Borderline Personality Disorder: a Study Based on Quantitative Meta-Analysis Approach

Allahrabbi, Motahareh; Bagholi, Hossein; Barzegar, Majid; Naziri, Ghasem

doi:10.32592/jeche.5.4.129

Volume 5, Issue 4 (January 2025) 2025, 5(4): 129-149 | Back to browse issues page

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Allahrabbi M, Bagholi H, Barzegar M, Naziri G. (2025). Borderline Personality Disorder: a Study Based on Quantitative Meta-Analysis Approach. Journal of Childhood Health and Education. 5(4), 129-149. doi:10.32592/jeche.5.4.129
URL: http://jeche.ir/article-1-220-en.html

Borderline Personality Disorder: a Study Based on Quantitative Meta-Analysis Approach

Motahareh Allahrabbi¹

, Hossein Bagholi ^*²

, Majid Barzegar²

, Ghasem Naziri²

1- Phd. Student in Psychology, Department of Psychology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.
2- Assistant Professor, Department of Psychology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.

Keywords: Borderline personality disorder, Effect size, quantitative meta-analysis

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*EXTENDED ABSTRACT*	*ARTICLE INFORMATION*
Background and Aim: Personality is a set of psychological traits that are relatively stable in different individuals and influence their thoughts and behaviors (Golestani Nejad & Mohammadi, 2020). In general, personality encompasses unique tendencies and traits that lead to individual differences in behavior, stability over time, and continuity of behavior in various situations (Ghaderi et al., 2020). One of the important factors in the development of psychological disorders is personality dimensions, which play a crucial role in the onset of personality disorders (Nozari Gharayi et al., 2020). When an individual's personality traits are so inflexible and maladaptive that they significantly impair functioning, they are recognized as a personality disorder (Abramo et al., 2019). The primary and common feature of personality disorders is rigid and inflexible behaviors, and since these behaviors hinder an individual's adaptation to daily activities and the surrounding environment (Ashouri & Vahdat Panahi, 2020). Among these, one of the most prevalent personality disorders is borderline personality disorder. Borderline personality disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, often accompanied by impulsivity. Suicide and self-harm attempts are key indicators of this disorder (American Psychological Association, 2019). The findings showed that emotional triggers during childhood and psychological trauma from this period play a prominent role in the development of borderline personality disorder in individuals. Childhood plays an important role in the formation of borderline personality disorder; therefore, this paper aims to explore the existing theories in the field of borderline personality disorder to identify the factors exacerbating the prevalence of this disorder and answer the question: Based on the conducted studies, what are the most important factors involved in borderline personality disorder? Methods: This research is applied in terms of its purpose and is a mixed-methods study in terms of its approach. The study was conducted systematically, utilizing previous studies in the form of an article through meta-analysis. The participants in this study were all published texts in this field. To identify important sources related to borderline personality disorder in children under eight years of age, searches were conducted in credible internal and external databases. The inclusion criteria for the research were: articles published on reputable websites between 2013 and 2023 (or equivalent years 1392 to 1402 in the Iranian calendar) related to the causes and factors of borderline personality disorder, with appropriate methodology (correct method, sample size, and statistical method); articles that were fully accessible; and articles that reported sufficient data for effect size measurement. The target population of the research consisted of articles published between 2013 and 2023 (1392 to 1402 in the Iranian calendar) on borderline personality disorder. In total, 38 domestic articles and 27 foreign articles published within the last 10 years in the field of borderline personality disorder were identified. Ultimately, based on the inclusion criteria, 38 domestic articles and 27 foreign articles retrieved from credible databases were selected. Articles that did not report effect sizes were excluded, and after applying the exclusion criteria, 31 Persian articles and 10 English articles were chosen for conducting the quantitative meta-analysis using the Comprehensive Meta-Analysis (CMA) version 4 software. Initially, the literature search was carried out separately by two researchers who were familiar with information retrieval methods. Then, based on the systematic review method, all the components mentioned in these studies were collected and identified based on the shared components across studies and their frequency, which were used as units of analysis. In the next stage, all titles and abstracts of the sources available in the mentioned databases were compiled by the researchers. After reviewing the articles, those meeting the necessary conditions were selected for study and summarized. The required data were then entered into the CMA version 4 software, and necessary analyses were conducted to examine the research questions on the data. To examine the research questions, effect sizes for each