Sex Differences in Early Weight Loss Success During a Diabetes Prevention Intervention.

Objectives: Males often lose more weight than females during treatment, and early weight loss predicts weight loss longer-term. Yet, mechanisms for sex differences in early weight loss are unknown and were examined in this study.Methods: Adults≥21 years old with overweight or obesity and prediabetes (N=206) participated in a lifestyle intervention and completed baseline psychosocial questionnaires. Percent weight loss, session attendance, and number of days participants self-monitored dietary intake and weight were determined at week 5. Principal components, regression, and mediation analyses were conducted to determine whether weight loss differed by sex and potential mediators of weight change. Results: Mean (±SD) weight loss was greater for males (2.59±1.62%) than females (2.05±1.54%; p=.02). Attendance, self-monitoring, and beliefs regarding disease risk were independent predictors of weight loss (all p<.05) but did not explain sex differences. The association between attendance and weight loss was stronger for males than females (p<.05). Conclusions: Additional research is needed to identify mechanisms that explain sex differences in early weight loss. However, strengthening risk beliefs, attendance, and self-monitoring may promote greater early weight loss for all participants.

A longitudinal examination of the reciprocal relationship between borderline personality features and interpersonal relationship quality.

Interpersonal dysfunction is a core characteristic of borderline personality disorder (BPD). Cross-sectional research suggests that higher BPD features are associated with lower relationship quality. Many researchers have examined the associations between interpersonal stressors and short-term increases in emotional reactivity or impulsivity among those with high levels of BPD features. Yet, most research paradigms assume that interpersonal stressors change over time, whereas BPD features remain relatively stable; however, the stability of BPD features in the context of fluctuating interpersonal stressors has yet to be tested longitudinally. In the current study, we examined co-occurring changes in relationship quality and BPD features over time. In Study 1, 126 female, undergraduate participants completed ratings of relationship quality (i.e., conflict, criticism, closeness, satisfaction, and support) with recent interpersonal partners as well as self-reported BPD features at baseline and 1-month follow-up. In Study 2, 50 female participants from the community (n = 27 with BPD; n = 23 without any psychiatric diagnoses) completed the same measures at baseline and 1-, 3-, and 6-month follow-ups. Across both studies, when participants reported decreases in the quality of their interpersonal relationships, they endorsed increases in BPD features. Similarly, when participants endorsed worsening BPD features, their perceptions of relationship quality with all recent interaction partners (in Study 1) or more frequent interaction partners (in Study 2) decreased as well. Even in samples with a wide range of BPD features, these results suggest that the quality of interpersonal relationships and BPD features may influence each other over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between physiological and self-reported indices of emotion dysregulation across varying levels of alcohol use among individuals with and without borderline personality disorder.

Emotional functioning can be assessed across multiple levels of analysis (e.g., subjective, physiological). The degree of concordance/discordance across such indices may mark psychopathology risk. The current study assessed associations between physiological and subjective indices of emotional responding among drinkers, with (n = 39) and without (n = 42) borderline personality disorder. Subjective changes in affect were assessed by calculating difference scores on the Positive and Negative Affective Schedule, administered before and following a lab-based stress task. Physiological dysregulation was indexed by respiratory sinus arrhythmia (RSA) reactivity. We created Discordance Index scores to examine the direction and magnitude of misalignment. More frequent alcohol use was associated with greater discordance between RSA and positive affect changes (ß = -0.07, p-value = 0.009). Findings were confirmed with a response surface modeling analysis. Results highlight that individuals with greater discordance between indices of emotional responding may be at elevated risk for frequent alcohol use.

Development of the National Network of Depression Centers Mood Outcomes Program: A Multisite Platform for Measurement-Based Care.

