Clinical Psychology and Psychotherapy
Clin. Psychol. Psychother. 14, 365–376 (2007)
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/cpp.549

Copyright © 2007 John Wiley & Sons, Ltd.

Assessment of
Borderline Pathology
Using the Inventory of
Interpersonal Problems
Circumplex Scales
(IIP-C): A Comparison
of Clinical Samples

Mark J. Hilsenroth,

1

John Menaker,

1

Eric J. Peters

2

and

Aaron L. Pincus

3

1

The Derner Institute of Advanced Psychological Studies, Adelphi University

2

Psychology Department, Bronx Psychiatric Center

3

Department of Psychology, Pennsylvania State University

We examined the interpersonal functioning of 74 outpatients at a uni-
versity-based community clinic in a naturalistic study. Twenty-three
individuals diagnosed with borderline pathology (BP) were com-
pared with a non-BP clinical control group (n

= 51). Based on previ-

ous research, we hypothesized that individuals with BP would report
significantly greater overall interpersonal distress as well as greater
problems associated with non-assertive, overly accommodating, self-
sacrificing and intrusive/needy relational behaviours. We found that
individuals with BP reported greater interpersonal distress in regard
to overly accommodating, self-sacrificing and intrusive/needy rela-
tional behaviours. A trend was observed in regard to differences in
overall interpersonal distress. Evaluation of the group-level circum-
plex profiles confirmed group homogeneity in interpersonal problem
endorsement, supporting the aggregate descriptions of interpersonal
style as representative of individuals within each group. The clinical
utility of our results, specifically in regard to psychotherapy process
and outcome as well as therapeutic alliance, will be discussed. Copy-
right © 2007 John Wiley & Sons, Ltd.

* Correspondence to: Mark J. Hilsenroth, 220 Weinberg Bldg.,
158 Cambridge Ave., The Derner Institute of Advanced
Psychological Studies, Adelphi University, Garden City,
NY, 11530.
E-mail: [e-mail]

tions that one develops (e.g., Benjamin, 1996;
Pincus, 2005a; Pincus & Ansell, 2003; Pincus, Dick-
inson, Schut, Castonguay, & Bedics, 1999). It then
follows that borderline personality disorder (BPD)
represents a particular internal framework to mod-
ulate the nature of interpersonal experience. That is,
borderline pathology (BP) can be viewed as the spe-
cific manner in which information regarding inter-
personal interaction comes to be organized and as
such has a link to enduring relational patterns and

Interpersonal style is understood to encompass a
view of self, as well as self in relation to others,
which becomes apparent in the context of the inter-
nal working models, schemas or object representa-

Assessment

366

Hilsenroth et al.

Copyright © 2007 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 14, 365–376 (2007)

DOI

: 10.1002/cpp

subsequent interpersonal problems (Benjamin,
1992). From this vantage point, several authors have
noted the BPD patient’s deep-seated fear of aban-
donment that manifests in an exaggerated need for
relatedness, incapacity to tolerate being alone, com-
pulsive care seeking and their working desperately
to retain connections to others (Bateman & Fonagy,
2004; Blatt & Blass, 1996; Clarkin, Widiger, Frances,
Hurt, & Gilmore, 1983; Greenberg & Mitchell, 1983;
Gunderson, 1996; Masterson, 1981, 1976; Sack,
Sperling, Fagen, & Foelsch, 1996).

In particular, dysfunctional interpersonal styles

are considered an important aspect of both Axis I
and Axis II disorders (Benjamin, 2003; Horowitz,
2004; Kiesler, 1996; Pincus, 2005a, 2005b; Widiger &
Frances 1985; Widiger & Kelso, 1983). The interper-
sonal problems circumplex is a two-dimensional
circular model of interpersonal dysfunction arising
from the major interpersonal dimensions of per-
sonality (Alden, Wiggins, & Pincus, 1990; Horowitz,
Alden, Wiggins, & Pincus, 2000; Kiesler, 1996;
Pincus & Gurtman, 2006) where the vertical axis
represents problems with Dominance (or more
broadly, Agency) and the horizontal axis represent-
ing problems with Nurturance (or more broadly,
Communion). As a measure of relational function-
ing, the Inventory of Interpersonal Problems-Cir-
cumplex (IIP-C; Alden et al., 1990; Horowitz et al.,
2000) may provide a potentially nuanced view of
the dynamics involved in BP and will be the focus
of the current investigation.

