BORDERLINE PERSONALITY; TRAIT AND DISORDER Morey and Zanarini

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 stress–related paranoia or dissociation Clinical diagnosis; must meet minimum of five of the DSM-IV criteria

TWO REPRESENTATIONS BP; FFM 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 feature’s not associated with FFM

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?

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.

Method Participants Inpatients at a hospital in Massachusetts Aged 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

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

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

Results Participants: 290 BPD, 72 at least one other Axis 2 disorder (control). NonborderlineBorderline TraitMeanSDMeanSDSig N p<.001 E p<.001 O ns A p<.01 C ns

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?

More than personality? There were aspects within the 4 sections of the DIB- R that weren’t 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.

IN CONCLUSION 1.Diagnosis BP related to FFM N scores elevated compared other patients PD’s. C discriminated BPD from other PD’s but limited effect. 2.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.