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Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression

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Abstract

A number of clinical theories emphasise self-concept disturbance as central to borderline personality disorder (BPD). To date, however, there has been limited empirical examination of exactly how BPD changes the content and structure of self-concept. Moreover, it is unclear if patterns of self-concept disturbance are unique to BPD or are driven by axis-I comorbidities such as depression. To examine this issue, the present study adopted a dimensional design, examining how performance on a novel adaptation of a well-validated measure of self-concept (the Psychological Distance Scaling Task) was related to BPD and depression symptoms in a sample of 93 individuals with a wide range of symptom severity. While greater BPD severity was associated with less positive and more negative content of self-concept, this was driven by depression symptoms. Similarly, positive content was more diffuse and negative content more interconnected at higher levels of BPD severity, but for positive content, this was most clearly linked to comorbid depression features. In contrast, BPD severity (over and above depression symptoms) was uniquely associated with greater ‘clustering’ for positive and negative content (i.e. a more fragmented self-concept). This pattern of results lends support to clinical theories arguing that self-concept fragmentation is core to BPD and also supports the utility of dimensional analyses to identify patterns of cognitive-affective disturbance unique to BPD versus those shared with comorbid conditions like depression.

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Notes

  1. While we feel that dimensional designs are particularly well suited to answering questions of specificity, we are not intending to make any strong claims here as whether dimensional designs are superior to diagnostic ones in general. This issues remains contentious in the field. In our view, categorical and dimensional models and design can happily co-exist alongside one another (see Arntz 1999). Each approach brings with it particular theoretical and clinical pros and cons (e.g. see Paris et al. 2009) and researchers and clinicians should choose the framework that most suits their particular purpose.

  2. List of words used in the PDST available from the corresponding author.

  3. To examine convergent validity of the continuous BPD measure, we repeated this analysis with BPD diagnostic status as a between-groups factor rather than PAI-BOR score as a continuous covariate. An identical pattern of results emerged. This was also true for the interconnectedness and clustering analyses. See Online Resource 1.

  4. To validate our clustering measure as a sensitive and unique measure of self-concept disturbance in BPD, we conducted some additional exploratory analyses to see if clustering was most clearly related to the identity disturbance factor of the PAI-BOR. As expected, greater identity disturbance was associated with greater clustering, r = .42, p < .001, and this held when controlling for depression severity, rp = .37, p = .001. However, in both zero-order and partial correlation analyses (controlling for depression) the other factors of the PAI-BOR were also related to clustering: affect instability, r = .34, p < .01, rp = .28, p = .02; negative relationships, r = .39, p = .001, rp = .34, p < .01; and self-harm, r = .26, p = .02, rp = .19, p = .11. Next, we examined if these associations for each PAI-BOR factor held when also controlling for the other PAI-BOR factors (and depression severity). There remained a trend significant relationship for identity disturbance, rp = .22, p = .07, but the affect instability, rp = .6, p = .64, negative relationships, rp = .15, p = .21, and self-harm, rp = .01, p = .96, were no longer significant. These pattern of findings show that the identity disturbance factor of the PAI-BOR is most clearly related to clustering on the PDST as expected, validating this index as a useful additional outcome measure for future PDST studies. Effectively, these analyses move beyond a latent variable approach (where a single “BPD” dimension is driving results) to an overlapping network systems approach (where particular symptom clusters within the BPD construct are driving results; see Cramer et al. 2010).

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Acknowledgments

Thanks to Helena Crockford and Win Bolton for help with recruitment. This study was supported by the UK Medical Research Council (U1055.02.002.00001.01) and was conducted while Davy Evans and Barnaby Dunn worked at the MRC Cognition and Brain Sciences Unit

Conflict of interest

Davy Evans, Tim Dalgleish, Robert B Dudas, Chess Denman, Maxine Howard and Barnaby D Dunn declare they have no conflict of interest. The data presented in this study were collected as part of Davy Evans’s doctoral thesis, and have not been presented elsewhere.

Informed Consent

All procedures involving human participants performed in the study were in accordance with the ethical standards of the Cambridge Psychology Research Ethics Committee (CPREC), the Cambridgeshire 2 NHS Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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No animal studies were carried out by the authors for this paper.

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Authors and Affiliations

  1. Clinical Office, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

    Davy Evans

  2. Dudley and Walsall Mental Health Partnership NHS Trust, Dudley, UK

    Davy Evans

  3. Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK

    Tim Dalgleish

  4. Department of Psychiatry, University of Cambridge, Cambridge, UK

    Robert B. Dudas

  5. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK

    Robert B. Dudas & Chess Denman

  6. Norfolk and Suffolk NHS Foundation Trust, Norfolk, UK

    Robert B. Dudas

  7. Clinical, Educational and Health Psychology, University College London, London, UK

    Maxine Howard

  8. Mood Disorders Centre, University of Exeter, Exeter, UK

    Barnaby D. Dunn

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Evans, D., Dalgleish, T., Dudas, R.B. et al. Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression. Cogn Ther Res 39, 613–626 (2015). https://doi.org/10.1007/s10608-015-9695-3

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