Recent research published in Affective Disorders Journal suggest that deep-rooted negative beliefs formed during childhood influence how borderline personality traits manifest in people with bipolar disorder. This study provides evidence that people with severe borderline traits experience a stronger psychological web of negative relationship patterns and self-harm than those with milder traits. These findings provide new insights into how mental health professionals can better tailor treatments for complex mood disorders.
Bipolar disorder is a mental health condition characterized by extreme mood swings, including high emotions and depression. Many people with this condition also exhibit borderline personality traits. These characteristics include emotional instability, a distorted sense of self, disrupted relationships, and behaviors that lead to self-harm.
The authors of the new study wanted to understand why some patients with bipolar disorder show very severe borderline features, while others only have mild symptoms. The researchers hypothesized that early maladaptive schemas may explain these differences. Early maladaptive schemas are deeply ingrained, unhelpful patterns of thinking and feeling about ourselves and the world. These negative beliefs typically develop during childhood, when a child’s basic emotional needs are not met.
“Some patients with bipolar disorder exhibit severe borderline personality traits, while others do not. Since the level of borderline personality traits is associated with variations in patients’ clinical characteristics such as mood symptoms, self-identity, and interpersonal relationships, we thought it was important to explore the mechanisms underlying these differences,” explained Myeong-geun Cho from Asan Medical Center.
“We also hypothesized that differences in the levels of borderline personality traits may be related to early maladaptive schemas, as schema therapy assumes that early maladaptive schemas influence some personality-related issues. We therefore decided to compare the levels and associations of borderline personality traits with early maladaptive schemas between bipolar patients with severe borderline personality traits and bipolar patients with less severe borderline personality traits.”
To conduct the study, researchers analyzed data from 557 outpatients being treated at a hospital in Seoul, South Korea. All participants were between 18 and 49 years old and had a formal diagnosis of bipolar I or bipolar II disorder. Bipolar I disorder includes severe manic episodes that are often accompanied by deep depression, whereas bipolar II disorder includes a pattern of depressive episodes and less severe manic episodes.
Patients completed a standardized psychiatric questionnaire as part of their routine medical care. Scientists used specific assessment tools to measure the severity of four borderline traits: emotional instability, identity issues, negative relationships, and self-harm. They also assessed 18 different initial maladaptive schemas using a secondary questionnaire.
These 18 schemas included feelings of abandonment, emotional deprivation, social isolation, and a persistent sense of inadequacy. The researchers divided participants into two different categories based on their assessment scores. The final sample included 345 patients with severe borderline features and 212 patients with non-severe borderline features.
The researchers used a statistical method called network analysis to uncover how these different traits and beliefs are interconnected. Network analysis is a mathematical technique that allows scientists to visualize complex relationships, treating each symptom or belief as a point on a map and drawing lines between them based on how strongly connected they are.
The researchers found that the group with severe borderline traits scored higher on all four borderline traits. This severe group scored higher on all 18 initial maladaptive schemas compared to the non-severe group.
Network analysis revealed several similarities between the two groups. In both patient sets, initial negative beliefs were highly correlated. Specifically, schemas related to feelings of deficiency, shame, and conquest tended to become central hubs of psychological networks.
Submission refers to a person’s tendency to surrender control to others to avoid conflict or rejection. Furthermore, in both groups, patients’ struggles with identity and negative relationships were strongly tied to schemas that included feelings of disconnection and rejection by others.
Another common pattern included self-harm. For all participants, engaging in self-harm was directly related to schemas characterized by insufficient self-control and lack of self-discipline. This provides evidence that the belief that one cannot control one’s impulses contributes to self-destructive behavior.
Despite these commonalities, scientists have found distinct differences in how the traits interact. For patients in the severe group, negative relationship patterns were more strongly intertwined with initial negative beliefs than in the non-severe group. This shows that their interpersonal struggles are deeply rooted in a chronic and unhelpful worldview.
Emotional instability manifests itself differently depending on the severity of borderline traits. For patients with severe borderline features, emotional instability was directly related to self-harm. For people with less severe traits, emotional instability was more related to internal conflict with one’s own identity.
“I would like to emphasize that regardless of whether the borderline personality traits are severe or not, identity issues and negative relationships are directly related to the schema of ‘others reject me,’ and self-harm is directly related to the schema of ‘I can’t tolerate pain well,'” Cho told SciPost. “Another point is that patients with severe borderline personality traits have greater severity across all maladaptive schemas, and negative relationships with others are more closely associated with maladaptive schemas.”
Although this study provides extensive details about the psychological networks of these patients, there may be some misconceptions and limitations that should be considered. This study relied on cross-sectional data. This means that the information was collected at a single point in time. Because of this design, scientists are unable to definitively prove that early maladaptive schemas cause borderline traits. It remains possible that having severe borderline traits changes the way a person remembers and reports their childhood beliefs.
Furthermore, this study only included Korean outpatients from a single hospital. This specific sample may limit the extent to which the findings apply to individuals with different cultural backgrounds and clinical settings.
Future studies should include long-term studies that follow patients over months or years. Observing these changes over time may help uncover direct causal relationships between childhood schemas and personality traits. The scientists also recommend testing whether specific psychotherapies that target these deep-seated beliefs can effectively reduce borderline symptoms in people with bipolar disorder.
The study, “Levels and associations of borderline personality traits and early maladaptive schemas in bipolar disorder: A comparative network analysis,” was authored by Myangkeun Cho, Chanhee Park, Eunbyeol Lee, and C. Hyung Keun Park.
