Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review

Isabel Morales-Muñoz,1,2 Buse Beril Durdurak,1 Ayten Bilgin,3 Steven Marwaha,1,4 Catherine Winsper5 1Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK; 2Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland; 3School of Psychology, University of Kent, Canterbury, UK; 4The Barberry National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK; 5Coventry and Warwickshire Partnership NHS Trust, Research and Innovation, Coventry, UKCorrespondence: Isabel Morales-MuñozInstitute for Mental Health, School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UKEmail I.Morales-Munoz@bham.ac.ukObjective: Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.Methods: We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic–Pituitary–Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.Results: The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.Conclusion: The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.Keywords: sleep, borderline personality disorder, biosocial developmental model, childhood, adolescence, mechanisms