Elucidating DSM-5 and ICD-11 Diagnostic Features of Borderline Personality Disorder Using Schemas and Modes

Abstract

Background: Borderline personality disorder (BPD) comprises a heterogeneous constellation of problems operationalized in the DSM-5 and the forthcoming ICD-11. In schema therapy, schemas and modes are employed to conceptualize and treat these problems. Aim: The current study investigated whether the 9 diagnostic BPD features are associated with schemas and modes. Method: Psychiatric outpatients with predominant BPD features (n = 142; 68% females) were administered the Structured Clinical Interview for DSM-IV Axis II (SCID-II) and self-report inventories for schemas and modes. Associations were investigated by means of bivariate point-biserial correlations and multiple logistic regression analysis. Results: BPD features were largely associated with conceptually related schemas and modes. Consistent with the schema therapy literature and previous research, we found schemas of Abandonment/Instability and Mistrust/Abuse along with modes of Angry/Enraged Child, (internalized) Punitive Parent, and Impulsive Child to uniquely predict thematically related BPD features including fear of abandonment, self-destructiveness, feelings of emptiness, stress-related paranoid ideation, inappropriate anger, and impulsivity. Conclusion: Most of the 9 BPD features were related to conceptually meaningful schemas/modes, suggesting that BPD is composed of dormant themes along with salient affective-behavioral responses. Consequently, individual BPD features may be differentially conceptualized and targeted in therapy by means of schemas and modes.

Trust Beliefs, Biases, and Behaviors in Borderline Personality Disorder: Empirical Findings and Relevance to Epistemic Trust

“…Perhaps unsurprisingly given the prevalence of NDP in BPD, schemas that include mistrust of others figure prominently in the disorder. These include distrust [25], mistrust/abuse [26,27], and disconnection/rejection [28]. The prevalence of mistrust/abuse beliefs may differentiate BPD from other personality disorders (e.g., [26,29]), and it has been suggested that the predominance of mistrustfulness/anger beliefs may define a subtype of BPD [30].…”

Schema therapy: Conceptualization and treatment of personality disorders.

“…Several recent publications discuss the compatibility of the ST approach to PD conceptualization with recent developments in DSM-5-AMPD and ICD-11 PD (Bach & Lobbestael, 2018). In ST, the distinction between disorder and normal limits is determined by the frequency and intensity of schema activation and mode triggering, which is a dimensional approach.…”

Social Aspects of the Relationship between Narcissistic and Borderline Personality Disorder

“…Zaključeno je da su grandioznost (makar skrivena/vulnerabilna) i traženje pažnje nužni za dijagnozu narcističnog poremećaja ličnosti, dok granični poremećaj ličnosti mora sadržavati barem jedan od sljedećeg -impulzivnost, rizično ponašanje i/ili hostilnost. Tako se trenutno najpreciznije očituje razlika između narcisa i borderline-a u formalnim dijagnostičkim kriterijima (51)(52)(53).…”

“…It has been concluded that grandiosity (even hidden/vulnerable types) and attention-seeking are necessary for the diagnosis of narcissistic personality disorder, whereas borderline personality disorder much include at least one of the following -impulsivity, risky behavior, and/or hostility. This is currently the most precise way to describe the difference between narcissistic and borderline personality disorder in formal diagnostic criteria (51)(52)(53).…”