The majority of empirical investigations linking

the interpersonal circumplex model and BPD have
examined correlations between self-reported BP
and the IIP-C in non-clinical (e.g., Pincus &
Wiggins, 1990; Ryan & Shean, 2007; Sim & Romney,
1990), general clinical samples (e.g., Soldz, Budman,
Demby, & Merry, 1993) or forensic samples (Leich-
senring, Kunst, & Hoyer, 2003). Only a few studies
have examined the IIP-C responses of patients clin-
ically diagnosed with BPD (Bellino, Zizza, Rinaldi,
& Bogetto, 2006; Kvarstein, Karterud, & Pedersen,
2004; Leihener et al., 2003).

Using the Interpersonal Check List (LaForge,

1977), Sim and Romney (1990) found self-ratings
of individuals with BPD to be related to greater
affiliation and submissiveness represented in the
Overly Accommodating/Exploitable (JK) and Self-
sacrificing/Overly-nurturant (LM) octants of the
circumplex. Results also indicated that individuals
diagnosed with BPD rely upon more problematic
and rigid interpersonal behaviours relative to
normal individuals. Using the IIP-C with a clinical
sample, Soldz et al. (1993), found BPD indices to

fall in the Intrusive/Needy (NO) octant represent-
ing issues of inappropriate self-disclosure, exces-
sive attention seeking and difficulty being alone,
replicating this link between BP and greater desire
for interpersonal connection Although Sim and
Romney (1990), as well as Soldz et al. (1993),
reported the placement of BPD individuals in the
circumplex space, neither study directly compared
interpersonal distress of BPD individuals with clin-
ical control groups made up of non-BPD patients.
Conversely, using diagnostic efficiency statistics,
Stern, Kim, Trull, Scarpa, and Pilkonis (2000) sup-
ported the utility of their IIP Personality Disorder
Scales as a screening tool for the presence or
absence of BPD and other personality disorders.
Also, results reported by Lejuez et al. (2003) indi-
cate the utility of the IIP Personality Disorder
Scales for use in analogue studies of BP.

Recently, Leihener et al. (2003) found the IIP-C

useful for understanding two BPD subtypes:
autonomous and dependent. Autonomous indi-
viduals described themselves as cold, aloof and
non-obsequious, represented by high scores on the
Cold/Distant (DE) and Domineering/Controlling
(PA) octants of the IIP-C and low scores on the
Overly Accommodating/Exploitable (JK) and
Non-assertive (HI) octants. In contrast, dependent
individuals described themselves as lacking
autonomy in relationships, complacent and con-
flict-avoidant, characterized by low scores for
Domineering/Controlling (PA) and Vindictive/
Self-centered (BC) octants and high scores for the
Non-assertive (HI) octant. In this sample, nearly
73% of BPD patients were of the dependent
subtype (n

= 69), constituted with patients who

exhibited greater levels of affiliative and submis-
sive tendencies relative to the autonomous subtype
(n

= 26). Ryan and Shean (2007) recently replicated

these results in a large student analogue sample.
Similarly, Leichsenring et al. (2003) reported two
major correlational trends between the IIP-C and
subscales of the Borderline Personality Inventory
(BPI; Leichsenring, 1999). BPI Identity Diffusion
was significantly correlated with Overly Accom-
modating/Exploitable (JK), Self-sacrificing (LM)
and Intrusive/Needy (NO) interpersonal prob-
lems. BPI Primitive Defenses/Object Relations was
significantly correlated with Domineering/Con-
trolling (PA), Vindictive/Self-centered (BC), Cold/
Distant (DE) and Socially Inhibited (FG) interper-
sonal problems. Thus, previous research indicates
BP is related to a variety of dysfunctional interper-
sonal patterns, most consistently overly affiliative
problems reflecting exploitability, difficulty setting

Borderline IIP

367

Copyright © 2007 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 14, 365–376 (2007)

DOI

: 10.1002/cpp

relational limits and intrusive/needy behaviours.
In some studies, more controlling and hostile prob-
lems were also identified (e.g., Bellino et al., 2006),
consistent with the clinical literature.

