Negative Affectivity and Disinhibition as Moderators of an Interpersonal Pathway to Suicidal Behavior in Borderline Personality Disorder

In this longitudinal study, we examined whether personality traits moderate the link between interpersonal dysfunction and suicidal behavior in a high-risk sample of 458 individuals diagnosed with borderline personality disorder. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Using multilevel structural equation modeling, we examined (a) longitudinal, within-persons relationships among interpersonal dysfunction, suicidal ideation, and suicide attempts and (b) moderation of these relationships by negative affectivity and disinhibition. Negative affectivity predicted a stronger within-persons coupling between interpersonal dysfunction and suicidal ideation. Disinhibition predicted a stronger coupling between ideation and suicide attempts. Assessing negative affectivity and disinhibition in a treatment setting may guide clinician vigilance toward people at highest risk for interpersonally triggered suicidal behaviors.

Personality Disorders are Dead, Long Live the Interpersonal Disorders

Widiger and Hines raise a number of significant concerns with the Alternative Model of Personality Disorders (AMPD). This places the major class of psychiatric difficulties represented by the personality disorders in a precarious position because the model used in prior editions of the Diagnostic and Statistical Manual of Mental Disorders and currently reprinted in Section II is moribund if not dead, and with the AMPD’s significant problems their future is unclear. Although we agree that Widiger and Hines’ criticisms have merit, they are not the whole picture. We review additional relevant research that supports the contention that what differentiates personality disorders from other psychopathology is the self and interpersonal dysfunction, as Criterion A of the AMPD currently states. We emphasize the importance of drawing a distinction between the conceptual model and its operationalization. We argue that paradoxically, to save personality disorders we need to do away with them and replace them with the “interpersonal disorders”. There is strong theory, empirical research, and ethical arguments in favor of this conceptual reframing.

The Interpersonal Circumplex and the Alternative Model of Personality Disorders: Relationships among Older Adults

Introduction The interpersonal circumplex model measures interpersonal dysfunction along two axes (communion and agency), resulting in eight unhealthy patterns: Domineering, Vindictive, Cold, Socially Avoidant, Nonassertive, Exploitable, Overly Nurturant, and Intrusive. It is unclear how the circumplex model applies to older adults and their unique biopsychosocial contexts. This study examined relationships between the circumplex and personality disorder features, using the Alternative Model of Personality Disorder’s (AMPD) personality functioning and pathological personality trait constructs. Method: Older adults (N = 202) completed the Inventory of Interpersonal Problems-Short Circumplex (IIP-SC), the Levels of Personality Functioning Scale-Self-Report (LPFS-SR), and the Personality Inventory for DSM-5 (PID-5) to measure pathological personality traits. Results Correlations were computed between the IIP-SC’s eight circumplex scales with the LPFS-SR’s four personality functioning domains and with the PID-5’s five domains. All circumplex scales significantly (p < .001) and positively correlated with all LPFS-SR and PID-5 domains, with large effect sizes (> .45). Next, regressions were conducted, with the LPFS-SR and PID-5 domains predicting each IIP-SC scale. Across the eight regressions, the AMPD constructs accounted for significant variance in the IIP-SC scales, ranging from 38% (Nonassertive) to 64% (Domineering and Cold). Discussion Significant overlap between the interpersonal circumplex and the AMPD was demonstrated, but patterns are distinct from previous research among younger adults. The circumplex was limited in its relation to the AMPD’s personality functioning, but the pathological personality trait model was well represented through the circumplex. Results indicate that the circumplex may have some validity among older adults and warrants further investigation.

Interpersonal dysfunction in individuals high in chronic worry: relations with interpersonal problem-solving

