals' FFM data with regard to these PD prototypes, including similarity scores and simple additive counts that are based on a quantitative prototype matching methodology. Both techniques, which result in very strongly correlated scores, demonstrate convergent and discriminant validity, and provide clinically useful information with regard to various forms of functioning. The techniques described here for use with FFM data are quite different from the prototype matching methods used elsewhere.

Comparing methods for scoring personality disorder types using maladaptive traits in DSM-5

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) Section III will include an alternative hybrid system for the diagnosis of personality disorder (PD). This alternative system defines PD types partly through specific combinations of maladaptive traits, rather than by using a set of polythetic diagnostic criteria. The current report utilizes a large sample of undergraduates (n = 1,159) to examine three dimensional methods for comparing an individual's trait profile to each PD type. We found that the sum of an individual's scores on the assigned traits obtained large convergent correlations (Mdn r =.61) and best reproduced the patterns of PD discriminant correlations observed within the DSM-IV measure. We also tested the DSM-5 Section III model algorithms and compared them with different thresholds for assigning categorical diagnoses. Frequency rates using the algorithms were greatly reduced, whereas requiring half of the assigned traits produced rates that more closely approximated current prevalence estimates. Our research suggests that DSM-5 Section III trait model can reproduce the DSM-IV-TR PD constructs and identifies effective methods of doing so.

Assessing change in a personality profile

We tested the validity of 6 methods (mean difference, variance difference, bivariate, profile agreement, pattern similarity, and intraclass) to assess change in a personality profile. During their first 2 months of college, 372 students completed reactive and spontaneous measures of their personality. Eight weeks later, 300 returned to complete a second set of the same measures and noted change in their spontaneous personality list. Sixty participants returned during their second semester to complete a third set of assessments. The bivariate and intraclass change coefficients showed consistent convergent, discriminant, and concurrent validity across time points. Recommendations and caveats for using these coefficients are discussed.

Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design

We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing and externalizing symptoms were all correlated, the discordant twin analyses and biometric modeling showed little to no evidence that was consistent with a causal effect of childhood abuse on BPD traits. Instead, our results indicate that the association between childhood abuse and BPD traits stems from common genetic influences that, in some cases, also overlap with internalizing and externalizing disorders. These findings are inconsistent with the widely held assumption that childhood abuse causes BPD, and they suggest that BPD traits in adulthood are better accounted for by heritable vulnerabilities to internalizing and externalizing disorders.

Clinical application of the five-factor model

The Five-Factor Model (FFM) has become the predominant dimensional model of general personality structure. The purpose of this paper is to suggest a clinical application. A substantial body of research indicates that the personality disorders included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) can be understood as extreme and/or maladaptive variants of the FFM (the acronym "DSM" refers to any particular edition of the APA DSM). In addition, the current proposal for the forthcoming fifth edition of the DSM (i.e., DSM-5) is shifting closely toward an FFM dimensional trait model of personality disorder. Advantages of this shifting conceptualization are discussed, including treatment planning.

Non-suicidal self-injury: the contribution of general personality functioning

Non-suicidal self-injury (NSSI) is a public health problem of increasing significance. The purpose of the present study was to determine if individuals with and without a history of NSSI would differ significantly on the domains and facets of the Five Factor Model (FFM) as well as the facets from the UPPS-P Impulsive Behaviour Scale. Self-report measures of personality, borderline personality disorder and NSSI were administered to an undergraduate sample (n = 211). Individuals who had engaged in NSSI had significantly elevated levels of FFM facets of neuroticism (i.e. anxiousness, angry hostility, depressiveness, self-consciousness, impulsiveness and vulnerability) and openness (i.e. aesthetics, feelings and values) and significantly lower levels of conscientiousness (i.e. order, achievement, self-discipline and deliberation). Additionally, those with an NSSI history scored higher on UPPS-P negative urgency, lack of premeditation and lack of perseverance. The knowledge gained from this study provides further support for personality's role in NSSI. This information may aid in the identification of risk factors for NSSI and assist in efforts examining interventions for NSSI that are targeted toward personality-relevant strategies.

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

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.

Personality Disorders Assessment Instruments

This article discusses the assessment of personality disorder, focusing in particular on self-report inventories and semistructured interviews. It summarizes the convergent validity reported in sixty-eight studies among five semistructured interviews, one rating form, and ten self-report inventories. The article also explores discriminant validity; the boundaries with Axis I disorders; the boundaries with normal personality functioning; the boundaries among the personality disorders; and culture, ethnicity, and gender bias.