Association Between Borderline Personality Traits and Addictive Features of Non-Suicidal Self-Injury in Adolescent Patients With Depressive Disorder

Abstract

Objective: This study aimed to investigate the association between borderline personality traits and addictive features of non-suicidal self-injury (NSSI) in adolescent patients with depressive disorder, identify independent risk factors for NSSI addictive features and provide evidence for clinical intervention.

Methods: A cross-sectional study design was utilised. A total of 320 adolescent patients with depressive disorder (aged 12–18 years, mean ± SD: 15.82 ± 1.74 years; 238 females, 74.38%) admitted to Jingzhou Mental Health Center between January 2024 and October 2025 were enrolled. Assessments were conducted using the 17-item Hamilton Depression Rating Scale, the Borderline Personality Features Scale for Children (BPFS-C), the Adolescent Self-Rating Life Events Checklist (ASLEC), the 20-item Toronto Alexithymia Scale, the Family APGAR Index and the Addiction Subscale of the Ottawa Self-Injury Inventory (OSI-AS). Pearson correlation analysis was conducted to explore the association between borderline personality traits and NSSI addictive features. Binary logistic regression analysis was performed to identify independent influencing factors for NSSI addictive features.

Results: Based on the presence or absence of NSSI addictive features, the 201 patients in the NSSI group were further divided into an addictive NSSI subgroup (n = 111) and a non-addictive NSSI subgroup (n = 90). The OSI-AS score was significantly higher in the addictive NSSI subgroup than in the non-addictive subgroup (p < 0.001). The total BPFS-C score and its subscale scores showed significant positive correlations with NSSI addictive features (p < 0.001). Binary logistic regression analysis revealed that, after adjusting for confounders such as age, gender, severity of depression and family function, the total BPFS-C score (odds ratio [OR] = 1.116, 95% confidence interval [CI]: 1.077–1.157, p < 0.001) and the total ASLEC score (OR = 1.051, 95% CI: 1.021–1.082, p = 0.001) were independent risk factors for NSSI addictive features. The overall prediction accuracy of this model was 84.7%.

Conclusion: Borderline personality traits are an independent risk factor for NSSI addictive featuresin adolescent patients with depressive disorder and are closely associated with the severity of addictive NSSI. In clinical practice, screening for borderline personality traits should be implemented for adolescents with depression and NSSI. Early psychological interventions targeting core features such as affective instability and impulsivity should be conducted to reduce the risk of NSSI addiction.