Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of borderline personality features in population samples: Is the Personality Assessment Inventory–Borderline Features scale measurement invariant across sex and age?

Borderline personality disorder (BPD) is more often diagnosed in women than in men, and symptoms tend to decline with age. Using a large community sample, the authors investigated whether sex and age differences in four main features of BPD, measured with the Personality Assessment Inventory–Borderline Features scale (PAI-BOR; Morey, 1991), are a result of measurement bias or if they represent true differences. The PAI-BOR was completed by four Sex × Age groups (N = 6,838). Multigroup confirmatory factor analysis showed that the PAI-BOR is measurement invariant across sex and age. Compared with men, women reported more borderline characteristics for affective instability, identity problems, and negative relationships but not for self-harm. Younger men had higher scores for identity problems and self-harm than did older men. Younger women had higher scores for identity problems and affective instability than did older women. Results suggest that the PAI-BOR can be used to study the etiology of BPD features in population-based samples and to screen for BPD features in clinical settings in both men and women of varying ages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective instability: Measuring a core feature of borderline personality disorder with ecological momentary assessment.

Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (≥90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the heterogeneity of BPD symptoms through latent class analysis: Initial results and clinical correlates among inner-city substance users.

The current study investigated the heterogeneity of borderline personality disorder (BPD) symptoms in a sample of 382 inner-city, predominantly African American male substance users through the use of latent class analysis. A 4-class model was statistically preferred, with 1 class interpreted to be a baseline class, 1 class interpreted to be a high-BPD class, and 2 classes interpreted as intermediate classes. As a secondary goal, we examined the resulting BPD classes with respect to relevant clinical correlates, including temperamental vulnerabilities (affective instability, impulsivity, and interpersonal instability), childhood emotional abuse, drug choice, and co-occurring mood and anxiety disorders. The high-BPD class evidenced the highest levels of the temperamental vulnerabilities and environmental stressors, the baseline class evidenced the lowest levels, and the 2 intermediate classes fell in between. In addition, the high-BPD class had a higher probability of cocaine and alcohol dependence, as well as mood and anxiety disorders, than did the baseline class. Rates of alcohol use and mood disorders for the intermediate classes fell in between the high-BPD and the baseline classes. Results are discussed in relation to the current diagnostic conceptualization of BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional granularity and borderline personality disorder.

This study examined the affective dysregulation component of borderline personality disorder (BPD) from an emotional granularity perspective, which refers to the specificity in which one represents emotions. Forty-six female participants meeting criteria for BPD and 51 female control participants without BPD and Axis I pathology completed tasks that assessed the degree to which participants incorporated information about valence (pleasant–unpleasant) and arousal (calm–activated) in their semantic/conceptual representations of emotions and in using labels to represent emotional reactions. As hypothesized, participants with BPD emphasized valence more and arousal less than control participants did when using emotion terms to label their emotional reactions. Implications and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The stability of personality traits in individuals with borderline personality disorder.

Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder.

Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an “oddball” task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Associations in the Course of Personality Disorders and Axis I Disorders Over Time.

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive response to physostigmine challenge in borderline personality disorder patients

The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline personality disorder (BPD) patients, other non-BPD personality disorder patients, and normal controls. Thirty-four personality disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, personality disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of personality disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other personality disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II disorders.     

Specifying the impulsivity of female inmates with borderline personality disorder.

Impulsivity is regarded as a core feature of borderline personality disorder (BPD; M. C. Zanarini, J. G. Gunderson, & F. R. Frankenburg, 1989) despite lack of evidence from laboratory research (D. M. Dougherty, J. M Bjork, H. C. G. Huckabee, F. G. Moeller, & A. C. Swann, 1999). This study examined impulsivity in incarcerated women with BPD using a passive avoidance task (J. P. Newman & W. A. Schmitt, 1998) and the Impulsiveness-Monotony Avoidance-Detachment inventory (IMD; D. Schalling, 1978). As predicted, incarcerated women diagnosed with BPD committed more passive avoidance errors and reported more impulsivity on the IMI than controls. These findings identify disinhibition as a potentially important component of the impulsivity that characterizes BPD. Specifying the impulsive behavior identified with BPD may contribute to the effective assessment and management of the disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimethod investigation of interpersonal functioning in borderline personality disorder.

Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other-reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders.

Impulsivity and risk taking propensity were assessed in participants with borderline personality disorder (BPD-only; n = 19), BPD and a current or past substance use disorder (BPD-SUD; n = 32), and a matched comparison group (MC; n = 28). Participants were administered behavioral measures of two facets of the multidimensional construct of impulsivity [GoStop, delay discounting task (DDT)], one measure of risk-taking propensity [Balloon Analog Risk Task (BART)], and two self-report measures of impulsivity (i.e., Barrett Impulsiveness Scale, Eysenck Impulsiveness Scale). The BPD-SUD group, but not the BPD-only group, discounted delayed rewards faster than the MC group on the DDT, suggesting that the BPD-SUD/MC group difference may be because of the SUD rather than BPD. In contrast, both the BPD-SUD and BPD-only groups exhibited poorer behavioral response inhibition compared with the MC group, but the two BPD groups did not differ from one another. This finding suggests that the differences in behavioral response inhibition may be because of BPD rather than SUD and that behavioral response disinhibition may be a core feature of BPD. None of the groups differed on the measure of risk-taking propensity (i.e., BART). On self-report questionnaires, the BPD-SUD group reported more impulsivity than the BPD-only group and both BPD groups reported more impulsivity than the MC group. Data from the DDT and self-report measures provide partial support for the hypothesis that BPD individuals with a SUD are more impulsive than BPD individuals without a SUD on some facets of impulsivity (e.g., desire to obtain a smaller immediate reward rather than wait to obtain a larger reward in the future). Results suggest that behavioral response inhibition may be a novel treatment outcome variable for BPD treatment studies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Five-factor trait instability in borderline relative to other personality disorders.

Borderline personality disorder (BPD) is related to five-factor model (FFM) traits and can be characterized as involving psychological and behavioral instability. A previous study comparing the FFM trait stability across individuals with borderline and other personality disorders found that the BPD group tended to have lower stability, particularly on neuroticism and conscientiousness and the overall configuration of FFM profiles over 6 years, suggesting that associated psychological and behavioral variability may be due to trait variability. The current study was designed to test the degree to which these findings replicate in another sample using different diagnostic and trait measures and extending the measurement period to 10 years. Results are consistent with previous findings in showing lower differential (rank-order) stability on conscientiousness, greater mean-level decreases on neuroticism, lower individual-level stability on conscientiousness, and lower ipsative stability of trait profile configurations among those with BPD. However, unlike the previous study, no differences were observed for differential or individual-level neuroticism or mean-level conscientiousness. Overall, findings show that the instability characteristic of BPD extends into typically stable personality traits, and that it does so with some specificity in terms of which traits are affected and how instability manifests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the relations between impulsivity-related traits, suicidality, and nonsuicidal self-injury: A test of the incremental validity of the UPPS model.

Borderline personality disorder (BPD) has received significant attention as a predictor of suicidal behavior (SB) and nonsuicidal self-injury (NSSI). Despite significant promise, trait impulsivity has received less attention. Understanding the relations between impulsivity and SB and NSSI is confounded, unfortunately, by the heterogeneous nature of impulsivity. This study examined the relations among 4 personality pathways to impulsive behavior studied via the UPPS model of impulsivity and SB and NSSI in a residential sample of drug abusers (N = 76). In this study, we tested whether these 4 impulsivity-related traits (i.e., Negative Urgency, Sensation Seeking, Lack of Premeditation, and Lack of Perseverance) provide incremental validity in the statistical prediction of SB and NSSI above and beyond BPD; they do. We also tested whether BPD symptoms provide incremental validity in the prediction of SB and NSSI above and beyond these impulsivity-related traits; they do not. In addition to the main effects of Lack of Premeditation and Negative Urgency, we found evidence of a robust interaction between these 2 personality traits. The current results argue strongly for the consideration of these 2 impulsivity-related domains—alone and in interaction—when attempting to understand and predict SB and NSSI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: An Evaluation in Hispanic Men and Women With Substance Use Disorders.