OBJECTIVES: Mood disorders are among the most burdensome public health concerns. The National Network of Depression Centers (NNDC) is a nonprofit consortium of 26 leading clinical and academic member centers in the United States providing care for patients with mood disorders, including depression and bipolar disorder. The NNDC has established a measurement-based care program called the Mood Outcomes Program whereby participating sites follow a standard protocol to electronically collect patient-reported outcome assessments on depression, anxiety, and suicidal ideation in routine clinical care. This article describes the approaches taken to develop and implement the program. METHODS: Since 2015, eight pilot sites have implemented the program and followed more than 10,000 patients. This pilot study presents descriptive statistics based on the first 24-month period of data collection. RESULTS: In this sample, 58.6% of patients with bipolar disorder (N=849) and 57.5% of patients with unipolar depression (N=3,998) remained symptomatic at follow-up. Lifetime rates of planned or actual suicide attempts were high, ranging from 27.6% for patients with unipolar mood disorders to 33.5% for patients with bipolar disorder. Men, unmarried individuals, and those with comorbid anxiety had a poorer longitudinal course. This initial snapshot of clinical burden is consistent with public health data indicating that mood disorders are severely debilitating. CONCLUSIONS: This study demonstrates the potential of the Mood Outcomes Program to create a nationwide "learning health system" for mood disorders. This goal will be further realized as the program expands in reach and scope across additional NNDC sites.

Characterization of relationship instability in women with borderline personality disorder: A social network analysis.

Interpersonal dysfunction is considered a cornerstone of borderline personality disorder (BPD). Relationships are described as intense and unstable, with individuals with BPD alternating between idealization and devaluation of relationship partners. Furthermore, a lack of stable and supportive relationships may be related to symptom maintenance and exacerbation. Despite widespread recognition of the importance of relationship instability in BPD, there is little empirical evidence about the nature of such instability and how it emerges over time. We examined the stability of social networks of women diagnosed with BPD (n = 27) and healthy controls (HCs; n = 23) by assessing key characteristics of relationships (satisfaction, support, closeness, conflict, and criticism) over a 6-month period. We conducted analyses to examine whether relationship instability depended on the frequency of interaction with members of the network. Results showed that the relationships of women in the BPD group were perceived as more unstable than those of the HC group. Compared with women in the HC group, women with BPD had networks with more relationships that had undergone significant change or had been "cut off" over the course of the study. The relationship between frequency of interaction and instability in support and satisfaction differed between groups. Women in the HC group showed greater instability in support with partners they interacted with infrequently, whereas women in the BPD group showed greater instability in satisfaction with partners they interacted with more frequently. Implications for understanding interpersonal dysfunction in BPD are discussed and possible areas of relevance for treatment development are highlighted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study.

African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.

Too Much Too Soon?: Borderline Personality Disorder Symptoms and Romantic Relationships in Adolescent Girls.

Despite the centrality of adult romantic relationships to the conceptualization of borderline personality disorder (BPD), little is known about the earlier development of this interdependency during adolescence. Thus, we examined the co-development of romantic relationships and BPD symptoms from ages 15 to 19 in a large urban sample of girls (N = 2310) in the Pittsburgh Girls Study. We had two major aims. First, we sought to examine associations between BPD symptoms and romantic relationship involvement (number of partners, importance of relationship) and relational insecurity (concerns about infidelity and tactics to maintain relationship) during adolescence. Second, we investigated mutual influences and temporal precedence of BPD symptoms and four specific romantic relationship characteristics (perceived support and antagonism, verbal and physical aggression) during adolescence using latent growth curve models (LGCMs). Results indicated that BPD symptoms were associated with increased involvement in romantic relationships and heightened relational insecurity across adolescence. Furthermore, higher BPD symptoms at age 15 predicted increases in antagonism, verbal aggression, and physical aggression across ages 15 to 19. Conversely, perceptions of higher levels of relationship support at age 15 predicted steeper increases in BPD symptoms across ages 15 to 19, suggesting a potential negative influence of early involvement in close romantic relationships. These findings demonstrate the reciprocal nature of romantic relationship functioning and BPD symptoms during adolescence and suggest novel prevention targets for youth at risk for BPD.

Attachment styles, social behavior, and personality functioning in romantic relationships.

