Modeling Heterogeneity in Momentary Interpersonal and Affective Dynamic Processes in Borderline Personality Disorder

A complex systems perspective on chronic aggression and self-injury: case study of a woman with mild intellectual disability and borderline personality disorder

BACKGROUND

Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as "complex". Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases.

CASE PRESENTATION

A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days.

CONCLUSIONS

A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.

The link between daily affective complexity and anxiety is altered by oral contraceptive use

Affective complexity - the unique ways in which individuals' emotions covary and differentiate - is an important aspect of internalizing problems. For instance, daily affective complexity has been linked to anxiety increases in women and to decreases in men. The mechanisms underlying this gender difference have not been widely investigated, but a role for ovarian hormones is likely. Research on oral contraceptives (OCs) provides promising insights into such mechanisms, as OCs suppress endogenous ovarian hormone production and vary in exogenous hormone formulations. Thus, the goal of this study was to examine links between daily affective complexity and internalizing problems in OC users (n = 84), focusing on dimensionally-assessed anxiety, and to investigate whether the links varied by pill formulation. Affective complexity was operationalized as number of factors for each person, as estimated by p-technique (i.e., person-specific factor analysis) of 75-day intensive longitudinal data. There was not a relation between affective complexity and anxiety in OC users, and this did not depend on OC pill formulation (i.e., estrogenic, progestational, or androgenic activities). Thus, OC use may blunt the relation between affective complexity and anxiety, as OC users had a relation in between the established positive relation for naturally cycling women and the inverse for men (despite a similar range of factors). Findings are consistent with a growing literature showing that OC use modulates stress and anxiety-linked processes, and suggest that gendered mechanisms underlying the relation between affective complexity and anxiety may be suppressed along with ovarian hormones in OC users.

How personality functioning relates to psychological distress and behavioral attitudes during the Covid-19 pandemic

Functional aspects of personality are crucial for experiencing and handling emotional distress. With the outbreak of the Covid-19 virus and the subsequent installation of mitigation rules of social distancing, severe psycho-social challenges were posed upon people. Research has shown that individuals react differently to these challenges. This study aimed to investigate the role of dimensional aspects of personality during the Covid-19 pandemic. Specifically, we examined how personality functioning, defense mechanisms, and narcissism were related to psychological distress and cognitive and behavioral attitudes towards the rules of social distancing. In a non-clinical sample (N = 254), Level of Personality Functioning Scale, Inventory of Personality Organization, Defense Style Questionnaire, Pathological Narcissism Inventory, and three single questions regarding emotional distress and behavioral attitudes towards the pandemic were used. Structural equation models with reference and residual factors were calculated. Impairments in personality functioning and vulnerable narcissism showed significant positive relationships, adaptive defense mechanisms significant negative relationships with psychological distress during the pandemic. Residual factors for aggression and low moral values showed distinct negative relationships with psychological distress related to social distancing. Among individuals who chose to ignore the rules of social distancing, greater impairment in personality organization was found. Personality functioning may elucidate individual differences in psychological distress and compliance with the mitigation rules during the pandemic. Limitations of measures are carefully considered in all interpretations.

Modeling Heterogeneity in Temporal Dynamics: Extending Latent State-Trait Autoregressive and Cross-lagged Panel Models to Mixture Distribution Models

Longitudinal models suited for the analysis of panel data, such as cross-lagged panel or autoregressive latent-state trait models, assume population homogeneity with respect to the temporal dynamics of the variables under investigation. This assumption is likely to be too restrictive in a myriad of research areas. We propose an extension of autoregressive and cross-lagged latent state-trait models to mixture distribution models. The models allow researchers to model unobserved person heterogeneity and qualitative differences in longitudinal dynamics based on comparatively few observations per person, while taking into account temporal dependencies between observations as well as measurement error in the variables. The models are extended to include categorical covariates, to investigate the distribution of encountered latent classes across observed groups. The potential of the models is illustrated with an application to self-esteem and affect data in patients with borderline personality disorder, an anxiety disorder, and healthy control participants. Requirements for the models' applicability are investigated in an extensive simulation study and recommendations for model applications are derived.

