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Borderline Personality Disorder From the Perspective of General Personality Functioning

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Abstract

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits.
Borderline Personality Disorder From the Perspective of General
Personality Functioning
Timothy J. Trull
University of Missouri—Columbia
Thomas A. Widiger and Donald R. Lynam
University of Kentucky
Paul T. Costa Jr.
National Institute on Aging
The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be
understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of
personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was
correlated with individuals’ FFM profiles to yield a similarity score, an FFM borderline index. Results
across all samples indicated that the FFM borderline index correlated as highly with existing borderline
measures as they correlated with one another, and the FFM borderline index correlated as highly with
measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional
measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality
traits.
The diagnostic approach to personality disorders in the Ameri-
can Psychiatric Association’s (APA) Diagnostic and Statistical
Manual of Mental Disorders (fourth edition; DSM–IV; APA, 2000)
“represents the categorical perspective that Personality Disorders
are qualitatively distinct clinical syndromes” (APA, 2000, p. 689).
A number of researchers, however, have raised compelling con-
cerns regarding the validity of this categorical model (Clark,
Livesley, & Morey, 1997; Livesley, 1998, 2001a; Trull, 2000;
Widiger, 1993) and have offered alternative dimensional models
(Clark, 1993; Cloninger, Svrakic, Bayon, & Przybeck, 1999;
Livesley, 1998; Widiger & Costa, 1994; Wiggins & Pincus, 1989).
One of the most widely studied of these dimensional models is
the five-factor model (FFM) of personality (John & Srivastava,
1999; McCrae & Costa, 1999). Wiggins and Pincus (1989) were
the first to provide published data on the relationship of the FFM
to the APA (1980, 1987) personality disorders, although many
previous FFM studies had also provided relevant data (e.g., Mc-
Crae, Costa, & Busch, 1986). Since that original effort, over 50
additional published studies have focused on the relationship be-
tween the FFM and personality disorder symptomatology (Widiger
& Costa, 2002). The results of these studies, using a variety of
measures and populations, have indicated that borderline person-
ality disorder symptoms (for example) are correlated positively
with the FFM domain of Neuroticism and negatively with the FFM
domains of Agreeableness and Conscientiousness (e.g., Ball, Ten-
nen, Poling, Kranzler, & Rounsaville, 1997; Blais, 1997; Costa &
McCrae, 1990; Duijsens & Diekstra, 1996; Dyce & O’Connor,
1998; Reynolds & Clark, 2001; Soldz, Budman, Demby, & Merry,
1993; Trull, 1992).
Although there is good evidence that the borderline diagnosis
does identify valid and clinically meaningful maladaptive person-
ality traits (Adams, Bernat, & Luscher, 2001; Gunderson, 2001;
Paris, 1994), its diagnostic criteria are not without problems. For
example, Tyrer (1999) has suggested that some of the symptoms,
such as episodes of wrist slashing or an overdose, are perhaps
better understood as expressions of a time-limited mood disorder
rather than a maladaptive personality trait. Thus, it may not be
desirable for the FFM to reproduce all of the findings associated
with the diagnosis. However, if the FFM is to become a viable
alternative to the DSM–IV personality disorder diagnostic catego-
ries, it should reproduce the important clinical and theoretical
components of the disorder’s nomological network (Livesley,
2001b; Lynam & Widiger, 2001).
Four studies have examined more specifically the ability of the
FFM to describe borderline personality disorder (Clarkin, Hull,
Cantor, & Sanderson, 1993; Morey & Zanarini, 2000; Wilburg,
Urnes, Friis, Pederson, & Karterud, 1999; Zweig-Frank & Paris,
1995). Clarkin et al. (1993) examined 62 female inpatients with
borderline personality disorder and confirmed a close correspon-
dence between facets of Neuroticism and borderline symptomatol-
ogy. McCrae et al. (2001) calculated a .89 profile agreement score
between the mean NEO Personality Inventory (Costa & McCrae,
1992) scores obtained by the 62 Clarkin et al. borderlines and the
Timothy J. Trull, Department of Psychological Sciences, University of
Missouri—Columbia; Thomas A. Widiger and Donald R. Lynam, Depart-
ment of Psychology, University of Kentucky; Paul T. Costa Jr., Laboratory
of Personality and Cognition, National Institute on Aging, Baltimore.
This research was supported by National Institute of Mental Health
Grants R55 MH52695 and RO1 MH52695 awarded to Timothy J. Trull and
National Institute of Mental Health Grant R01 MH 60104 awarded to
Donald R. Lynam.
Correspondence concerning this article should be addressed to Tim-
othy J. Trull, Department of Psychological Sciences, 106C McAlester
Hall, University of Missouri, Columbia, Missouri 65211. E-mail: trullt@
missouri.edu
Journal of Abnormal Psychology Copyright 2003 by the American Psychological Association, Inc.
2003, Vol. 112, No. 2, 193–202 0021-843X/03/$12.00 DOI: 10.1037/0021-843X.112.2.193
193
FFM borderline profile hypothesized by Widiger, Trull, Clarkin,
Sanderson, and Costa (1994). The findings of Clarkin et al. were
subsequently replicated by Wilburg et al. (1999).
Zweig-Frank and Paris (1995) obtained DSMIIIR personality
disorder diagnoses on 150 female patients, 59 of whom completed
the Revised NEO Personality Inventory (NEOPIR; Costa &
McCrae, 1992) 2 years later. Twenty-nine of the follow-up partic-
ipants had been originally diagnosed with borderline personality
disorder; the others had been diagnosed with other personality
disorders. Zweig-Frank and Paris (1995) found only a few mar-
ginal FFM differences between the 29 borderlines and the 30
nonborderlines and concluded that there were few overall differ-
ences on the five factors between borderline and nonborderline
patients (p. 525). However, there are methodological issues that
weaken the impact of their conclusions. The borderline and FFM
assessments were conducted 2 years apart, and the testretest
reliability of the borderline diagnosis is problematic, at best (Mc-
David & Pilkonis, 1996; Zimmerman, 1994). In addition, Zweig-
Frank and Paris focused primarily on group comparisons, using
only the domains of the FFM. Current research suggests that better
differentiation occurs at the level of the facets (Axelrod, Widiger,
Trull, & Corbitt, 1997; Lynam & Widiger, 2001; Reynolds &
Clark, 2001; Trull, Widiger, & Burr, 2001).
