Dissociation and dysfunctional personality traits in patients with borderline personality disorder: a study based on DSM-5 alternative model

Borderline Personality Disorder (BPD) and dissociative experiences are frequently co-occurring conditions. This study aimed to assess the relationship between DSM-5 Alternative Model of Personality Disorder (AMPD) maladaptive personality facets and self-report dissociation in a sample of patients with BPD. Our sample consisted of 178 Italian adult patients who met the criteria for BPD diagnosed by Structured Clinical Interview for DSM IV-Axis II. They were administered the Personality Inventory for DSM-5 (PID-5) and the Dissociative Experiences Scale (DES). An agglomerative hierarchical cluster analysis was performed using facets as clustering variables. Multivariable regression analysis was performed to identify the PID-5 characteristics which could suggest a dissociative dimension. Our results showed the potential of PID-5 to hypothesize a dissociative dimension towards DES scores. Therefore, we theorized a specific BPD phenotype characterized by high levels of Unusual Behaviors and Beliefs, high levels of Perceptual Dysregulation, high levels of Withdrawal, low levels of Impulsivity and Irritability, low levels of Callousness and low levels of Avoidance, for which it may be assumed a dissociative framework. Moreover, it could be postulated that patients with dissociative symptoms who will be diagnosed with BPD according to the AMDP would have the domain of Psychoticism as “specifier”. Lastly, we highlighted the role of gender as a moderator between personality traits and dissociative symptoms. Consistently with this study, an initial assessment with PID-5 personality facets may detect an underlying dissociative psychopathology, suggesting significant clinical implications for both treatment and prognosis.