Examining the dynamic relationship between nonsuicidal self-injury and alcohol use experiences

INTRODUCTION

Nonsuicidal self-injury (NSSI) is a prevalent and concerning behavior and its risk pathways require a greater understanding, particularly in predicting short-term risk. Although the literature has supported a between-person link among NSSI and alcohol use, limited research has directly examined the nuances of this relationship at the within-person level using intensive longitudinal data.

METHOD

Utilizing two independent samples (total n = 85), the current study examined bidirectional, concurrent and prospective risk relationships between NSSI and alcohol, considering both urges and behavior engagement, via ecological momentary assessment.

RESULTS

Findings demonstrate concurrent, within-person relationships between NSSI urges and alcohol urges, as well as alcohol use. Alternatively, prospective between-person findings demonstrated negative relationships between NSSI urges and alcohol use, as well as alcohol urges and NSSI acts; however, this may represent suppression effects as associations were positive with the removal of autoregressive effects.

CONCLUSIONS

Together, findings support proximal risk relationships between NSSI and alcohol experiences that, for urges in particular, is bidirectional.

The social domains organization of mentalizing processes in adolescents: a contribution to the conceptualization of personality function and dysfunction in young people

BACKGROUND

We propose and evaluate a contribution to the conceptualization and assessment of personality functioning based on social domains and mentalizing hypotheses. Social domains are distinct social contexts, such as with acquaintances and friends, with differentiated expectations regarding participants' behaviours and social attributions. The capacity to organize social participation according to these expectations requires the ability, we suggest, to modulate mentalizing processes domain by domain. Drawing on evidence that social domain organization is impaired in borderline personality disorder (BPD) and that hypermentalizing, a heightened interpretation of others' motives, thoughts or emotions, is elevated in adolescent BPD, we hypothesized that hypermentalizing levels in adolescents will vary by social domain and that elevated BPD features will be associated with impairment of this domain organization of hypermentalizing.

METHODS

Measures including the borderline personality features scale for children (BPFSC) and the movie for the assessment of social cognition (MASC) were administered to 171 adolescents aged 12-17 recruited from public schools and community organizations in a large metropolitan area in southwestern United States. Mean hypermentalizing scores were computed for adolescent interpretations of sequences in the MASC focusing on the social domains of acquaintance, friends and romantic interactions.

RESULTS

There was a progressive increase in hypermentalizing scores across the acquaintance, friends and romantic interactions (repeated measures ANOVA, p < .001, all pairwise comparisons, p ≤ .02), which was markedly reduced in the presence of elevated BPD features (interaction term, p = .007).

CONCLUSIONS

Hypermentalizing is organized according to social domain and this organization is impaired in the presence of elevated BPD features. The findings are consistent with the proposal that personality functioning entails a social domains organization of hypermentalizing, which is impaired in personality dysfunction. Identifying mentalizing processes domain by domain has the potential to create a personalized focus for the treatment of adolescents with personality difficulties.

Insights from personalized models of brain and behavior for identifying biomarkers in psychiatry

A main goal in translational neuroscience is to identify neural correlates of psychopathology ("biomarkers") that can be used to facilitate diagnosis, prognosis, and treatment. This goal has led to substantial research into how psychopathology symptoms relate to large-scale brain systems. However, these efforts have not yet resulted in practical biomarkers used in clinical practice. One reason for this underwhelming progress may be that many study designs focus on increasing sample size instead of collecting additional data within each individual. This focus limits the reliability and predictive validity of brain and behavioral measures in any one person. As biomarkers exist at the level of individuals, an increased focus on validating them within individuals is warranted. We argue that personalized models, estimated from extensive data collection within individuals, can address these concerns. We review evidence from two, thus far separate, lines of research on personalized models of (1) psychopathology symptoms and (2) fMRI measures of brain networks. We close by proposing approaches uniting personalized models across both domains to improve biomarker research.