Personality disorders (PDs) are commonly associated with romantic relationship disturbance. However, research has seldom evaluated who people with high PD severity partner with, and what explains the link between PD severity and romantic relationship disturbance. First, we examined the degree to which people match with partners with similar levels of personality and interpersonal problems. Second, we evaluated whether the relationship between PD severity and romantic relationship satisfaction would be explained by attachment styles and demand/withdraw behavior. Couples selected for high PD severity (n = 130; 260 participants) engaged in a conflict task, were assessed for PDs and attachment using semi-structured interviews, and self-reported their relationship satisfaction. Dyad members were not similar in terms of PD severity but evidenced a small degree of similarity on specific attachment styles and were moderately similar on attachment insecurity and interpersonal problems. PD severity also moderated the degree to which one person's attachment anxiety was associated with their partner's attachment avoidance. In addition, using a dyadic analytic approach, we found attachment anxiety and actor and partner withdrawal explained some of the relationship between PD severity and relationship satisfaction. Our results indicate people often have romantic partners with similar levels of attachment disturbance and interpersonal problems and that attachment styles and related behavior explains some of the association between PD severity and relationship satisfaction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Detecting the Presence of a Personality Disorder Using Interpersonal and Self-Dysfunction.

Calls have increased to place interpersonal and self-disturbance as defining features of personality disorders (PDs). Findings from a methodologically diverse set of studies suggest that a common factor undergirds all PDs. The nature of this core of PDs, however, is not clear. In the current study, interviews were completed for DSM-IV PD diagnosis and interpersonal dysfunction independently with 272 individuals (PD = 191, no-PD = 91). Specifically, we evaluated interpersonal dysfunction across social domains. In addition, we empirically assessed the structure of self-dysfunction in PDs. We found dysfunction in work and romantic domains, and unstable identity uniquely predicted variance in the presence of a PD. Using receiver operating characteristic analysis, we found that the interpersonal dysfunction and self-dysfunction scales each predicted PDs with high accuracy. In combination, the scales resulted in excellent sensitivity (.90) and specificity (.88). The results support interpersonal and self-dysfunction as general factors of PD.

Borderline personality disorder symptoms and affective responding to perceptions of rejection and acceptance from romantic versus nonromantic partners.

We examined event-contingent recording of daily interpersonal interactions in a diagnostically diverse sample of 101 psychiatric outpatients who were involved in a romantic relationship. We tested whether the unique effect of borderline personality disorder (BPD) symptoms on affective responses (i.e., hostility, sadness, guilt, fear, and positive affect) to perceptions of rejection or acceptance differed with one's romantic partner compared with nonromantic partners. BPD symptoms were associated with more frequent perceptions of rejection and less frequent perceptions of acceptance across the study. For all participants, perceptions of rejecting behavior were associated with higher within-person negative affect and lower within-person positive affect. As predicted, in interactions with romantic partners only, those with high BPD symptoms reported heightened hostility and, to a lesser extent, attenuated sadness in response to perceptions of rejection. BPD symptoms did not moderate associations between perceptions of rejection and guilt, fear, or positive affect across romantic and nonromantic partners. For all participants, perceived acceptance was associated with lower within-person negative affect and higher within-person positive affect. However, BPD symptoms were associated with attenuated positive affect in response to perceptions of accepting behavior in interactions with romantic partners only. BPD symptoms did not moderate associations between perceptions of acceptance and any of the negative affects across romantic and nonromantic partners. This study highlights the specificity of affective responses characteristic of BPD when comparisons are made with patients with other personality and psychiatric disorders. Implications for romantic relationship dysfunction are discussed. (PsycINFO Database Record

Social disadvantage and borderline personality disorder: A study of social networks.

Examining differences in social integration, social support, and relationship characteristics in social networks may be critical for understanding the character and costs of the social difficulties experienced of borderline personality disorder (BPD). We conducted an ego-based (self-reported, individual) social network analysis of 142 participants recruited from clinical and community sources. Each participant listed the 30 most significant people (called alters) in their social network, then rated each alter in terms of amount of contact, social support, attachment strength and negative interactions. In addition, measures of social integration were determined using participant's report of the connection between people in their networks. BPD was associated with poorer social support, more frequent negative interactions, and less social integration. Examination of alter-by-BPD interactions indicated that whereas participants with low BPD symptoms had close relationships with people with high centrality within their networks, participants with high BPD symptoms had their closest relationships with people less central to their networks. The results suggest that individuals with BPD are at a social disadvantage: Those with whom they are most closely linked (including romantic partners) are less socially connected (i.e., less central) within their social network. (PsycINFO Database Record

The effect of pathological narcissism on interpersonal and affective processes in social interactions.

