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Borderline personality disorder: stress reactivity or stress generation? A prospective dimensional study

Published online by Cambridge University Press:  27 July 2020

Timothy A. Allen Open the ORCID record for Timothy A. Allen [Opens in a new window] ,
Alexandre Y. Dombrovski ,
Paul H. Soloff  and
Michael N. Hallquist
Timothy A. Allen*
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Alexandre Y. Dombrovski
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Paul H. Soloff
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Michael N. Hallquist
Affiliation:
Department of Psychology, Pennsylvania State University, State College, PA, USA
*
Author for correspondence: Timothy A. Allen, E-mail: allenta2@upmc.edu
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Abstract

Background

Individuals diagnosed with borderline personality disorder (BPD) often describe their lives as stressful and unpredictable. However, it is unclear whether the adversity faced by those with BPD is a product of stress reactivity or stress generation. Here, we examined the dynamic, prospective associations between BPD and stressful life events over 3 years. Given the heterogeneity present in BPD, we sought to understand which empirically derived dimensions of this heterogeneous disorder explain stress reactivity v. stress generation.

Methods

Participants included 355 individuals diagnosed with BPD and followed longitudinally at three annual assessments. Auto-regressive cross-lagged panel models were used to examine prospective associations between stressful life events and three latent dimensions implicated in BPD: negative affect, disinhibition, and antagonism.

Results

Antagonism and disinhibition, but not negative affect, prospectively predicted dependent stressful life events (events the individual may have some role in). Evidence for decompensation under stress was more tenuous, with independent stressful life events (those presumably outside the individual's control) predicting increases in negative affect.

Conclusions

Our longitudinal study of a well-characterized clinical sample found more evidence for stress generation than for stress-induced decompensation in BPD. Stress generation in BPD is driven by externalizing dimensions: antagonism and disinhibition. These results highlight the utility of empirically derived dimensions for parsing heterogeneity present in BPD, leading to improvements in diagnostic evaluation, clinical prediction, and individualized approaches to treatment planning.

Keywords

antagonismborderline personality disorderdisinhibitionlife stressnegative affect
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1014 - 1021
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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