Executive Function Deficits and Borderline Personality Disorder Symptomatology in a Nonclinical Adult Sample: A Latent Variable Analysis

While borderline personality disorder (BPD) symptomatology has been studied extensively in clinical populations, the mechanisms underlying its manifestation in nonclinical populations remain largely understudied. One aspect of BPD symptomatology in nonclinical populations that has not been well studied is cognitive mechanisms, especially in relation to executive functions. To explore the cognitive mechanisms underlying BPD symptomatology in nonclinical populations, we analysed a large-scale dataset of 233 young adults that were administered with nine executive function tasks and BPD symptomatology assessments. Our structural equation modelling did not find any significant relations between latent factors of executive functions and the severity of BPD symptomatology. Contrary to our hypothesis, our result suggests that deficits in executive functions were not a risk factor for BPD symptomatology in the nonclinical young adult sample.

Individualized learning potential in stressful times: How to leverage intensive longitudinal data to inform online learning

Societal events - such as natural disasters, political shifts, or economic downturns - are time-varying and impact the learning potential of students in unique ways. These impacts are likely accentuated during the COVID-19 pandemic, which precipitated an abrupt and wholesale transition to online education. Unfortunately, the individual-level consequences of these events are difficult to determine because the extant literature focuses on single-occasion surveys that produce only group-level inferences. To better understand individual-level variability in stress and learning, intensive longitudinal data can be leveraged. The goal of this paper is to illustrate this by discussing three different techniques for the analysis of intensive longitudinal data: (1) regression analyses; (2) multilevel models; and (3) person-specific network models, (e.g., group iterative multiple model estimation; GIMME). For each technique, a brief background in the context of education research is provided, an illustrative analysis is presented using data from college students who completed a 75-day intensive longitudinal study of cognition, somatic symptoms, anxiety, and intellectual interests during the 2016 U.S. Presidential election - a period of heightened sociopolitical stress - and strengths and limitations are considered. The paper ends with recommendations for future research, especially for intensive longitudinal studies of online education during COVID-19.

Applying P-Technique Factor Analysis to Explore Person-Specific Models of Readiness-to-Exercise

Recent research in exercise prescription and periodization has emphasized the importance of subjective experience, both in medium- and long-term monitoring, but also in the acute experience. Emerging evidence also highlights an important role of subjective readiness (pre-exercise mental and physical states) in determining how exercise is experienced, and in acutely modifying the prescribed exercise intensity. The concept of "readiness-to-exercise" shows promise in enabling and informing this acute decision-making to optimize the experiences and outcomes of exercise. While subjective experiences can be effectively assessed using psychometric scales and instruments, these are often developed and deployed using cross-sectional samples, with resulting structures that reflect a normative pattern (nomothetic). These patterns may fail to reflect individual differences in sensitivity, experience and saliency (idiographic). We conducted this research with the primary aim of comparing the nomothetical and idiographic approaches to modeling the relatively novel concept of readiness-to-exercise. Study 1 (nomothetic) therefore analyzed data collected from 572 participants who completed a one-time survey using R-technique factor analysis. Results indicated a four-factor structure that explained 60% of the variance: "health and fitness;" "fatigue;" "vitality" and "physical discomfort." Study 2 (idiographic) included a sample of 29 participants who completed the scale multiple times, between 42 and 56 times: permitting intra-individual analysis using separate P-technique factor analyses. Our analyses suggested that many individuals displayed personal signature, or "profiles" of readiness-to-exercise that differed in structure from the nomothetic form: only two participants' personal signatures contained four structures as modeled in Study 1, whereas the majority demonstrated either two or three factors. These findings raise important questions about how experiential data should be collected and modeled, for use in research (conceptual development and measurement) and applied practice (prescribing, monitoring)-as well as in more applied research (implementation, effectiveness).

