Identity disturbance in borderline personality disorder: an empirical investigation

Identity Disturbance in Borderline Personality Disorder: A Scoping Review Protocol

Background

Borderline personality disorder (BPD) is a complex mental health condition characterized by instability in interpersonal relationships, affect regulation, and impulse control. A core feature of BPD is identity disturbance, marked by a persistently unstable self-image and sense of self. Despite clinical recognition, the precise nature of identity disturbance remains ambiguous, with no clear consensus on its specific manifestations and measurable parameters. With the scoping review projected in this protocol, we aim to define what has been said in the literature about identity disturbance, its types, and methods of measurement.

Study Design

Scoping review protocol.

Methods

Included publications will comprise empirical and theoretical studies focusing on identity disturbance in individuals diagnosed with BPD. Databases will include PubMed, PsycINFO, Scopus, and Web of Science Core Collection, supplemented by Google for grey literature. Data will be screened by two reviewers and discrepancies will be resolved through discussion or a third reviewer if necessary. Extracted data will include study details, methodological data, definitions of identity, conceptualizations of identity disturbance, types of disturbance, and assessment tools.

Conclusions

The forthcoming results will have the potential to make significant contributions to both theoretical and empirical knowledge on identity disturbance in BPD. It is expected that the results of the review will help to inform and improve therapeutic strategies, enabling more tailored and effective interventions for BPD patients with identity disturbance.

Longitudinal dynamics between the central nodes in the symptoms network of borderline personality disorder: An intraindividual network analysis

BACKGROUND

Borderline Personality Disorder (BPD) is a severe and heterogeneous psychiatric condition. Current research has some limitations: (1) findings from group (i.e., interindividual) analyses are often incorrectly generalized to individuals (i.e., intraindividual); and (2) research tends to emphasize common causes of symptomatology rather than exploring the interrelationships between symptoms.

METHOD

The current study aimed to analyze the intraindividual dynamics of central BPD symptoms using a temporal network analysis. Longitudinal measurement data collected over two years at regular six-month intervals in 212 patients diagnosed with BPD were used.

RESULTS

The network analysis extracted temporal and contemporaneous intraindividual relationships, the former were directional relationships between previous emptiness and subsequent identity instability, as well as identity instability and anger dysregulation. Also, previous anger dysregulation predicted identity instability and subsequent emptiness. In the same time window, the contemporaneous network and its topology underscored the relevance of anger dysregulation for its relation to most BPD symptoms, including identity instability and suicidal intent.

LIMITATION

Measurements with widely spaced intervals do not capture symptom dynamics in a recording window similar to real-time.

CONCLUSION

Exploring the dynamic between anger dysregulation and identity instability may be crucial for understanding the severity of BPD at the individual level and could potentially inform treatment.

Social media addiction and borderline personality disorder: a survey study

Background and aims

Borderline personality disorder (BPD) is a serious and difficult to treat psychiatric condition characterized by affective and interpersonal instability, impulsivity, and self-image disturbances. Although the relationship between BPD and substance use disorders has been well-established, there has been considerably less research regarding behavioral addictions in this population. The purpose of this study is to determine the prevalence of social media addiction (SMA) among individuals with BPD and to explore whether it is related to aspects of disorder symptomology.

Methods

300 adults completed an online survey via Prolific. Individuals completed the McLean Screening Instrument for BPD (MSI-BPD), along with the Bergen Social Media Addiction Scale (BSMAS). Additionally, all participants reported how often they use social media for the following reasons: distraction from interpersonal problems, reassurance seeking, self-confidence issues, and anger/revenge.

Results

Of the 289 subjects that completed all measures, 38 (13.1%) screened positive for BPD. Individuals screening positive for BPD were more likely to meet criteria for SMA than controls, and they were more likely to report using social media for interpersonal distraction, reassurance seeking, self-confidence issues, and anger/revenge seeking than controls. Among individuals with BPD, SMA was positively associated with the frequency of each of these behaviors, except for anger/revenge seeking.

Discussion and conclusion

The results of this study demonstrate that SMA is common among the BPD population and may be related to aspects of disorder symptomology. Whether SMA worsens BPD symptoms or whether addressing SMA could lead to improvements in the BPD remains to be seen and is an important area for future research.

The Structure of Identity Dysfunction in Self-Report Measures

Identity dysfunction is considered core to psychopathology, contributing to emotional and interpersonal problems across psychiatric diagnoses. Despite its centrality in theories of personality and psychopathology, the empirical research on the structure of identity dysfunction is fragmented by a plethora of self-report measures assessing varied domains of identity dysfunction. This project examines conceptual domains of identity dysfunction in self-report assessments, with the goal of elucidating a clear structure of identity dysfunction to advance both theory and measurement. Toward this aim, we a) investigate the factor structure of identity dysfunction in existing self-report measures, using exploratory factor analysis and b) examine relationships between identity dysfunction and closely related constructs, using exploratory structural equation modeling. We assess responses from 632 young adults to 17 commonly used identity functioning self-report measures. In a series of exploratory factor analyses, we identified four content-domains of Identity Dysfunction (Self-Alienation, Susceptibility to External Influence, Self-Dysregulation, and Contingent Self-Esteem) and three content domains of Identity Clarity (Self-Consistency, Reflective Functioning, and Authentic Living). These content domains were largely well-represented by a single factor. In a series of exploratory structural equation models, emergent factors related similarly to personality, emotion dysregulation, and values and problems in interpersonal relationships.

The interplay between identity and personality pathology in emerging adults: A 7-year cross-lagged study

Personality pathology is hypothesized to be an important factor in shaping identity, yet longitudinal evidence linking dimensional measures of identity and personality pathology remains scarce. To address this knowledge gap and shed light on the reciprocal dynamics proposed by the alternative model of personality disorder, we conducted a comprehensive seven-year study involving 372 emerging adults from a community sample (Mage T1 = 21.98 years, SD T1 = 1.13; 57% females). Pathological personality traits were assessed using the short form of the Personality Inventory for DSM-5 (PID-5 SF) while identity was assessed with the Dimensions of Identity Development Scale (DIDS). Cross-lagged analyses in Mplus revealed that personality pathology consistently predicts subsequent different levels of identity seven years later, whereas only one significant pathway from identity to personality pathology was found. Notably, negative affectivity and detachment emerge as the most influential pathological personality trait, whereas no significant effects were found for disinhibition and psychoticism. In summary, our study uncovered compelling longitudinal associations that underscore the pivotal role of pathological personality traits in the development of identity. Implications and suggestions for future research are discussed.

