5 - (SYM 113) BPD Compass: Targeting the Higher-order Personality Dimensions That Underscore Varied Presentations of Borderline Personality Disorder

Borderline personality disorder (BPD) is a heterogenous condition; indeed, there are 256 combinations of the nine DSM criteria for this disorder, and it is possible for individuals to be assigned the same BPD diagnosis and share only two symptoms in common. These variations in BPD presentations may be accounted for by individual differences in higher-order dimensions that can account for symptoms. For example, in the DSM’s Alternative Model of Personality Disorders (AMPD), BPD is understood as elevations in negative affectivity, antagonism, and disinhibition, whereas in the HiTOP model, BPD is represented by the internalizing and antagonistic externalizing spectra. Targeting the higher-order mechanisms that drive an individual patient’s BPD symptoms (and understanding that different patients may endorse different elevations in these mechanisms), rather than focusing on the BPD diagnosis, may provide a more efficient, personalized approach to care. BPD Compass is a novel, personality-based intervention for BPD (BPD Compass) that was developed to address BPD symptoms (and commonly comorbid conditions) by directly targeting the higher-order dimensions of negative affectivity, antagonism, and disinhibition. Patients (N = 100) with BPD (confirmed by clinician-rated structured interview) participated in a randomized controlled trial in which they were assigned to receive 18 sessions of BPD Compass immediately or after an 18 week wait. Results suggest that BPD Compass is associated with significant pre- to post treatment improvements in negative affectivity, disinhibition and antagonism, along with significant reductions in BPD symptoms that were large in magnitude. Within person improvements in each personality dimension was associated with next session improvements in BPD symptoms, providing preliminary evidence that personality dimensions may serve as a mechanism of change. Taken together, these data suggest that a treatment focused on higher-order dimensions of psychopathology is an efficacious approach to treatment for BPD symptoms.