Background: Interpersonal dysfunction has been proposed as an important maintenance factor in chronic worry and generalized anxiety disorder (GAD). Perceptions of problems and the problem-solving process as threatening, and unhelpful (e.g. avoidant, impulsive) problem-solving styles are implicated in worry and have also been suggested to be associated with dysfunctional interpersonal styles. Aims: The present study assessed the relationships between interpersonal dysfunction and problem-solving orientation, approach, and effectiveness in a sample of individuals high in chronic worry and investigated the indirect effect of interpersonal dysfunction on GAD symptom severity through negative problem-solving beliefs and approaches. Method: Fifty-nine community participants completed questionnaires and an interpersonal problem-solving task. Results: Greater interpersonal dysfunction was significantly associated with greater negative problem-solving orientation and greater habitual avoidant and impulsive/careless problem-solving styles. Greater interpersonal dysfunction was associated with poorer effectiveness of solutions when the task problem involved conflict with a romantic partner. Negative problem-solving orientation fully mediated the relationship between interpersonal dysfunction and GAD symptoms. Conclusions: These findings support that problem-solving processes are implicated in interpersonal dysfunction and that negative beliefs about problem-solving account for the relationship between interpersonal dysfunction and GAD symptoms. Theoretical implications are discussed.

Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains

The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits—Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)—plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the “statistical” model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales’ psychometrics were excellent, as were the domains’ and their components’ convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.

Don't Make Me Angry: Frustration-Induced Anger and Its Link to Aggression in Women With Borderline Personality Disorder

Aggression is a prominent interpersonal dysfunction of individuals with borderline personality disorder (BPD). In BPD aggression is predominantly reactive in nature, often triggered by frustration, provocation, or social threat and is associated with intense anger and an inability to regulate this strong, negative emotion. Building on previous research, we were interested in investigating negative emotionality in general and anger in particular in women with BPD before and after frustration induction. To achieve this, 60 medication-free women with BPD and 32 healthy women rated the intensity of negative emotions (angry, frustrated, upset, embarrassed, nervous) before and after performing a Titrated Mirror Tracing Task, which reliably induces frustration and distress. As expected, women with BPD reported significantly greater intensity of negative emotions before and after frustration than healthy women. Specifically, they showed a significantly stronger frustration-induced increase in anger, while other negative emotions remained unaffected by frustration induction. This anger increase was significantly related to aggressive behavior reported in the 2 weeks prior to the experiment, as well as to the level of frustration experienced in the experiment itself, but not with emotion dysregulation. The current data confirm the important role of frustration-induced anger independent of emotion dysregulation in BPD, in particular with regard to aggression, a prominent interpersonal dysfunction of this disorder. These findings underline the importance of interventions with particular focus on anger.

How Do We Target NSSI in BPD? Exploring The Relationship Between Emotion Dysregulation, Interpersonal Dysfunction, And Non-Suicidal Self-Injury

The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and nonsuicidal self-injury (i.e., NSSI) over the course of DBT, and 2) whether changes in emotion dysregulation mediate the recovery of other features of BPD in treatment. Individuals with BPD (N = 120) enrolled in a multi-site study were assessed at five timepoints over 12 months of dialectical behaviour therapy (i.e., DBT). Results indicated that interpersonal dysfunction and NSSI decreased linearly over the course of DBT. Emotion dysregulation decreased in a quadratic manner; most of the gains in emotion dysregulation may occur in earlier phases of DBT. Results also revealed that although changes in emotion dysregulation was not a significant mediator of the relationship between changes in interpersonal dysfunction and in NSSI, changes in interpersonal dysfunction predicted changes in emotion dysregulation. Future research directions regarding NSSI, emotion dysregulation, and interpersonal dysfunction within DBT are discussed.

How Do We Target NSSI in BPD? Exploring The Relationship Between Emotion Dysregulation, Interpersonal Dysfunction, And Non-Suicidal Self-Injury

The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and nonsuicidal self-injury (i.e., NSSI) over the course of DBT, and 2) whether changes in emotion dysregulation mediate the recovery of other features of BPD in treatment. Individuals with BPD (N = 120) enrolled in a multi-site study were assessed at five timepoints over 12 months of dialectical behaviour therapy (i.e., DBT). Results indicated that interpersonal dysfunction and NSSI decreased linearly over the course of DBT. Emotion dysregulation decreased in a quadratic manner; most of the gains in emotion dysregulation may occur in earlier phases of DBT. Results also revealed that although changes in emotion dysregulation was not a significant mediator of the relationship between changes in interpersonal dysfunction and in NSSI, changes in interpersonal dysfunction predicted changes in emotion dysregulation. Future research directions regarding NSSI, emotion dysregulation, and interpersonal dysfunction within DBT are discussed.