Psychosocial pathways to borderline personality disorders: towards an integrative and empirically based model

Abstract

The relationship between adverse childhood experiences (ACE) and borderline personality disorder (BPD) is undeniable, at least from the perspectives of traditional categorical models. In the transition to a hybrid dimensional diagnosis present in DSM-5 AMPD and ICD-11, this relationship needs more research. The general objective was to test and refine a comprehensive psychosocial model of BPD proposed by Leichsenring et al. (2011) based on the relationship between ACE (CTQ-SF), criterion A (levels of personality functioning; LPFS-SR 2.0), and B (personality traits; HEXACO; PID-5; PID-5BF +M) from the dimensional model, and the BPD symptom components (ZAN-BPD and ZAN-BPD: SRV). We conducted two different studies, one with secondary data collected in Germany with n=741 individuals from a clinical sample and a healthy control group, and the second one involved a parallel data collection in Chile and Germany n= 1313 with a clinical sample with a lifetime PD diagnosis, and a community-based sample. For the second study we validated three different scales of for assessing BPD. We used path analytics methods for analyzing the relationship between ACE and BPD symptom components data with three different mechanisms: FFM, maladaptive traits, and levels of personality functioning. Emotional trauma (abuse and neglect) was the subtype that most strongly predicted BPD. We found clear pathways from ACE towards specific BPD symptom components, being affective and relational components the most strongly predicted. Moreover, our three models worked as mechanisms in this relationship, especially low extraversion, high negative affect, high psychoticism, as well as the self-dysfunctions. Identifying mechanisms such as these mechanisms during childhood or early adolescence, particularly after ACE, might help us to better identify risk factors and timely provide specific personalized interventions for promoting healthier psychosocial pathways towards adulthood. These results are exploratory and need further studies for translation into clinical practice.