Symptoms as rapidly fluctuating over time: Revealing the close psychological interconnections among borderline personality disorder symptoms via within-person structures

Despite the clinical emphasis on processes happening within individuals, investigations into the psychological, structural connections between mental health symptoms have almost exclusively analyzed differences between people. These investigations have revealed important findings; however, they do not reveal the close connections among symptoms in an individuals' psychology. This study thus examined the psychological connections between symptoms directly, using borderline personality disorder (BPD) symptoms as an example. Participants (252; 74 with BPD) reported their momentary BPD symptoms five times daily, and 165 did so again 18 months later. In support of personalized medicine (Wright & Woods, 2020), individuals' BPD symptom structures differed considerably from each other and from the between-person structure. A novel technique revealed that differences were greater than expected by chance. Within-person structures tended to exhibit more symptom granularity (more factors and lower variance explained) and differing symptom meanings (patterns of loadings). For example, some individuals exhibited close connections between relationship turmoil and identity uncertainty, whereas other individuals exhibited close connections between relationship turmoil and impulsivity. Thus, conceptions of any given person's psychopathological processes using between-person structural findings will most likely be inaccurate. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies

Background

Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies.

Objectives

This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments.

Methods

Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion.

Results

The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person's history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed.

Conclusions

Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.

Personalized models of psychopathology as contextualized dynamic processes: An example from individuals with borderline personality disorder

OBJECTIVE

Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case formulation involve understanding and developing a personalized model for each patient's contextualized dynamic processes, and research would benefit from a similar focus on the individual.

METHOD

We use group iterative multiple model estimation, which estimates a model for each individual and identifies general or shared features across individuals, in both a mixed-diagnosis sample (N = 78) and a subsample with a single diagnosis (n = 24).

RESULTS

We found that individuals vary widely in their dynamic processes in affective and interpersonal domains both within and across diagnoses. However, there was some evidence that dynamic patterns relate to transdiagnostic baseline measures. We conclude with descriptions of 2 person-specific models as an example of the heterogeneity of dynamic processes.

CONCLUSIONS

The idiographic models presented here join a growing literature showing that the individuals differ dramatically in the total patterning of these processes, even as key processes are shared across individuals. We argue that these processes are best estimated in the context of person-specific models, and that so doing may advance our understanding of the contextualized dynamic processes that could identify maintenance mechanisms and treatment targets. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Personalized Models of Psychopathology

The personalized approach to psychopathology conceptualizes mental disorder as a complex system of contextualized dynamic processes that is nontrivially specific to each individual, and it seeks to develop formal idiographic statistical models to represent these individual processes. Although the personalized approach draws on long-standing influences in clinical psychology, there has been an explosion of research in recent years following the development of intensive longitudinal data capture and statistical techniques that facilitate modeling of the dynamic processes of each individual's pathology. Advances are also making idiographic analyses scalable and generalizable. We review emerging research using the personalized approach in descriptive psychopathology, precision assessment, and treatment selection and tailoring, and we identify future challenges and areas in need of additional research. The personalized approach to psychopathology holds promise to resolve thorny diagnostic issues, generate novel insights, and improve the timing and efficacy of interventions.