Identity and Temporal Fragmentation in Borderline Personality Disorder: A Systematic Review

BACKGROUND

Borderline Personality Disorder (BPD) is a prevalent psychopathological condition, affecting 0.7-2.7% of the general population. Given the known link between identity formation and the temporal, metacognitive, and narrative processes that contribute to its coherence, the aim of the present systematic review is to synthesize the current literature about the relationship between identity diffusion and lived time in adult patients with BPD. This would enhance knowledge and treatments, leading to a better understanding of the implications of time processes on identity diffusion in BPD.

METHODS

According to PRISMA guidelines, the main databases were consulted, and specific eligibility criteria were applied. The selection leads to the inclusion of 15 articles, investigating through integrated techniques the lived time, memory, self-reported narratives, and metacognition in BPD subjects.

RESULTS

A general agreement among researchers was found, confirming greater difficulty for BPD subjects in producing autobiographical stories, logically and temporally integrated, characterized by positive content. Functional and structural alterations were detected to explain narrative incoherence, as well as symptoms such as emotional dysregulation and cognitive biases.

CONCLUSIONS

The difficulty for BPD subjects in producing a coherent personal narrative has been interpreted as a correlation of anomalies in autobiographical memories and consequently identities, which were equally compromised by the experience of discontinuity in the temporal structure. This would confirm the hypothesis of the temporal fragmentation of the self in BPD. Although some limitations have been encountered, we suggest that the understanding of identity diffusion and lived time in BPD subjects could represent a useful guide for further research.

Prevalence of homosexual and bisexual orientation in patients with borderline personality disorder and associated factors - a systematic review and meta-analysis

Introduction

This meta-analysis aimed to quantitatively evaluate the association between homosexual and bisexual orientation and borderline personality disorder (BPD), including factors contributing to the association and clinical outcomes of homosexual and bisexual patients with BPD.

Methods

We systematically searched PUBMED, PsycINFO, Cochrane Library, MEDLINE, EMBASE and Web of Science for cross-sectional or cohort studies comparing the prevalence of homosexual and bisexual orientation amongst patients with BPD and controls.

Results

Our search identified 7 eligible studies, with a total sample case of 636 subjects with BPD and 535 subjects without BPD. Patients with BPD had a significantly higher likelihood of homosexual and bisexual orientation (Risk ratio [RR] 3.39, 95%CI 1.88-6.12) with a pooled prevalence of 28% (95% CI 0.24-0.31; I2 73%; 7 studies, 1171 participants). Subgroup analyses validated that BPD was independently associated with higher prevalence of both homosexual (RR 8.51, 95% CI 3.36-21.54) and bisexual orientation (RR 3.82, 95% CI 1.81-8.04), but no gender difference was yielded. Childhood sexual abuse (CSA) was associated with the development of homosexual and bisexual orientation in patients with BPD.

Discussion

Poorer clinical outcomes, including physical and mental health, were associated with BPD status. Further studies are necessary to evaluate the feasibility and efficacy of sexual minority-specific treatment for these patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=538356, identifier CRD42024538356.

Levels of grit in patients with borderline personality disorder: Description and prediction

This study describes the 6-year course of grit scores among patients with borderline personality disorder (BPD) who have and have not experienced a symptomatic and psychosocial recovery. This study also explores predictors of grittiness in BPD patients. These patients (N = 224) were assessed as part of the McLean Study of Adult Development (MSAD). Levels of grit were assessed using the Grit Scale, a self-report measure assessing overall grittiness and three sub-scales of grit: consistency of interest, perseverance, and ambition. Recovered patients reported significantly higher levels of grit on three outcomes (overall grit, perseverance, and ambition) compared to non-recovered patients across time. One temperamental factor (conscientiousness) and one childhood factor (competency) were significant multivariate predictors of overall grit scores in patients with BPD. Taken together, these results suggest that recovered BPD patients have higher levels of grit that are stable across time. These results also suggest that grit is related to both temperamental and environmental factors.

Socio-demographic predictors of the time interval between successive hospitalizations among patients with borderline personality disorder

Background: Borderline personality disorder (BPD) affects 0.7 to 2.7% of the adult population and higher rates are reported in inpatient care. Hospitalizations of BPD patients are a complex and controversial challenge for mental health professionals. Recurrent hospitalizations are common and it is essential to identify risk factors that characterize patients who benefit from their hospitalization and those who return to the ward shortly after discharge. Aim: To investigate the potential link between BPD patients' socio-demographic factors and the expected time interval between their successive hospitalizations. Methods: A retrospective analysis of 1051 hospitalization records from 174 BPD patients. Through univariate, bivariate, and multivariate analyses, we investigated the possible relationship between patients' primary socio-demographic factors and the time between their successive hospitalizations. Results: Patients' age, marital status, and living arrangement were found to be statistically connected with the time interval between successive hospitalizations. Specifically, being older, married and/or patients to live with one's spouse/partner seem to be linked with a longer time interval between successive hospitalizations compared to patients who are young, single/divorced and/or those who live with their parents. Conclusions: The expected time interval between successive hospitalization of BPD patients can be partly explained by their socio-demographic characteristics.

Identity Disturbance in the Digital Era during the COVID-19 Pandemic: The Adverse Effects of Social Media and Job Stress

The empirical study aimed to explore the relationships among social media exposure, job stress, anxiety, and identity disturbance in a nonclinical setting in the COVID-19 pandemic context. An online questionnaire was administered to 282 participants in the United States of America (USA) during the COVID-19 pandemic. The study utilized a two-step Structural Equation Modeling (SEM) approach consisting of both measurement model and structural model testing. Relationships between the model variables of social media exposure, identity disturbance, anxiety, and job stress were analyzed using standardized beta coefficients, standard errors, t-values, and p-values. The results indicate that both social media exposure and job stress are associated with increased anxiety levels, which, in turn, influence identity disturbance. Moreover, there is a moderating effect of job stress on the relationship between social media exposure and anxiety, as well as the mediating effect of anxiety on the relationship between social media exposure and identity disturbance. The findings are valuable for organizations and can be used to develop programs aimed at mitigating the adverse effects of social media exposure on mental health. Prioritizing employee mental health through awareness and support initiatives is paramount, especially for those facing high stress and extensive social media use.

