Pathways of dysphoria. Development and validation of a psychopathological-dynamic model for understanding borderline personality disorder.

Borderline personality disorder is one of the most controversial disorders in the contemporary psychopathological scenario. Despite its prevalence both in clinical settings and in nonclinical ones, it falls far behind other major psychiatric disorders in awareness and research, remaining strongly stigmatized by mental health professionals themselves who want to avoid situations that are problematic by nature. Several consequences result from this “sidelining”. The most serious one is that still little is known (or, rather, still little is the general consensus) about BPD core psychopathology. This thesis aims to fill this gap, proposing a new, psychopathological-dynamic model for understanding BPD that tries to describe the subjective experience of these patients, from basic lived experience to symptomatic disturbances level through here-and-now lived experience. In more detail, Chapter 1 will introduce borderline personality disorder from a general point of view. BPD will be described from different perspectives: first of all, epidemiological data related to the disorder will be presented; secondly, use, misuse, and overuse of the borderline diagnosis will be discussed; thirdly, the clinical core of BPD will be examined; fourthly, a multifactorial etiology will be highlighted. Chapter 2 will present the new, psychopathological-dynamic model for understanding BPD from a theoretical point of view. Firstly, the model will be described as a whole; after that, each part of the model will be described in detail, from the psychopathological features at the basic lived experience (“background dysphoria” and “negative interpersonal disposition”) to the variety of symptomatic disturbances (divided into “organizing” and “disorganizing” pathways), through temporary affect depending on situational triggers at the here-and-now lived experience (“situational dysphoria”). Chapter 3 will describe the first empirical investigation of the new, psychopathologicaldynamic model for understanding BPD in a sample of 105 borderline patients (and a group of 105 healthy controls). Findings will be presented according to two steps: I) development and analysis of the psychometric properties of the Situational Dysphoria Scale (SITDS), a questionnaire created ad hoc to measure “situational dysphoria”; II) validation of the whole psychopathological-dynamic model using structural equation modeling analysis (SEM). Results showing very good psychometric properties of SITDS and a close-to-acceptable fit of the whole model in the BPD sample will be finally discussed in order to highlight clinical and theoretical implications of the study as well as directions for future research.