Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach

Abstract

In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, Mage = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.

Key factors selection on adolescents with non-suicidal self-injury: A support vector machine based approach

“…Specifically, borderline personality disorder is one of the most common co-morbidities of adolescent NSSI ( 71 ). Studies have shown that ~61% of adolescents with borderline personality disorder engaged in at least one NSSI behavior ( 73 ). More than that, NSSI was considered a precursor to the development of borderline personality disorder under the sociobiological developmental model ( 16 ).…”

The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults

“…This sample was part of the Longitudinal Study on Identity in Adolescents (Buelens et al, 2020a;Buelens et al, 2020b). There were two different versions of the surveys, with one of the versions focusing on personality measures.…”

The Role of Impairments in Self–Other Distinction in Borderline Personality Disorder: A Narrative Review of Recent Evidence

“…BPD patients' lower threshold for switching from controlled to automatic mentalizing under stress (Fonagy and Luyten, 2009;Nolte et al, 2010) as a result of fronto-limbic dysfunction in BPD (Krause-Utz and Elzinga, 2018) may play an important role in this context. Non-suicidal self-injury, which is prevalent in BPD (Buelens et al, 2020), may end dissociative episodes by generating physical sensations that allow the individual to "feel real" again (Klonsky, 2007). The perfect contingency between seeing one's own action and experiencing pain during self-harm creates a salient experience of interoceptive-exteroceptive match, which may help to reestablish perceptual SOD.…”