More recently, Morey and Zanarini (2000) compared the ability
of the FFM, assessed by the NEO Five-Factor Inventory (NEO
FFI; Costa & McCrae, 1992), and the Revised Diagnostic Inter-
view for Borderlines (DIBR; Zanarini, Gunderson, Frankenburg,
& Chauncey, 1989) to predict hypothesized correlates of border-
line personality disorder (e.g., family history of mood disorder,
childhood history of abuse, lifetime rate of suicide attempts, and
level of functioning). They indicated that the NEOFFI represen-
tation of borderline personality disorder explained a significant
portion of the variance in historical and outcome variables, indeed,
in some cases more than the original diagnoses from which this
representation had been derived (Morey & Zanarini, 2000, p.
735), but they also emphasized that there were aspects of the
borderline personality disorder diagnosis not fully captured by the
five-factor representation (p. 735). For example, multiple regres-
sions of the NEOFFI five domain scores indicated substantial
correlations with the cognitive, interpersonal, and affective com-
ponents of the DIBR assessment of borderline personality disor-
der but not with the DIBR section devoted to impulse action
patterns (i.e., substance abuse, sexual deviance, self-mutilation,
and suicidality). In addition, variance in DIBR borderline symp-
tomatology not accounted for by the NEOFFI correlated signif-
icantly with hypothesized correlates of the disorder, including, for
example, a history of abuse in childhood. Although not explicitly
represented within the borderline diagnostic criteria, physical and
sexual abuse are often evident in the childhood of persons diag-
nosed with this disorder (Johnson, Cohen, Brown, Smailes, &
Bernstein, 1999; Zanarini, 2000), and these experiences are con-
sidered to be important in theoretical models of its etiology (Gun-
derson, 2001; Zanarini, 2000). Morey and Zanarini reported that
the NEOFFI domain scores considered together correlated .23
(p .01) with a history of abuse in childhood, comparable to the
.26 correlation obtained by the DIBR, but they emphasized that
the variance in the DIBR not accounted for by the NEOFFI
correlated .16 (p .01) with a history of childhood abuse. Morey
and Zanarini (2000) concluded that diagnostic elements that are
independent of this FFM representation of borderline personality
appear to be valid elements of the disorder, as reflected by their
association with theoretically important correlates (p. 736).
We suggest, instead, that it is more impressive that a lengthy and
extensive interview of borderline symptomatology covering a wide
range of affective dyscontrol, cognitive aberrations, impulse dys-
control, and dysfunctional interpersonal relationships was able to
explain only a small proportion of additional variance in childhood
abuse, relative to a much briefer self-report measure of general
personality functioning (Widiger & Costa, 1994). Although the
NEOFFI, used by Morey and Zanarini (2000), provides a reliable
and valid assessment of the FFM domains (Costa & McCrae,
1992), the hypotheses regarding the relationship of the FFM to the
personality disorders provided by Widiger et al. (1994) and Lynam
and Widiger (2001) have been at the level of the facets within each
of the five broad domains. Not all of the facets of FFM Consci-
entiousness, Antagonism, Openness, or Extraversion are expected
to correlate with borderline personality disorder. For example, lack
of deliberation is but one of six facets of FFM Conscientiousness,
yet it is the aspect most strongly related to borderline impulsivity
(Whiteside & Lynam, 2001). It is perhaps unrealistic to expect a
combination of NEOFFI domain scales (with only two items to
assess each FFM facet) to relate as highly as the DIBR (with 186
items specific to borderline personality disorder) with hypothe-
sized correlates of borderline personality disorder.
The purpose of the current study is to extend FFM personality
disorder research using an expert-consensus FFM borderline per-
sonality disorder profile as a basis for a more specific FFM
borderline index. Our procedure was modeled after the effort of
Miller, Lynam, Widiger, and Leukefeld (2001) to obtain an FFM
NEOPIR score for psychopathy. Miller et al. first assessed the
similarity between the expert-consensus FFM profile of the pro-
totypic psychopath (obtained by averaging expertsratings on each
facet; scale ranged from 1 to 5, where 1 prototypic case is
extremely low on this trait, 5 prototypic case is extremely high
on this trait) with individuals obtained NEOPIR profiles. This
similarity index was then used as an index of psychopathy for each
study participant. Miller et al. found that the NEOPIR psychop-
athy index correlated substantially with a self-report psychopathy
inventory; with symptoms of antisocial personality disorder, sub-
stance abuse, and substance dependence; and with the occurrence
of frequent and varied antisocial activities. Further, this index
correlated negatively with internalizing symptoms of anxiety and
depression. All of the findings replicated in magnitude results
previously reported using incarcerated, Psychopathy Checklist-
Revised (Hare, 1991) defined psychopaths.
The same procedure was used in the current study to obtain an
FFM measure of borderline personality disorder. The FFM bor-
derline prototype reported by Lynam and Widiger (2001) was
matched empirically against an individuals NEOPIR (Costa &
McCrae, 1992) profile to yield a similarity score. The more similar
an individual is to this FFM prototype, the more he or she could be
said to exhibit the FFM borderline personality profile. This simi-
larity index was then used as an FFM index of borderline person-
ality disorder and compared empirically with existing measures of
borderline personality disorder across a variety of samples and
hypothesized correlates.
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TRULL, WIDIGER, LYNAM, AND COSTA
Method
Data were obtained from three independent samples of participants: (a)
a large, nonclinical sample of undergraduates, a subset of which endorsed
significant borderline personality disorder features (nonclinicalborderline
features); (b) a sample of 52 clinical outpatients receiving treatment (Clin-
ical Sample 1); and (c) a second sample of 46 clinical outpatients receiving
treatment (Clinical Sample 2). Results from two of these data collections
(nonclinical sample, Clinical Sample 2) have been reported in previous
articles (Trull, 2001; Trull et al., 1998, 2001), but none of the findings in
this article have been reported previously.
NonclinicalBorderline Features Sample
This sample is part of a larger longitudinal study examining the devel-
opment of borderline personality disorder features in young adults (Trull,
2001). First, 4,927 freshmen at the University of Missouri were screened
with items from the Personality Assessment InventoryBorderline Fea-
tures scale (PAIBOR; Morey, 1991). This scale is a well-validated 24-
item self-report measure of features of personality pathology associated
with the borderline personality disorder (i.e., affective instability, identity
problems, negative relationships, and self-harm). Individuals who scored
higher than 38 on the PAIBOR (two standard deviations above the mean
score for community participants) and those who scored below this thresh-
old (lower than 38) were identified. From these lists of above- and
below-threshold scorers, individuals were randomly selected for additional
testing. Above-threshold individuals were oversampled to ensure that the
final sample would contain a reasonable number of these participants, and
an effort was also made to sample an approximately even number of men
and women from each threshold group.
Each person who agreed by written informed consent to participate first
completed the PAIBOR a second time to ensure that she or he scored in
the same range at retest (i.e., above [B] or below threshold [B]).