This study extends the scope of existing research

and broadens our understanding of the interper-
sonal components of BP using the Inventory of
Interpersonal Problems. Previous research has
explored BP in circumscribed populations (e.g.,
Kvarstein et al., 2004; Leichsenring et al., 2003; Lei-
hener et al., 2003), with few studies examining the
relational aspects of this diagnostic category in an
unrestricted clinical sample. This study, in contrast,
is unique in that patients naturalistically sought
treatment for problems related to Axis I and/or
Axis II disorders, consistent with applied clinical
practice. As far as can be discerned, this study is
the first to compare a group of patients with BP on
the IIP-C with a clinical comparison group to
control for the effects of general clinical distress.
Also, given the increasing recognition of dimen-
sional models of psychopathology, the current
investigation includes a patient sample with a
range of BP as would likely be found in real-world
clinical settings (Bagge, Nickell, Stepp, Durrett,
Jackson, & Trull, 2004; Shedler & Westen, 2004;
Skodol, et al., 2005; Trull, 2001; Westen, Novotny,
& Thompson-Brenner, 2004; Westen & Shedler,
1999; Zittel-Conklin & Westen, 2005). Together, the
use of a naturalistic treatment-seeking sample,

patients with a range of BP and a clinical control
group serves to increase the generalizability of our
findings.

Based on the research reviewed previously on the

interpersonal functioning present in BP, we expect
these patients to score significantly higher on overall
interpersonal problems and on octants representing
interpersonal affiliation and submissiveness rela-
tive to a non-BPD clinical control group. Specifically,
significant differences are predicted for the Non-
assertive (HI), Overly Accommodating/Exploitable
(JK), Self-sacrificing/Overly nurturant (LM) and
Intrusive/Needy (NO) octants of the IIP-C.

METHOD

Participants

All participants were representative of those actu-
ally seeking outpatient treatment at a university-
based community clinic. Cases were assigned to
treatment practica and clinicians in an ecologically
valid manner based on real-world issues regarding
aspects of clinician availability, caseload etc. More-
over, patients were accepted into treatment regard-
less of disorder or comorbidity. The participants in
this study were all patients (N

= 74) admitted to a

psychodynamic psychotherapy treatment team at a
university-based community outpatient clinic who
had completed an IIP-C. Table 1 shows demo-

Table 1. Participant demographics

BP

Non-BP

Total

n

= 23

n

= 51

n

= 74

Mean age (years)

30.5

29.2

29.5

Gender

Male

4 (17%)

20 (39%)

24 (32%)

Female

19 (83%)

31 (61%)

50 (68%)

Marital status

Single

13 (57%)

28 (55%)

41 (55%)

Married

4 (17%)

12 (24%)

16 (22%)

Divorced

6 (26%)

10 (20%)

16 (22%)

Widowed

0 (0%)

1 (2%)

1 (1%)

Primary Axis I diagnosis

Adjustment disorder

1 (4%)

9 (18%)

10 (14%)

Anxiety disorder

2 (9%)

5 (10%)

7 (9%)

Eating disorder

0 (0%)

1 (2%)

1 (1%)

Mood disorder

18 (78%)

27 (53%)

45 (61%)

Substance related disorder

1 (4%)

1 (2%)

2 (3%)

V code relational problem

1 (4%)

8 (16%)

9 (12%)

Axis II diagnosis

21 (91%)

18 (35%)

39 (53%)

Axis II traits/features

2 (9%)

12 (24%)

14 (19%)

BP

= patients with borderline pathology.

368

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Copyright © 2007 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 14, 365–376 (2007)

DOI

: 10.1002/cpp

graphic information as well as the distribution of
patients’ primary Axes I and II diagnoses for the
entire sample in accordance with the Diagnostic
and Statistical Manual of Mental Disorders (4th ed.)
(DSM-IV) (American Psychiatric Association,
1994). All 74 patients in this study received a DSM-
IV Axis I diagnosis, and 39 patients received an Axis
II disorder. In addition, 14 patients were assessed to
have subclinical but prominent Axis II features or
traits. Thus, this sample consisted of primarily
mood disorder patients with relational problems
manifested in subclinical traits/features of Axis II
personality disorders. Of the Axis II patients, nine
met full (five or more individual BPD criteria) cri-
teria for DSM-IV BPD, 12 exhibited prominent
traits/features (i.e., three or four individual criteria)
of BPD as part of personality disorder not otherwise
specified diagnosis, where these BPD symptoms
were seen as the primary personality pathology (see
Grilo et al., 2005; Gunderson et al., 2000; Zimmer-
man, Rothschild, & Chelminski, 2005 for similar
procedures) and two patients exhibited prominent
subclinical traits/features (i.e., three individual
criteria) of BPD. In the remaining 51 patients, none
met DSM-IV criteria for any clinical or subclinical
traits/features of BPD. Although within the non-BP
sample (n

