Explaining the Severity of Clinical Symptoms of Borderline Personality Disorder Based on Early Maladaptive Schemas and Coping Styles

Borderline Personality Disorder (BPD) manifests in several deficiencies in self–conceptual interpersonal relationships and behavioral, emotional, and cognitive actions. A factor affecting BPD is the Early Maladaptive Schemas (EMSs), i.e., created in the individual. EMSs begin to form at the beginning of each person's life. When EMSs are triggered, individuals react to them with inefficient coping styles. These dysfunctional styles lead to the continuation of the EMSs. BPD has a high tendency to become chronic; thus, it has a high mortality rate, and numerous other disorders are associated with it. Moreover, the incidence of BPD in society has multiple consequences, including divorce, treatment costs, and so on. Therefore, it is necessary to identify the potentially dangerous factors for this disorder and improve individuals' conditions. Thus, this study aimed to explain the severity of clinical symptoms of BPD based on EMSs and coping styles.

The present correlational study used structural equation modeling. The statistical population of this study included all patients with BPD referring to psychology clinics in Tehran city, Iran, in 2018. The statistical sample consisted of 300 patients with BPD (per clinical psychologist's diagnosis) who were selected by the purposive sampling method. The study's inclusion criteria included having BPD symptoms and its approval by a clinical psychologist. The exclusion criterion of the study was no co–morbidity with other mental illnesses. The required data were collected using Millon Clinical Multiaxial Inventory–III (Millon, 1994), Young Early Maladaptive Schemas Scale (Young, 1990), Young–Rygh Avoidance Inventory (Young & Rygh, 1994), and Young Compensation Inventory (Young, 1995). This study used descriptive statistics (central & dispersion indices, e.g., mean &d standard deviation), inferential statistics (Pearson correlation coefficient) and structural equation modeling to analyze the data. A bootstrap test was used to evaluate the mediating relationships. The significance level was considered 0.05. These analyzes were performed using SPSS and LISREL.

The obtained Pearson correlation coefficient data indicated that there was more correlation between EMSs and extreme compensation (p<0.001, r=0.466) and less correlation between clinical symptoms and avoidance (p<0.001, r=0.10). Moreover, the total path coefficient (sum of direct & indirect path coefficients) between EMSs and the clinical syndrome (p<0.001, β=0.77) was positive and significant. The direct path coefficient between the EMSs and extreme compensation was positive and significant (p<0.001, β=0.60), and path coefficients between EMSs and avoidence (p=0.010, β=0.51) and EMSs and clinical syndrome (p<0.001, β=0.41) were positive and significant. Finally, the indirect path coefficient between the EMSs and the clinical syndrome was mediated by extreme compensation (p=0.015, β=0.12). The indirect path coefficient between the EMSs and the clinical symptoms was significant with the mediation role of avoidance (p=0.013, β=0.49). The goodness of fit indices also supported the optimal fit of the model with the collected data (X2/df=2.282, CFI=0.93, GFI=0.90, AGFI=0.88, RMSEA=0.065).

According to the results, extreme compensation and avoidance coping styles play a mediating role in the relationship between EMSs and BPD symptoms. Overall, the collected results highlight the importance of the role of EMSs in individuals with BPD.