Through this two-stage process, a total of 421 individuals completed the
initial phase of the study; 197 individuals in the B group, and 224
individuals in the B group. The B group consisted of 119 women
and 78 men, whereas the B group consisted of 110 women and 114 men.
Most participants were Caucasian (84%) and single (99.5%); some re-
ported previous outpatient treatment for a psychological condition (25%),
and a small percentage (1.7%) reported previous inpatient hospitalization.
The present article focuses on the 407 individuals who provided complete
data on the NEOPIR and on the borderline personality disorder
measures.
The internal consistency of the PAIBOR at its second administration
was .92; testretest reliability was .94 (Trull, 2001). Other measures
administered at this time were the NEOPIR (Costa & McCrae, 1992),
Minnesota Multiphasic Personality Inventory (MMPI) Borderline Person-
ality Disorder scale (Morey, Waugh, & Blashfield, 1985), Structured
Interview for DSMIV Personality (SIDPIV; Pfohl, Blum, & Zimmerman,
1997), Revised Diagnostic Interview for Borderlines (DIBR; Zanarini et
al., 1989), Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg,
Baer, Ureno, & Villasenor, 1988), Family HistoryResearch Diagnostic
Criteria interview (FHRDC; Endicott, Andreasen, & Spitzer, 1978), and
Familial Experiences Interview (FEI; Ogata, 1988).
The NEOPIR (Costa & McCrae, 1992) is a self-report measure of the
personality traits that are part of the FFM. The NEOPIR assesses the five
major domains of the FFM (Neuroticism, Extraversion, Openness to Ex-
perience, Agreeableness, and Conscientiousness), and each domain is
further broken down into six trait facets. The NEOPIR scores have been
shown to be internally consistent and reliable over time, and evidence
supports the convergent and discriminant validity of the domain and facets
scales. In the current sample, the internal consistency of NEOPIR
domain scores was high: Neuroticism .94; Extraversion .90; Open-
ness .88; Agreeableness .91; and Conscientiousness .93. The
MMPI Borderline Personality Disorder scale (Morey et al., 1985) is a
22-item scale consisting of original MMPI items that were judged to
represent DSMIII criteria for borderline personality disorder and that
discriminated between high and low scorers on the total scale score.
Several studies have found that MMPI Borderline scores discriminate
borderline patients from those with other personality disorders (Widiger &
Coker, 2002). The internal consistency of MMPI Borderline items was .76.
The SIDPIV (Pfohl et al., 1997) is a semistructured interview for the
assessment of the criteria for the DSMIV personality disorders, including
borderline personality disorder (Kaye & Shea, 2000; Widiger & Coker,
2002). The DIBR (Zanarini et al., 1989) is a semistructured interview
devoted to the assessment of borderline personality disorder. Scores from
four major sections (affect, cognition, impulse actions patterns, and inter-
personal relationships) are combined to calculate a total score (range
010). The interrater reliability (intraclass correlation coefficient) for the
SIDPIV and DIBR borderline scores in the current study was .81 and
.77, respectively.
The IIP (Horowitz et al., 1988) is a 127-item self-report measure of
distress arising from interpersonal sources (assertiveness, sociability, inti-
macy, submissiveness, responsibility, and control). The mean score across
all 127 IIP items (i.e., total IIP score) is used to represent the overall mean
level of interpersonal distress and has been shown to be both a reliable and
a valid measure of interpersonal distress (Kaye & Shea, 2000). The internal
consistency of the IIP items in this study was .97.
An expanded version of the FHRDC (Endicott et al., 1978) was
administered to all participants to assess a history of mental disorders in
their biological parents. A total of 21 individual diagnoses were evaluated
for each biological parent, and we collapsed across individual categories to
create higher order diagnostic categories for each biological parent (e.g.,
any psychotic disorder, any mood disorder, any anxiety disorder, any
substance use disorder). The interrater reliability of FHRDC parent diag-
noses obtained in the current study ranged from a kappa of .67 to .93.
All participants also completed the FEI (Ogata, 1988), which assesses
retrospectively physical and sexual abuse, physical neglect, loss, and other
areas of family experience. The FEI has been used reliably in a number of
childhood abuse studies, including prior research on borderline personality
disorder (e.g., Silk, Lee, Hill, & Lohr, 1995). In addition, Nigg et al. (1991)
provided validity data on the FEI (i.e., presence/absence of childhood
abuse) by interviewing informants, typically a patients mother or sibling.
The primary FEI scores calculated for the present study were the presence/
absence of physical or sexual abuse. The interrater reliability for FEI
ratings of physical and sexual abuse obtained in the current study was .71
and .82, respectively.
Finally, each participant completed the Social Adjustment Scale (SAS;
Weissman, 1990), a semistructured interview that contains items assessing
major areas of functioning (e.g., work, social and leisure activities, rela-
tionships with extended family, marital/partnership role, and parental role).
Studies have indicated good interrater reliability for SAS item scores, and
SAS scores have been shown to discriminate between impaired (e.g.,
depressed) and unimpaired individuals and to be sensitive to clinical
improvement in patients (Weissman, 1990). In the present study, the
interrater reliability (intraclass correlation) of the sum of SAS scores was
.94.
Clinical Sample 1
This sample of 52 outpatients was drawn from several outpatient clinics
in Columbia, Missouri. Participants were recruited through flyers and
advertisements soliciting participants for a study concerned with person-
ality features in adults. All participants were psychiatric outpatients
screened for a history of brain damage, organic disorder, or developmental
disability. Participants gave their written consent to be in the study and
were paid $5 per hour.
The sample was composed of 40 women and 12 men. The mean age
was 36.0 years (SD 14.4); approximately 90% were White, and approx-
195
FFM BORDERLINE
imately 8% were African American. Half of the sample was single, 19%
were married, and 31% were divorced, separated, or widowed. Across all
participants, the average number of months in outpatient treatment
was 50.6 (SD 64.6), 42% reported a previous psychiatric hospitalization,
67% were currently taking medication for their psychological condition,
and 50% reported a family history of mental illness. This sample was
generally well educated; 90% reported at least some college education.
In addition to the NEOPIR, the Schedule for Nonadaptive and Adap-
tive Personality (SNAP; Clark, 1993), a 375-item truefalse self-report
measure, was also completed. The SNAP contains 12 trait scales and 3
temperament scales. In addition, the SNAP includes diagnostic scales to
assess personality disorder characteristics, including a scale that assesses
features of borderline personality disorder. In this clinical sample, the
internal consistency coefficients of the SNAP trait and temperament scales
ranged from .67 to .90, with a median value of .85. These values are
comparable to those reported in the SNAP manual (Clark, 1993).
