Date Published: May 23, 2019
Publisher: Public Library of Science
Author(s): Yvette Vardy, Nicholas J. S. Day, Brin F. S. Grenyer, Stephan Doering.
Intolerance of aloneness is considered a core feature of borderline personality disorder (BPD) that is clinically significant, yet under-researched. This study developed a measure of aloneness for individuals with BPD.
Interviews investigating the experience of aloneness for BPD participants (n = 12) formed the basis for the development of the measure. Pilot testing then occurred with BPD participants, control participants and qualified respondents. Validity, reliability and factor analysis of an Experience of Time Alone Scale (ETAS) was conducted with BPD participants (n = 112) and a comparison control group (n = 105).
A three factor structure was revealed: (a) Cannot Cope Alone (α = .92), (b) Need to Escape from Others (α = .90), and (c) Consumed in Intolerable Distress (α = .88). The measure correlated significantly (p < .01) with the Mental Health Inventory, the Aloneness and Evocative Memory Scale, and the Hurvich Experience Inventory- Revised. Comparisons revealed highly significant differences between the BPD sample and control group on all subscales and the total score (U = 75.5, p = < .001, r = -.85). This study represents one of the first empirical examinations of a construct that has largely only been studied theoretically. This newly developed measure may contribute to diagnosis and therapy.
Borderline personality disorder (BPD) involves instability of interpersonal relationships, self-image, behaviours and affects . Globally, personality disorder prevalence is estimated at 6% , but individuals with BPD can account for up to 26% of emergency presentations and 25% of inpatient admissions within Australia , reflecting a mental health priority area . Intolerance of being alone was once a criteria for BPD in the Diagnostic and Statistical Manual of Mental Disorders , however, in spite of it being one of the more discriminating features, its inclusion in DSM-IV was voted down by committee members who favoured an atheoretical perspective . Despite its deletion, intolerance of being alone remains a key descriptive feature for BPD [7, 8]. As revision of personality disorder criteria is still ongoing , intolerance of being alone remains a clinically relevant yet under-examined feature of BPD that is worthy of further study.
The aim of these studies was to develop a measure of the experience of time alone for individuals with BPD. First, Study 1 examined the essential experience of time alone for BPD participants. Based on these findings a self-report scale was created and pilot-tested to assess the soundness and clarity of the measure. Study 2 then aimed to demonstrate the reliability and validity of the developed scale through correlations with theoretically relevant measures and comparisons between groups in their responses to the scale. As hypothesized, mean scores on the ETAS and all other measures demonstrated that there were significant differences between BPD and control participants in the aversive experiences of aloneness, in general psychopathology, in the intensity of annihilation fears and in both aloneness and evocative memory. BPD participants strongly endorsed ETAS items yet control participants did not indicate that they related to or shared in these experiences to the same extent or even, sometimes, at all. Furthermore, as predicted, higher ratings of aloneness did significantly correlate to poorer general psychopathology, higher ratings of annihilation anxiety, and higher scores on existing measures of aloneness , including poorer evocative memory. These results suggest the ETAS to be a valid measure of the experience of time alone for people with BPD.