Self-esteem instability in borderline personality disorder

One of the things that draws me to a research summary is the quality of the design. Kockler et al. (2022) published “Self-esteem instability might be more characteristic of borderline personality disorder than affective instability: Findings from an e-diary study with clinical and healthy controls” in Journal of Psychopathology and Clinical Science. 

They were interested in contrasting affective and self-esteem instability. They begin by noting that, “Borderline personality disorder (BPD) is commonly characterized by pervasive instability. Affective instability, despite being a diagnostic criterion in the DSM–5, is commonly seen as a transdiagnostic feature, but recent studies have brought new attention to the importance of self-esteem instability as a potential defining feature of BPD.” They used e-diaries to collect data twelve times daily on 4 consecutive days in 71 patients with BPD, 121 patients with anxiety disorders (ADs), and 74 healthy controls (HCs). In contrast to the controls, the patients with BPD and those with ADs exhibited heightened self-esteem instability and affective instability. Importantly, the clinical groups did not differ in affective instability, whereas self-esteem instability was significantly higher in patients with BPD than in those with ADs across all instability indices. Beyond the influence of mean self-esteem, patients with BPD had the highest general instability, the most frequent extreme changes, and the largest decreases in self-esteem, especially from high levels of self-esteem. Our results support previous findings on affective instability, which may constitute a transdiagnostic feature, and they provide the first evidence that heightened self-esteem instability is particularly prominent in BPD, underscoring the importance of self-esteem for the understanding of dysregulation in BPD.

Ideally, if replicated, these findings may be helpful in differentiating borderline personality disorder from anxiety disorder and in suggesting therapeutic interventions that look at both affective and self-esteem instability.