= 51) 30 patients met criteria for either

Axis II personality disorders or subclinical
traits/features other than BPD. In this non-BP
sample, 16 patients demonstrated personality
pathology from Cluster C (avoidant, dependent,
obsessive–compulsive), six patients from Cluster A
(paranoid, schizoid, schizotypal) and even eight
patients from Cluster B (antisocial, histrionic, nar-
cissistic), excluding BPD. The inter-rater reliability
for the classification of personality pathology across
three dimensions—(1) presence of a personality dis-
order; (2) presence of subclinical traits/features;
and (3) absence of a personality disorder—was
found to be excellent (i.e., ICC

> 0.74; Shrout &

Fleiss, 1979) for this project (Hilsenroth et al., 2000;
Peters et al., 2006). In addition, inter-rater reliability
for the presence or absence of BPD pathology was
also found to be quite high (Kappa

= 0.74; Stein,

Pinsker-Aspen, & Hilsenroth, 2007). Finally, each
participant provided written informed consent to
be included in this research.

Procedure

Each participant completed a videotaped semi-
structured clinical interview that lasted approxi-
mately 2 hours. The clinical interview focused on
a number of salient therapeutic topics, such as pre-

senting problems, psychiatric and medical history,
family history; developmental, social, educational
and work history; an exploration of both historic
and current relational episodes; and a mental
status examination that included an assessment of
all DSM-IV symptom criteria for schizophrenia,
major depressive/manic/mixed episode, dys-
thymia, as well as many anxiety symptoms. In
addition to when Axis II disorders or significant
subclinical trait/features appeared to be present
(i.e., three or four individual criteria for a given
personality disorder), interviewers inquired about
and assigned DSM-IV ratings for the Axis II disor-
der diagnosis under consideration. In addition to
the clinical interview, each participant received an
interpretive/feedback session lasting 1–1.5 hours,
also videotaped, organized according to a Thera-
peutic Model of Assessment (Finn & Tonsager,
1997; Fischer, 1994). This approach focuses on col-
laboration, alliance building, exploration of factors
maintaining life problems (often relational) and
identification of potential solutions, and thera-
pist–patient interaction. Further details of the
methodology and procedures used in this assess-
ment process are described more fully elsewhere
(see Ackerman et al., 2000; Hilsenroth, 2007;
Hilsenroth, Peters, & Ackerman, 2004).

Advanced graduate students enrolled in an

American Psychological Association-approved
clinical psychology Ph.D. programme conducted
the psychological assessment, feedback sessions
and ratings of DSM-IV diagnoses. All clinicians
had completed graduate course training in de-
scriptive psychopathology and were supervised by
a licensed Ph.D. clinical psychologist with several
years of applied experience. Also, each clinician
received a minimum of 3

1

/

2

hours of supervision

per week (1

1

/

2

hours individually, and 2 hours in a

group treatment team meeting) on the therapeutic
assessment model/process, scoring/interpretation
of assessment measures, clinical interventions and
presentation/organization of collaborative feed-
back. Ratings of Axis II pathology were based on
the semi-structured interview and feedback ses-
sions. Ratings provided by the clinician were based
on the patient’s level of relational functioning at
the time of evaluation (i.e., semi-structured inter-
view and feedback). External raters then indepen-
dently rated the Axis II pathology for each
participant immediately after viewing videotapes
of the clinical interview and feedback sessions. For
all cases, scoring of the measures by the external
raters was completed independent of the clini-
cian’s ratings. External raters in this study con-

Borderline IIP

369

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Clin. Psychol. Psychother. 14, 365–376 (2007)

DOI

: 10.1002/cpp

sisted of the same pool of trained Ph.D. graduate
clinicians (none provided video ratings for their
own patients) or in some cases the study supervi-
sor (a licensed Ph.D. clinical psychologist).

Participants were asked to complete the IIP-C as

part of the assessment process. Before administer-
ing the IIP-C, the clinician and the patient
reviewed the instructions and discussed how com-
pleting the measure as openly as possible would
aid in a better understanding of the patient’s
current life problems as well as facilitate the devel-
opment of treatment goals. The patient indepen-
dently completed the IIP-C; however, the clinician
was available in the clinic to the patient during this
time to answer any questions that may arise during
the testing.