The Personality Disorder Interview-IV (PDIIV; Widiger, Mangine,
Corbitt, Ellis, & Thomas, 1995) is a semistructured interview used to assess
the 10 DSMIV personality disorders (APA, 1994). In this sample, only
selected sections of the PDIIV were administered, including the PDIIV
borderline personality disorder questions. Diagnostic criteria are rated on a
3-point scale, ranging from 0 to 2; 0 means the criterion is absent, 1
indicates its presence (APA, 1994), and 2 is used to indicate a more
severely dysfunctional manifestation. Two interviewers, both masters
level clinical psychology graduate students, administered the PDIIV
items. Interviewers received extensive training before the study com-
menced, and all interviews were videotaped. Reliability checks were con-
ducted on 30 randomly selected tapes, and the kappa for a borderline
diagnosis was .84. Twelve percent of the sample was diagnosed with
borderline personality disorder.
Participants also completed three sections of the Personality Diagnostic
QuestionnaireIV (PDQ4; Hyler, Skodol, Oldham, Kellman, & Doidge,
1992), used to assess antisocial, borderline, and histrionic symptom counts.
The PDQ4 is a truefalse self-report measure of DSMIV (APA, 1994)
personality disorder symptoms. For this study, only the PDQ4 borderline
items were used.
Clinical Sample 2
This sample consisted of 46 outpatients who were receiving treatment at
a community mental health clinic in Columbia, Missouri (Trull et al.,
1998). All participants gave written informed consent and completed two
self-report inventories, the NEOPIR (Costa & McCrae, 1992) and the
PDQR (Hyler et al., 1992), and an interview-based assessment of the
FFM, the Structured Interview for the Assessment of the Five-Factor
Model (SIFFM; Trull & Widiger, 1997). The SIFFM is a 120-item semi-
structured interview that assesses the five major domains of the FFM as
well as the 30 first-order trait facets identified by Costa and McCrae (1992)
that make up these dimensions. Answers to each SIFFM item (i.e., inter-
view questions) are scored 0 (absent),1(present and does not result in
significant dysfunction), or 2 (present and may result in significant dys-
function). Initial research on SIFFM scores indicates good to excellent
internal consistency and testretest reliability and excellent convergent and
discriminant validity with the NEOPIR (Trull & Widiger, 1997; Trull et
al., 1998).
Participants were assessed individually, which required up to 3 hr of
time. They were paid $15, and all gave written informed consent. Mean age
was 32.3 years (SD 8.3; range 2061 years), 78% were women, 54%
had at least a college degree, 46% had never been married, 30% had at least
one child, and the average annual income was $12,350 (SD $11,586;
range $1,200$55,000). Approximately 39% were taking medication for
their psychological condition; most were taking an antidepressant. The
median number of treatment sessions at the time of assessment was 17.5
(range 195). The average number of previous courses of outpatient
treatment was 1.9 (SD 1.7; range 09). Approximately 20% had a
history of at least one inpatient psychiatric hospitalization (range 15).
According to the clinic charts, 13% of the sample had a history of at least
one suicide attempt, 9% had a history of self-mutilation, 20% had a history
of substance abuse, 6% had a history of at least one arrest, 2% had a history
of violent or assaultive behavior, 6% had a history of hallucinations, and
4% had a history of delusions. DSMIV (APA, 1994) diagnostic informa-
tion, provided by the treating clinician, was also gathered from the clinic
charts. The most frequently occurring Axis I diagnoses were dysthymic
disorder (46%), major depressive disorder (21.74%), and adjustment dis-
order (11%). The most prevalent Axis II diagnoses were personality
disorder not otherwise specified (11%) and borderline personality disorder
(11%).
Results
We calculated similarity between the Lynam and Widiger
(2001) expert-consensus FFM description of a prototypic border-
line personality disorder and individuals raw NEOPIR facet
scores using an intraclass Q-correlation for each of the 407
nonclinicalborderline features participants, the 52 participants in
Clinical Sample 1, and the 46 participants in Clinical Sample 2.
This correlation is computed as an intraclass correlation in which
the raw facet scores are double entered and treated as cases, and an
individual and the prototype are treated as variables (in the first
entry, individuals scores on the 30 facets are contained in Variable
A, and the scores on the 30 facets of the prototype are contained
in Variable B; in the second entry, the data are reversed; these two
columns of 60 data points are then correlated with one another to
yield an intraclass correlation; Haggard, 1958). As an intraclass
correlation, the similarity index assesses the similarity between an
individuals NEOPIR profile and the expert consensus profile in
terms of both shape and magnitude. Because the two sets of scores
must be of the same metric and because the prototype facet scores
range from 1 to 5 (Lynam & Widiger, 2001), individual NEO
PIR items were transformed from a 04 scale to a 15 scale, with
facet item averages serving as the facet scores. The mean NEO
PIR FFM borderline index score for the nonclinicalborderline
features sample was .09 (SD .35, range ⫽⫺.81.74), for
Clinical Sample 1 it was .08 (SD .30; range ⫽⫺.65.48), and
for Clinical Sample 2 it was .08 (SD .30; range ⫽⫺.77.46).
Convergent Validity
Table 1 indicates that the FFM borderline index correlated as
highly with the direct and specific measures of borderline person-
ality disorder as the latter correlated with each other. These find-
ings were replicated with the data obtained in Clinical Sample 1.
The FFM borderline index correlated as highly with the PDQ4
and SNAP self-report assessments of borderline personality disor-
der as they correlated with each other. A significant but smaller
correlation was obtained with the PDIIV interview-based mea-
sure of borderline symptoms, but this correlation was again similar
in magnitude to that obtained with the two self-report measures.
Finally, the results from Clinical Sample 2 indicated that the
relationship of the FFM borderline index with the PDQR self-
report assessment replicated across self-report (NEOPIR; Costa
& McCrae, 1992) and interview measures (SIFFM; Trull & Wi-
diger, 1997) of the FFM. The convergent validity of the FFM
borderline index across the self-report and interview-based meth-
ods of assessment was quite good (r .81, p .001).
