Three studies of Borderline Personality Disorder

All three studies of Borderline Personality Disorder (BPD) addressed here are from the same journal. Estimates of the frequency of BPD range from 1.4% to over 5%, with most sources saying that 75% of BPD patients are female, while noting that men with BPD may well be more often diagnosed with PTSD and depression. First, Aleva et al. (2023) published “Emotion Dysregulation in Young People with Borderline Personality Disorder: One pattern or distinct subgroups?” in Personality Disorders: Theory, Research, and Treatment.  Here’s the edited abstract:

Emotion dysregulation is a key feature of borderline personality disorder (BPD). Given the heterogeneity of BPD and emotion regulation, this study sought to define subgroups among a sample of young people with BPD based on their pattern of emotion regulation abilities. Baseline data from the Monitoring Outcomes of BPD in Youth (MOBY) clinical trial were used, in which 137 young people (Mage = 19.1, SDage = 2.8; 81% female) completed the self-report Difficulties in Emotion Regulation Scale (DERS), as a measure of emotion regulation abilities. Latent profile analysis (LPA) was conducted to identify subgroups, based upon response patterns on the six DERS subscales. Subsequent analysis of variance and logistic regression models were used to characterize the identified subgroups. LPA revealed three subgroups. A “low and unaware” (n = 22) subgroup, reporting the least emotion dysregulation, apart from high emotional unawareness. A “moderate and accepting” subgroup (n = 59), reporting high emotional acceptance within its own pattern, and moderate emotion dysregulation compared with the other subgroups. A “high and aware” subgroup (n = 56), reporting the highest level of emotion dysregulation, but with high emotional awareness. Some demographic, psychopathology, and functioning characteristics were associated with subgroup membership. The identification of distinct subgroups highlights the importance of considering the level of emotional awareness in the context of other regulatory abilities and suggests that therapies should not take a “one-size-fits-all” approach to emotion dysregulation. Future research should seek to replicate the identified subgroups given the relatively small sample size in the current study. In addition, examining the stability of subgroup membership and the influence upon treatment outcome will be interesting avenues for further exploration. 

I like all of the studies presented today because each emphasizes the importance of not making simple assumptions about people with BPD. The next study looks at the challenges of keeping people with BPD engaged in treatment. Doyle, Smith, Watt, Cohen & Couture (2023) published “Higher Baseline Emotion Dysregulation Predicts Treatment Dropout in Outpatients with Borderline Personality Disorder” in Personality Disorders: Theory, Research, and Treatment.  

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. 

What I find most fascinating here, though it’s not a huge sample size, is that none of their pretreatment variables except baseline emotion dysregulation and distress tolerance predicted dropout. It’s not a huge sample, but may be helpful to clinicians who work with BPD clients. Finally, Herr, Kivity, Ramadurai, Covington & Gunthert (2023) published “Empathic Accuracy of Romantic Partner Negative Affect is Influenced by Borderline Personality Symptoms” in Personality Disorders: Theory, Research, and Treatment.  Here’s the edited abstract:

The present study sought to examine the relation between borderline personality disorder (BPD) symptoms and empathic accuracy while improving on prior methodologies by using daily affect assessment in romantic partners. BPD symptoms were assessed in both members of 81 community couples who also reported on their own and their partner’s negative and positive affect daily for 3 weeks. Data were analyzed using the Truth and Bias Model of Judgment, which allows the source of empathic accuracy to be parsed into partner affect (truth) and own affect (bias). Results provided evidence that individuals with higher BPD symptoms exhibited increased empathic accuracy for a partner’s negative affect, particularly when partners also had higher BPD symptoms. The source of this accuracy stemmed more from bias forces than truth forces, indicating that participants’ own affective states lead to more accurate judgments of partner affective state. The results suggest that this bias reduced the general tendency among participants to underestimate partner negative affect, thus leading to higher empathic accuracy. Overall, our results extend and provide support for previous research indicating that BPD symptoms are associated with heightened, not diminished, empathic accuracy. 

I found this study intriguing because, for me, it was initially counterintuitive. In the end, however, it makes sense that clients with BPD exhibit more bias toward their own affect, but use that to evaluate their partner’s affective state.