Socio-demographic Predictors of Hospitalization Duration Among Patients with Borderline Personality Disorder

Borderline personality disorder (BPD) is a complex psychopathology associated with high service utilization rates. In turn, the hospitalization of BPD patients is a controversial challenge for mental health professionals. Prior literature has identified certain socio-demographic factors as linked to an increased risk of BPD. In this study, we examined the possible connection between these socio-demographic factors and hospitalization duration. We analyzed 1077 hospitalization records of 200 BPD-diagnosed patients. Patients' gender, age, education level, employment and marital statuses, and living arrangement were statistically significantly linked with hospitalization duration. Specifically, female gender, age twenty or below, no high-school diploma (or, to a lesser extent, a diploma with no academic education), unemployment status and/or patients who live with parents are strongly associated with longer hospitalizations compared to male gender, older patients, more educated, married/divorced status and/or those who do not live with their parents. Additionally, the results point to a weak, albeit statistically significant, temporal pattern with more advanced hospitalizations generally aligning with the duration of their preceding ones, while being slightly shorter. In order to prevent potentially unnecessary prolonged and regressive hospitalizations, an estimation of the expected hospitalization duration should be explicitly considered when setting hospitalization goals and plans.

How negative self-views may interfere with building positive relationships: An experimental analogue of identity dysfunction in borderline personality disorder

INTRODUCTION

A disturbed, negative sense of self is associated with various interpersonal difficulties and is characteristic of disorders such as borderline personality disorder (BPD). Negative self-views may affect an individuals' ability to build positive relationships, including a therapeutic relationship. However, it is not yet well understood how identity disturbances give rise to interpersonal difficulties. Using an experimental analogue design, we tested whether identity disturbances are associated with interpersonal difficulties.

METHODS

Participants were university students (N = 43, age M = 20.51 (SD = 3.08), women N = 32 (74.4%)) who reported moderate to high levels of BPD features, with 34.9% reporting significant BPD features as measured by the Borderline scale of the Personality Assessment Inventory (PAI-BOR). In a within-subject experimental paradigm using a Social Feedback Task, participants received negative, intermediate, and positive evaluations, supposedly from a panel. Using multilevel models, we tested whether negative self-views were associated with how much the participants liked, trusted, and felt close to each of the three panel members who provided either predominantly negative, intermediate, or positive feedback.

RESULTS

People with more negative self-views reported lower mood in response to positive feedback. In addition, where people with more positive self-views felt better when receiving feedback that was congruent with their self-views, people with more negative self-views did not report a better mood. Importantly, people with negative self-views felt lower desire to affiliate with the member who provided predominantly positive feedback. Affiliation was not affected when feedback was given by the negative member and intermediate member to those with negative self-views.

CONCLUSIONS

The findings validated that those with more negative self-views anticipated and expected more negative responses from others. Negative self-views, as relevant for BPD, may explain how people relate differently to those giving different types of feedback. Pervasive negative self-views may interfere with building new relationships including the therapeutic alliance. It may be helpful for clinicians to be aware of the potential challenges around creating a supportive therapeutic relationship for patients with negative self-views. Overly positive affirmations made by clinicians may inadvertently lower the patient's mood and may impede alliance formation.

'Commanded to be ill, accused of being well' a lived-experience-led, qualitative investigation of service user perspectives on the impact of emotionally unstable personality disorder diagnosis on self-concept

BACKGROUND

Emotionally unstable personality disorder (EUPD) is a mental disorder impairing health and functioning and increasing suicide risk and it is a stigmatised condition among healthcare professionals. EUPD diagnosis may significantly affect self-concept, yet no previous investigation has explicitly examined this.

AIMS

To explore service user perspectives on (a) the impact of EUPD diagnosis on self-concept and (b) mediators of positive and negative impacts.

METHODS

Service user-led, qualitative semi-structured interviews with n = 10 participants with EUPD.

RESULTS

Perceived impacts of diagnosis on self-concept were, broadly, negative. Factors mediating between positive and negative impacts included: exposure to online stigma and public understanding, the responses of relatives, friends, intimate partners and trusted communities, and the attitudes and behaviours of healthcare staff. There were indications that recent guideline and practice developments (guidelines recommending alternatives to inpatient admissions for people with EUPD and "recovery-focused" approaches to self-harm) may have worsened inpatient staff attitudes and led to more rejecting service user experiences.

CONCLUSION

Mitigating negative impacts of EUPD diagnosis on self-concept may require addressing hateful, online content related to EUPD; revisiting use of the personality disorder label; improving medical communication around diagnosis and improving practice and policy in the management of EUPD in inpatient settings.

How to target disturbed identity in borderline patients? Self-identification program: A case study

Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.

Management Strategies for Borderline Personality Disorder and Bipolar Disorder Comorbidities in Adults with ADHD: A Narrative Review

This narrative review examines two of the common comorbidities of attention-deficit/hyperactivity disorder, bipolar disorder (BD), and borderline personality disorder (BPD), which each share several common features with ADHD that can make assessment and diagnosis challenging. The review highlights some of the key symptomatic differences between adult ADHD and these disorders, allowing for more careful consideration before establishing a formal diagnosis. When the disorders are found to be comorbid, further complications may arise; thus, the review will also help to provide evidence-based treatment recommendations as well as suggestions on how to minimize adverse events. Incorporating evidence from systematic reviews, journal articles, randomized controlled trials, and case reports, this review highlights that the diagnosis of ADHD and some of its common comorbidities is challenging and requires full, in-depth assessment and management. The management strategies of these comorbidities will also be addressed, with emphasis on achieving mood stabilization for BD prior to initiating appropriate ADHD pharmacotherapy. Medications, specifically mood stabilizers, antipsychotics, and antidepressants, are fundamental in treating symptoms seen in BD and some cases of BPD, alongside psychotherapy and lifestyle modifications when appropriate. The review highlights the effectiveness of specific medications, including psychostimulants, atomoxetine, and bupropion, as add-on therapies to mood-stabilizing treatments for addressing ADHD symptoms in patients with these comorbidities. Despite limited research, the review will address various pharmacological and psychotherapeutic approaches for managing comorbid ADHD and BPD, emphasizing the need for further investigations to better understand the unique needs of this patient population.

