Impulsivity, compulsivity, and impulse control disorders in adults with elevated borderline personality disorder traits

While impulsivity is a core feature of borderline personality disorder (BPD), rates of comorbid impulse control disorders in those with BPD are unclear. Moreover, despite the tendency for impulsivity and compulsivity to present together, compulsivity has been understudied in BPD.

289 participants responded to an online survey on Prolific and completed the following measures: McLean Screening Instrument for BPD, to identify those with elevated BPD traits; the Barratt Impulsiveness Scale-15 (BIS-15), to examine trait impulsivity; the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), to assess compulsivity; and the Minnesota Impulse Disorders Interview, to screen for probable impulse control disorders.

13.1% of the sample met criteria for elevated BPD traits (mean age = 33.24, SD = 11.79; 55.3% women). Those with elevated traits scored significantly higher on both trait impulsivity and compulsivity after controlling for age, sexual orientation, and comorbidities. The compulsivity elevation was primary driven the reward drive subscale. Participants with elevated traits were significantly more likely to screen positive for probable compulsive sexual behavior, but there were no significant differences in rates of other impulse control disorders (i.e., binge eating, compulsive buying, gambling, and trichotillomania).

Individuals with BPD may exhibit more compulsivity than expected, challenging the notion that BPD is solely an impulsive disorder. Compulsive sexual behavior was the one impulse control disorder more common in this group, though whether this reflects a distinctive feature of BPD or greater statistical power for a more prevalent disorder remains unclear.

Both impulsive and compulsive tendencies appear relevant to BPD and its comorbidities. Treatments addressing compulsivity, alongside the impulsivity and emotion dysregulation typically targeted, may warrant further study.