Inventory of Interpersonal Problems Circumplex

Scales (IIP-C; Alden et al., 1990; Horowitz et al.,
2000; Horowitz, Rosenberg, Baer, Ureno, & Vil-
laseñor, 1988). The IIP-C is a 64-item inventory of
distressing interpersonal behaviours the respon-
dent identifies as ‘hard to do’ (i.e., behavioural
inhibitions) or ‘does too much’ (i.e., behavioural
excesses) on a 0 (not at all) to 4 (extremely) Likert
scale. Items were derived from verbatim tran-
scripts of patients’ psychotherapy intake inter-
views. Subsequent analyses identified the current
version, which conforms to the interpersonal cir-
cumplex, through the covariation among the eight
IIP-C octant scales. These eight scales can be rep-
resented pictorially as a circle such that attributes
adjacent to one another have more similarity and
those across from one another have opposite qual-
ities. Counterclockwise from the top of the circle,
these subscales include (1) Domineering/Control-
ling (PA), i.e., being too controlling or manipula-

tive in interpersonal interactions; (2) Vindictive/
Self-centered (BC), i.e., being frequently egocentric
and hostile in dealing with others; (3) Cold/
Distant (DE), i.e., having minimal feelings of affec-
tion for, and little connection with, other people;
(4) Socially Inhibited/Avoidant (FG), i.e., being
socially avoidant and anxious, and having diffi-
culty approaching others; (5) Non-assertive (HI),
i.e., having difficulty expressing one’s needs to
others; (6) Overly Accommodating/Exploitable
(JK), i.e., being gullible and easily taken advantage
of by people; (7) Self-sacrificing/Overly nurturant
(LM), i.e., being excessively selfless, generous,
trusting, caring and permissive in dealing with
others; and (8) Intrusive/Needy (NO), i.e., impos-
ing one’s needs and having difficulty respecting
the personal boundaries of other people. The IIP-C
has well-documented reliability and validity
(Horowitz et al., 2000) with subscale alpha coeffi-
cients ranging from 0.76 to 0.88 and test–retest reli-
abilities ranging from 0.58 to 0.84 (total r

= 0.79).

RESULTS

Between-Group Comparisons

All statistical analyses used an alpha level of 0.05
(two-tailed) for significance and trends towards
significance at

£0.10. When group comparisons

were examined, Cohen’s d was calculated using
pooled SDs, and these effects were weighted for
unequal sample size (Cohen, 1988). Based on
Cohen’s (1988) recommendation, d values of 0.2,
0.5 and 0.8 were used to represent small, medium
and large effects, respectively. Results from the cat-
egorical analyses shown in Table 2 generally sup-

Table 2. Differences in IIP-C variables between BP and non-BP groups

BP

Non-BP

F-value

p-value

d

n

= 23

n

= 51

Mean

SD

Mean

SD

IIP total score

1.44

0.49

1.24

0.49

2.78

0.10

0.41

IIP variables (octants)
Domineering/Controlling (PA)

0.87

0.51

0.68

0.47

2.24

0.14

0.39

Vindictive/Self-centered (BC)

0.87

0.51

0.93

0.58

0.2

0.65

-0.11

Cold/Distant (DE)

1.03

0.7

1.24

0.76

1.26

0.27

-0.28

Socially inhibited (FG)

1.5

0.87

1.49

0.8

3.86

0.98

0.01

Non-assertive (HI)

1.88

0.9

1.67

0.94

0.83

0.37

0.23

Overly accommodating (JK)

1.91

0.79

1.57

0.72

3.31

0.07

0.46

Self-sacrificing (LM)

2.05

0.8

1.43

0.66

12.35

0.001

0.88

Intrusive/Needy (NO)

1.22

0.57

0.87

0.53

6.94

0.01

0.65

d

> 0.8 = large effect size. d > 0.5 = medium effect size. d > 0.2 = small effect size (Cohen, 1988).

IIP-C

= Inventory of Interpersonal Problems-Circumplex. BP = patients with borderline pathology. SD = standard deviation. d = effect

size utilizing pooled SD. IIP

= Inventory of Interpersonal Problems.

