Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

Abstract

Background There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. Methods A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA). Results The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. Conclusions Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

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

“…Males were not overrepresented in the externalizing cluster, unlike what was seen in one earlier study with a similar cluster solution [ 2 ]. A similar externalizing cluster has been identified in several other studies [ 2 , 10 , 17 ]. Further, the internalizing cluster was characterized by greater psychic anxiety, stress susceptibility, lack of assertiveness and detachment, and lower adventure seeking than the other two clusters, as well as less undercontrol than the externalizing cluster.…”

“…Studies designed with a basis in cluster subgroups of BPD using the hybrid approach have been performed. For example, Gamache et al [ 10 ] found four clusters based on the AMPD, comprising a dimensional component of severity (BPD traits, moderate pathology, and severe pathology), with the moderate pathology cluster separated into two categorical dimensions of impulsivity vs. identity/depressiveness, resembling the externalizing-internalizing findings of previous studies [ 2 , 13 ].…”

“…Previously, other cluster solutions have also been found. For example, Leihener et al [ 14 ] and Soloff and Chiappetta [ 16 ] found two-cluster solutions, Gamache et al [ 10 ] and Sleuwaegen et al [ 13 ] found four-cluster solutions, while Salzer et al [ 15 ] found a five-cluster solution.…”

“…For example, Smits et al found a core BPD cluster characterized by more severe BPD [ 2 ]. Gamache et al [ 10 ], who used the AMPD for diagnosing the sample (including subclinical BPD), found three levels of severity. Interestingly, when testing the different cluster solutions in this study, the two-cluster solution maintained the higher and lower psychopathology clusters, while the internalizing and externalizing clusters were merged – indicating severity as a distinct factor, separate from the qualitative differences between the two qualitative styles.…”

“…Others have based their analyses on emotional regulation strategies [ 13 ], intrapersonal problem inventories [ 14 , 15 ], suicidal behavior [ 16 ], or a variety of demographic and psychological variables [ 17 ]. To date, findings on subtype patterns of BPD are diverse [ 10 ] – with differing numbers of clusters comprising differing characteristics – and consensus is not achieved. However, there are patterns that have recurred to some extent.…”