Borderline personality disorder and intimate partner violence

Borderline personality disorder and intimate partner violence

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This paper looks at the relationship between borderline personality disorder (BPD) and intimate partner violence (IPV) (Munro and Sellbom, 2020). It compares the DSM-V traditional categorical personality disorder (PD) model, with the DSM-5 Alternative Model of PD (AMPD). (I know – an ELFel lot of acronyms!).

The traditional DSM-V personality disorder model is categorical in its approach – a yes/no approach to diagnosis. An alternative model was added because there were a few challenges with the original model. The alternative model understands BPD as a mix of dimensional (existing on a spectrum) and categorical (separate and distinct) constructs, on the bases of two criterion. Criterion A is impairment in personality functioning, and criterion B being dimensional personality traits.

Intimate partner violence (IPV) refers to any act of abuse (physical, emotional, sexual, financial) towards another within an intimate relationship. The office of national statistics reported that in England and Wales in the year ending March 2020, an estimated 5.5% of adults aged 16 to 74 years (that is 2.3 million people) experienced domestic abuse in the last year (Office for National Statistics, 2020). IPV is associated globally with poorer physical and mental health outcomes (Potter et al., 2020), including suicide (Rahmani et al., 2019) and Post Traumatic Stress Disorder (Dekel et al., 2020), and so should be an area of global health priority.

Borderline Personality Disorder (BPD) is the most commonly recognised personality disorder and people with a BPD diagnosis can experience difficulties in their emotion regulation, patterns of thinking and impulse control (NHS England, 2019). These difficulties are also observed in individuals who perpetrate intimate partner violence, and research has explored the relationship between BPD and IPV for decades (Jackson et al., 2015). However, it is important to note that these vary, and each individual who has a BPD diagnosis will have their own unique experiences.

The aims of the study were to elaborate on BPD and IPV perpetration by including the alternative model of personality disorder (AMPD) dimensional perspective. Authors aimed to examine the relationship between IPV perpetration and BPD using the DSM-5 AMDP dimensional operationalisation of BPD (criteria A & B) and directly compare those findings to traditional BPD – (comparing the new with the old). The authors wanted to find out whether BPD is differently associated with physically sexual and psychological forms of IPV and to see whether the association between BPD and IPV perpetration varied by gender. Individual APMD traits were also of interest, and the authors wanted to investigate their importance in relation to IPV perpetration.

There are two approaches to conceptualising borderline personality disorder – traditional and alternative. This paper explores these and their relationship with intimate partner violence.

There are two approaches to conceptualising borderline personality disorder – traditional and alternative. This paper explores these and their relationship with intimate partner violence.

Methods

250 participants were recruited from ‘Prolific Academic’, a well-established online crowdsourcing platform for academic research.

Inclusion criteria:

  • 18 years or older
  • English speaking
  • In a relationship of at least 4 months

Participants completed the online survey, self-reporting on the following measures:

  • The Revised Conflict Tactics Scale (CTS-2). This uses 5 scales to assess the use of violence and negotiation tactics in intimate relationships. The 5 scales are: Negotiation, Psychological Aggression, Physical Assault, Sexual Coercion, and Injury
  • The Personality Inventory for DSM-5 Short Form (PID-5-SF), which uses four items to assess each of the 25 DSM-5 AMPD Criterion B personality trait facets
  • Level of Personality Functioning Scale (LPFS-BF), which measures the levels of personality functioning scale of the DSM-5 AMPD model
  • The McLean Screening Instrument for Borderline Personality Disorder, which assesses traditional BPD symptomology according to the DSM-IV/DSM-5 diagnostic criteria
  • Structured clinical interview for DSM-IV Axis II Disorders Questionnaire, which assessed PD according to the DSM-IV/DSM-5 Section II diagnostic criteria.

The authors carried out correlational analyses and multiple regression analyses.

Results

The final sample included 239 participants, 116 of which were female and 119 male. The mean age was 30.25 years and ranged from 18-90. The results are summarised below.

