Borderline Personality Disorder (BPD) is a complex mental health condition that can cause a range of symptoms, including emotional dysregulation, impulsivity, and relationship instability. Although previous research has attempted to identify subtypes of BPD, there has been no consensus on the matter. A recent study by Antoine and colleagues (2023), published in the journal Psychiatry Research, aimed to address this issue.
The researchers conducted three studies involving over 500 people with BPD who were receiving treatment in various clinical settings. They used a statistical technique called latent class analysis (LCA) to identify subgroups of individuals with distinct symptom profiles. The measures used in the study included the BPD section of the International Personality Disorder Examination, the Childhood Trauma Questionnaire, the Beck Depression Inventory, and the Symptom Checklist 90.
The analysis revealed three distinct subgroups, each with unique features. The first group, which accounted for 10.5% of the sample, showed fewer symptoms of emotional dysregulation and dissociation and had a lower likelihood of experiencing childhood sexual abuse. The second group, which comprised 55.4% of the sample, had significantly higher levels of dissociative and paranoid symptoms, but a more stable sense of self and lower rates of frantic efforts to avoid abandonment. This group also had a higher risk of comorbidity, meaning they were more likely to have other diagnoses in addition to BPD. The third group, which made up 34.1% of the sample, had the highest levels of frantic efforts to avoid abandonment, as well as higher rates of anger, aggression, and relationship instability. This group also had a higher likelihood of experiencing childhood sexual abuse, although not to the same extent as the second group.
Overall, these findings provide important insights into the heterogeneity of BPD and suggest that there may be meaningful subtypes of the disorder. Identifying these subtypes could have important implications for treatment, as different subgroups may benefit from different types of interventions.
Implications for Treatment
The recent study on Borderline Personality Disorder (BPD) has significant implications for individuals with BPD, their loved ones, and mental health professionals. The findings suggest that different subtypes of BPD exist, which may require different treatment approaches, including psychotherapy, medication, and self-regulatory practices.
The Non-Labile group, characterized by lower rates of childhood trauma and less impulsive behaviour, may benefit from building executive function to reduce impulsive actions. It is crucial to recognize this smaller subset and tailor treatment accordingly.
The Dissociative/Paranoid group, with the highest rates of childhood trauma, including sexual abuse, may require a focus on complex PTSD. They may have learned to shut down emotionally to cope with potential threats, making them vulnerable to manipulation and abuse. Restoring awareness can reduce revictimization and retraumatization by recognizing warning signs in others.
The Interpersonally Unstable group, similar to the Dissociative/Paranoid group in terms of trauma and abuse, displays splitting, hostility, and aggression, leading to relationship issues.
Future studies can explore the applicability of these findings and identify effective treatment approaches, such as meditation or environmental modifications. In the meantime, the study sheds light on BPD subtypes and helps mental health professionals develop treatment plans that cater to specific needs. It is worth noting that this study has some limitations, such as a lack of diversity in the sample, and further research is needed to replicate and extend these findings.
In the meantime, at STG Health Services Inc., DBT group and individual counselling sessions can carefully start looking at the symptomatology of each of the clients receiving treatment.
Antoine, S. M., Fredborg, B. K., Streiner, D., Guimond, T., Dixon-Gordon, K. L., Chapman, A. L., … & McMain, S. (2023). Subgroups of Borderline Personality Disorder: A Latent Class Analysis. Psychiatry Research, 115131.