Increases in negative affective arousal precede lower self-esteem in patients with borderline personality disorder but not in patients with depressive disorders: an experience sampling approach

BACKGROUND

Instability in self-esteem and instability in affect are core features of borderline personality disorder (BPD). For decades, researchers and theorists have been interested in the temporal dynamics between these constructs. Some hypothesize that changes in affective states should precede changes in self-esteem (Linehan, Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993), while others suggest that changes in self-esteem should precede changes in affective states (Kernberg, Borderline conditions and pathological narcissism, 1975).

METHODS

In this study, we investigated the temporal relations between negative affective arousal states and current self-esteem in daily life. Patients with BPD (n = 42) or depressive disorders (DD; n = 40), and non-clinical controls (NCC; n = 40) were assessed every 15 min for 13 h.

RESULTS

As expected, dynamic structural equation modeling showed higher levels of average daily negative affective arousal and lower levels of average daily self-esteem in the BPD group compared with the NCC group, and scores in the DD group were in-between the BPD and the NCC groups. In line with predictions based on Linehan's (Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993) model of affective dysregulation in BPD, negative affective arousal (t) and subsequent self-esteem (t+ 1) were significantly linked only in the BPD group, implying that higher negative affective arousal is followed by lower current self-esteem in the next measurement (ca. 15 min later). Importantly, self-esteem (t) and subsequent negative affective arousal (t + 1) were not significantly related (Kernberg, Borderline conditions and pathological narcissism, 1975).

CONCLUSIONS

Our findings suggest close dynamic temporal relations between affective instability and self-esteem instability in BPD, which highlights the importance of providing patients with means to effectively modulate high negative affective arousal states.

Self-report response style bias and borderline personality features

Borderline personality disorder (BPD) is characterized by dichotomous thinking, biases in processing emotion-related information, impulsive responding, and identity disturbance - each of which may affect how individuals respond to assessment items. This study used item-response theory tree models to examine the association between number of self-reported BPD symptoms and response style bias on the NEO Five Factor Inventory-3, administered annually from ages 18 to 20 to 2196 community participants enrolled in the Pittsburgh Girls Study. Small to moderate negative correlations emerged between number of BPD symptoms and midpoint responding. Small correlations emerged between BPD symptoms and extremity responding. These patterns did not vary by age. Participants who endorsed higher initial BPD symptoms reported lower extraversion over time, whereas those initially endorsing midpoint extroversion reported greater decreases in BPD severity. Low initial agreeableness was associated with higher BPD symptom slopes. The current study found only small associations between response style biases and BPD symptoms among a sample with subthreshold symptoms for diagnosis.

Homo dissipans: Excess and Expenditure as Keys for Understanding the Borderline Condition?

This paper sheds light on some aspects of what contemporary clinical theory calls "borderline" condition providing a description of a key figure of late-modern culture that I will call Homo dissipans (from Latin dissipatio, -onis = scattering, dispersion). Homo dissipans is the opposite of Homo œconomicus, the form that "narcissism" takes on in contemporary "achievement society," solely concerned with rational action aimed to utility and production. In order to define Homo dissipans, I follow French philosopher, anthropologist, and novelist Georges Bataille's descriptions of two core phenomena: "excess" and "expenditure." The former can be defined as a surplus of energy that according to Bataille characterizes human existence, animated by a general movement of exudation and dilapidation and an inexhaustible drive to "pour out" of oneself, especially outside the limits of composure and reasonableness. The latter is an ethical attitude which gives its approval to excess and to its metamorphic and destructive power. The Homo dissipans' credo is to profitlessly dissipate the surplus of energy, escape into a world of pure intensities in which all forms - including identity - dissolve and surrender themselves to transformation. I argue that Bataille's ideas about "dissipation" can help us reconsider two features attributed to borderline personality disorder which have been extensively described and sometimes stigmatized - "identity diffusion" and "stable instability" - and to better recognize, understand, and make sense of their phenomenology in the clinical context.

Modelling Identity Disturbance: A Network Analysis of the Personality Structure Questionnaire (PSQ)

Due to the relevance of identity disturbance to personality disorder this study sought to complete a network analysis of a well validated measure of identity disturbance; the personality structure questionnaire (PSQ). A multi-site and cross-national methodology created an overall sample of N = 1549. The global network structure of the PSQ was analysed and jointly estimated networks were compared across four subsamples (UK versus Italy, adults versus adolescents, clinical versus community and complex versus common presenting problems). Stability analyses assessed the robustness of identified networks. Results indicated that PSQ3 (unstable sense of self) and PSQ5 (mood variability) were the most central items in the global network structure. Network structures significantly differed between the UK and Italy. Centrality of items was largely consistent across subsamples. This study provides evidence of the potential network structure of identity disturbance and so guides clinicians in targeting interventions facilitating personality integration.

MDMA-Assisted Psychotherapy for Borderline Personality Disorder

Borderline personality disorder is a complex psychiatric disorder with limited treatment options that are associated with large heterogeneity in treatment response and high rates of dropout. New or complementary treatments for borderline personality disorder are needed that may be able to bolster treatment outcomes. In this review, the authors comment on the plausibility for research on 3,4-methylenedioxymethamphetamine (MDMA) used in conjunction with psychotherapy for borderline personality disorder (i.e., MDMA-assisted psychotherapy [MDMA-AP]). On the basis of the promise of MDMA-AP in treating disorders overlapping with borderline personality disorder (e.g., posttraumatic stress disorder), the authors speculate on initial treatment targets and hypothesized mechanisms of change that are grounded in prior literature and theory. Initial considerations for designing MDMA-AP clinical trials to investigate the safety, feasibility, and preliminary effects of MDMA-AP for borderline personality disorder are also presented.

Identity and Personality Pathology: A Convergence Across the DSM-5 Personality Disorder Model and the Alternative Model for Personality Disorders

Long-standing theory regarding personality pathology as well as the recently proposed DSM-5 Alternative Model for Personality Disorders (AMPD) posit that self/identity problems are a hallmark feature cutting across forms of personality pathology. With emergence of the AMPD, researchers have started to focus empirical investigations on identity pathology as a transdiagnostic factor across personality pathology. The current study investigated identity pathology across indicators of personality pathology from both the current categorical perspective (DSM-5 PD) and the dimensional perspective in the AMPD. Identity diffusion and low self-concept clarity were correlated with all PD feature scales and all maladaptive personality dimension scales. Regression analyses revealed most indicators of personality pathology were significant correlates of identity diffusion and low self-concept clarity. Borderline and Avoidant PD feature scales and Negative Affectivity and Detachment maladaptive personality dimension scales emerged as the strongest correlates of identity pathology. The role that identity pathology plays in personality pathology is highlighted.

Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses

OBJECTIVE

Eating disorders and borderline personality disorder have high rates of comorbidity. However, the extent to which individual BPD symptoms are elevated in patients with EDs is largely unknown. Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs.

METHODS

We performed nine separate meta-analyses (one for each BPD symptom) to compare levels of symptoms in patients with EDs versus healthy controls. A total of 122 studies (range = 4-34 studies across symptoms) were included.

RESULTS

Affective instability was the BPD symptom most elevated, while anger was the BPD symptom least elevated, in patients with EDs compared to controls. When comparing effect sizes across ED subtypes, anorexia nervosa binge-eating/purging subtype had the largest effect sizes for the greatest number of BPD symptoms, while effect sizes for AN restrictive subtype were not significantly larger than those of other EDs for any BPD symptom. The least studied BPD symptoms were identity disturbance and interpersonal difficulties.

DISCUSSION

These meta-analyses suggest that certain symptoms of BPD play a more prominent role in the comorbidity between BPD and EDs than others. Targeting affective instability when treating cases of comorbid ED and BPD may be especially likely to ameliorate the negative outcomes related to this comorbidity. Future research should further investigate identity disturbance and interpersonal difficulties in the context of EDs.

PUBLIC SIGNIFICANCE

Having an eating disorder and borderline personality disorder is a common comorbidity associated with a severe clinical presentation. BPD is characterized by nine distinct symptoms. This research examined levels of individual BPD symptoms in patients with versus without EDs. Findings can guide researchers and clinicians towards studying and treating symptoms that may be most relevant for BPD-ED comorbidity and in turn, improve outcomes for these patients.

The self-reference effect as a behavioral indicator of identity disturbances associated with borderline personality features in a non-clinical sample

BACKGROUND

Identity disturbances are a common feature of personality pathology and BPD. The Self-Reference Effect paradigm is a method used to measure the impact of self-relevant processing on encoding/memory, whereby self-relevant information is typically advantaged in cognitive processes. We postulated that difficulties with identity might impede the process by which one encodes self-relevant information. Based on this reasoning, we predicted that high levels of identity disturbance could be associated with atypical impact of the SRE.

METHODS

Undergraduate participants were randomized into one of three groups where they were exposed to 60 trait adjectives for seven seconds each. Depending on condition, participants either indicated whether a word was/wasn't capitalized (Capitalization condition), whether it was a good synonym for "openness" (Synonyms condition), or whether it described them as a person (Self-reference condition). After a brief delay, all participants were asked to recall as many of the 60 words as possible. Finally, we measured identity disturbance using the Borderline Features-Identity Problems (BOR-I) scale from the Personality Assessment Inventory.

RESULTS

We found significant but modest correlations between Recall and scores on the BOR-I subscale in the Self-Reference condition, but not the two control conditions. Contrary to expectations, the interaction between BOR-I and Condition was not a significant predictor of Recall, suggesting that identity disturbance did not significantly moderate the SRE.

CONCLUSIONS

While our primary hypothesis was not supported, there is a need for multimethod approaches to studying personality pathology. Future research should continue to examine the extent to which behavioral paradigms like the SRE might be useful indicators of identity disturbance/personality pathology, with an emphasis on the use of clinical populations.

Dissociation, trauma, and borderline personality disorder

Dissociation is a complex phenomenon, which occurs in various clinical conditions, including dissociative disorders, (complex) post-traumatic stress disorder (CPTSD, PTSD), and borderline personality disorder (BPD). Traumatic stress is considered an important risk factor, while the etiology of dissociation is still debated. Next to traumatic experiences, temperamental and neurobiological vulnerabilities seem to contribute to the development of dissociation. Stress-related dissociation is a prevalent symptom of BPD, which may interfere with psychosocial functioning and treatment outcome. More research in the field is strongly needed to improve the understanding and management of this complex phenomenon. This article collection brings together research on dissociation and trauma, with a special focus on BPD or sub-clinical expressions of BPD. In this editorial, recent conceptualizations of dissociation and relevant previous research are introduced in order to provide a framework for this novel research.

How Does It Feel to Have a Disturbed Identity? The Phenomenology of Identity Diffusion in Patients With Borderline Personality Disorder: A Qualitative Study

Identity diffusion is one of the defining characteristics of borderline personality disorder (BPD). Given its central importance in the formal diagnostic criteria for personality disorders, identity diffusion is remarkably under-researched. In particular, our knowledge of the phenomenology of identity diffusion needs to be improved. This study is based on semistructured interviews with 16 younger women SCID-5-diagnosed with BPD. All interviews were analyzed using the interpretative phenomenological analysis approach. On the basis of this analysis, the patients' descriptions of how identity diffusion manifests itself in their subjective experience are classified into nine categories: disintegrated self-image; using various façades to stabilize the self; painful feelings of the self as broken; feeling that the self does not fit in; inner emptiness; "I don't know what I want"; great need for attention from others to stabilize identity; feeling unable to handle interpersonal relationships; and using sex to distract the self and regulate painful self-states.

Taking care of a real self - description of the psychotherapeutic process of a patient with narcissistic personality disorders in the field of dance/movement psychotherapy

Introduction: Dance/movement psychotherapy (DMT) is a psychotherapeutic trend that belongs to the approaches that involve working with the body. Thinking about a wider perspective, DMT belongs to the group of action-oriented psychotherapies. It assumes that the person, while moving, can show his/her emotional states. Additionally, it can lead to development and personal integration. The goal is to deepen awareness. Psychotherapy with dance and movement is practiced among psychotic patients, patients suffering from neurotic or personality disorders, and as a method of personal development. The aim of the work is to describe the psychotherapeutic process of an individual client in the field of dance/movement psychotherapy as a method in which dance leads to development and personal integration.

