Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review

Abstract

Objective Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD. Methods We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic–Pituitary–Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review. Results The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD. Conclusion The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.

Trajectories, comorbidity, and risk factors for adolescent disordered eating and borderline personality disorder features

“…Fourth, this is the first study to examine population attributable fractions in relation to disordered eating. We included a broad range of the most common and largest risk factors, but we were unable to examine all risks common to ED and BPD, such as genetic predisposition, gene-environment interactions, neglect, emotional abuse, or sleep problems (Amad et al, 2014;Morales-Muñoz et al, 2021;Solmi et al, 2021;Winsper et al, 2016;Yilmaz et al, 2015). In this study, childhood physical and sexual abuse were the largest interpersonal risk factors for BPD and bullying victimization was the largest interpersonal risk factor for disordered eating.…”