Conceptualizing Borderline Personality Disorder as a Relationship Use Disorder (TLUR)

This study aims to explore a novel conceptualization of Borderline Personality Disorder (BPD) as a "Relationship Use Disorder." The research proposes that BPD shares key features with behavioral addictions, specifically addiction to interpersonal relationships. The study builds upon previous findings suggesting that individuals with BPD experience intense emotional dysregulation, including negative self-perception, shame, and a compulsive need for external validation. This addiction to relationships, much like substance use disorders, is thought to contribute significantly to the difficulties faced by these individuals, including interpersonal conflicts, self-destructive behaviors, and emotional instability.

The study seeks to demonstrate that the relational difficulties central to BPD meet the diagnostic criteria for addiction as defined by the DSM-5. It will also explore how these relational struggles are mediated by dysfunctional self-perception and whether they are linked to behaviors such as compulsive sexual behaviors (CSBD) or suicidal tendencies. Additionally, the research will investigate the relationship between addiction to relationships and neurobiological factors, including endorphin levels, in individuals with BPD compared to those with bipolar disorder and healthy controls. The hypothesis is that individuals with BPD will exhibit higher levels of relationship addiction, with this addiction being tied to their perception of self-worth and emotional experiences in relationships.

This innovative approach aims to refine the understanding of BPD, reduce stigma, and improve treatment strategies by providing scientific evidence supporting the conceptualization of BPD as a "Relationship Use Disorder."

Study Overview

• Status: Not yet recruiting
• Conditions: Borderline Personality Disorder; Bipolar Disorder (BD); Borderline Personality Disorder (BPD)
• Intervention / Treatment: Other: Relationship-use questionnaire

• Study Type: Interventional
• Enrollment (Estimated): 194
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• General : aged 18-45
• Specific :
• Borderline personality disorder (BPD)assessed by SCID, without bipolar disorder
• Bipolar disorder (assessed by SCID), without BPD (evaluated by SCID)
• Healthy controls with no psychiatric disorders (screened by SCID).

Exclusion Criteria:

• Psychotic disorders (evaluated by SCID)
• lack of informed consent
• Not affiliated with social security
• Under judicial or administrative confinement or involuntary hospitalization
• Protected by law (e.g., under guardianship)
• Pregnancy or breastfeeding
• Inability to understand, speak, or write in French
• Inability to understand the study's purpose or methodology
• Excluded from another study during the exclusion period
• Participants who have received over €6000 in annual indemnities
• For Bipolar Participants (without BPD) : Current moderate or severe depressive episode (BDI score > 18) or Current hypomanic/manic episode (YMRS < 12)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patients with borderline personality; Patients with borderline personality disorder without bipolar disorder	Other: Relationship-use questionnaire; Questionnaire adapted from the 'Substance Use Disorders' section of the DSM-5: Disorder related to the use of close relationships
Experimental: Patients with bipolar disorder; patients with bipolar disorder without borderline personality disorder	Other: Relationship-use questionnaire; Questionnaire adapted from the 'Substance Use Disorders' section of the DSM-5: Disorder related to the use of close relationships
Experimental: Healthy controls; Healthy controls (i.e. without psychiatric disorders), from the general population	Other: Relationship-use questionnaire; Questionnaire adapted from the 'Substance Use Disorders' section of the DSM-5: Disorder related to the use of close relationships

