The Complexity of Borderline Personality Disorder: Network Analysis of Personality Factors and Defense Styles in the Context of Borderline Personality Organization
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Objective Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it’s crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD.Methods Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment.Results Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network.Conclusion Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.
Abstract
Objective Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it’s crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD.Methods Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment.Results Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network.Conclusion Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.
참고문헌 (39)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2013), American Psychiatric Association
- Frías Á, "Comorbidity between post-traumatic stress disorder and borderline personality disorder : a review", Psychopathology, 48, pp.1~10 (2015)
- Leichsenring F, "Borderline per sonality disorder", Lancet, 377, pp.74~84 (2011)
- Oldham JM, "Borderline personality disorder and suicidality", Am J Psy chiatry, 163, pp.20~26 (2006)
- Trull TJ, "DSM-5 borderline personality dis order : at the border between a dimensional and a categorical view", Curr Psychiatry Rep, 13, pp.43~49 (2011)
- Oldham JM, "Comorbidity of axis I and axis II disorders", Am J Psychiatry, 152, pp.571~578 (1995)
- Zanarini MC, "Axis II comorbidity of borderline personality disorder", Compr Psychiatry, 39, pp.296~302 (1998)
- Zanarini MC, "Predic tion of the 10-year course of borderline personality disorder", Am J Psy chiatry, 163, pp.827~832 (2006)
- Barrachina J, "Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity", Compr Psychiatry, 52, pp.725~730 (2011)
- Zanarini MC, "Defense mechanisms associated with borderline personality disorder", J Pers Disord, 23, pp.113~121 (2009)
- Kramer U, "Beyond splitting : ob server-rated defense mechanisms in borderline personality disorder", Psychoanal Psychol, 30, pp.3~15 (2013)
- Bond M, "Defense styles and borderline person ality disorder", J Pers Disord, 8, pp.28~31 (1994)
- Koenigsberg HW, "Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affec tive instability and impulsivity?", J Pers Disord, 15, pp.358~370 (2001)
- Lee YJ, "Defense mechanisms and psychological characteristics according to suicide at tempts in patients with borderline personality disorder", Psychiatry Investig, 17, pp.840~849 (2020)
- Zanarini MC, "Defense mechanisms reported by patients with borderline personality disorder and axis II comparison subjects over 16 years of prospective follow-up : descrip tion and prediction of recovery", Am J Psychiatry, 170, pp.111~120 (2013)
- Bond M, "Long-term changes in defense styles with psychody namic psychotherapy for depressive, anxiety, and personality disorders", Am J Psychiatry, 161, pp.1665~1671 (2004)
- Kernberg O, "Borderline personality organization", J Am Psychoanal Assoc, 15, pp.641~685 (1967)
- Fischer-Kern M, "The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder", Psychoanal Psychol, 27, pp.395~409 (2010)
- Perry JC, "Defense mechanisms in schizotyp al, borderline, antisocial, and narcissistic personality disorders", Psychiatry, 76, pp.32~52 (2013)
- Bowins B, "Personality disorders : a dimensional defense mechanism approach", Am J Psychother, 64, pp.153~169 (2010)
- Borsboom D, "Network analysis : an integrative approach to the structure of psychopathology", Annu Rev Clin Psychol, 9, pp.91121~ (2013)
- Bond MP, "An empirical study of the relationship between diagnosis and defense style", Arch Gen Psychiatry, 43, pp.285~288 (1986)
- Chung MW, "A preliminary study for the develop ment of a defense style questionnaire adapted for Koreans", J Korean Neuropsychiatr Assoc, 32, pp.707~716 (1993)
- Hyler SE, "Validity of the personality diagnostic questionnaire--revised : comparison with two structured interviews", Am J Psychiatry, 147, pp.1043~1048 (1990)
- Kim DI, "The preliminary study of reliability and validity on the Korean version of personality disorder question naire-4+ (PDQ-4+)", J Korean Neuropsychiatr Assoc, 39, pp.525~538 (2000)
- Zhao T, "The huge package for high-dimensional undirected graph estimation in R", J Mach Learn Res, 13, pp.1059~1062 (2012)
- "Extended Bayes ian information criteria for Gauss ian graphical models" (2010)[URL]
- Spiller TR, "On the validity of the centrality hypothesis in cross-sectional between subject networks of psychopathology", BMC Med, 18, pp.297~ (2020)
- Epskamp S, "Estimating psychological networks and their accuracy : a tutorial paper", Behav Res Methods, 50, pp.195212~ (2018)
- Hyler SE, "Factor analysis of the DSM-III personality disor der clusters : a replication", Compr Psychiatry, 29, pp.304~308 (1988)
- Vaillant GE, "Ego mechanisms of defense and personality psychopathol ogy", J Abnorm Psychol, 103, pp.44~50 (1994)
- Hayden MC, "Increasing mentalization to reduce maladaptive defense in patients with mental disorders", Front Psychiatry, 12, pp.637915~ (2021)
- Shahar G, "Defensive projection, superimposed on simplistic object relations, erodes patient-provider relationships in high-risk preg nancy : an empirical investigation", J Am Psychoanal Assoc, 58, pp.953974~ (2010)
- Rosell DR, "Schizotypal person ality disorder : a current review", Curr Psychiatry Rep, 16, pp.452~ (2014)
- Disney KL, "Dependent personality disorder : a critical review", Clin Psy chol Rev, 33, pp.1184~1196 (2013)
- Staebler K, "Rejection sensitivi ty and borderline personality disorder", Clin Psychol Psychother, 18, pp.275~283 (2011)
- Zeigler–Hill V, "Borderline personality features : instability of self–esteem and affect", J Soc Clin Psychol, 25, pp.668~687 (2006)
- Hörz-Sagstetter S, "Clinical characteristics of comorbid narcissistic per sonality disorder in patients with borderline personality disorder", J Pers Disord, 32, pp.562~575 (2018)
- Kim HG, "Differences of defense mechanisms and psychological characteristics between the patients with cluster B and C personality disorders of DSM-IV: impli cation for theory of borderline personality organization", Psychoanal, 25, pp.13~23 (2014)