Narcissism has significant interpersonal costs, yet little research has examined behavioral and affective patterns characteristic of narcissism in naturalistic settings. Here we studied the effect of narcissistic features on the dynamic processes of interpersonal behavior and affect in daily life. We used interpersonal theory to generate transactional models of social interaction (i.e., linkages among perceptions of others' behavior, affect, and one's own behavior) predicted to be characteristic of narcissism. Psychiatric outpatients (N = 102) completed clinical interviews and a 21-day ecological momentary assessment protocol using smartphones. After social interactions (N = 5,781), participants reported on perceptions of their interaction partner's behavior (scored along the dimensions of dominant-submissive and affiliative-quarrelsome), their own affect, and their own behavior. Multilevel structural equation modeling was used to examine dynamic links among behavior and affect across interactions, and the role of narcissism in moderating these links. Results showed that perceptions of others' dominance did not predict dominant behavior, but did predict quarrelsome behavior, and this link was potentiated by narcissism. Furthermore, the link between others' dominance and one's own quarrelsome behavior was mediated by negative affect. Moderated mediation was also found: Narcissism amplified the link between ratings of others' dominance and one's own quarrelsomeness and negative affect. Narcissism did not moderate the link between other dominance and own dominance, nor the link between other affiliation and own affiliation. These results suggest that narcissism is associated with specific interpersonal and affective processes, such that sensitivity to others' dominance triggers antagonistic behavior in daily life. (PsycINFO Database Record

Identifying a borderline personality disorder prodrome: Implications for community screening.

Elucidating early signs and symptoms of borderline personality disorder (BPD) has important implications for screening and identifying youth appropriate for early intervention. The purpose of this study was to identify dimensions of child temperament and psychopathology symptom severity that predict conversion to a positive screen for BPD over a 14-year follow-up period in a large, urban community sample of girls (n = 2 450). Parent and teacher reports of child temperament and psychopathology symptom severity assessed when girls were ages 5-8 years were examined as predictors of new-onset BPD cases when girls were ages 14-22 years. In the final model, parent and teacher ratings of emotionality remained significant predictors of new-onset BPD. Additionally, parent ratings of hyperactivity/impulsivity and depression severity, as well as teacher ratings of inattention severity, were also predictive. Results also revealed that elevations in these dimensions pose a notable increase in risk for conversion to BPD over the follow-up period. Supplementary analyses revealed that with the exception of parent-reported depression severity, these same predictors were associated with increases in BPD symptom severity over the follow-up period. These findings suggest BPD onset in adolescence and early adulthood can be detected from parent and teacher reports of temperament and symptom severity dimensions assessed in childhood. The identification of this prodrome holds promise for advancing early detection of children at risk prior to the development of the full-blown disorder. Copyright © 2017 John Wiley & Sons, Ltd.

Interpersonal problems across levels of the psychopathology hierarchy.

We examined the relationship between psychopathology and interpersonal problems in a sample of 825 clinical and community participants. Sixteen psychiatric diagnoses and five transdiagnostic dimensions were examined in relation to self-reported interpersonal problems. The structural summary method was used with the Inventory of Interpersonal Problems Circumplex Scales to examine interpersonal problem profiles for each diagnosis and dimension. We built a structural model of mental disorders including factors corresponding to detachment (avoidant personality, social phobia, major depression), internalizing (dependent personality, borderline personality, panic disorder, posttraumatic stress, major depression), disinhibition (antisocial personality, drug dependence, alcohol dependence, borderline personality), dominance (histrionic personality, narcissistic personality, paranoid personality), and compulsivity (obsessive-compulsive personality). All dimensions showed good interpersonal prototypicality (e.g., detachment was defined by a socially avoidant/nonassertive interpersonal profile) except for internalizing, which was diffusely associated with elevated interpersonal distress. The findings for individual disorders were largely consistent with the dimension that each disorder loaded on, with the exception of the internalizing and dominance disorders, which were interpersonally heterogeneous. These results replicate previous findings and provide novel insights into social dysfunction in psychopathology by wedding the power of hierarchical (i.e., dimensional) modeling and interpersonal circumplex assessment.

