4 - (SYM 6) Cutting-edge Methods and Idiographic Models for Assessing Ovarian Hormone Sensitivity in Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) suffer from rapidly shifting emotional, interpersonal, and behavioral symptoms. Understanding how fluctuations in ovarian hormones across the menstrual cycle may contribute to symptom expression and instability (hormone sensitivity) among ovulating people with BPD is key for accurate assessment of symptoms and effective implementation of behavioral interventions. Our prior small study (N=15) demonstrated 73% with BPD had clinically significant symptom changes across the cycle; our aim is to extend these findings with a larger sample and assessment of a broader range of symptoms and daily hormone levels.

Data presented are initial findings (N=30 at present, expected to be at least 50 when analyzed for this presentation) from a larger, ongoing study examining fluctuation in psychological symptoms across 2 menstrual cycles in ovulating females with clinically significant (3+) BPD symptoms. For generalizability, participants may also meet criteria for most other disorders; our sample includes co-morbid diagnoses such as mood, anxiety, eating, and substance use disorders, ADHD, and PTSD. Participants completed diagnostic interviews and self-report measures at baseline and reported daily emotional and behavioral symptoms across 60-75 days. LH surge testing confirmed ovulation across the study period, and daily levels of progesterone (P4) and estrogen (E2) were assessed via cutting edge urine testing technology.

Compliance rates for daily measures are high across the sample (approximately 80%). We will present results from several analyses, including (1) menstrual cycle phase contrasts in multilevel models, (2) the Carolina Premenstrual Assessment Scoring System (C-PASS), a standardized tool for evaluating clinically significant cycle effects on symptoms, and (3) idiographic network analyses modeling associations between daily hormone changes and self-report symptoms within individual participants.

Results will not only provide evidence from the largest sample to date on menstrual cycle exacerbation of BPD symptoms, but also demonstrate feasibility of assessments and new approaches analyses (idiographic network models with daily hormones) with potential for a wide range of research and clinical applications. Given that Dialectical Behavior Therapy is the gold standard treatment for BPD, we will specifically discuss implications for assessment and treatment, such as how to use daily cycle data to inform approaches to skills training for hormone sensitive clients.