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Borderline personality disorder (BPD), a complex disorder linked to adverse behavioral outcomes and impaired functioning, is associated with difficulties in emotion regulation (ER)—including both ER abilities and use of ER strategies. BPD commonly co-occurs with other disorders that are themselves linked to emotion dysregulation. Thus, it is important to consider the potential role of these comorbidities when examining ER difficulties in BPD. The present study investigated relationships between ER abilities, ER strategies, and BPD, while considering key comorbidities, among a sample of participants: (a) diagnosed with BPD, (b) without BPD but matched to BPD group members on key classes of psychopathology (i.e., mood, anxiety, substance use, trauma-related, and other personality disorders; matched psychiatric control [MPC] group), or (c) free of assessed psychopathology (healthy control [HC] group). Results revealed few significant differences between the BPD and MPC groups, who both demonstrated greater impairments than the HC group across most ER abilities and strategies. Notable exceptions were greater impulse control difficulty (ability) and anger rumination (strategy) in the BPD relative to both other groups. Additionally, lower composite maladaptive ER strategies and higher composite adaptive strategies distinguished the HC from BPD group, with neither composite ER abilities nor strategies differentiating the MPC from BPD group, though this result is limited by statistical overlap between variables. By elucidating the potential role of psychiatric comorbidity in two key components of ER in BPD, this study contributes to a growing literature that may help inform therapeutic interventions targeting the severe emotional and behavioral dysregulation commonly seen in this complex disorder. / Psychology

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The World Health Organization has proposed for the ICD-11 a differentiation of symptoms to distinguish separate disorders of PTSD and complex PTSD (CPTSD), rather than one disorder of PTSD as in the current DSM-5. In addition, the accuracy and usefulness of the borderline personality disorder (BPD) diagnosis has been debated for years due to this history of trauma often associated with the diagnosis. New instruments have been developed to assess CPTSD, allowing needed research to expand our understanding of CPTSD and how it may differ from PTSD. The present study explored the relationships between the three different patterns of symptom expression associated with these disorders and various coping strategies in a sample of trauma survivors. A canonical correlation analysis (CCA) showed a significant relationship between trauma symptoms and coping strategies and suggested that individuals with higher borderline personality disorder symptoms, and subsequently complex PTSD and PTSD symptoms, were more likely to cope using avoidant coping strategies- behavioral disengagement, denial, and substance use. This finding was similar to previous research findings that suggested high rates of negative psychological outcomes for adults cognitive and behavioral avoidant coping strategies. Contributions from other coping techniques, such as restraint and venting, also showed significant, but not as strong relationships to higher psychological symptoms.

Recent discussion of proposed changes to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders highlighted the struggle to categorize and define the characteristics of persons who present with Borderline Personality Disorder (BPD). BPD has traditionally been defined as a personality disorder, assuming a distinct trajectory and prognosis that sets it apart from other mood disorder diagnoses. However, early discussion in the development of the DSM-V introduced the possibility of BPD as one of several disorders existing on a shared mood disorder or emotion-regulation disorder spectrum. The final, published DSM-V retained BPD as a personality disorder on a diagnostic spectrum apart from mood or emotion regulation disorders; however, does BPD represent a broader and persistent difficulty with emotion regulation, rather than a disorder of the personality? In the current study, 73 psychiatric inpatients in a state-operated forensic hospital and 428 undergraduate students from a local university were administered the Difficulties in Emotion Regulation Scale (DERS), as well as the BPD section of the Structured Interview for the Diagnosis of Personality Disorders, DSM-IV version (SIDP-IV). Total and subscale scores on the DERS were correlated with individual symptom ratings from the SIDP-IV Borderline. Results suggest many of the subscales representing different facets of emotion regulation evidenced low to moderate correlations with symptoms of BPD. The subscales of the DERS least associated with symptoms and diagnosis of BPD are those that emphasize cognitive regulation of emotional experiences. Thus, it is likely that BPD would fit well within a conceptualization of emotion regulation disorder. Results also suggest some differences between groups, where more overlap between constructs exist for college students rather than psychiatric inpatients, with the least associated constructs are those that emphasize both cognitive and behavioral components of emotional regulation.

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This thesis examined the borderline personality disorder symptom profiles of teenage girls who were referred to a tertiary child and youth psychiatry clinic. Self-injury and unstable mood are key features of Borderline Personality Disorder (BPD) but are also associated with other disorders such as depression and anxiety disorders. The aim of the larger study was to determine whether BPD can be differentiated from other disorders in a highly comorbid adolescent sample who self-injure. To answer this question, individuals in our sample were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. The subgroups that emerged from our sample were then compared to each other across other clinical measures. Four latent classes were identified. The most impaired class had a high prevalence of BPD (70%). An intermediate class had a significantly higher prevalence of PTSD (41.7%). Another intermediate group had a higher prevalence of anxiety disorders (62%) (Social Phobia and Generalized Anxiety Disorder). The largest class had a low prevalence of all psychiatric disorders. The results indicated that only a small subset of teenage girls who presented with self-injury and unstable mood met criteria for BPD. These girls represented a distinct and severely impaired group with high comorbidity. The subgroups that emerged from our sample provide guidance to clinicians regarding the likelihood of a personality disorder diagnosis in this population and the pattern of emotional difficulties of youth who self-injure. / Thesis / Master of Science (MSc)

Title: Borderline personality disorder: examining trajectories of development among adolescents Background: Borderline personality disorder (BPD) tends to be highly comorbid with other disorders. In adolescence, information about the classification and development of BPD is in its early stages. There is limited empirical research available that investigates predictors of clinically significant symptom trajectories of the disorder using data collected in childhood. Given the enormous personal and societal costs associated with BPD, early detection and prevention is important. Clinical implications of this research include an improved understanding of risk factors and possible mechanisms for development of BPD symptomatology. Objectives: To identify trajectories of BPD symptomatology in a Canadian sample of adolescents (N = 703) assessed at ages 13, 14, 15 and 16, while examining predictors of trajectory group membership assessed at age 12. Methods: Data from the McMaster Teen Study was used to examine trajectories of BPD symptoms using group-based trajectory modeling. The influence of gender, depression, ADHD, family functioning and various sociodemographic variables as predictors of an individual’s group membership was tested. Chi-square, analysis of variance and multinomial logistic regression was used to analyze the data. Results: A four-group trajectory model was most robust at describing BPD symptomatology in this age group. Univariate analyses supported female gender, depression and ADHD at baseline, parental age, marital status, education, and income as significant predictors of group membership. Female gender, depression and ADHD severity at baseline were significant predictors of group membership when adopting a multivariate approach. There is a greater prevalence of girls with higher depression and ADHD scores in the high-increasing features and BPD group. Conclusion: Findings demonstrate four various developmental trajectories of BPD features. Results further the understanding of the factors associated with development of the disorder across time. / Thesis / Master of Science (MSc) / Information about the classification and development of borderline personality disorder (BPD) in adolescence is in its early stages. While evidence for similar construct validity to the adult disorder exists for adolescents, major gaps in knowledge regarding the stability in course of BPD symptoms and predictors of clinically significant symptom trajectories in this age group remain. As most clinicians will assess youth already having significant features of the disorder, early detection requires knowledge of the indicators that precede an unfavourable trajectory. This dissertation will help address these gaps by modeling trajectories of BPD symptoms in youth across ages 13-16, whilst examining factors influencing trajectory group membership.

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