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TRULL, WIDIGER, LYNAM, AND COSTA
Discriminant Validity
We also examined the discriminant validity of the FFM border-
line index relative to the antisocial and avoidant personality dis-
orders. Table 2 provides the discriminant validity coefficients
(assessments for personality disorders other than borderline were
available only for the SIDPIV, SNAP, and PDQR). Given the
questionable discriminant validity of the borderline diagnosis
(Widiger & Coker, 2002), we did not expect the FFM borderline
index to obtain perfect discrimination. In line with this expecta-
tion, the FFM borderline index did at times correlate significantly
with the antisocial and avoidant measures. Nevertheless, discrimi-
nant validity correlations were significantly lower than the corre-
lations with the SIDPIV borderline score, t(404) ⫽⫺3.4 and
4.8, respectively, p .01, and the SNAP borderline score,
t(49) ⫽⫺2.5 and 2.5, respectively, p .05. The FFM borderline
index correlated as highly with the PDQR Avoidant scale as it did
with the PDQR borderline scale, t(43) .22, p .10, but the
correlation with the PDQR Antisocial scale was significantly
lower, t(43) ⫽⫺3.4, p .01.
Components of Borderline Personality Disorder
The top portion of Table 3 provides the correlations of the
NEOPIR FFM borderline index with the four components of the
DIBR (i.e., affect, cognition, impulse actions, interpersonal rela-
tions) along with the correlations obtained by the other three
measures of borderline personality disorder (i.e., MMPI, PAI, and
SIDPIV). It is evident from Table 3 that the FFM, by itself,
accounted for 7% to 27% of the variance in the DIBR borderline
subscales. In addition, the FFM borderline index was generally as
highly correlated with the components of the DIBR (including
impulse actions) as with the two borderline self-report inventories.
The PAIBOR also includes subscales for the assessment of
core components of borderline personality disorder (i.e., Affective
Instability, Identity Problems, Self-Harm, Negative Relations).
The lower portion of Table 3 provides the correlations of the
NEOPIR FFM borderline index with the four PAI components.
The FFM borderline index accounted for 38% to 53% of the
variance in the borderline subscales and often obtained the highest
correlations.
Table 3 also provides the correlations of each borderline per-
sonality disorder scale with the DIBR and PAI borderline sub-
scales after the variance within the respective subscales that were
accounted for by the NEOPIR FFM borderline index was re-
moved (i.e., the residual values). Consistent with the results of
Morey and Zanarini (2000), the MMPI, PAI, DIBR, and
SIDPIV borderline scales were able to account for additional
variance in a component of borderline personality disorder (as
Table 1
Convergent Validity of Five-Factor Model Borderline Score
With Other Borderline Measures
Measure PAI MMPI SIDPIV DIBR
Nonclinical borderline features sample (n 407)
FFM NEO .77*** .65*** .47*** .54***
PAI .70*** .45*** .58***
MMPI .40*** .51***
SIDPIV .64***
PDQ4 SNAP PDIIV
Clinical sample 1 (n 52)
FFM NEO .68*** .68*** .41**
PDQ4 .61*** .53***
SNAP .42***
PDQR FFM SIFFM
Clinical sample 2 (n 46)
FFM NEO .55*** .81***
PDQR .56***
Note. PAI Personality Assessment Inventory (Morey, 1991); MMPI
Morey et al. (1985) Minnesota Multiphasic Personality Inventory person-
ality disorder scales; SIDPIV Structured Interview for the Assessment
of DSMIV Personality Disorders (Pfohl et al., 1997); DIBR Revised
Diagnostic Interview for Borderlines (Zanarini et al., 1989); FFM NEO
five-factor model borderline index assessed by the NEO Personality In-
ventory Revised (Costa & McCrae, 1992); PDQ4 Personality Diag-
nostic QuestionnaireIV (Hyler et al., 1992); SNAP Schedule for
Nonadaptive and Adaptive Personality (Clark, 1993); PDIIV Person-
ality Disorder InterviewIV (Widiger et al., 1995); FFM SIFFM five-
factor model borderline index assessed by the Structured Interview for the
Five Factor Model (Trull & Widiger, 1997); PDQR Personality Diag-
nostic QuestionnaireRevised (Hyler et al., 1992).
** p .01. *** p .001.
Table 2
Discriminant Validity of Five-Factor Model Borderline Score
FFM NEO
SIDPIV
a
SNAP
b
PDQ4
c
12 3 1 2 3 1 2 3
1. BDL .47 .31 .22 .68 .38 .40 .55 .06 .51
2. ANT .27 .47 .13 .25 .35 .28 .32 .33 .12
3. AVD .27 .11 .52 .39 .02 .85 .16 .12 .64
Note. Convergent correlations appear in boldface. FFM NEO five-factor model borderline index assessed by
the NEO Personality Inventory Revised (Costa & McCrae, 1992); SIDPIV Structured Interview for the
Assessment of DSMIV Personality Disorders (Pfohl et al., 1997); SNAP Schedule for Nonadaptive and
Adaptive Personality (Clark, 1993); PDQ4 Personality Diagnostic QuestionnaireIV (Hyler et al., 1992);
BDL borderline; ANT antisocial; AVD avoidant.
a
Nonclinical borderline features sample (n 407).
b
Clinical Sample 1 (n 52).
c
Clinical Sample 2 (n
46).
197
FFM BORDERLINE
assessed by either the DIBR or the PAI) that was not explained
by the NEOPIR FFM borderline index. However, it is also
apparent from Table 3 that in each instance there was a substantial
decrease in the variance accounted for by the MMPI, PAI, DIBR,
and SIDPIV borderline scales after the variance accounted for by
the NEOPIR borderline index was removed (e.g., reduction
from 22% to 3% of the affective component of the DIBR ac-
counted for by the MMPI after NEOPIR FFM variance was
removed).
Not included in Table 3 are the correlations with the NEOPIR
borderline index after variance accounted for by the traditional
measures of borderline personality disorder was removed. These
analyses were also conducted, and in each instance the FFM
borderline index demonstrated significant incremental validity. For
example, the NEOPIR borderline index correlated .30, .28, .31,
and .34 (p .001 in each case) with the PAI Affective Instability,
Identity Problems, Self-Harm, and Negative Relations subscales
after variance accounted for by the MMPI was removed. The
NEOPIR borderline index correlated .35 (p .001), .10 (p
.05), .16 (p .01), and .11 (p .05) with the DIBR Affect,
Cognition, Impulse Action, and Interpersonal Relations subscales
after the variance that could be accounted for by the SIDPIV was
removed.
Correlates of Borderline Personality Disorder
Table 4 provides the correlations of the FFM NEOPIR bor-
derline index with hypothesized correlates of borderline personal-
ity disorder in the nonclinicalborderline features sample (n
407). It is evident that the FFM NEOPIR borderline index
correlated as highly as four explicit measures of borderline per-
sonality disorder did with two of three measures of dysfunction,
including an interview-based measure of general level of function-
ing (SAS) and a self-report measure of interpersonal dysfunction
(IIP).
