Unveiling the Layers of Borderline Personality Disorder: A Systematic Review of Clinical Subtypes
Abstract
Background: Borderline personality disorder (BPD) is characterised by significant clinical heterogeneity. Classifying subtypes of BPD may offer deeper insights into the disorder’s complexity and inform more tailored therapeutic strategies. The exploration of data-driven subtyping using cluster-analytic approaches represents a promising avenue for capturing variability in symptomatology and comorbidity profiles. Aim: This systematic review aims to synthesise and critically evaluate the empirical studies that have applied cluster-analytic methods to identify subtypes of BPD in adult populations. It further assesses the consistency of findings and their alignment with theoretical models of the disorder. Methods: A comprehensive search of PubMed, Scopus, and PsycNet was conducted in accordance with the PRISMA guidelines. Eligible studies employed either traditional or probabilistic clustering techniques to classify adult individuals diagnosed with BPD based on the DSM criteria. A total of 29 studies, encompassing 24,345 participants, met the inclusion criteria. The study quality and risk of bias were assessed using the AXIS tool. Results: Most studies identified clinically meaningful BPD subtypes based on dimensions such as affective regulation, effortful control, interpersonal style, and impulsivity or aggression. Several findings supported the existence of internalizing and externalizing profiles, which converge with long-standing theoretical conceptualisations of BPD.…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 24,345 participants or records.
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