TRAIT AND DISORDER
Morey and Zanarini
• Distinct personality disorder beginning in childhood and
characterised by pervasive pattern of impulsivity and
unstable personal relationships, self-image and affect.
frantic attempts to avoid real or imagined abandonment
intense and unstable personal relationships
fluctuating self image
impulsivity and recurrent suicidal or self mutilating
gestures or behaviour
transient stress–related paranoia or dissociation
• Clinical diagnosis; must meet minimum of five of the
TWO REPRESENTATIONS BP;
FFM and Categorical Diagnosis
• Global level BPM characterized by very
high N, low A and low C, explaining
features such as identity problems and
fears of abandonment
• BUT other feature’s not associated with
Relationship FFM in a clinical sample
Highlight aspects of categorical diagnostic
concept not captured by the FFM representation
Does FFM miss essential aspects of the BP
Do the residual elements of the categorical
diagnosis add to a diagnostic understanding of
CONTRIBUTION OF RESIDUAL TO
• Antecedent validity; etiological factors
(family history of psychiatric disorders,
childhood abuse and neglect)
• Concurrent validity; symptoms of
dysphoric inner states and dissociative
• Predictive validity; intermediate –term
outcomes at two follow-up intervals –
temporal patterns of functional behaviour.
•Inpatients at a hospital in Massachusetts
• Aged 18-35
•Normal or better intelligence
•No history or current symptoms of serious
•Had been assigned a definite or probable
Axis II diagnosis by a physician
•This resulted in 378 subjects available for
• 3 semi-structured interviews
• Structured Clinical Interview for DSM-III-R Axis I
• Revised Diagnostic Interview for Borderlines (DIB-R)
• Diagnostic Interview for DSM-III-R Personality Disorders
• Five Factor Model
• Self-reported version of the NEO Five-Factor Inventory
• Difficult Childhood Experiences
• Revised Childhood Experiences Questionnaire, which is
a semi-structured interview
• Family History
• Revised Family History Questionniare
• Symptomatology Associated with BPD
• Dissociative Experiences Scale and the Dysphoric Affect
• Global Outcome At Follow-up (2 and 4
• The Global Assessment of functioning scale
• Psychosocial functioning assessed with the Revised
Borderline Follow-up Interview
• Participants: 290 BPD, 72 at least one other Axis
2 disorder (control).
Trait Mean SD Mean SD Sig
N 26.33 7.9 35.07 7.0 p<.001
E 25.66 6.7 22.59 6.9 p<.001
O 30.51 6.6 29.80 6.6 ns
A 32.68 6.5 30.35 6.7 p<.01
C 28.59 7.4 28.56 7.7 ns
• N seemed to be the largest differentiation
between borderline and non-borderline patients.
• C was the only other sig. factor but suggests that
it is a suppressor, in that high levels of C
removes an unwanted portion of the variance in
the N variable.
• FFM captures a sizable proportion of the
variance associated with a borderline diagnosis.
• But what about the rest of the diagnostic
More than personality?
• There were aspects within the 4 sections of the DIB-
R that weren’t fully captured by the NEO-FFI.
Impulse action patterns were the least represented.
• But correlation with measures of BPD showed that
the NEO-FFI representation explained a sig.
proportion of the historical and outcome variables.
• But also history of sexual abuse was related to BPD
diagnosis in a way not fully captured by the NEO-
• FFM factors were more highly associated with long
term outcome than elements of BPD that were
independent of these factors.
1. Diagnosis BP related to FFM
• N scores elevated compared other patients PD’s.
• C discriminated BPD from other PD’s but limited effect.
2. FFM did NOT capture all definitional aspects of BPD
• DBI-R four section – all included aspects not represented by FFM. Affect
section best explained (N) but impulsive actions least explained.
3. Diagnostic elements independent FFM are valid elements of the disorder
and are associated with theoretically important correlates (antecedent,
concurrent and predictive) of the disorder not error variance.
“N as a characteristic level of personality dysfunction... is almost
ubiquitous within clinical populations”
Residual elements represent theoretically viable aspects of BPD
DISTINCTION DISORDER (BPD) AND TRAIT (N)
BPD disorder that changes in severity over time whereas N reflects a stable trait.
• N represents estimate of LT outcome
• Disorder representing meaningful predictors within certain sectors in
response to the situation e.g. symptom severity.