intervention were calculated separately, and the combined effect size was calculated using both fixed and random effects models. Homogeneity tests and S-F statistics were also performed. Results: According to the review, regarding the variables studied, 133 variables were targeted in Persian studies, and 44 variables in English studies. After removing duplicate variables, the final count was adjusted to 47 variables. Among these, in 31 Persian articles and 10 English articles where correlation coefficients and regression coefficients were reported, the main variables related to borderline personality disorder included 3 criterion variables (rumination, self-harm, and non-suicidal self-injury behavior) and 45 predictor variables, totaling 48 variables. The meta-analysis result of 45 variables showed that the variables of primary emotional traits, self-esteem, depression, psychological pain, object relations, trauma, mentalization, emotional dysregulation, self-worth, difficulty in emotional regulation, mindfulness, negative spiritual coping, communication skills, psychological flexibility, and self-compassion had the most significant impact on borderline personality disorder. The findings also indicated that the heterogeneity between observed effect sizes suggests the presence of mediating variables that have influenced the results of the studies. Discussions: This study was conducted with the aim of quantitatively combining the results of research on borderline personality disorder (BPD) conducted in 2023. The articles focused on 45 variables as predictors of borderline personality disorder. The meta-analysis of these 45 variables revealed that variables such as primary emotional traits, self-esteem, depression, psychological pain, object relations, trauma, mentalization, emotional dysregulation, self-worth, difficulty in emotional regulation, mindfulness, negative spiritual coping, communication skills, psychological flexibility, and self-compassion had the greatest impact on borderline personality disorder. Among the mentioned variables, trauma and primary emotional traits were related to early childhood experiences. In general, these studies suggest that borderline personality disorder is associated with multiple factors, including childhood experiences, emotional responses, decision-making processes, sensitivity to rejection, and social influences. These interrelationships highlight the complexity of the disorder and the need for multidimensional therapeutic approaches that cater to the individual needs of each patient (Klein, 2019). Moreover, a review of the course of borderline personality disorder indicates that it has a highly variable progression. The most common pattern involves chronic instability beginning in early adulthood, accompanied by severe emotional dysregulation and impulsivity, and a high frequency of visits to healthcare and mental health centers. Follow-up studies on individuals identified at outpatient mental health clinics show that after about ten years, half of the individuals no longer exhibit the behavioral patterns consistent with all the criteria for full-blown borderline personality disorder (American Psychological Association, 2019). There is also substantial evidence indicating that neurocognitive factors are associated with borderline personality disorder. Overall, multiple cognitive and risk factors for borderline personality disorder have been reported, which can be broadly categorized into environmental and temperamental factors (Zanarini & Frankenburg, 2017). What is clear is that painful childhood experiences are closely related to borderline personality disorder. An environmental risk factor for borderline personality disorder is stressful and unpleasant early life experiences, particularly physical neglect and sexual abuse. Sexual abuse in early childhood is a strong predictor of borderline personality disorder in adulthood (Hoffman, 2019). In addition to adverse childhood experiences, emotional difficulties in the mother-child relationship and the development of an independent personality (Zanarini & Frankenburg, 2017), as well as attachment styles (Scott et al., 2019; Ben-Yehuda et al., 2017; Fonagy & Bateman, 2017), play a role in the development of borderline personality disorder. The findings also showed that heterogeneity between the observed effect sizes suggests the presence of mediating variables influencing the research results. Therefore, despite numerous studies on the causes and factors of borderline personality disorder that have examined various aspects of the disorder, there is still heterogeneity between these studies. Heterogeneity refers to the differences between the results of research, which can arise from various causes. Based on the review, borderline personality disorder is related to numerous factors, indicating the disorder's complexity and the necessity for multidimensional therapeutic approaches tailored to the individual needs of each patient. In this context, conducting research aimed at integrating and systematically analyzing existing information from various studies can provide a better and more comprehensive understanding of borderline personality disorder and its underlying causes. 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	Corresponding Author’s Info Email: a.aghajani147@gmail.com
	Article history: Received: 2024/02/04 Revised: 2024/05/30 Accepted: 2024/06/02 Published online: 2025/02/28
	Keywords: Borderline personality disorder Effect size Quantitative meta-analysis