An evidence-based integrated process framework of borderline personality disorder clinical features: Insights from the general population

Background: Empirical and clinical models of borderline personality disorder (BPD) have hypothesized different core dimensions that should explain its phenotypic variability. Nevertheless, no previous studies have directly explored how these dimensions might interplay in capturing BPD features. The current study investigated the role of emotional dysregulation (ED), behavioral dysregulation (BD), dissociative processes reflecting altered self functioning (ASF) and interpersonal sensitivity (IS) in predicting a probable diagnosis of BPD and its clinical features. Methods: A sample of 694 adults from the general population was recruited. An online self-report assessment battery composed of SCID-5-BPD, DERS, UPPS-P, DES-II and RSQ-A was administered. The analyses were based on the application of logistic regression, structural equation modeling (SEM) and path analysis. Results: ED had the largest predictive power for BPD diagnosis and each BPD criterion compared to the other dimensions, followed by DOS and BD. IS had an incremental predictive power for BPD diagnosis and affective BPD criteria above and beyond the effects of ED, ASF and BD. SEM and path analysis showed that these dimensions were organized around internalizing (ED, ASF, IS) and externalizing (BD) factors significantly correlated to each other. The internalizing factor had the most influential impacts in predicting BPD psychopathology. Conclusion: These findings provisionally supported an integration of the most influential clinical models of BPD considering how ED, ASF, BD and IS interplay to each other in capturing the clinical variability of this condition. Future clinical and longitudinal studies are needed to corroborate the current insights from the general population.