BORDERLINE PERSONALITY; TRAIT AND DISORDER

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BORDERLINE PERSONALITY TRAIT AND DISORDER

• Morey and Zanarini

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BPD?

• Distinct personality disorder beginning in
  childhood and characterised by pervasive pattern
  of impulsivity and unstable personal
  relationships, self-image and affect.
• Includes
• frantic attempts to avoid real or imagined
  abandonment
• intense and unstable personal relationships
• fluctuating self image
• impulsivity and recurrent suicidal or self
  mutilating gestures or behaviour
• emotional instability
• transient stressrelated paranoia or dissociation
• Clinical diagnosis must meet minimum of five of
  the DSM-IV criteria

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TWO REPRESENTATIONS BPFFM and Categorical
Diagnosis

• Global level BPM characterized by very high N,
  low A and low C, explaining features such as
  identity problems and fears of abandonment
• BUT other features not associated with FFM

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PRESENT STUDY

• Goal One
• Relationship FFM in a clinical sample
• Goal Two
• Highlight aspects of categorical diagnostic
  concept not captured by the FFM representation
• Does FFM miss essential aspects of the BP
  diagnosis?
• Do the residual elements of the categorical
  diagnosis add to a diagnostic understanding of
  BP?

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CONTRIBUTION OF RESIDUAL TO DIAGNOSTIC VALIDITY

• Antecedent validity etiological factors (family
  history of psychiatric disorders, childhood abuse
  and neglect)
• Concurrent validity symptoms of dysphoric inner
  states and dissociative experiences
• Predictive validity intermediate term outcomes
  at two follow-up intervals temporal patterns of
  functional behaviour.

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Method

• Participants
• Inpatients at a hospital in Massachusetts
• Aged 18-35
• Normal or better intelligence
• No history or current symptoms of serious organic
  condition
• Had been assigned a definite or probable Axis II
  diagnosis by a physician
• This resulted in 378 subjects available for
  testing

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Instruments

• 3 semi-structured interviews
• Structured Clinical Interview for DSM-III-R Axis
  I Disorders
• Revised Diagnostic Interview for Borderlines
  (DIB-R)
• Diagnostic Interview for DSM-III-R Personality
  Disorders (DIPD-R)
• Five Factor Model
• Self-reported version of the NEO Five-Factor
  Inventory
• Difficult Childhood Experiences
• Revised Childhood Experiences Questionnaire,
  which is a semi-structured interview

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Family History

• Revised Family History Questionniare
• Symptomatology Associated with BPD
• Dissociative Experiences Scale and the Dysphoric
  Affect Scale
• Global Outcome At Follow-up (2 and 4 years)
• The Global Assessment of functioning scale
• Psychosocial functioning assessed with the
  Revised Borderline Follow-up Interview

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Results

• Participants 290 BPD, 72 at least one other Axis
  2 disorder (control).

Nonborderline Nonborderline Borderline Borderline
Trait Mean SD Mean SD Sig
N 26.33 7.9 35.07 7.0 plt.001
E 25.66 6.7 22.59 6.9 plt.001
O 30.51 6.6 29.80 6.6 ns
A 32.68 6.5 30.35 6.7 plt.01
C 28.59 7.4 28.56 7.7 ns
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Regression analysis

• N seemed to be the largest differentiation
  between borderline and non-borderline patients.
• C was the only other sig. factor but suggests
  that it is a suppressor, in that high levels of C
  removes an unwanted portion of the variance in
  the N variable.
• FFM captures a sizable proportion of the variance
  associated with a borderline diagnosis.
• But what about the rest of the diagnostic
  variance?

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More than personality?

• There were aspects within the 4 sections of the
  DIB-R that werent fully captured by the NEO-FFI.
  Impulse action patterns were the least
  represented.
• But correlation with measures of BPD showed that
  the NEO-FFI representation explained a sig.
  proportion of the historical and outcome
  variables.
• But also history of sexual abuse was related to
  BPD diagnosis in a way not fully captured by the
  NEO-FFI.
• FFM factors were more highly associated with long
  term outcome than elements of BPD that were
  independent of these factors.

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IN CONCLUSION

• Diagnosis BP related to FFM
• N scores elevated compared other patients PDs.
• C discriminated BPD from other PDs but limited
  effect.
• FFM did NOT capture all definitional aspects of
  BPD
• DBI-R four section all included aspects not
  represented by FFM. Affect section best explained
  (N) but impulsive actions least explained.
• 3. Diagnostic elements independent FFM are
  valid elements of the disorder and are associated
  with theoretically important correlates
  (antecedent, concurrent and predictive) of the
  disorder not error variance.
• N as a characteristic level of personality
  dysfunction... is almost ubiquitous within
  clinical populations
• BUT
• Residual elements represent theoretically viable
  aspects of BPD
• DISTINCTION DISORDER (BPD) AND TRAIT (N)
• BPD disorder that changes in severity over time
  whereas N reflects a stable trait.
• N represents estimate of LT outcome
• Disorder representing meaningful predictors
  within certain sectors in response to the
  situation e.g. symptom severity.