Consistent with the results of Morey and Zanarini (2000), a
significant proportion of variance in general dysfunction (rang-
ing in value from 6% to 12%) was accounted for by the DIBR
after the variance explained by the NEOPIR FFM borderline
index was removed. However, it is also apparent from Table 4
that only negligible amounts of variance in childhood sexual or
physical abuse or in parental history of mood or substance use
disorder were accounted for by the PAI, MMPI, SIDPIV, or
DIBR after the variance that could be accounted for by the
NEOPIR FFM borderline index was removed. In addition,
the NEOPIR FFM index itself demonstrated incremental
validity in accounting for dysfunction after variance explained
by the DIBR was removed (residual correlations of .14, .31,
and .29 with the SCID, IIP, and SAS, respectively; p .01 in
each case) and for dysfunction assessed by the SAS after
variance explained by the PAI was removed (residual r .16,
p .001).
Discussion
The results of this study indicate that the similarity of a
persons FFM personality trait profile to the prototypic FFM
profile for borderline personality disorder correlated substan-
tially with self-report and interview measures of BPD, as highly
as these measures correlated with each another. The NEOPIR
FFM borderline index also correlated substantially with spe-
cific components of borderline personality disorder assessed
by the PAI and correlated as highly as the self-report measures
did with the DIBR components of borderline personality
disorder.
Table 3
Correlations and Residual Correlations of Five-Factor Model and Other Borderline Scores With
Facets of Borderline Personality Disorder (n 407)
DIBR subscales
FFM
NEO MMPI
MMPI
residual PAI
PAI
residual SIDPIV
SIDPIV
residual
Affect .52*** .47*** .16** .57*** .21*** .43*** .22***
Cognition .29*** .13** .06 .32*** .11* .45*** .29***
Impulse actions .36*** .37*** .15* .32*** .04 .45*** .29***
Interpersonal relations .26*** .26** .11* .34*** .16** .35*** .24***
PAI subscales
FFM
NEO MMPI
MMPI
residual DIBR
DIBR
residual SIDPIV
SIDPIV
residual
Affective instability .73*** .68*** .30*** .55*** .22*** .46*** .16*
Identity problems .62*** .62*** .27*** .49*** .19*** .35*** .08
Self-harm .63*** .51*** .12* .44*** .13* .31*** .02
Negative relations .62*** .56*** .20*** .49*** .20*** .40*** .12*
Note. Residual value is the correlation of the respective borderline scale with the DIBR or PAI subscale
after variance within the subscale accounted for by the FFM NEO has been removed. DIBR Revised
Diagnostic Interview for Borderlines (Zanarini et al., 1989); FFM NEO five-factor model borderline
index assessed by the NEO Personality Inventory Revised (Costa & McCrae, 1992); MMPI Morey et al.
(1985) Minnesota Multiphasic Personality Inventory Borderline scale; PAI Personality Assessment
Inventory (Morey, 1991); SIDPIV Structured Interview for the Assessment of DSMIV Personality
Disorders (Pfohl et al., 1997).
* p .05. ** p .01. *** p .001.
198
TRULL, WIDIGER, LYNAM, AND COSTA
The self-report and interview-based measures of borderline per-
sonality disorder did at times account for additional variance in
borderline symptomatology that was unaccounted for by the FFM
borderline index. However, the extent of the additional variance
was in most instances negligible. For example, some additional
variance in PAI self-harm was accounted for by the MMPI and the
DIBR after the variance due to the FFM borderline index was
removed, but this represented only 1% of additional variance for
the MMPI and 2% for the DIBR. In addition, the FFM borderline
index often outperformed the direct and explicit measures of
borderline personality disorder. For example, the FFM borderline
index accounted for 40% of the variance in self-harm assessed by
the PAI, whereas the MMPI accounted for only 26% of PAI
self-harm, the DIBR accounted for only 19%, and the SIDPIV
accounted for only 10%. The FFM borderline index accounted for
12% additional variance in the DIBR assessment of borderline
affectivity after variance that could be accounted for by the
SIDPIV was removed. The cross-method convergent validity of
the FFM borderline index was substantial and exceeded any con-
vergent validity obtained with the traditional measures of border-
line personality disorder.
The FFM borderline index also replicated the correlations of the
PAI, MMPI, SIDPIV, and DIBR borderline scales with hypoth-
esized correlates of borderline personality disorder. These corre-
lates included global and interpersonal dysfunction, history of
childhood sexual and physical abuse, and parental history of mood
and substance-related disorders. The PAI, MMPI, SIDPIV, and
DIBR measures of borderline personality disorder did account for
significant proportions of variance in global and interpersonal
dysfunction after the variance that could be accounted for by the
FFM borderline index was removed. However, the amount of
additional variance in parental history of mood or substance use
disorders was negligible, and the NEOPIR index, in turn, dem-
onstrated incremental validity over these traditional measures of
borderline personality disorder (including the DIBR) in account-
ing for dysfunction. These findings are discrepant with Morey and
Zanarini (2000) and are perhaps largely due to our use of a more
specific measure of the FFM conceptualization of borderline
personality.
Consistent with the findings of Morey and Zanarini (2000), the
results of the current study do indicate that the FFM borderline
index was unable to account fully for all of the variance within
currently used measures of borderline personality disorder. How-
ever, this same shortcoming is present in all of the existing
borderline measures, as none of them can account for all of the
variance within each other. One potential explanation for the
inability of the FFM borderline index to account for all of the
variance within the DIBR is that there are aspects of borderline
personality disorder that are not within the domain of the FFM
(Morey & Zanarini, 2000). Benjamin (1993) has argued that some
extremely deviant and dysfunctional behaviors, such as wrist
slashing, are difficult to conceptualize as being simply a maladap-
tive variant of a common personality trait. On the other hand,
behaviors that exemplify the tail end of a distribution may only
appear to be qualitatively different from the behaviors that exem-
plify the middle of a distribution. Brutally assaulting a defenseless
victim, failing to speak for years to ones relatives because of a
lack of interest in close relationships, passive submission to den-
igrating exploitation, and self-mutilation are not behaviors that are
seen in the average person nor within most of the members of a
population, but they could be behavioral manifestations of the tail
end of a distribution of traits that are present to varying degrees
throughout the population (Livesley, Jang, & Vernon, 1998; Tyrer,
2001).
