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

Abstract

Background Individuals with borderline personality disorder frequently display comorbid mental disorders. These disorders include “internalizing” disorders (such as major depressive disorder and anxiety disorders) and “externalizing” disorders (such as substance use disorders and antisocial personality disorder). It is hypothesized that these disorders may arise from latent “internalizing” and “externalizing” liability factors. Factor analytic studies suggest that internalizing and externalizing factors both contribute to borderline personality disorder, but the extent to which such contributions are familial is unknown. Methods Participants were 368 probands (132 with borderline personality disorder; 134 without borderline personality disorder; and 102 with major depressive disorder) and 885 siblings and parents of probands. Participants were administered the Diagnostic Interview for DSM-IV Personality Disorders; the Revised Diagnostic Interview for Borderlines; and the Structured Clinical Interview for DSM-IV. Results On confirmatory factor analysis of within-person associations of disorders, borderline personality disorder loaded moderately on internalizing (factor loading .53, SE .10; p<.001) and externalizing latent variables (.48, SE .10; p<.001). Within-family associations were assessed using structural equation models of familial and non-familial factors for borderline personality disorder, internalizing disorders, and externalizing disorders. In a Cholesky decomposition model, 84% (SE 17%; p<.001) of the association of borderline personality disorder with internalizing and externalizing factors was accounted for by familial contributions. Conclusions Familial internalizing and externalizing liability factors are both associated with, and therefore may mutually contribute to BPD. These familial contributions account largely for the pattern of comorbidity between BPD and internalizing and externalizing disorders.

Association of eating disorder symptoms with internalizing and externalizing dimensions of psychopathology among men and women

“…Despite their strong association with distress‐mediated disorders, particularly depression, it is important to note that rates of externalizing (e.g., substance use) and fear (e.g., phobias) disorders have been shown to be elevated among individuals with EDs as well. BN has been associated with high rates of substance use disorders as well as borderline personality disorder, which is considered to encompass both internalizing and externalizing facets of psychopathology . Nonetheless, our results and those of previous studies suggest that EDs may be most strongly associated with disorders characterized primarily by negative affect, worry, and rumination.…”

“…BN has been associated with high rates of substance use disorders 2 as well as borderline personality disorder, 25 which is considered to encompass both internalizing and externalizing facets of psychopathology. 26 Nonetheless, our results and those of previous studies 5,6 suggest that EDs may be most strongly associated with disorders characterized primarily by negative affect, worry, and rumination. Taken together, extant results underscore the importance of the role that depressive symptomatology, and affect regulation more generally, 27,28 may play in the development and maintenance of disordered eating.…”

Borderline Personality Disorder

“…However, these family study findings could not in themselves differentiate the proportion of etiological variance contributed by genetic and focus.psychiatryonline.org FOCUS Spring 2013, Vol. They found a range of heritability from 44%-60%, with the remaining variance contributed by individual specific environmental factors (18,60,92). 2 environmental factors (already outlined above).…”

“…Moreover, within the nosological superstructure of internalizing versus externalizing dimensions it appears to occupy some space of its own, whereby it combines characteristics of both (16)(17)(18). Where it belongs in the classification system is one such issue.…”

Multiple Faces of Personality Domains: Revalidating the Proposed Domains

“…The internalizing/externalizing model has proven to be useful for characterizing Axis I disorders in DSM-IV classification and could be linked to and translated to personality structure (James & Taylor 2008, Krueger et al 2001. Moreover, studies have reported that the covariation between internalizing and externalizing dimensions may be clearer after examining the connection between personality and these features and that internalizing and externalizing factors both contribute to BPD (Hudson et al 2014). Additional findings showed that neuroticism as a personality trait is an inherited marker of both internalizing and externalizing pathologies (Hink et al 2013).…”