Material and method: Working with a client, Beata, took place in a strictly defined setting. Meetings took place once a week in the same office during 55 minutes. They were of an individual nature. First, Beata was diagnosed according to the DSM-5 [1] and ICD-10 [2] classification, which was supplemented with the PDM-2 diagnosis [3]. During the therapeutic work, the phenomena of transference and countertransference were taken into account, the patient’s behavior was interpreted according to John Bowlby’s attachment theory and mentalization. During practicing DMT it is important to take care of Authentic Movement method, observation of movement using the Laban Bartenieff Movement System (LBMS) method and the Kastenberg Movement Profile (KMP).

Results: The changes that DMT psychotherapy started to bring were observed both in the client’s movement and in the verbal layer. The client has acquired the ability to observe her feelings and needs. This influenced her perception of announcement heard from different people and the decisions she made. The DMT therapy with Beata is not over yet, which makes it possible to take a deeper look at topics related to therapeutic goals.

Conclusions: Dance/movement psychotherapy has proved to be an effective method of working with patients with personality disorders psychopathology of the narcissistic type. This method makes it possible to build a sense of the patient’s boundaries and needs, and to strengthen self-esteem. Sessions seem to be very helpful in integrating inner life, feelings and experience. In addition, it helps in dealing with the internal tension of patients and gives the opportunity to expand ranges of movement. In the verbal part, it is possible to discuss the problems that the client carries within himself, which cause him fear, anxiety and other unpleasant emotions.

Psychometric Properties of a Cultural Adapted Version of the Assessment of Identity Development in Adolescence in Panama

The Assessment of Identity Development in Adolescence (AIDA) is a self-report instrument to detect pathological development of Identity. In Panamá, psychometric instruments for assessment of psychopathology in adolescence are lacking. Our aim was to develop a valid and reliable version of the AIDA Inventory for Panamanian Population. AIDA was adapted to Spanish considering cultural aspects of Panamanian population. Two pilot tests were performed prior to main test to assess item-total correlation at subscale, primary scale and total scale levels and internal consistency at subscale level. A mixed sample of students and PD patients (N = 315) completed the AIDA inventory, the "Strength and Difficulties Questionnaire" and "Defense Style Questionnaire-40." AIDA was retested in a sub sample from school population (n = 98). The Structured Clinical Interview for Axis II Disorders was used for diagnosis of personality disorders in the patient sample (n = 25). Psychometric properties were tested to assess internal consistency, reliability, factorial validity, convergent validity, and criterion validity. AIDA Panama showed excellent internal consistency for the total scale Identity Diffusion with Cronbach's α:0.94 and a retest reliability of 0.84. A Bifactorial CFA was modeled to assess the dimensionality of the inventory. The proportion between OmegaH and Omega at total scales 96% of the variance is explained by a general factor. Furthermore, the Explained Common Variance for the General Factor is 73% supporting unidimensionality. In line with theory, AIDA total scale showed a high positive correlation (r = 0.67) with Total Difficulties scale and high positive correlation (r = 0.71) with Immature Defense scale. The AIDA total score differed highly significant (p = 0.000) between the patient sample and the students with a large effect size (d = 1.02).

CONCLUSION

The adaptation and validation of AIDA for Panamanian adolescent population was successful with good psychometric properties and significant correlations with related psychopathological constructs. AIDA showed high clinical validity by providing a valid discrimination between the school sample and a diagnosed PD sample, in line with the assumption that impaired identity functioning is at the core of personality disorders, especially in adolescence.

The relation between self-event connections and personality functioning in youth with severe psychopathology

Objective

One way in which individuals construct their narrative identity is by making self‐event connections, which are often linked to better functioning. Being unable to make connections is related to identity discontinuity and psychopathology. Work in the general population corroborates this association, but also highlights the importance of focusing on specific aspects of these connections and on vulnerable populations.

Method

We examined the association of self‐event connections with personality functioning in youth with severe psychopathology (cross‐sectional N = 228, M_age = 19.5, longitudinal N = 84), and the role of event and connection valence in the subsample of youth who made a connection (n = 188 and n = 68). Negative affectivity was controlled for in all models.

Results

We found no evidence that self‐event connections, nor connection valence and its interaction with event valence, are related to functioning. Positive event valence was associated with better functioning. Higher negative affectivity was strongly linked to lower functioning and explained the relation between event valence and functioning. No longitudinal associations emerged.

Conclusions

These findings show that for youth with severe psychopathology making self‐event connections may not be associated with better functioning. Moreover, negative affectivity may be a distal predictor of both event valence and functioning.

Approaching Identity Problems Common in Clinical Practice

The concept of identity is pervasive in psychology and culture, but clinicians have lacked a conceptual framework for addressing problems related to identity. After reviewing the development of identity, I distinguish four of the most common categories of such problems and consider approaches to each: identity diffusion, distorted identity, threats to identity, and difficulty integrating disparate aspects of one's identity. While making identity a focus of clinical attention can strengthen the alliance and place the treatment within a larger context, doing so raises moral questions about the clinician's role as an agent of validation or change.

Borderline personality disorder

Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.

The Cognitive, Ecological, and Developmental Origins of Self-Disturbance in Borderline Personality Disorder

Self-disturbance is recognized as a key symptom of Borderline Personality Disorder (BPD). Although it is the source of significant distress and significant costs to society, it is still poorly specified. In addition, current research and models on the etiology of BPD do not provide sufficient evidence or predictions about who is at risk of developing BPD and self-disturbance, and why. The aim of this review is to lay the foundations of a new model inspired by recent developments at the intersection of social cognition, behavioral ecology, and developmental biology. We argue that the sense of agency is an important dimension to consider when characterizing self-disturbances in BPD. Second, we address the poorly characterized relation between self-disturbances and adverse life conditions encountered early in life. We highlight the potential relevance of Life-History Theory-a major framework in evolutionary developmental biology-to make sense of this association. We put forward the idea that the effect of early life adversity on BPD symptomatology depends on the way individuals trade their limited resources between competing biological functions during development.

Sexual Orientation and Gender of Intimate Relationship Partners Among Adolescents With BPD and Psychiatrically Healthy Adolescents

The first aim of this study was to describe reported sexual orientation in a group of adolescents diagnosed with borderline personality disorder compared to a group of psychiatrically healthy adolescents. The second purpose was to compare data on dating and gender of dating partners in the same two groups. Two semistructured interviews, which assessed sexual orientation, dating history, and gender of dating partners, were administered to 104 borderline adolescents and 60 psychiatrically healthy comparison subjects. Borderline adolescents were significantly more likely than comparison subjects to report having a gay/lesbian/bisexual orientation. They also were significantly more likely to date and to report dating a same-gender partner or same- and other-gender partners than comparison subjects. The results of this study suggest that same-gender attraction and/or intimate relationships may be an important interpersonal issue for approximately one-third of adolescents with BPD.