Another explanation for the inability of the NEOPIR border-
line index to account for all of the variance in currently used
measures of borderline personality disorder is that these measures
might simply be providing more specific, thorough, and/or differ-
entiated assessments of maladaptive variants of the personality
traits included within the FFM. It is important to recognize that the
PAI, MMPI, PDQR, SIDPIV, DIBR, SNAP, and PDIIV are
inventories and interviews with numerous items developed specif-
Table 4
Relationship of Borderline Scores With Measures of Functioning and Correlates of Borderline Personality Disorder (n 407)
Measure FFM NEO PAI
PAI
residual MMPI
MMPI
residual SIDPIV
SIDPIV
residual DIBR
DIBR
residual
Global functioning (SCID) .42*** .51*** .19*** .40*** .14*** .46*** .29*** .54*** .35***
Interpersonal functioning (IIP) .53*** .65*** .28*** .47*** .15*** .39*** .16*** .49*** .24***
Global dysfunction (SAS) .52*** .49*** .09 .33*** .02 .39*** .15** .52*** .28***
Childhood sexual abuse .19*** .24*** .11* .21*** .09 .21*** .10 .18*** .14***
Childhood physical abuse .20*** .19*** .04 .16** .03 .20*** .11* .23*** .12*
Biol. parentany disorder .26*** .31*** .09 .26*** .07 .20*** .06 .25*** .09
Biol. fathersubstance use disorder .23*** .24*** .05 .20*** .04 .14** .03 .18*** .05
Biol. fathermood disorder .09 .21*** .14*** .11* .05 .10* .06 .13* .08
Biol. mothersubstance use disorder .05 .10* .04 .04 .01 .06 .02 .06 .02
Biol. mothermood disorder .21*** .23*** .05 .22*** .07 .19*** .09 .26*** .14*
Note. Residual value is the correlation of the borderline scale with the variable (e.g., global functioning) after variance accounted for by the FFM NEO
has been removed from the variable. Note that higher SCID Global Functioning scores indicate better functioning. FFM NEO five-factor model
borderline index assessed by the NEO Personality Inventory Revised (Costa & McCrae, 1992); PAI Personality Assessment Inventory Borderline
Features scale (Morey, 1991); MMPI Morey et al. (1985) Minnesota Multiphasic Personality Inventory Borderline scale; SIDPIV Structured
Interview for the Assessment of DSMIV Personality Disorders (Pfohl et al., 1997). DIBR Revised Diagnostic Interview for Borderlines (Zanarini et
al., 1989); SCID Structured Clinical Interview for DSMIV Axis I disorders (First et al., 1995); IIP Inventory of Interpersonal Problems (Horowitz
et al., 1988); SAS Social Adjustment Scale (Weissman, 1990); Biol. biological.
* p .05. ** p .01. *** p .001.
199
FFM BORDERLINE
ically to assess borderline personality disorder psychopathology.
Whereas the DIBR devotes approximately 2 hr to administer 186
questions written specifically for the assessment of borderline
psychopathology, none of the NEOPIR items were written spe-
cifically to assess borderline psychopathology. It should not be
surprising, then, for the DIBR to outperform the NEOPIR FFM
borderline index in the assessment of borderline personality dis-
order symptomatology and psychopathology. It is perhaps more
revealing that the NEOPIR FFM borderline index, which was
developed for the assessment of general personality functioning,
performed as well as the DIBR in most instances and outper-
formed the DIBR in some instances.
Similar conclusions have been made with respect to compari-
sons of assessments by the SNAP, NEOPIR, and Dimensional
Assessment of Personality PsychopathologyBasic Questionnaire
(DAPPBQ; Livesley et al., 1998). For example, Reynolds and
Clark (2001) reported that the 15 SNAP scales outperformed the
NEOPIR facet scales in predicting personality disorder symp-
toms, but they emphasized that the maladaptive personality traits
assessed by the SNAP were strongly represented in the facet scales
of the NEOPIR (Reynolds & Clark, 2001, p. 216). They
suggested that the primary reason that the SNAP outperformed the
NEOPIR was that the FFM measures assess normal-range traits
[whereas] the SNAP primarily assesses extreme variants of
normal-range traits that are maladaptive and clinically relevant
(Reynolds & Clark, 2001, p. 218). In other words, it is not that the
SNAP and the NEOPIR are assessing qualitatively different
domains of personality functioning. Rather, the SNAP and NEO
PIR are covering largely the same domains of personality func-
tioning, but the SNAP, relative to the NEOPIR, is providing
more focus on the maladaptive variants of FFM personality traits.
Researchers and clinicians who are interested solely in the
assessment of borderline personality disorder symptomatology
might be well served by using the DIBR rather than the NEO
PIR, as the DIBR will provide a much more specific and
thorough assessment of borderline personality disorder than will
be provided by the NEOPIR (Zanarini et al., 1989). Researchers
and clinicians whose interest is confined largely to maladaptive
personality traits might be better served by using the SNAP,
DAPPBQ, SIDPIV, MMPI, PAI, PDQ4, or PDIIV, as these
instruments will provide more specific and thorough assessments
of maladaptive personality functioning than will be provided by
the NEOPIR (Clark & Harrison, 2001; Kaye & Shea, 2000;
Widiger & Coker, 2002). However, researchers and clinicians
whose interest also includes general personality functioning as
well as maladaptive personality traits might be well served by
using the NEOPIR, as it will provide a more thorough coverage
of normal personality functioning, allow a screening assessment of
all the personality disorders, and indicate the relations of the
personality disorders to general personality functioning.
Often neglected in comparisons of predictive utility and validity
is a consideration of parsimony and conceptual utility. To the
extent that personality disorders can be understood from the FFM
perspective, basic science research on general personality func-
tioning can be brought to bear. Research on the structure (John &
Srivastava, 1999), genetics (Plomin & Caspi, 1999), neurobiology
(Depue, 1996), and development (Caspi, 1997) of personality can
be applied to the personality disorders to generate theory and to
extend our understanding of their mechanisms and treatment
(Livesley, 2001a). For example, there has been considerable re-
search using pharmacologic challenge and animal models that has
informed neurobiological theories of neuroticism (negative affec-
tivity), constraint (conscientiousness), and extraversion (Depue,
1996). Similarly, there has been considerable interest in the rela-
tionship of temperament to general personality functioning (Clark
& Watson, 1999; Halverson, Kohnstamm, & Martin, 1994). To the
extent that borderline personality disorder is a maladaptive variant
of general personality functioning, the findings of this neurobio-
logical and temperament research can inform our understanding of
the neurobiology and development of borderline personality dis-
order. As acknowledged by Morey and Zanarini (2000), from this
perspective, the FFM could indicate a temperament vulnerability
to a disorder that is then triggered by developmental events (such
as childhood neglect or abuse) (p. 737).
