(PS7-58) Identifying subgroups of individuals meeting criteria for borderline personality disorder: A latent profile analysis of symptoms endorsed

Abstract Text: Borderline personality disorder (BPD) is recognized as one of the most deleterious psychiatric conditions, with extremely high rates of comorbid psychopathology (e.g., 60.7% lifetime comorbidity for mood disorders, 27.8% for PTSD, between a 23-76% rate of past suicide attempt, and up to a 10% rate of death by suicide). The simplest assessment for BPD requires the endorsement of at least 5 of 9 symptoms, meaning there are 265 unique permutations that meet criterion for BPD, making it the most diversely presenting psychiatric disorder within the DSM-5 and in dire need of further study.
Few studies have sought to explore the presentation of and trends between specific diagnostic symptoms of BPD and other mental health outcomes, and fewer still have examined the relationships between symptoms themselves. To address this gap in literature, a weighted latent profile analysis (LPA) was conducted among a nationally representative sample of adults with BPD (n=4301) to see if there are distinct groupings among symptoms that can be linked with different behavioral outcomes.
The weighted latent profile analysis, and quantitative and qualitative results, supported a 3-profile solution. Assignment to the first emergent profile corresponded to the lowest endorsement across all BPD symptoms (n = 2614, 60.1%). Assignment to the second emergent profile corresponded to the highest endorsement across nearly all symptoms (e.g., particularly identity disturbance, emptiness, and stress-related paranoia/dissociation), but almost no endorsement of suicide/self-injurious behaviors (n = 496, 11.5%). Assignment to the third emergent profile corresponded to high endorsement of suicide/self-injurious behaviors, and moderate endorsement across all other symptoms relative to other profiles. Additional analyses will examine profile differences based on suicide attempt history, treatment utilization, demographic (e.g., sex, age, race) differences, and experiences with potentially traumatic event exposure.
Results of this study speak to the spectrum of symptom presentation and severity within BPD. Most adults in this sample exhibit low symptom endorsement relative to the other two profiles. Of note, the group with the highest total symptom endorsement exhibited minimal acute suicide behaviors while those with moderate severity endorsed high suicide behaviors, suggesting there may be more nuanced factors influencing risk for suicide and suicide behavior beyond plain symptom severity. Crucially, these data suggest that severity of BPD symptoms may not always be related to or predictive of suicide risk. Such findings should be taken in careful consideration, not only in future study of BPD traits on an empirical level but especially those of tailored therapeutic implementation and suicide prevention