Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users

Hong Wang Fung; Ming Yu Claudia Wong; Stanley Kam Ki Lam; Emily Nga Man Wong; Wai Tong Chien; Suet Lin Hung; Kun-Hua Lee; Jialiang Cui; Colin A Ross

doi:10.1186/s40479-023-00228-x

Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users

Borderline Personal Disord Emot Dysregul. 2023 Jul 3;10(1):22. doi: 10.1186/s40479-023-00228-x.

Authors

Hong Wang Fung¹, Ming Yu Claudia Wong², Stanley Kam Ki Lam³, Emily Nga Man Wong⁴, Wai Tong Chien³, Suet Lin Hung⁵, Kun-Hua Lee⁶, Jialiang Cui⁷, Colin A Ross⁸

Affiliations

¹ Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong. andyhwfung@gmail.com.
² Department of Health and Physical Education, The Education University of Hong Kong, Ting Kok, Hong Kong.
³ Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁴ Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong.
⁵ Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong. slhung@hkbu.edu.hk.
⁶ Department of Educational Psychology and Counseling, National Tsing Hua University, 521 Nan-Da Road, Hsinchu City, 30014, Taiwan.
⁷ Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁸ The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA.

Abstract

Background: Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation.

Methods: We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used.

Results: The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features - including impulsivity, identity disturbance and suicidal/self-mutilation behaviors - were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation.

Conclusions: Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.

Keywords: Borderline personality disorder (BPD); Comorbidity; Dissociation; Trauma; Trauma-informed care.