Change in personality functioning during treatment with BPD compass

The Alternative Model of Personality Disorders suggests that borderline personality disorder (BPD) is characterized by disturbed personality functioning (self- and other), along with elevated levels of negative affectivity, antagonism, and disinhibition. This study explored the extent to which BPD Compass, a cognitive-behavioral intervention targeting maladaptive personality variants most associated with BPD, addresses the components of Alternative Model of Personality Disorders-defined BPD. In addition, we explored whether improvements in personality functioning were associated with improvements in BPD symptoms. Our intent-to-treat sample included 100 adults (N = 93 who started treatment and had data available for analyses) who met criteria for BPD and were, on average, 28.13 (SD = 8.80) years old, White (n = 88; 88.9%), identified as female (n = 73; 73.7%), and identified as sexual minorities (n = 64; 64.6%). We employed a series of hierarchical linear models to evaluate changes across personality domains and facets during 18 sessions of BPD Compass delivered via telehealth. We also tested whether changes in personality functioning were associated with changes in BPD symptoms using multilevel structural equation modeling. Results suggest significant improvements in negative affectivity, antagonism, disinhibition, and personality functioning during treatment, with medium-to-large effect sizes observed for multiple facets. BPD Compass also was associated with significant improvements in BPD symptoms, and changes in symptoms were significantly correlated with changes in each higher order personality trait. This pattern of results provides support for the feasibility of targeting dimensional traits and indicates that targeting higher order personality traits may streamline care and improve outcomes for BPD patients. (PsycInfo Database Record (c) 2026 APA, all rights reserved).