Sleep disturbance and maladaptive sleep-related cognitions in borderline personality disorder in the longitudinal McLean Study of Adult Development.

Abstract

Study objectives: Sleep and mental illnesses, particularly mood disorders, share complex bidirectional relationships. Emerging evidence suggests sleep may also play an important role in the course of borderline personality disorder (BPD). This study was designed to examine associations between sleep disturbance and maladaptive sleep-related cognitions with recovery from BPD in a longitudinal sample.

Methods: The Pittsburgh Sleep Quality Index and brief Dysfunctional Beliefs and Attitudes about Sleep-16 scales were completed by 223 participants in the McLean Study of Adult Development at the 16-year follow-up wave and over 4 additional consecutive biannual follow-up waves. Generalized estimating equations were used to assess relationships between sleep-related outcomes and recovery vs nonrecovery among participants with BPD over time.

Results: After controlling for clinical and demographic covariates, nonrecovered BPD participants had poorer sleep quality as assessed by the Pittsburgh Sleep Quality Index, lower self-reported sleep quality, greater sleep disturbance, higher use of sleep medication, and greater daytime dysfunction compared to recovered BPD (all P < .002). Additionally, in adjusted analyses, nonrecovered BPD participants had greater maladaptive sleep-related cognitions measured by the overall Dysfunctional Beliefs and Attitudes about Sleep-16 and its related subscales (all P < .006).

Conclusions: These findings demonstrate relationships between sleep disturbance and maladaptive sleep-related cognitions with recovery from BPD over a decade of longitudinal evaluation. Further research to determine whether interventions that target sleep improve core symptoms, functional impairment, and recovery in BPD is indicated.

Citation: Plante DT, Glass IV, Zanarini MC. Sleep disturbance and maladaptive sleep-related cognitions in borderline personality disorder in the longitudinal McLean Study of Adult Development. J Clin Sleep Med. 2025;21(10):1733-1741.