Borderline personality disorder symptoms and aggression: A within-person process model.

Theoretical and empirical work suggests that aggression in those with borderline personality disorder (BPD) occurs primarily in the context of emotional reactivity, especially anger and shame, in response to perceived rejection. Using intensive repeated measures, we examined a within-person process model in which perceived rejection predicts increases in aggressive urges and behaviors via increases in negative affect (indirect effect) and in which BPD symptoms exacerbate this process (moderated mediation). Participants were 117 emerging adult women (ages 18-24) with recent histories of aggressive behavior who were recruited from a community-based longitudinal study of at-risk youth. Personality disorder symptoms were assessed by semistructured clinical interview, and aggressive urges, threats, and behaviors were measured in daily life during a 3-week ecological momentary assessment protocol. Multilevel path models revealed that within-person increases in perceived rejection predicted increases in negative affect, especially in women with greater BPD symptoms. In turn, increases in negative affect predicted increased likelihood of aggressive urges or behaviors. Further analysis revealed that BPD symptoms predicted greater anger and shame reactivity to perceived rejection, but not to criticism or insult. Additionally, only anger was associated with increases in aggression after controlling for other negative emotions. Whereas BPD symptoms exacerbated the link between perceived rejection and aggression via increases in negative affect (particularly anger), this process was attenuated in women with greater antisocial personality disorder symptoms. These findings suggest that anger reactivity to perceived rejection is one unique pathway, distinct from antisocial personality disorder, by which BPD symptoms increase risk for aggression. (PsycINFO Database Record

Momentary patterns of covariation between specific affects and interpersonal behavior: Linking relationship science and personality assessment.

Relationships are among the most salient factors affecting happiness and wellbeing for individuals and families. Relationship science has identified the study of dyadic behavioral patterns between couple members during conflict as an important window in to relational functioning with both short-term and long-term consequences. Several methods have been developed for the momentary assessment of behavior during interpersonal transactions. Among these, the most popular is the Specific Affect Coding System (SPAFF), which organizes social behavior into a set of discrete behavioral constructs. This study examines the interpersonal meaning of the SPAFF codes through the lens of interpersonal theory, which uses the fundamental dimensions of Dominance and Affiliation to organize interpersonal behavior. A sample of 67 couples completed a conflict task, which was video recorded and coded using SPAFF and a method for rating momentary interpersonal behavior, the Continuous Assessment of Interpersonal Dynamics (CAID). Actor partner interdependence models in a multilevel structural equation modeling framework were used to study the covariation of SPAFF codes and CAID ratings. Results showed that a number of SPAFF codes had clear interpersonal signatures, but many did not. Additionally, actor and partner effects for the same codes were strongly consistent with interpersonal theory's principle of complementarity. Thus, findings reveal points of convergence and divergence in the 2 systems and provide support for central tenets of interpersonal theory. Future directions based on these initial findings are discussed. (PsycINFO Database Record

An examination of social network quality and composition in women with and without borderline personality disorder.

Borderline personality disorder (BPD) is characterized by interpersonal difficulties including fears of abandonment, unstable relationships, and intense and inappropriate anger (American Psychiatric Association, 2013). However, there is limited research aimed at understanding the social networks of individuals with BPD, particularly in comparison to others. In this study, we compared the social networks of women with BPD to a group of women who did not meet criteria for any psychological disorders (i.e., healthy control (HC) group). Participants recruited from the community and local clinics completed a diagnostic evaluation and the social network assessment, a measure designed to assess the number and perceived quality of partners with whom participants frequently interact. Women in the BPD group had smaller social networks, characterized by less satisfaction and support, and more conflict and criticism among partners than women in the HC group. In addition, the networks of women with BPD were more variable in terms of these quality variables compared to the networks of HC women. However, the 2 groups did not differ on overall closeness or variability in closeness in relationships. Finally, women with BPD reported more relationships in which there had been a significant change or rupture in the past month. These findings suggest that interpersonal distress experienced by women with BPD occurs in the context of smaller and less satisfying social networks compared to the networks of their peers. The examination of additional control groups and longitudinal social network change will further characterize interpersonal dysfunction experienced in BPD. (PsycINFO Database Record

Disorganized attachment and personality functioning in adults: A latent class analysis.

