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Borderline Personality Traits Predict Poorer Functioning During Partial Hospitalization: The Mediating Role of Depressive Symptomatology

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Abstract

A number of factors contribute to the difficulty providers experience in treating borderline personality disorder (BPD). One complicating factor for treatment effectiveness is the presence of comorbid affective psychopathology (e.g., depression, anxiety). Participants were 176 adults (60 % female; M age = 32.20) in a partial hospital program. Using a mediation model, the current study examined the relationship among traits of BPD, affective symptomatology, and general functioning post-treatment. Additional analyses explored whether change in the perception of therapeutic skill implementation moderated the relationship among traits of BPD, affective symptomatology, and general functioning. Little improvement/worsening of depression during partial hospitalization, but not changes in anxiety, mediated the relationship between traits of BPD and poor general functioning. Additionally, regardless of changes in perception of cognitive- or dialectical-behavioral skill implementation, little improvement/worsening depressive symptomatology continued to mediate the negative relationship noted above. This study has important implications for treatment of BPD and suggests that targeting depressive symptoms in short-term settings may be crucial in acute stabilization.

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Notes

  1. Our focus on CBT and DBT in the Introduction is based on the treatment models represented in the current partial program and analytic focus presented in the Results section. While other approaches to the treatment of BPD, such as Mentalization-Based Treatment (Bateman and Fonagy 2009), have received substantial support, we are unable to evaluate those approaches in the present study due to the nature of the program.

  2. Given the overlap in problems with impulse control and emotion regulation, Narcissistic, Histrionic, and Antisocial Personality Disorder, along with Borderline Personality Disorder, are referred to as Cluster B disorders. Using a mediation model that controlled for Narcissistic, Histrionic, and Antisocial traits, Borderline personality traits still emerged as a predictor of poorer functioning at discharge mediated by depressive symptoms (indirect effect Confidence Interval: .02–.06).

  3. In light of the recent debate regarding dimensional versus categorical conceptualizations of psychiatric disorders and the statistical power gained in using a continuous measure, we opted to use continuous measure of traits of BPD in our primary analysis. However, using a categorical measure of BPD (cut of 5 or more endorsed traits), the mediation model remains statistically significant, Indirect Effect Confidence Interval: .04–.14.

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Authors and Affiliations

  1. Department of Psychology, Suffolk University, 41 Temple Street, Boston, MA, 02114, USA

    Stephanie M. Jarvi

  2. Department of Psychology, Yale University, New Haven, CT, USA

    Arielle R. Baskin-Sommers

  3. Department of Psychology, Boston University, Boston, MA, USA

    Bridget A. Hearon

  4. Department of Psychiatry, McLean Hospital, Belmont, MA, USA

    Stephanie Gironde & Thröstur Björgvinsson

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Jarvi, S.M., Baskin-Sommers, A.R., Hearon, B.A. et al. Borderline Personality Traits Predict Poorer Functioning During Partial Hospitalization: The Mediating Role of Depressive Symptomatology. Cogn Ther Res 40, 128–138 (2016). https://doi.org/10.1007/s10608-015-9726-0

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