Underlying Dimensions of Borderline Personality Disorder: A Systematic Review of Factor Analytic Studies

Borderline personality disorder (BPD) is considered to be a heterogeneous diagnostic entity, with multiple facets of the disorder influencing its course. Disentangling the structure of BPD criteria is fundamental to better understanding the disorder and targeting problematic behaviors. To identify and critically appraise factor analytic studies examining the structure of BPD criteria. A systematic review was conducted according to PRISMA guidelines. Three computerized databases (Pubmed, Scopus,PsycNET) were searched, resulting in the inclusion of 27 relevant studies. The unified model of BPD has been confirmed by a number of studies, while among multidimensional models, a three-factor model has also gained considerable empirical support. Multidimensional models of BPD tend to cluster together "disordered self" symptoms (identity disturbance and emptiness), affective symptoms (affective instability and anger), and behavioral symptoms (impulsivity and self-harming behaviors). Unidimensional and multidimensional models of the BPD structure are not necessarily in competition. An understanding of BPD as a unified diagnosis composed of three underlying dimensions, could serve the purpose of recognizing and targeting different aspects of the disorder, while maintaining a robust, and clinically useful diagnosis.