Traditional vs alternative model of personality disorder, borderline personality disorder and intimate partner violence perpetration

  • Traditional and AMPD BPD scores were significantly correlated with all measures of IPV
  • Both traditional and AMPD scores were significantly correlated with almost all measures of psychological and physical injury and sexual IPV
  • Physical IPV was most strongly associated with BPD, with correlation magnitudes of 0.27 to 0.35
  • There was no difference between traditional and AMPD BPD in relation to IPV types. The only exception was psychological IPV, which had a significantly stronger correlation with traditional BPD compared with AMPD
  • Gender affected the BPD-IPV association. Male BPD scores were significantly correlated with considerably more IPV variables than female scores, with just under half showing medium effect sizes.

Alternative model of personality disorder, borderline personality disorder dimensions and IPV perpetration

  • Impairment in personality functioning was associated with nearly all CTS-2 IPV perpetration variables (CTS-2 measures violence and negotiation tactics in intimate relationships)
  • There were a number of significant gender differences in the AMPF personality traits associated with IPV perpetration, with a larger correlation magnitude for men
  • AMPD personality trait facet hostility was significantly associated with greater odds of having inflicted all types of IPV within the last year, with the exception of sexual IPV.

Traditional and alternative models of borderline personality disorder appear to be pretty much equal in relation to intimate partner violence.

Traditional and alternative models of borderline personality disorder appear to be pretty much equal in relation to intimate partner violence.

Conclusions

This study aimed to expand on BPD and IPV perpetration research and compare the existing BPD model, with the AMPD.

  • Overall, the study found that traditional BPD and the AMPD were approximately equal in relation to IPV perpetration
  • The study also found that BPD is individually associated with psychological, physical and sexual forms of IPV, and that there were gender differences in the BPD-IPV association
  • In terms of the AMPD trait facets, hostility was the most influential AMPD trait in relation to psychological and physical IPV
  • Risk taking and suspiciousness were the most important predictors of IPV.

There is little difference between the traditional BPD model and the alternative BPD model in terms of interpersonal violence perpetration

There is little difference between the traditional BPD model and the alternative BPD model in terms of interpersonal violence perpetration

Strengths and limitations

This paper addresses an important issue. As discussed before, IPV affects a large amount of people, and that is just the figures we know about. This paper raises important issues around IPV and conceptualisation of BPD and provides novel information to the field of BPD research. Another strength of the research is within its methodology. Validity questions were used throughout the study questionnaire, and the measures that were used had good reliability and validity across the board.

This survey captures responses from across the globe. This serves as a strength and a weakness. The results state that of the participants, 23.8% reside in a variety of ‘non English speaking countries’ and 17.5% reside in ‘other non-speaking English countries’ (other than Canada, United Kingdom and the United States). These countries are not specified, and should be to have an understanding of differences across the globe. Whilst the inclusivity across the globe and a broad representation is a strength, the limitations lie within variance of the cultural understanding and acceptance of intimate partner violence in different parts of the world. Culture is an extremely important factor to take into consideration when looking at not only intimate partner violence, but also how BPD and mental health difficulties in general are conceptualised and understood.

This study did not explore interpersonal violence within the context of same gendered or same sex relationships. A recent review of the literature found that despite IPV being a prevalent issue in same sex or same gendered relationships, there is a distinct lack of studies that explore this violence (Rollè et al., 2018).

Furthermore, in this study, only three participants identified as transgender. Given that male BPD scores were correlated with more IPV variables than female scores, gender is clearly an important factor in understanding IPV. Therefore, it is important we understand the role of IPV in relationships where there are people who identify as transgender. The author’s acknowledge that the small sample size is likely to have led to attenuated statistical power for the gender comparison analysis. A recent systematic review and meta-analysis found that Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth (Peitzmeier et al., 2020). People who identify as lesbian, gay, bisexual, transgender and intersex (LBGTI +) have significantly worse mental health outcomes than their heterosexual counterparts and so this is an important area of research that should be explored (Klotzbaugh & Glover, 2016). The authors provide some relationship demographics, however there was also no data on the types of relationships, for example monogamous; polyamorous, open etc.