This study examined diagnostic efficiency of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria for borderline personality disorder (BPD). One hundred thirty monolingual Hispanic adults (90 men, 40 women) at an outpatient psychiatric and substance abuse clinic were assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders (C. M. Grilo, L. M. Anez, & T. H. McGlashan, 2003). The BPD diagnosis was determined by the best-estimate method. Diagnostic efficiency indices were calculated for all BPD criteria, for the entire study group, and separately by gender. Overall, the best exclusion criterion was affective instability, whereas suicidality or self-injury was the best inclusion criterion and the best predictor overall. These findings did not differ by gender, are similar to those reported elsewhere in the literature, and have implications for the refinement of diagnostic systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addresing issues of specificity.

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability and variability of affective experience and interpersonal behavior in borderline personality disorder.

This study examined both mean levels and intraindividual variability in the mood and interpersonal behavior of individuals with borderline personality disorder (BPD) and nonclinical control participants over a 20-day event-contingent recording period. Individuals in the BPD group experienced more unpleasantly valenced affect and were less dominant, more submissive, more quarrelsome, and more extreme in overall levels of behavior than control participants. In addition to these mean-level differences, individuals with BPD also reported more intraindividual variability in overall affect valence and in pleasantly valenced affect; displayed greater variability in dominant, quarrelsome, and agreeable behaviors; and exhibited an increased tendency to "spin" among interpersonal behaviors relative to nonclinical control participants. The findings document behavioral and affective manifestations of BPD in the context of naturally occurring interpersonal situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Features of borderline personality disorder, perceived childhood emotional invalidation, and dysfunction within current romantic relationships.

The mechanisms through which current romantic relationship dysfunction develops in individuals with borderline personality disorder (BPD) symptoms are still unclear. One possible pathway may be childhood experiences of emotional invalidation by parents, which may result in the development of poor social problem-solving skills or cognitive responses such as splitting, which impair current romantic relationships. This study examines the relationship between features of BPD and current romantic relationship dysfunction, and demonstrates that perceived emotional invalidation by parents during childhood mediates the relationship between BPD features and current romantic relationship dysfunction. Structural equations modeling was used to test the hypothesized model in 758 young adults in an ethnically diverse community sample. The proposed model fit the data well; perceived childhood emotional invalidation partially mediated the relationship between features of BPD and romantic relationship dysfunction, even when controlling for the presence of a major depressive episode in the last year. The findings of this study suggest that individuals with features of BPD experience relationship dysfunction that cannot be accounted for by comorbid depression and that perceived childhood emotional invalidation may contribute to these problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Too upset to think: The interplay of borderline personality features, negative emotions, and social problem solving in the laboratory.

Borderline personality disorder (BPD) is associated with poor social problem solving and problems with emotion regulation. In this study, the social problem-solving performance of undergraduates with high (n = 26), mid (n = 32), or low (n = 29) levels of BPD features was assessed with the Social Problem-Solving Inventory—Revised and using the means-ends problem-solving procedure before and after a social rejection stressor. The high-BP group, but not the low-BP group, showed a significant reduction in relevant solutions to social problems and more inappropriate solutions following the negative emotion induction. Increases in self-reported negative emotions during the emotion induction mediated the relationship between BP features and reductions in social problem-solving performance. In addition, the high-BP group demonstrated trait deficits in social problem solving on the Social Problem-Solving Inventory—Revised. These findings suggest that future research must examine social problem solving under differing emotional conditions, and that clinical interventions to improve social problem solving among persons with BP features should focus on responses to emotional contexts. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts.

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)