Applied ambulatory assessment: Integrating idiographic and nomothetic principles of measurement

Ambulatory assessment (AA; also known as ecological momentary assessment) has enjoyed enthusiastic implementation in psychological research. The ability to assess thoughts, feelings, behavior, physiology, and context intensively and repeatedly in the moment in an individual's natural ecology affords access to data that can answer exciting questions about sequences of events and dynamic processes in daily life. AA also holds unique promise for developing personalized models of individuals (i.e., precision or person-specific assessment) that might be transformative for applied settings such as clinical practice. However, successfully translating AA from bench to bedside is challenging because of the inherent tension between idiographic and nomothetic principles of measurement. We argue that the value of applied AA will be most fully realized by balancing the ability to develop personalized models with ensuring comparability among individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Foundations of idiographic methods in psychology and applications for psychotherapy

Researchers have long called for greater recognition and use of longitudinal, individual-level research in the study of psychopathology and psychotherapy. Much of our current research attempts to indirectly investigate individual-level, or idiographic, psychological processes via group-based, or nomothetic, designs. However, results from nomothetic research do not necessarily translate to the individual-level. In this review, we discuss how idiographic analyses can be integrated into psychotherapy and psychotherapy research. We examine and review key statistical methods for conducting idiographic analyses. These methods include factor-based and vector autoregressive approaches using longitudinal data. The theoretical framework behind each approach is reviewed and critically evaluated. Empirical examples of each approach are discussed, with the aim of helping interested readers consider how they may use idiographic methods to analyze longitudinal data and psychological processes. Finally, we conclude by citing key limitations of the idiographic approach, calling for greater development of these analyses to ease their successful integration into clinical settings.

An idiographic statistical approach to clinical hypothesis testing for routine psychotherapy: A case study

In order to develop more targeted, efficient, and effective psychotherapeutic interventions, calls have been made in the literature for greater use of idiographic hypothesis testing. Idiographic analyses can provide useful information regarding mechanisms of change within individuals over time during treatment. However, it remains unclear how clinicians might utilize idiographic statistical analyses during routine treatment to test clinical hypotheses, and in turn, guide treatment. We present an idiographic statistical framework for clinical hypothesis testing with routine treatment data that enables clinicians to examine a) whether the client's symptoms and hypothesized mechanisms change over time, b) whether trajectories of change reflect the timing of interventions, c) whether mechanisms predict subsequent symptoms, and d) whether relationships exist between multiple mechanisms, symptoms, or other treatment-related constructs over time. We demonstrate the utility of the approach for clinical hypothesis testing by applying it to routine treatment data collected from a 56 year-old male who presented with a combination of anger problems, anxiety, and depressive symptoms. We discuss how results from analyses can inform the case-formulation and guide clinical decision-making. We aim to make these methods more accessible by providing an online platform where clinicians can enter client data, test their clinical hypotheses using idiographic analyses, and utilize the results to disseminate their findings.

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

Use of Ecological Momentary Assessment (EMA) in Non-Suicidal Self-Injury (NSSI): A systematic review

Conceptualization and assessment of non-suicidal self-injury (NSSI) has evolved substantially in recent years. In both cross-sectional and longitudinal studies, NSSI and its related variables have traditionally been assessed retrospectively, leading to less precise studies of the mechanisms involved in the maintenance, cessation, or aggravation of this behavior. Ecological momentary assessment (EMA) enables real-time collection of patient states, which can be very useful in the study of the mechanisms implied in this behavior. This systematic review aims to elucidate the current status of EMA use in NSSI investigation. An exhaustive search in PubMed and PsycINFO was conducted up to September 2017. All papers included were focused on the study of NSSI using EMA. Studies with methodological diversity were included, which were afterwards organized according to main topic of studies. There were no ineligibility criteria based on age or diagnosis. Twenty-three papers were studied, the majority of which are short-term studies focused on the study of affect dynamics and the emotion-regulation function of NSSI. Implications of these results and recommendations for future research are discussed.

From Dynamics to Function

A vast majority of psychological science focuses on snapshots of individuals. Clinical outcome studies may integrate multiple snapshots, typically with yearly intervals. However, there is much to learn about psychological processes as they unfold over real time, including minutes, days, weeks, and months. This special issue contains several articles that make significant advances in real-time assessment of psychological processes using state-of-the-art measurement. This is a brief summary of the specific innovations of this special issue. The summary includes suggestions for applying these measurement innovations to the study of functional dynamics that lead to clinically and socially significant events. Several examples provide ways in which a dynamical analysis of function may be revealing. Most important, the assessment of dynamic mechanisms underlying the amplification of psychopathology seems especially useful for tailoring clinical interventions to meet clients' specific needs.