Though researchers have attended to disorganized attachment in infants and children, they have infrequently focused on the character of disorganized attachment in adults. In this study, we aimed to identify clusters of participants based on attachment levels and styles, seeking to better delineate severity and stylistic differences in disorganized attachment than has been previously articulated. We used a new assessment approach focused on a hierarchy of attachment organization, including secure, insecure (dismissive and preoccupied), rigid-controlling (hostile control and compulsive caregiving), and disorganized (contradictory, impoverished, and unresolved) levels of attachment. Clinical evaluators used information from diagnostic and attachment-based interviews to rate participants on each of these aspects of attachment. Latent class analysis (LCA) revealed a 4-class solution, including a secure (n = 33), insecure (n = 110), and 2 disorganized classes. One disorganized class (disorganized-oscillating) was characterized by elevations on contradictory and preoccupied styles (n = 77) and another (disorganized-impoverished) showed elevations on impoverished and dismissive styles (n = 53). The disorganized-oscillating class exhibited elevated personality disorder (PD) severity and general symptom severity, borderline personality disorder (BPD), histrionic, and antisocial dimensional scores, and the most severe identity disturbance compared with the other classes. The impoverished-dismissive class exhibited the highest avoidant and schizoid PD dimensional scores of the classes, and higher PD severity compared with the insecure and secure classes. These results highlight the possibility of identifying distinct classes of attachment organization, differentiated both by aspects of severity and interpersonal style. They also shed light on the manifestation of attachment disorganization in adults. (PsycINFO Database Record

A Within-Person Analysis of the Association between Borderline Personality Disorder and Alcohol Use in Adolescents.

Many studies examining the association between borderline personality disorder (BPD) and alcohol use during adolescence have focused on between-individual differences (rank order stability), comparing whether adolescents with elevated rates of alcohol use have higher BPD symptoms than those with lower rates of alcohol use. As such, the extent to which an individual's alcohol use is associated with concurrent and future BPD symptoms has been relatively unstudied. The current study assessed year-to-year fluctuations in alcohol use and BPD symptoms in a large urban sample of girls from age 14 to age 17 (N = 2450). The primary aim was to examine whether increases in alcohol use were associated with increases in adolescent girls' BPD symptoms in the same year and in the following year. Results of fixed-effects (within-individual) models revealed that even while controlling for the time-varying impact of symptoms of both internalizing and externalizing disorders, prior and concurrent other substance use, and all time invariant, pre-existing differences between individuals, higher past-year alcohol use was associated with higher levels of BPD symptoms. Furthermore, this association did not vary by age, or by sociodemographic factors, including child race and socioeconomic status of the family. The results of this study indicate heightened risk for the exacerbation of BPD symptoms following increases in alcohol use frequency and highlight the potential utility of interventions targeting drinking behavior for preventing escalations in BPD symptoms.

A systematic review of risk factors prospectively associated with borderline personality disorder: Taking stock and moving forward.

There is an urgent need to identify signs that harbinger onset of borderline personality disorder (BPD). Advancement in this area is required to refine developmental theories, discover etiological mechanisms, improve early detection, and achieve our ultimate goal of prevention. Though many studies have supported a wide range of factors that increase subsequent risk for BPD, this literature has yet to be critically evaluated, and there are no comprehensive reviews that examine and integrate these findings. To address this limitation, we conducted a systematic review to summarize and synthesize the current literature. Electronic databases were systematically searched for prospective, longitudinal studies that examined risk factors of subsequent BPD outcomes (features, symptoms, diagnosis), resulting in a total of 39 studies, reflecting 24 unique samples. Though increased risk for BPD was reliably attributed to multiple factors within social, family, maltreatment, and child domains, the most striking limitation of this research is its lack of disorder-specific findings. Additional limitations, including notable heterogeneity in sampling methodology, symptom assessment methodology, and developmental timing of assessments, are discussed in terms of how close we are to pinpointing who is most at risk and why in an attempt to provide a roadmap for future research. (PsycINFO Database Record