Cluster analysis of personality traits in psychiatric patients with borderline personality disorder

Abstract

Background Though the heterogeneous expression of symptoms of borderline personality disorder (BPD) is well-known, it is far from fully understood. Hybrid models combining dimensional and categorical ways of diagnosing BPD have been suggested to better handle this heterogeneity, but more research is needed. The aim of this study was to identify potential clusters in BPD, and evaluate if these clusters differed in diagnostic composition, severity, psychiatric symptoms, emotion regulation and control, or sociodemographic features. Methods Clusters were based on personality traits measured with the Swedish universities Scales of Personality (SSP) in 141 psychiatric patients diagnosed with BPD. Hierarchical cluster analysis was performed using Ward’s method. We used one-way analysis of variance to explore the different clusters’ properties. Effect sizes were calculated using partial eta squared. Results We found three distinct clusters: the lower psychopathology cluster (N = 67), the externalizing cluster (N = 28), and the internalizing cluster (N = 46). The clusters differed regarding trait composition, severity, and emotion regulation and control. Conclusions Our findings support hybrid models for diagnosing BPD by showing that clusters differed in terms of both severity (lower and higher psychopathology) and personality traits/style (internalizing and externalizing). Assessment of personality traits may be a feasible way to differentiate between clusters. In the future, this knowledge might be used to personalize treatment.

Subtypes of borderline personality disorder in a day-clinic setting—Clinical and therapeutic differences.

“…Cluster analysis results in three distinct subtypes: internalizing, externalizing, and mixed subtypes. The internalizing roughly resembles the "internalizing" of Oladottir et al (2022) and the "highfunctioning subtype" of Bradley et al (2005) in terms of identity disturbance and feelings of emptiness. The externalizing resembles the externalizing of Oladottir et al (2022), the "extravert/externalizing This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Cluster analysis results in three distinct subtypes: internalizing , externalizing , and mixed subtypes. The internalizing roughly resembles the “internalizing” of Oladottir et al (2022) and the “high-functioning subtype” of Bradley et al (2005) in terms of identity disturbance and feelings of emptiness. The externalizing resembles the externalizing of Oladottir et al (2022), the “extravert/externalizing subtype” of Smits et al (2017) in terms of low identity disturbance and the “angry-externalizing subtype” (Bradley et al, 2005) in terms of feelings of anger and unexpected action.…”

“…The internalizing roughly resembles the “internalizing” of Oladottir et al (2022) and the “high-functioning subtype” of Bradley et al (2005) in terms of identity disturbance and feelings of emptiness. The externalizing resembles the externalizing of Oladottir et al (2022), the “extravert/externalizing subtype” of Smits et al (2017) in terms of low identity disturbance and the “angry-externalizing subtype” (Bradley et al, 2005) in terms of feelings of anger and unexpected action. The mixed subtype roughly resembles the “core BPD subtype” which showed relatively more BPD features but was mainly characterized by the absence of marked elevation (Smits et al, 2017).…”

“…Smits et al (2017) performed cluster analysis on dimensional PD features, as assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) on a sample of BPD patients identifying three subtypes, namely, "core BPD," "schizotypal/paranoid," and "extravert/externalizing." Others identified subtypes reflecting both severity and personality style (Gamache et al, 2021;Oladottir et al, 2022), corresponding to the "Alternative Model of Personality Disorders" (AMPD) of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; APA, 2022) or the International Classification of Diseases, 11th Revision (ICD-11;WorldHealth Organization [WHO], 2022).…”

Examining readmission factors in psychiatric emergency care for individuals with personality disorders: A 6-year retrospective study.

“…The poor results obtained may in part be attributed to the use of categorical variables, but they also indicate the limitations of logistic regression techniques for assessing the risk of readmission. In order to gain further knowledge and explanatory power on readmission and time-to-readmission, this orientates future research to employ dimensional instead of categorical measures and to use different statistical techniques such as cluster analysis or structural equations modelling (Kupek, 2006; Oladottir et al, 2022). We also suggest that it would be fruitful to investigate psychological processes such as emotion regulation or cognitive flexibility (Bryan & Rozek, 2018; Dutcher et al, 2017; Martin et al, 2017; Wolff et al, 2018), and personality traits such as impulsivity (Auerbach et al, 2017; Moeller et al, 2001) known to be involved in a mental health crisis.…”