Advancing the Assessment of Dynamic Psychological Processes

Most commonly used clinical assessment tools cannot fully capture the dynamic psychological processes often hypothesized as core mechanisms of psychopathology and psychotherapy. There is therefore a gap between our theories of problems and interventions for those problems and the tools we use to understand clients. The purpose of this special issue is to connect theory about clinical dynamics to practice by focusing on methods for collecting dynamic data, statistical models for analyzing dynamic data, and conceptual schemes for implementing dynamic data in applied settings. In this introductory article, we argue for the importance of assessing dynamic processes, highlight recent advances in assessment science that enable their measurement, review challenges in using these advances in applied practice, and adumbrate the articles in this issue.

Variable-Centered, Person-Centered, and Person-Specific Approaches

The variable-centered approach is favored in management and applied psychology, but the person-centered approach is quickly growing in popularity. A partial cause for this rise is the finer-grained detail that it allows. Many researchers may be unaware, however, that another approach may provide even finer-grained detail: the person-specific approach. In the current article, we (a) detail the purpose of each approach, (b) describe how to determine when each approach is most appropriate, and (c) delineate when the approaches diverge to give differing results. Through achieving these goals, we suggest that no single approach is the “best.” Instead, the choice of approach should be guided by the research question. To further emphasize this point, we provide illustrative examples using real data to answer three distinct research questions. The results show that each research question can be fully addressed only by the appropriate approach. To conclude, we directly suggest certain research areas that may benefit from the application of person-centered and person-specific approaches. Together, we believe that discussing variable-centered, person-centered, and person-specific approaches together may provide a more thorough understanding of each.

The current state and future of factor analysis in personality disorder research

The major debates in the personality disorder (PD) field center on the structure of personality pathology. Factor analysis is designed to elucidate the underlying structure of observed phenomena. Therefore, factor analysis has already played a major role in the debates about the structure of PD, and will continue to be an often-used and indispensable tool moving forward. However, misconceptions about the utility and interpretation of factor analyses abound. The purpose of this article is to provide a conceptual primer on available factor analytic techniques and how they have been applied in PD research, and to highlight novel ways of using factor analysis moving forward. The techniques reviewed include exploratory and confirmatory factor analysis, exploratory structural equation modeling, multilevel structural equation modeling, and person-specific (i.e., P-technique) factor analysis. Additionally, the notion that exploratory and confirmatory factor analytic approaches lie on an exploratory to confirmatory spectrum is introduced. Examples from the published literature are used to illustrate key points. (PsycINFO Database Record

Biting the hand that feeds: current opinion on the interpersonal causes, correlates, and consequences of borderline personality disorder

Borderline personality disorder (BPD) is a complex psychiatric diagnosis characterized by dysregulated behaviors, emotions, cognitions, and interpersonal relationships. In recent years, developmental psychopathologists have sought to identify early origins of BPD, with the ultimate goal of developing and providing effective preventative interventions for those at highest risk. In addition to heritable biological sensitivities, many scholars assert that environmental and interpersonal risk factors contribute to the emergence and maintenance of key borderline traits. Nonetheless, many BPD researchers examine only affected individuals, neglecting the family, peer, couple, and other dynamic contextual forces that impinge upon individual-level behavior. In the past decade, however, theoretical and empirical research has increasingly explored the interpersonal causes, correlates, and consequences of BPD. Such work has resulted in novel research and clinical theories intended to better understand and improve interpersonal dynamics among those with borderline traits. A major objective for the field is to better characterize how interpersonal dynamics affect (and are affected by) the behaviors, emotions, and thoughts of vulnerable individuals to either reduce or heighten risk for BPD.