Conceptualizing borderline personality disorder from the per-
spective of the FFM may also be helpful in resolving disputes
concerning the disorder (Clark et al., 1997; Widiger, 1993). For
example, borderline personality disorder is among the more co-
morbid diagnoses within clinical settings (Adams et al., 2001;
Gunderson, 2001). This comorbidity has been so extensive that the
validity of the diagnosis has been questioned (Clark et al., 1997;
Livesley, 1998; Widiger, 1993). From the perspective of the FFM,
personality disorders are expected to be comorbid to the degree
that they assess the same facets of the FFM. Lynam and Widiger
(2001) indicated that much of the borderline diagnostic co-
occurrence with other personality disorders is consistent with its
FFM conceptualization.
It is important in future research to replicate and extend the
results of this study in a larger clinical sample. A limitation of this
study is the relatively small sample of clinic patients (52 in the first
sample, and 46 in the second) and, concomitantly, the relatively
low number of persons who met diagnostic criteria for borderline
personality disorder in each sample. On the other hand, almost 200
form fruste cases of borderline personality disorder were obtained
from an extensive sample of approximately 5,000 college students.
In addition, two clinical samples (total number of clinic patients
98) provided independent replications. Although it is possible that
a sample of even more severely dysfunctional borderline patients
would not replicate the findings obtained in this study (e.g., per-
haps more incremental validity would be obtained by the SIDPIV
in samples weighed heavily in favor of borderline symptomatology
that is relatively specific to this instrument), prior studies of more
severely dysfunctional borderline patients have obtained findings
consistent with FFM hypotheses (e.g., Clarkin et al., 1993; Wil-
burg et al., 1999), and a full range of borderline psychopathology
was obtained in the current study.
Our findings also have more general implications for the assess-
ment and study of other personality disorders that could also be
addressed in future research. For example, it is of interest in future
research to determine whether results obtained in the current study
for borderline personality disorder would also be obtained with
FFM indices of other personality disorders, such as the dependent,
narcissistic, schizotypal, or antisocial. For example, laboratory and
follow-up studies have indicated that persons with a dependent
personality disorder have a weak and ineffectual self-image and an
excessive need to please others that contribute to a variety of
maladaptive interpersonal consequences and episodes of depres-
sion (Bornstein, 1992). Laboratory and follow-up studies have
200
TRULL, WIDIGER, LYNAM, AND COSTA
similarly indicated that persons with narcissistic personality traits
have a vulnerable self-esteem and may at times react aggressively
to signs of threats to their self-esteem (Baumeister, Smart, &
Boden, 1996). It remains to be seen whether FFM dependency and
narcissistic indices, assessed by the correlation of individuals
FFM profiles with the prototypic FFM profiles for these person-
ality disorders, can reproduce the findings obtained with explicit
measures of these DSMIV personality disorders.
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Received August 23, 2001
Revision received March 15, 2002
Accepted August 22, 2002
202
TRULL, WIDIGER, LYNAM, AND COSTA
... These five broad domains are neuroticism versus emotional stability, extraversion versus introversion, openness versus closedness to experience, agreeableness versus antagonism, and conscientiousness versus disinhibition. Importantly, the FFM has been used to conceptualize personality disorders as maladaptive personality traits (O'Connor, 2005;Samuel & Widiger, 2008;Saulsman & Page, 2004), including BPD Trull & Brown, 2013;Trull et al., 2003). ...
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The Five-Factor Borderline Inventory (FFBI) and FFBI-Short Form (FFBI-SF) are 120-item and 48-item measures that assess the underlying maladaptive personality traits of borderline personality disorder (BPD). The purpose of this study was to develop a super short form (FFBI-SSF) and an FFBI-Screener to facilitate the use of dimensional trait measures for BPD. Using item response theory analyses, the 48-item measure was reduced to 22 items using a large undergraduate sample ( N = 1300) and then retested using a Mechanical Turk sample ( N = 602), demonstrating strong replicability. IRT was again used to further reduce the measure from 22 items to four items to provide a brief screening tool. Correlations of the FFBI-SSF and Screener with measures of BPD-related variables were compared across five samples ( N = 919, 204, 580, 281, and 488). Overall, the FFBI-SSF showed similar relations to the FFBI-SF at the full scale and domain-level scales, while the FFBI-screener demonstrated similar relations at the full scale level. This super short form and screener may best be used in large-scale research studies or as part of a screening tool in clinical settings.
... On the one hand, dimensional models should capture at least some aspects of the clinical phenomena defined by categorical diagnoses to verify that dimensional models are reliable and accurate. In fact, general (e.g., BPD: Trull et al., 2003;Miller et al., 2012) and pathological (e.g., Miller et al., 2015) trait models can almost perfectly re-create the nomological networks of the traditional personality disorders. Characterizing categorical diagnoses in terms of dimensional models may also facilitate the translation of existing research on categorical diagnoses to future work with dimensional models. ...
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Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). In the DSM-5 Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65; Mage = 27.60, 70.8% female, 76.9% white), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > .60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs > 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis.
... There is clear evidence that each of the personality disorders can be conceptualized as problematic combinations of these basic personality traits [14,15]. This perspective has been applied to BPD such that it is viewed as primarily consisting of neuroticism with some elements of agreeableness, conscientiousness, and openness to experience [14,16], leading to the development of the Five Factor Borderline Inventory (FFBI) [12] and the FFBI-short form [17] to assess subclinical levels of BPF. ...
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... Notably, the interconnectedness of BPD symptoms may not be limited to individuals with a diagnosis. Current conceptualizations of borderline personality follow a dimensional perspective where BPD is seen as an extreme variant of normal personality rather than a distinct category of psychopathology (Trull et al., 2005). Several taxonometric studies confirm that individuals with a BPD diagnosis are not qualitatively different from those without it; rather, they differ on a continuum of severity of BPD traits (Rothschild et al., 2003). ...
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... In hybrid models (Kernberg, 1984), it has retained both of these meanings. In empirical research, there are reasons to be skeptical that borderline personality repre sents a distinct "disorder" (Haslam et al., 2012;Trull et al., 2003) and reasons to think that it is, instead, a good proxy for relatively severe levels of personality dysfunction (Sharp et al., 2015;Wright et al., 2016). Ultimately, a focused research project that in cludes multimethod indicators of both personality dysfunction and borderline personality, ideally in longitudinal data with samples that vary in clinical complexity, is needed to de termine whether the borderline construct is broad enough to account for personality dys function, as well as whether it captures something more specific than that. ...
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... BPD has been significantly correlated with neuroticism (r = .54), low agreeableness (r = −.24), and low conscientiousness (r = −.29) in meta-analytic work (Samuel & Widiger, 2008), and profiles of FFM traits have been used to assess BPD and demonstrate nearly identical predictive validity as BPD symptoms (Miller et al., 2012;Trull et al., 2003). ...
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Chapter
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