At the Junction of Clinical and Developmental Science: Associations of Borderline Identity Disturbance Symptoms With Identity Formation Processes in Adolescence

Developmental scientists describe the role confusion that can occur for adolescents as they are forming a personal identity. Clinical psychologists describe low self-worth, lack of self-clarity, feelings of emptiness, and dissociation as the key elements of identity disturbance, and they link these to borderline personality disorder. In this study, the authors aimed to work at the juncture of these approaches by considering interrelations between four elements of identity disturbance, typical identity formation processes reflective of identity commitment and confusion, and borderline features. Australian youth (N = 505, 63% female and aged 12-20 years) recruited from clinical and community settings reported on identity commitment, exploration and reconsideration, four elements of identity disturbance, and borderline features. Identity confusion (especially reconsideration) and disturbance were associated with elevated borderline symptoms. Emptiness stood out as the strongest correlate of borderline symptoms. Youth reporting greater emptiness were nearly twice as likely to report a high borderline symptom profile.

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

PURPOSE OF REVIEW

The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD.

RECENT FINDINGS

Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.

The role of impairments in self-other distinction in borderline personality disorder: A narrative review of recent evidence

Impairments in maintaining a differentiated sense of "self" and "other" are thought to be a central feature of borderline personality disorder (BPD). However, studies directly focusing on self-other distinction (SOD) in BPD are scarce, and these findings have not yet been integrated with novel insights into the neural mechanism involved in SOD. Here, we present a narrative review of recent behavioral and neuroimaging findings focusing on impairments in SOD in BPD. Behavioral findings of SOD at the embodied level provide preliminary evidence for impairments in multisensory integration in BPD. Furthermore, both behavioral and neuroscientific data converge to suggest that SOD impairments in BPD reflect an inability to shift between self and other representations according to task demands. Research also suggests that disruptions in infant-caregiver synchrony may play a role in the development of these impairments. Based on these findings, we present a new, integrative model linking impairments in SOD to reduced neural and behavioral synchrony in BPD. The implications of these findings for future research and clinical interventions are outlined.

Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem

Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

Explicit and Implicit Measures of Identity Diffusion in Adolescent Girls With Borderline Personality Disorder

The present study is the first to examine both the implicit and explicit self-concept of identity diffusion in a sample of adolescent patients with borderline personality disorder (BPD). A clinical sample of adolescent girls with diagnosed BPD (N = 30; M age = 15.9 years) and a sample of girls with a healthy personality development (N = 33; M age = 16.6 years) completed an implicit association test (IAT) that was adjusted to identity diffusion, the core of BPD. Common domains of child and adolescent psychopathology and core components of BPD were assessed using self-reports on the Strengths and Difficulties Questionnaire (SDQ), the Borderline Personality Features Scale for Children-11 (BPFSC-11) and the Assessment of Identity Development in Adolescence (AIDA). BPD patients scored significantly higher on explicit measures of borderline pathology than girls with a healthy personality development. A crucial finding for this study was that girls with BPD had a significantly lower implicit preference for stability than their counterparts in the control group. Moreover, explicit measures of borderline personality pathology were significantly correlated with an implicit measure of identity diffusion, the core of BPD. However, when looking at the predictive ability of implicit and explicit measures, only explicit identity diffusion was significantly associated with borderline features. Our data suggests that adolescent girls with BPD differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to BPD related characteristics, which further advances the need for the identification of at-risk adolescents.

Identity Diffusion as the Organizing Principle of Borderline Personality Traits in Adolescents-A Non-clinical Study

Growing evidence shows that diagnosing and treating borderline personality disorder (BPD) is of high relevance for affected youths. Although identity crisis is part of the normative developmental process, identity diffusion is a potential candidate for being an appropriate concept in further developing screening tools and interventions for BPD treatment in adolescence. We hypothesized that severity of borderline traits (as indicated by the strength of their associations with identity diffusion) would be negatively associated with non-clinical adolescents' endorsement of borderline features' presence. We also hypothesized that identity diffusion had a central role in the network of borderline personality traits and could be conceived of as a latent organizing principle of borderline personality disorder. In our study, 169 non-clinical adolescents (81 girls and 88 boys; M _age = 15.38; SD_age = 1.52) filled out self-report measures of borderline personality features and identity diffusion. According to our results, having strong feelings and interpersonal sensitivity were the two most endorsed borderline personality features. Borderline personality features were positively correlated with identity diffusion. The more severe a borderline personality feature was, the less relevant it was for non-clinical adolescents. According to a network analysis, identity diffusion was the most central and least redundant element of the network of borderline personality traits. Results are discussed from a clinical point of view, further encouraging professionals to use identity diffusion screening tools to detect BPD in adolescence.

Time and Body. 2020. [DOI: 10.1017/9781108776660]

Time and Body promotes the application of phenomenological psychopathology and embodied research to a broad spectrum of mental disorders. In a new and practical way, it integrates the latest research on the temporal and intersubjective constitution of the body, self and its mental disorders from phenomenological, embodied and interdisciplinary research perspectives. The authors investigate how temporal processes apply to the contribution of embodiment and selfhood, as well as to their destabilization, such as in eating disorders and borderline personality disorders, schizophrenia, depression, social anxiety or dementia. The chapters demonstrate the applicability of phenomenological psychopathology to a range of illnesses and its relevance to treatment and clinical practice.

Identity pathology and borderline personality disorder: an empirical overview

Pathological identity-related functioning is a core feature of borderline personality disorder (BPD) that is grievously underrepresented in the empirical literature. Burgeoning evidence indicates that identity pathology is multifaceted, influenced by transactions between social and endogenous processes, and associated with a wide variety of maladaptive outcomes. Although historically defined by patterns of instability (e.g. frequent and rapid changes to career goals, religious beliefs, core values, friend groups, etc.), accumulating research indicates that identity pathology also manifests as distress and functional impairment related to excessive rigidity (i.e. unrelenting negative self-evaluations; overidentification with a restricted role or group membership) and/or incongruous behavior (i.e. simultaneously holding discordant beliefs/values/attitudes, actions that are grossly contradictory with values, incoherent sense of self, etc.). Despite the complex nature of this construct, and its centrality to BPD, researchers often assess identity pathology indirectly, inadequately, or fail to measure it entirely. In this article, we briefly describe how identity pathology may fit into etiological models of BPD, highlight emerging themes from recent research, and identify important gaps in our knowledge. We also discuss limitations associated with current assessment practices, recommend alternatives, and articulate a research agenda for the future.