370

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Copyright © 2007 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 14, 365–376 (2007)

DOI

: 10.1002/cpp

ported the hypotheses that the BP group would
report greater interpersonal distress and more
dependent-submissive relational functioning, as
well as impaired interpersonal boundaries evident
in intrusive-needy behaviours. First, we examined
the difference between the BP IIP-C total score (M

= 1.44, SD = 0.49) and the non-BP IIP-C total score
(M

= 1.24, SD = 0.49). This analysis demonstrated

a trend towards significance (F

= 2.78, p = 0.10),

with the BP group demonstrating a small to
medium effect over the clinical control group (d

=

0.41). Second, we examined if any differences were
present between the two groups on the eight
IIP-C octant scales. A trend towards significance
(F

= 3.31, p = 0.07), was observed between the

two groups on the Overly Accommodating/
Exploitable (JK) scale with the BP group (M

= 1.91,

SD

= 0.79) scoring higher on this scale the demon-

strating a small to medium effect size over the non-
BP sample (M

= 1.57, SD = 0.72, d = 0.46). Significant

differences in the expected direction between
groups were observed on both the Self-
sacrificing/Overly nurturant (LM; F

= 12.35, p =

0.001) and Intrusive/Needy (NO; F

= 6.94, p = 0.01)

scales. The BP group reported higher scores for
both the Self-sacrificing (LM; M

= 2.05, SD = 0.80)

and Intrusive/Needy (NO; M

= 1.22, SD = 0.57)

scales than the non-BP sample (M

= 1.43, SD = 0.66;

M

= 0.87, SD = 0.53, respectively). These group dif-

ferences demonstrated a moderate effect size for
the Intrusive/Needy subscale (NO; d

= 0.65) and

large effect size for the Self-sacrificing/Overly nur-
turant scale (LM; d

= 0.88) over the clinical control

group. These significant differences between the
BP and non-BP groups with moderate effect sizes
demonstrate the validity of the IIP-C in the differ-
entiation of outpatients with Axis I and II disorders
from those with BP. This tests the IIP-C quite well,
given the general clinical distress of these two
groups as, again, our comparison conditions were
also all outpatients and not from a non-clinical
sample. No significant statistical differences (p

>

0.05) or trends towards significance (p

> 0.10) were

detected between groups on the Domineering/
Controlling (PA), Vindictive/Self-centered (BC),
Cold/Distant (DE), Socially Inhibited/Avoidant
(FG) and Non-assertive (HI) scales.

Structural Summary of Group-Level Profiles

Next we sought to examine the interpersonal pro-
files of the BP and clinical comparison groups
using a circumplex structural summary (Gurtman,

1994; Pincus & Gurtman, 2003) of the group-level
profile. This circumplex analytical approach
involves creating a structural summary of the IIP-C
profile by modelling the pattern of octant scale
scores to a cosine-curve function. Accordingly, the
profile is ‘decomposed’ into two parts: a structured
component (cosine function) reflecting the proto-
type for a circumplex and a deviation component.
The parameters of this curve are its (a) angular dis-
placement, or the peak-shift of the curve, from 0°;
(b) amplitude, or peak value; and (c) elevation, or
mean level. The goodness-of-fit of the modelled
curve to the actual scores can be also calculated; the
R

2

value essentially indicates the degree to which

the profile conforms to circumplex expectations.
Gurtman and Balakrishnan (1998) provide a
detailed description of the structural summary, as
well as procedures for computing the various
parameters.

Gurtman and Balakrishnan (1998) also offer

interpretive guidelines that relate each of these
summary features to clinical hypotheses. The
angular displacement of the curve indicates the
person’s interpersonal ‘central tendency’, signify-
ing the individual’s ‘typology’ (Leary, 1957) or pre-
dominant interpersonal style (Kiesler, 1996). For
example, based on the circumplex, a displacement
of 135° suggests the central interpersonal qualities
of distrust, exploitativeness and vindictiveness
(broadly, hostile-dominance); 180° suggests lack of
warmth and interpersonal distance and so on.
Amplitude is viewed as a measure of the profile’s
‘structured patterning’, or degree of differentia-
tion, indicating the extent then to which the pre-
dominant trend ‘stands out’. An amplitude value
of 0 indicates a flat (i.e., undifferentiated) profile;
high amplitude indicates a profile with a clear
interpersonal peak (and trough). Interpretation of
elevation, or the mean level of the curve, depends,
in part, on the circumplex model applied. Gurtman
and Balakrishnan (1998) showed that for the
interpersonal problem circumplex, elevation is
an index of global interpersonal distress or
maladjustment (high values indicating high
overall distress).

