The role of DSM-5 borderline personality symptomatology and traits in the link between childhood trauma and suicidal risk in psychiatric patients

Abstract

BackgroundChildhood traumas appear to be linked to suicidal behavior. However, the factors that mediate between these two phenomena are not sufficiently understood. Recent findings suggest that borderline personality disorder (BPD) may explain some of the association.MethodThe present study investigated the potential mediating role of BPD symptomatology and traits between reported childhood trauma and suicidal risk in adult psychiatric outpatients (N = 124). BPD symptomatology was measured with DSM-5 Section II criterion-counts (SCID-II; Structured Clinical Interview for DSM-IV Axis II), whereas BPD traits were measured with specified DSM-5 Section III traits (PID-5; Personality Inventory for DSM-5). Childhood traumas were self-reported (CTQ; Childhood Trauma Questionnaire), whereas level of suicidal risk was measured with a structured interview (MINI Suicidality Module; Mini International Neuropsychiatric Interview). Mediation effects were tested by bias-corrected (10.000 boot-strapped samples) confidence intervals.ResultsBPD features account for a considerable part of the cross-sectional association between childhood trauma and level of suicidal risk, even when controlling for the influence of gender, age, and educational level. This finding remained stable when testing the model without the suicidality-related BPD criterion and PID-5 items. DSM-5 Section II BPD criterion-counts explained 67% of the total effect, whereas DSM-5 Section III BPD traits accounted for 82% of the total effect. The specific DSM-5 Section III trait facets of “Depressivity” (52%) and “Perceptual Dysregulation” (37%) accounted for most of this effect.ConclusionsThe findings provide preliminary support for the proposed mediation model indicating that BPD features may help explain relations between childhood trauma and elevated suicidal risk in adult life, in particular for DSM-5 Section III personality traits of depressivity (e.g., pessimism, guilt, and shame) and perceptual dysregulation (e.g., dissociation). To reduce the suicidal risk among those with a history of childhood trauma, BPD features (including “Depressivity” and “Perceptual Dysregulation”) might be an important target of assessment, risk management, and treatment. However, other factors are likely to be involved, and a longitudinal and more large-scale design is warranted for a conclusive test of mediation.Electronic supplementary materialThe online version of this article (doi:10.1186/s40479-017-0063-7) contains supplementary material, which is available to authorized users.

ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground

“…Finally, DSM-5 Psychoticism may also characterize important features of DSM-5 Section II Borderline PD in terms of stress-related dissociative symptoms (Bach and Fjeldsted, 2017; Bach and Sellbom, 2016; Evans and Simms, 2017; Sellbom et al, 2014). These findings are consistent with the initial construction of the DSM-5 trait model, where one facet of Psychoticism was first labeled Dissociation-proneness but subsequently relabeled Cognitive & Perceptual Dysregulation (Krueger et al, 2012).…”

“…Patients were required to rate each PID-5 item on a 4-point Likert scale from 0 (Very False or Often False) to 3 (Very True or Often True). We used the Danish version of the PID-5, which has demonstrated acceptable psychometric properties (Bach et al, 2016, 2017b; Bo et al, 2016) and facet-level continuity with categorical PDs (Bach et al, 2016, 2017a; Bach and Fjeldsted, 2017; Bach and Sellbom, 2016). In this study, we used the official scoring algorithm for computing the DSM-5 trait domains (APA, 2013) and a newly developed scoring algorithm for computing the proposed ICD-11 domains (Bach et al, 2017c).…”

Personality Inventory for DSM-5 (PID-5) in Clinical Versus Nonclinical Individuals: Generalizability of Psychometric Features

“…Subsequently, three primary scales (the most pure-loading facet scales) for each of the five domains were included in generating the five domain scores. The Danish version of the PID-5 has proved to have sound psychometric features in terms of internal consistency and factorial validity (Bo et al, 2016) as well as criterion validity (Bach, Anderson, & Simonsen, 2016; Bach, Lee, Mortensen, & Simonsen, 2016; Bach, Sellbom, Bo, & Simonsen, in press; Bach & Sellbom, 2016). For more details about the Danish translation of the PID-5, see Bo et al (2016).…”

“…Third, we did not collect specific diagnostic information about the patients, which is unfortunate as this may have implications for the range of symptoms (including PID-5 traits) in this sample. However, previous consecutive sampling from the same clinical setting suggests that the patients were predominantly characterized by at least one Cluster B and Cluster C Personality Disorder along with co-occurring emotional disorders (e.g., Bach & Fjeldsted, 2017).…”

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

“…Thus, the Defectiveness schema may include features of self-loathing and shame whereas the Vulnerable Child mode may involve activation of the Defectiveness schema including features of hopelessness linked to suicidal or parasuicidal behavior. Accordingly, research suggests that features of shame are related to self-harming or suicidal behavior [48, 49]. …”