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Relational Addiction	Using the experimental relationship-use questionnaire based on the DSM-5 Substance Use Disorder items among patients with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD, and healthy controls.	Measured at baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Function Acquisition Speed Test (FAST)	Administer the Function Acquisition Speed Test (FAST) to measure how quickly individuals learn associations between stimuli and responses, focusing on emotional biases related to self (e.g., feelings of unworthiness, ridicule) and others (e.g., dependency, validation). The aim is to assess the intensity of emotional biases in BPD patients compared to BD patients and healthy controls.	Measured at baseline
Visual Analogue Scale (VAS) for Perceived Alignment with BPD	After viewing an educational video explaining Borderline Personality Disorder (BPD) as relational addiction, assess how participants perceive the alignment of their personal experiences with BPD traits, using a Visual Analogue Scale (VAS) ranging from 0 to 10.	Measured at baseline
Love Addiction Inventory (LAI)	Using the Love Addiction Inventory (LAI), a 24-item self-report scale, to measure symptoms of love addiction. Participants rate their responses on a 5-point Likert scale, with higher scores indicating greater levels of love addiction symptoms, among patients with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD.	Measured at baseline
Beta-Endorphin Levels	valuate the correlation between beta-endorphin levels and the dimension of relational addiction among patients with BPD, BD, and healthy controls	Measured at baseline
Dysfunctional Self-Perception and Related Indicators (SES)	Assessing dysfunctional self-perception and its associated indicators-including feelings of emptiness - among BPD group, BD group and HC group, using : Subjective Emptiness Scale (SES): An 8-item self-report scale measuring feelings of inner emptiness. Higher scores indicate greater perceived emptiness.	Measured at baseline
Dysfunctional Self-Perception and Related Indicators (RSES)	Assessing dysfunctional self-perception and its associated indicators-including self-esteem-among BPD group, BD group and HC group, using : - Rosenberg Self-Esteem Scale (RSES): A 10-item self-report scale assessing global self-worth. The total score ranges from 0 to 30, with higher scores indicating higher self-esteem.	Measured at baseline
Dysfunctional Self-Perception and Related Indicators (ESS)	Assessing dysfunctional self-perception and its associated indicators-including shame,-among BPD group, BD group and HC group, using : - Experience of Shame Scale (ESS): A 25-item self-report scale covering eight domains of shame experiences, including personal habits, interpersonal behaviors, and body image. Higher scores reflect greater shame experiences.	Measured at baseline
Dysfunctional Self-Perception and Related Indicators (VAS)	Assessing dysfunctional self-perception and its associated indicators-including shame,-among BPD group, BD group and HC group, using : - Visual Analog Scale (VAS) for Psychological Pain: Participants mark a point on a 10 cm line that represents their current level of psychological pain. Higher values indicating greater psychological pain.	Measured at baseline
Painful Experiences Related to the Relational Object (MSR)	Assessing the impact of painful relational experiences, focusing on rejection sensitivity, among patients diagnosed with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD, and healthy controls (HC), using : - Rejection Sensitivity Scale (MSR): A 9-item self-report scale assessing the level of anxiety and likelihood of perceiving rejection in various interpersonal situations. Higher scores indicate greater sensitivity to rejection.	Measured at baseline
Painful Experiences Related to the Relational Object (ESUL)	Assessing the impact of painful relational experiences, focusing on loneliness, among patients diagnosed with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD, and healthy controls (HC), using : - University of Laval Loneliness Scale (ESUL): A 20-item self-report scale measuring perceived loneliness in adults. The scale assesses both emotional and social loneliness. Higher scores indicate greater loneliness.	Measured at baseline
Painful Experiences Related to the Relational Object (RSQ)	Assessing the impact of painful relational experiences, focusing on attachment styles, among patients diagnosed with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD, and healthy controls (HC), using : - Relationship Scale Questionnaire (RSQ): A 30-item self-report scale evaluating attachment styles and relational anxiety. Higher scores reflect more insecure attachment styles.	Measured at baseline
Compulsive Sexual Behavior Disorder	Assessing the severity of compulsive sexual behaviors (CSBD) among patients with Borderline Personality Disorder (BPD) without Bipolar Disorder (BD), those with BD without BPD, and healthy controls (HC), using : - Compulsive Sexual Behavior Scale (CSBD-19): a 19-item self-report scale that assesses the severity of compulsive sexual behaviors, following the diagnostic guidelines of the ICD-11. The scale evaluates key dimensions of CSBD, including control, salience, relapse, dissatisfaction, and negative consequences. Participants rate the frequency and impact of their sexual behaviors and impulses on a 5-point Likert scale. Higher scores indicate more severe compulsive sexual behavior.	Measured at baseline
Non-Relational Addictive Propensity	Assessment of Non-Relational Addictive Behaviors in Patients with Borderline Personality Disorder (BPD), Bipolar Disorder (BD), and Healthy Controls (HC), using substance use disorder criteria. Participants will be screened for a range of substances (e.g., alcohol, opioids, stimulants) and will be asked about the frequency, quantity, and impact of substance use in their life.	Measured at baseline
Suicidal Tendencies	Assessment of Suicidal Tendencies in Patients with Borderline Personality Disorder (BPD), Bipolar Disorder (BD), and Healthy Controls (HC), using : Columbia-Suicide Severity Rating Scale (C-SSRS): The C-SSRS is a clinician-administered assessment tool designed to measure the severity and frequency of suicidal and para-suicidal behaviors. The scale includes questions about lifetime suicidal ideation, recent suicidal ideation, and behaviors, including planning, attempts, and self-injurious actions.	Measured at baseline

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2026
• Primary Completion (Estimated): November 1, 2027
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: December 11, 2025
• First Submitted That Met QC Criteria: January 6, 2026
• First Posted (Actual): January 13, 2026

Study Record Updates

• Last Update Posted (Actual): January 13, 2026
• Last Update Submitted That Met QC Criteria: January 6, 2026
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: borderline personality disorder; relationship-use disorder
• Additional Relevant MeSH Terms: Bipolar and Related Disorders; Mental Disorders; Mood Disorders; Personality Disorders; Bipolar Disorder; Borderline Personality Disorder
• Other Study ID Numbers: RECHMPL24_0194

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No