Support for the new…and the old (models of borderline personality disorder)

Does this research support the new…and the old models of borderline personality disorder?

Implications for practice

This research demonstrates a clear association between IPV perpetration and AMPD, comparable with the traditional BPD. This study provides support for the construct validity of the DSM-V AMPD dimensional model conceptualisation of BPD. This study supports that the AMPD operationalisation of BPD does capture the relevant IPV criterion variables. Therefore, this study supports the transition from a categorical conceptualisation, to the integration of a dimensional conceptualisation of BPD in clinical practice. This builds on existing evidence that both traditional and AMPD operationalisations of BPD are built on the same constructs, and therefore the transition will have minimal disruption to clinicians and their practice.

This is the first study of its kind to examine the relative associations of traditional and AMPD dimensional conceptualisations of BPD, with external criterion variables. The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools. At present, most current IPV risk assessment tools assess for a general history of mental health concerns, however BPD symptomology is not specifically considered.

The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools.

The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools.

Statement of interests

None.

Links

Primary paper

Munro, O. E., & Sellbom, M. (2020). Elucidating the relationship between borderline personality disorder and intimate partner violencePersonality and mental health.

Other references

Dekel, R., Shaked, O., Ben-Porat, A., & Itzhaky, H. (2020). The interrelations of physical and mental health: self-rated health, depression, and PTSD among female IPV survivors. Violence against women, 26(3-4), 379-394.

Jackson, M. A., Sippel, L. M., Mota, N., Whalen, D., & Schumacher, J. A. (2015). Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration. Aggression and violent behavior, 24, 95-106.

Klotzbaugh, R., & Glover, E. (2016). A lesbian, gay, bisexual and transgender dedicated inpatient psychiatric unit in rural New England: a descriptive analysis in demographics, service utilisation and needs. Journal of clinical nursing, 25(23-24), 3570-3576.

NHS England. Overview. Borderline Personality Disorder. Available from Borderline personality disorder – NHS (www.nhs.uk). Last accessed 20th Dec 2020.

Office for National Statstics (2020). Domestic abuse in England and Wales overview: November 2020. Available at: .

Okada, M., & Oltmanns, T. F. (2009). Comparison of three self-report measures of personality pathology. Journal of Psychopathology and Behavioral Assessment, 31(4), 358-367.

Peitzmeier, S. M., Malik, M., Kattari, S. K., Marrow, E., Stephenson, R., Agénor, M., & Reisner, S. L. (2020). Intimate partner violence in transgender populations: systematic review and meta-analysis of prevalence and correlates. American journal of public health, 110(9), e1-e14.

Potter, L. C., Morris, R., Hegarty, K., García-Moreno, C., & Feder, G. (2020). Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women’s health and domestic violence. International Journal of Epidemiology.

Rahmani, F., Salmasi, S., Rahmani, F., Bird, J., Asghari, E., Robai, N., … & Gholizadeh, L. (2019). Domestic violence and suicide attempts among married women: A case–control study. Journal of clinical nursing, 28(17-18), 3252-3261.

Rollè, L., Giardina, G., Caldarera, A. M., Gerino, E., & Brustia, P. (2018). When intimate partner violence meets same sex couples: A review of same sex intimate partner violence. Frontiers in psychology, 9, 1506.

Photo credits

At present I am a Senior Research Assistant in the academic department at Midlands Partnership Foundation Trust. I am also the Patient and Public Involvement and Engagement lead for research. I graduated with a BSc in Psychology Counselling and Therapies from the University of Bedfordshire in 2016 and went on to complete an MSc Psychology in Clinical Practice at Nottingham Trent University in 2017. I have since worked in forensic services as a psychosocial substance misuse practitioner and an assistant psychologist. I am hoping to complete the Doctorate of Clinical Psychology in the future.

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