Borderline personality disorder research

Three studies today examine borderline personality disorder (BPD). First, Di Bartolomeo, Siegel, Fulham & Fitzpatrick (2024) published “Borderline Personality Disorder and Social Connectedness: A systematic review” in Personality Disorders: Theory, Research, and Treatment.  Here’s the edited abstract:

Borderline personality disorder (BPD) is a debilitating disorder characterized by deficits in social connectedness, which is a multifaceted construct with structural (i.e., the number, diversity, or frequency of social relationships), functional (i.e., the actual or perceived resources relationships provide), and quality (i.e., the positive and negative aspects of social relationships) elements (Holt-Lunstad, 2018). However, the literature is sparse and lacks integration regarding which specific elements of social connectedness are deficient in BPD and why. This systematic review synthesized the literature on the bidirectional relationship of social connectedness and BPD. Electronic searches of three databases (i.e., PsycInfo, PsycArticles, and PubMed) identified 1,962 articles which underwent title and abstract screening and, if potentially eligible, full-text review. Sixty two articles met the eligibility criteria and underwent data extraction and risk of bias assessment. Cross-sectional research supported associations between BPD and problems in structural, functional, and quality social connectedness, with most research underscoring deficits in quality social connectedness. Preliminary longitudinal research suggested that BPD pathology predicts problems across these domains, but little to no research exists testing the reverse direction. Although people with BPD may not have difficulties forming relationships, they exhibit a range of problems within those relationships. BPD may elicit such problems in social connectedness, but it is unclear whether such issues reciprocally exacerbate and elicit BPD, and longitudinal research investigating such directionality is needed. 

I found this study helpful in illustrating the difference between forming relationships and sustaining them. The enxt study examines a very different question. Atkinson, Kristinsdottir, Lee & Freestone (2024) published “Comparing the Symptom Presentation Similarities and Differences of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder: A systematic review” in Personality Disorders: Theory, Research, and Treatment.  The edited abstract

Complex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment. 

I thought this was helpful in making clear that BPD and Complex PTSD (CPTSD) are different diagnoses that can be comorbid. Since both include relationship impairments we may need more research on social connectedness in CPTSD. The final study looks at stigma. Amestoy, Best, Ruocco & Uliaszek (2024) published “Borderline Personality Disorder Stigma: Examining the effects of diagnostic disclosure, behavior, and gender as sources of stigma in the general population” in Personality Disorders: Theory, Research, and Treatment. Here’s the edited abstract:

Borderline personality disorder (BPD) is a severe mental disorder characterized by a pervasive pattern of emotional and behavioral dysregulation. Dysfunction and distress may be compounded by stigmatizing beliefs held by members of the community. There is a lack of research focusing on stigmatizing beliefs about BPD held by the general population. This study addressed this gap by examining the relationship between BPD and a variety of stigma domains in a community sample. The current study explored whether (a) stigma is more strongly related to BPD symptomatic behavior or the diagnostic label of BPD, (b) attaching a diagnosis of BPD to symptomatic behavior or nonclinical behavior influences stigma, and (c) the gender of a vignette character influences the stigmatization of BPD. A total of 295 participants read vignettes and completed questionnaires assessing stigma type and intensity. Findings from the current study suggest that stigma is higher for BPD symptomatic behavior than for the diagnosis itself. Attaching a diagnostic label of BPD to BPD symptomatic behavior did not significantly impact the resultant stigma; however, the diagnosis was found to increase stigma for nonclinical behavior. Findings concerning BPD stigma and gender are in line with broader gender stereotypes. Specifically, there was greater pity for women displaying BPD behavior, whereas there was greater anger for men displaying the same behavior. BPD symptomatic behavior vignettes depicting a man also received a higher level of dangerousness and fear. 

I thought it interesting that it is the symptoms more than the label that elicit stigma. The gender difference is also disturbing and makes it much more challenging for therapists to work with men who have BPD.