Identifying Bridge Symptoms Between Borderline Personality Disorder and Posttraumatic Stress Disorder: A Network Analysis From a National Cohort

Mahdi Fayad, MD ; Valentin Scheer, MD, MPH ; Carlos Blanco, MD, PhD ; Patrice Louville, MD ; Marina Sánchez-Rico, PhD ; Katayoun Rezaei, MPH ; Nicolas Hoertel, MD, MPH, PhD ; Frédéric Limosin, MD, PhD

J Clin Psychiatry 2024;85(4):23m15079

Abstract

Objective: Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) share common risk factors, including exposure to traumatic events. We aim to estimate networks of DSM-IV BPD and PTSD to describe the interactions between the symptoms of these 2 disorders and identify bridging symptoms between the 2 diagnoses that may play critical roles in their co-occurrence.

Methods: We performed a network analysis of data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC 2004–2005), a nationally representative sample of the US adult population. We calculated network stability using a bootstrap method and centrality measures for each symptom across 3 different network estimations.

Results: The networks were very stable. The symptom “chronic feelings of emptiness” was the most central in the BPD network. The symptoms “feeling of intense fear or horror” and “recurrent and intrusive memories of the traumatic event” were the most central in the PTSD network. The symptoms “self aggression,” “severe dissociation,” “chronic feelings of emptiness,” and “feelings of detachment” had significantly higher bridge expected influence than most other symptoms in the network in both the full sample and the subsample of participants who responded to all PTSD and BPD symptoms.

Conclusion: Self-aggression, chronic feelings of emptiness, dissociation symptoms, and feelings of detachment represent bridge symptoms between BPD and PTSD. These symptoms could potentially trigger and perpetuate the manifestations of one disorder in the presence of the other. Targeting these symptoms might allow better prevention and management of both disorders.

J Clin Psychiatry 2024;85(4):23m15079

Author affiliations are listed at the end of this article.

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