In the current study, we apply guidelines for the

circular profile interpretation of group-level data
(Slaney, Pincus, Uliaszek, & Wang, 2006). The
figural issue in profile interpretation is, ‘Does the
group profile adequately represent the individual
profiles making up the group?’. To evaluate this,
we computed structural summaries based on the
averaged group profiles. The main parameters to
evaluate here are amplitude and R

2

(this quantifies

Borderline IIP

371

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Clin. Psychol. Psychother. 14, 365–376 (2007)

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: 10.1002/cpp

the fit of the profile to circumplex, i.e., cosine,
expectations). Amplitude is best interpreted as
profile differentiation (Ansell & Pincus, 2004;
Gurtman & Balakrishnan, 1998; Gurtman & Pincus,
2003; Pincus & Gurtman, 2003, 2006). High ampli-
tude suggests a profile has a defined peak and
valley indicating differential endorsement of inter-
personal problems. Low amplitude suggests a
profile with little differentiation of endorsement
across substantively different problem areas (i.e., a
round profile has no amplitude even though it
could have substantial elevation). R

2

of the struc-

tural summary (Gurtman, 1994; Gurtman &
Balakrishnan, 1998; Gurtman & Pincus, 2003) is
highly informative regarding how heterogeneous
or homogeneous the group is in their pattern of
interpersonal problem endorsement (Ansell &
Pincus, 2004; Slaney et al., 2006). If a group profile
exhibits strong amplitude and a high R

2

, this indi-

cates that the group profile is consistent with indi-
vidual profiles making up the group. If amplitude
is low and R

2

is low (

<0.70), it indicates that there

is significant heterogeneity of profiles making up
the group (see e.g., Ansell & Pincus, 2004; Dickin-
son & Pincus, 2003; Kachin, Newman, & Pincus,
2001; Slaney et al., 2007).

Regarding the current data, the BP group

profile is a good representation of the individual
BPD patients (R

2

= 0.89), locates patients in the

Overly Accommodating/Exploitable octant (JK;
307.48°), with an elevated (0.85) and moderately
differentiated profile (amplitude

= 0.61). The non-

BP group profile also is a good representation
of the individual non-BP patients (R

2

= 0.98),

locates these patients in the Non-assertive
octant (HI; 260.41°), with slightly less elevation
(0.61) and slightly less profile differentiation
(amplitude

= 0.43).

DISCUSSION

The findings suggest that within a clinical outpa-
tient population, BP outpatients report greater
interpersonal problems related to being overly
accommodating/exploitable, self-sacrificing/
overly nurturant, intrusive and needy significantly
more than those clinical outpatients without BP.
Interpretively, these findings make sense as Overly
Accommodating individuals are described as those
who ‘avoid being assertive in order to maintain friendly
relationships. . . . Among their problems they report
being too exploitable, too easily taken advantage of by

others, and too gullible’ (Horowitz et al., 2000, p. 39).
Likewise Self-sacrificing individuals ‘regard them-
selves as warm, nurturant, and generous . . . [and] too
eager to serve and too ready to give . . . They complain
that they find it difficult to set limits on other people
. . . [and] to maintain boundaries’ (p. 40). Individuals
reporting difficulties with being Intrusive/Needy
have ‘a powerful need to feel engaged with other people
. . . [and find] it difficult to spend time alone. . . . they
open up too much, tell personal things too much, and
have a hard time keeping things private . . .’ (p. 40).
Thus, compared with others with DSM-IV diag-
noses who seek outpatient therapy, BP patients
report more overly affiliative and submissive rela-
tional problems. Differences in three of eight
octants, in addition to the trend exhibited for
overall interpersonal distress, suggest that indi-
viduals with BP report struggling more with these
affiliative–submissive issues relative to outpatients
without BP. Our findings that BP outpatients
report increased needy, obsequious and attach-
ment seeking interpersonal distress support previ-
ous research.

Contrary to expectation, differences between

groups in overall interpersonal problems were not
statistically significant, although a trend was
observed (F

= 2.78, p = 0.10, d = 0.41). Similarly, no

significant difference was found between groups
in the interpersonal pathology indicative of
non-assertiveness (HI; F

= 0.83, p = 0.37, d = 0.23).

