Triantafyllou Alexandra, Stefanatou Pentagiotissa, Konstantakopoulos George, Giannoulis Eleni, Malogiannis Ioannis
First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Department of Speech and Language Therapy, University of Peloponnese, 24150 Kalamata, Greece.
Behav Sci (Basel). 2025 Jul 9;15(7):928. doi: 10.3390/bs15070928.
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. 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. 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. 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. However, substantial heterogeneity was observed in subtyping bases, sample characteristics, and analytic procedures. Although this review highlights the recurring subtype patterns, the methodological inconsistencies and a lack of longitudinal and treatment-outcome data limit the strength of the conclusions. The future research should prioritise standardised subtyping frameworks and explore the prognostic and therapeutic utility of BPD subtypes in clinical settings.
边缘型人格障碍（BPD）具有显著的临床异质性。对BPD的亚型进行分类可能会更深入地洞察该障碍的复杂性，并为更具针对性的治疗策略提供依据。使用聚类分析方法探索数据驱动的亚型分类是捕捉症状学和共病特征变异性的一个有前景的途径。本系统评价旨在综合并批判性地评估应用聚类分析方法识别成年人群中BPD亚型的实证研究。它还评估了研究结果的一致性及其与该障碍理论模型的契合度。根据PRISMA指南对PubMed、Scopus和PsycNet进行了全面检索。符合条件的研究采用传统或概率聚类技术，根据DSM标准对诊断为BPD的成年个体进行分类。共有29项研究，涵盖24345名参与者，符合纳入标准。使用AXIS工具评估研究质量和偏倚风险。大多数研究基于情感调节、努力控制、人际风格以及冲动或攻击性等维度确定了具有临床意义的BPD亚型。一些研究结果支持内化和外化特征的存在，这与BPD长期以来的理论概念相契合。然而，在亚型分类基础、样本特征和分析程序方面观察到了显著的异质性。尽管本综述强调了反复出现的亚型模式，但方法学上的不一致以及缺乏纵向和治疗结果数据限制了结论的力度。未来的研究应优先考虑标准化的亚型分类框架，并探索BPD亚型在临床环境中的预后和治疗效用。