Microstructural white matter alterations in borderline personality disorder: A minireview

BACKGROUND

Borderline personality disorder (BPD) affects 1-5% of the population and is characterized by a complex symptomatology and selective functional impairments. Although brain imaging studies have contributed to better characterizing the pathophysiological mechanisms underlying BPD, the white matter (WM) deficits associated with this disorder are still unclear. Therefore, the present review aims at providing an overview of the findings emerged from the available diffusion tensor imaging (DTI) studies on BPD.

METHODS

From a bibliographic research in PubMed until May 2019, we collected 12 studies that fulfilled our inclusion criteria, including a total sample of 291 BPD subjects and 293 healthy controls.

RESULTS

Overall, the DTI studies reviewed showed impairments in selective WM tracts that are part of the prefronto-limbic system, including frontal WM (short and long tracts), anterior cingulate cortex, corpus callosum, corona radiata, hippocampal fornix and thalamic radiation, in BPD patients compared to healthy controls.

LIMITATIONS

Few DTI studies with heterogeneous findings.

CONCLUSIONS

Overall these results reported that BPD is characterized by selective structural connectivity alterations in prefronto-limbic structures, further supporting the neurobiological model of BPD that suggests the presence of an abnormal modulation of frontal regions over limbic structures. Finally, the results also highlighted that the disrupted WM integrity in selective brain regions may also explain key-aspects of BPD symptomatology, including emotional dysregulation, ambivalence, contradictory behaviors and cognitive dysfunctions.

Stuck in a negative me: fMRI study on the role of disturbed self-views in social feedback processing in borderline personality disorder

BACKGROUND

Interpersonal difficulties in borderline personality disorder (BPD) could be related to the disturbed self-views of BPD patients. This study investigates affective and neural responses to positive and negative social feedback (SF) of BPD patients compared with healthy (HC) and low self-esteem (LSE) controls and how this relates to individual self-views.

METHODS

BPD (N = 26), HC (N = 32), and LSE (N = 22) performed a SF task in a magnetic resonance imaging scanner. Participants received 15 negative, intermediate and positive evaluative feedback words putatively given by another participant and rated their mood and applicability of the words to the self.

RESULTS

BPD had more negative self-views than HC and felt worse after negative feedback. Applicability of feedback was a less strong determinant of mood in BPD than HC. Increased precuneus activation was observed in HC to negative compared with positive feedback, whereas in BPD, this was similarly low for both valences. HC showed increased temporoparietal junction (TPJ) activation to positive v. negative feedback, while BPD showed more TPJ activation to negative feedback. The LSE group showed a different pattern of results suggesting that LSE cannot explain these findings in BPD.

CONCLUSIONS

The negative self-views that BPD have, may obstruct critically examining negative feedback, resulting in lower mood. Moreover, where HC focus on the positive feedback (based on TPJ activation), BPD seem to focus more on negative feedback, potentially maintaining negative self-views. Better balanced self-views may make BPD better equipped to deal with potential negative feedback and more open to positive interactions.

Assessing Personality Disorders in Adolescence: A Validation Study of the IPOP-A

Background:

The need to develop clinical and empirically-based tools for assessing personality development in adolescence led to the proposal of the IPOP-A (Ammaniti, Fontana, Kernberg, Clarkin, & Clarkin, 2011), a semi-structured interview for adolescents that aims to differentiate personality organization processes from characteristics that may reflect a personality disorder.

Objective and Methods:

This research aimed to evaluate the adaptation of the IPOP-A to the Portuguese population, attending to its diagnostic properties and its discriminant validity by comparing a clinical group with a nonclinical one. A total sample of 44 adolescents from 13 to 18 years old has taken part in this study, 22 of whom had a previous personality disorder diagnosis. The content of the interviews was transcribed and codified according to the coding manual.

Results:

Acceptable internal consistency values across the dimensions of the IPOP-A are found and statistically significant differences are revealed between the clinical group and nonclinical group, with the clinical group revealing values that suggest higher impairment in the dimensions of the personality functioning in comparison with the nonclinical one.

Conclusion:

Our study supports that the Portuguese version of the IPOP-A can be considered a valid instrument to identify adolescents with a personality disorder.

Replication of the Self-Concept and Identity Measure (SCIM) Among a Treatment-Seeking Sample

Identity distress occurs within a variety of psychiatric conditions. Reliable tools for assessing identity-related functioning among clinical populations are greatly needed. The Self- Concept and Identity Measure (SCIM) is a brief self-report scale designed to assess healthy and disturbed identity dimensions. This measure has been validated within normative but not treatment seeking samples. The present study used an a priori confirmatory approach to replicate the SCIM's factor structure among disadvantaged women enrolled in treatment for chemical dependence (N = 216). The original three-factor structure and item loadings generally replicated within this diagnostically diverse, significantly impaired sample. Higher SCIM scores were also associated with other problems, such as emotion dysregulation and depression. Results support the SCIM's use and scoring with clinical populations.

Sense of Self: Its Place in Personality Disturbance, Psychopathology, and Normal Experience

Sense of self (SOS) is a cornerstone of psychological inquiry and therapy and is a defining feature of a range of psychological conditions including borderline personality disorder, yet it is poorly understood. SOS is that continuous experience of being a complete and authentic person who feels in control of their own activities. It is a part of normal development of the self and, when weakened by trauma or developmental neglect, is a vulnerability for developing many different disorders, including depression and dissociative, personality, and eating disorders. This review aims to provide a working definition and description of SOS and to summarize its transdiagnostic role in contributing to psychological disorders. To achieve this aim, the article encompasses and unites the literature from various theoretical domains including developmental psychology, identity theory, cognitive psychology, personality disorders, and psychodynamic theories. Implications are raised for psychological therapy and research into psychopathology and its underpinnings.