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Original Investigation |

Structure of Genetic and Environmental Risk Factors for Symptoms of DSM-IV Borderline Personality Disorder

Ted Reichborn-Kjennerud, MD, PhD1,2; Eivind Ystrom, PhD1; Michael C. Neale, PhD3,4,5; Steven H. Aggen, PhD3,4; Suzanne E. Mazzeo, PhD6; Gun Peggy Knudsen, PhD1; Kristian Tambs, PhD1; Nikolai O. Czajkowski, PhD1,7; Kenneth S. Kendler, MD3,4,5
[+] Author Affiliations
1Norwegian Institute of Public Health, Oslo
2Institute of Psychiatry, University of Oslo, Oslo, Norway
3Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
4Department of Psychiatry, Virginia Commonwealth University, Richmond
5Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
6Department of Psychology, Virginia Commonwealth University, Richmond
7Department of Psychology, University of Oslo, Oslo, Norway
JAMA Psychiatry. 2013;70(11):1206-1214. doi:10.1001/jamapsychiatry.2013.1944.
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Importance  Previous studies have indicated that the psychopathological dimensions of borderline personality disorder (BPD) are influenced by a unitary liability factor. However, to our knowledge, the underlying etiological nature of the individual criteria for BPD as defined by the DSM-IV has not been explored.

Objective  To determine the structure of genetic and environmental risk factors for the symptoms of BPD.

Design, Setting, and Participants  Multivariate twin study with BPD criteria assessed by personal interview within a general community setting. Participants included 2794 young adults from the Norwegian Institute of Public Health Twin Panel.

Main Outcomes and Measures  The 9 criteria for BPD assessed by the Structured Interview for DSM-IV Personality.

Results  A common pathway model dominated by 1 highly heritable (55%) general BPD factor that strongly influenced all 9 BPD criteria (standardized path coefficients, 0.53-0.79) fit the data best. The model also included 2 additional common liability factors, mainly influencing criteria reflecting the affective and interpersonal dimensions. Both of these were mostly influenced by environmental liability factors (heritability, 29.3% and 2.2%). With 1 exception (criterion 2, unstable and intense relationships), the specific criteria were strongly influenced by environmental factors. Five of the 9 criterion-specific genetic effects were either 0 or negligible.

Conclusions and Relevance  These results indicate that most of the genetic effects on the individual BPD criteria derive from 1 highly heritable general BPD factor, whereas the environmental influences were mostly criterion specific.

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Genetic and Nonshared Environmental Parameter Estimates From the Best-Fitting Model for the 9 DSM-IV Criteria for BPD

Values represent path coefficients, which need to be squared to calculate the proportion of variance in liability accounted for by the latent variables. Paths with values of 0.32 or greater (accounting for 10% or more of the phenotypic variance) from the 3 common latent factors are shown in green, red, and blue. Criterion-specific paths are shown in black. Paths not exceeding 0.32 are depicted in gray. A indicates additive genetic effects; BPD, borderline personality disorder; E, nonshared environmental effects.

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