Levels and associations of borderline personality features and early maladaptive schemas in bipolar disorder: A comparative network analysis of patients with and without severe borderline personality features.

OBJECTIVES

To compare the levels of borderline personality features (BPFs) and early maladaptive schemas (EMSs) and the patterns of associations among BPFs and EMSs between patients with bipolar disorder and severe BPFs (BPF+ group) and those with bipolar disorder and nonsevere BPFs (BPF- group).

METHODS

Korean psychiatry department outpatients aged 18-49 years and with bipolar I or II disorder were enrolled. The levels of BPFs and EMSs were compared between the BPF+ and BPF- groups using t-tests. Two undirected networks were estimated for both groups, and differences between the networks were tested across the following four aspects-network structure, global strength, node centrality, and edge weight.

RESULTS

The BPF+ group had higher levels of all BPFs and EMSs than the BPF- group. Common features in the networks of the two groups were as follows: (i) interrelationships among EMSs and high node strengths of the defectiveness/shame and subjugation schemas; (ii) connections of identity problems and negative relationships with the disconnection/rejection domain; and (iii) relationship between self-harm and the insufficient self-control/self-discipline schema. Conversely, the two networks differed in terms of: (i) higher bridge strength of negative relationships in the BPF+ group; and (ii) a pattern where affective instability was related with self-harm in the BPF+ group but with identity problems in the BPF- group.

CONCLUSION

Clinicians treating patients with bipolar disorder should note that patients with severe BPFs tend to have high EMS levels and mind the similarities and differences in the relationships among EMSs and BPFs across BPF levels.