Family Study of Borderline Personality Disorder and Its Sectors of Psychopathology

Abstract

Context The familiality of borderline personality disorder (BPD) and its sectors of psychopathology are incompletely understood. Objectives To assess the familial aggregation of BPD and its 4 major sectors (affective, interpersonal, behavioral, and cognitive) and test whether the relationship of the familial and nonfamilial associations among these sectors can be accounted for by a latent BPD construct. Design Family study, with direct interviews of probands and relatives. Setting A psychiatric hospital (McLean Hospital) and the Boston-area community. Participants A total of 368 probands (132 with BPD, 134 without BPD, and 102 with major depressive disorder) and 885 siblings and parents of probands. Main Assessments The Diagnostic Interview for DSM-IV Personality Disorders and the Revised Diagnostic Interview for Borderlines (DIB-R) were used to assess borderline psychopathology, and the Structured Clinical Interview for DSM-IV was used to assess major depressive disorder. Results Borderline personality disorder meeting both DSM-IV and DIB-R criteria showed substantial familial aggregation for BPD in individuals with a family member with BPD vs those without a family member with BPD, using proband-relative pairs (risk ratio, 2.9; 95% confidence interval, 1.5–5.5) as well as using all pairs of family members (3.9; 1.7–9.0). All 4 sectors of BPD psychopathology aggregated significantly in families, using both DSM-IV and DIB-R definitions (correlation of traits among all pairs of family members ranged from 0.07 to 0.27), with the affective and interpersonal sectors showing the highest levels; however, the level of familial aggregation of BPD was higher than that of the individual sectors. The relationship among the sectors was best explained by a common pathway model in which the sectors represent manifestations of a latent BPD construct. Conclusions Familial factors contribute to BPD and its sectors of psychopathology. Borderline personality disorder may arise from a unitary liability that finds expression in its sectors of psychopathology.

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

“…The view that core impairments in BPD are intrinsically related is consistent with three recent large twin studies that suggest a common pathway model with one highly heritable general BPD factor [68][69][70]. This view is also consistent with factor analytic studies in adolescents suggesting that BPD in adolescence is best represented by a single hierarchical superordinate factor [51,71].…”

The contribution of familial internalizing and externalizing liability factors to borderline personality disorder

“…Further details of these procedures are presented elsewhere (Gunderson et al , 2011). The kappa statistic for interrater reliability for the diagnosis of BPD, assessed on the basis of 18 interviews, was 1.0 for both the DIPD-R and DIB-R.…”

“…Calculation of the selection probabilities requires knowing the prevalence of BPD from the source population from which our sample was drawn. To calculate the prevalence of BPD, we used a method developed for estimating prevalence from relatives of case and control probands (Javaras et al , 2010b), and used previously (Arnold et al , 2006, Gunderson et al , 2011, Hudson et al , 2008, Javaras et al , 2008a, Javaras et al , 2008b). To calculate the prevalence of MDD, we used the prevalence of MDD from the weighted sample of probands and relatives from the BPD and non-BPD proband groups.…”

“…Specifically, relatives of probands with BPD show an elevated risk for both internalizing disorders – including major depressive disorder (Baron et al , 1985, Links et al , 1988, Silverman et al , 1991, Zanarini et al , 2009, Zanarini et al , 1988) and anxiety disorders (Zanarini et al , 2009) – and externalizing disorders, including substance use disorders (Loranger and Tulis, 1985, Pope et al , 1983, Silverman et al , 1991, Zanarini et al , 2009, Zanarini et al , 1988) as well as antisocial personality disorder (Links et al , 1988, Pope et al , 1983, Silverman et al , 1991, Zanarini et al , 2009, Zanarini et al , 1988). However, almost all of the family studies (with notable exceptions (Klein et al , 1995, Riso et al , 2000)) contain methodologic limitations that compromise interpretation of their results, including biased sampling, reliance on information from probands to determine a diagnosis in relatives rather than direct interviews of relatives, and small sample sizes (White et al , 2003; Gunderson et al , 2011). Furthermore, no family study has examined the relationship of BPD with internalizing and externalizing disorders in a multivariate manner.…”

Severity of Borderline Personality Symptoms in Adolescence: Relationship With Maternal Parenting Stress, Maternal Psychopathology, and Rearing Styles

“…It is now widely accepted that BPD develops from a combination of a strong genetic predisposition and environmental factors (Distel et al, 2011;Gunderson et al, 2011). However, most studies on environmental factors that have been conducted in adult BPD patients are retrospective, and therefore prone to recall bias (Hufford & Shiffman, 2003).…”