Perhaps these results are not so surprising given
that the comparison group was a treatment-
seeking sample with significant pathology of their
own and not a non-clinical sample. Previous inves-
tigations have typically compared clinical samples
with non-clinical control groups. Additionally, this
study lacked sufficient power to detect small
effects representing more subtle differences that
may actually be present in the population. For
example, a closer look at the Domineering/Con-
trolling octant revealed a non-significant, small-to-
medium effect size (PA; F

= 2.24, p = 0.14, d = 0.39),

indicating that individuals with BP may engage in
greater use of challenging and argumentative
behaviour in the service of regulating affect and
maintaining self-esteem.

These data are consistent with previous research

findings that clinical patients with BP report a
greater degree of interpersonal behaviours defined
by a tendency towards affiliation and submis-
siveness, represented by excessive accommo-
dating behaviours (JK; Overly Accommodating/
Exploitable), an incapacity to set limits on their
selflessness and permissiveness in dealing with

372

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Clin. Psychol. Psychother. 14, 365–376 (2007)

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others (LM; Self-sacrificing/Overly nurturant) and
difficulty spending time alone (NO; Intrusive/
Needy). The current study confirms these findings
using an outpatient clinical sample (with no exclu-
sion criteria). Our inclusion of a clinical compari-
son sample allows for greater confidence that
findings represent impairment in interpersonal
functioning related to BP and not just general clin-
ical distress, as well as greater generalizability to
real-world outpatient settings. Even in comparison
with other clinical outpatients, including other
types of personality pathology, BP patients appear
to exhibit significantly more interpersonal distress
related to the areas of increased neediness, obse-
quious and attachment seeking. This provides
additional support for the prominent role of needs
for relatedness, fears of abandonment and the
intolerance of being alone in BP. The ability to dif-
ferentiate BP from non-BP patients, including
patients with Axis II disorders other than BP, is an
extremely important clinical classification and
results demonstrate the utility of the IIP-C for these
purposes.

In a similar sample, Leihener et al. (2003) found

two IIP clusters of BPD patients: a primary cluster
with dependency problems and a secondary group
with autonomy problems. Our data replicate the
findings in Leihener et al.’s sample, where the
majority of individuals (approximately 73%)
exhibited significant affiliative and submissive
interpersonal behaviours, congruent with the
greater part of past research reported above, in
addition to our findings (see also, Ryan & Shean,
2007). The autonomous subtype of BPD individu-
als described themselves as cold, controlling and
non-obsequious, represented by high scores on the
Cold/Distant (DE) and Domineering/Controlling
(PA) octants of the IIP-C. Our data also suggested
a small-to-medium (d

= 0.39) and perhaps clinically

relevant, though not statistically significant (p

=

0.14), difference between groups in the expected
direction of more negative or unpleasant affec-
tive representations of others, represented in the
Domineering/Controlling (PA) octant of the IIP-C.
However, the BP group-level structural summary
indicated the present sample was quite homoge-
neous in their IIP-C responses (high R

2

and mod-

erate amplitude), and it did not suggest the
presence of multiple circular distributions within
the BP patients.

Some possible reasons we did not find indica-

tions of a more controlling and cold subset of
patients in the current sample can be suggested.
The current sample comprised treatment-seeking

outpatients. This could reflect greater affiliative
trends and less primitive pathology overall in the
sample relative to more severely disturbed
patients. Given Leichsenring et al. (2003) found
that primitive defences and object relations were
associated with controlling, vindictive and cold
interpersonal problems, while identity diffusion
was associated with overly affiliative interpersonal
problems, our treatment-seeking outpatient BP
sample may exhibit significant needs for related-
ness, fears of abandonment and the intolerance of
being alone, but in a less severe degree than typi-
cally seen in inpatient samples.

Further research with larger samples and a

greater range of psychopathology is needed to
further corroborate the differences found in the
current sample. Specifically, distinctions between
BP and non-BP samples should be replicated and
perhaps differentiating diagnostic algorithms can
be developed. In addition, our results may suggest
differences between outpatient treatment-seeking
BP patients versus more severely disturbed (inpa-
tient or forensic) BP patients that should be
explored. Such investigations might also utilize
differential interpersonal correlates, such as the
BPI, to understand these various nuances. Finally,
as is the case with all self-assessment data, our
findings represent the self-perception of these
BP patients’ interpersonal problems. Additional
ratings on the relational functioning BP of patients
from both clinically trained and lay observers in
conjunction with self-assessment data will likely
prove most fruitful in identifying the complexities
of a borderline relational style.

Implications for Treatment

Given the central role afforded interpersonal func-
tioning in BP by researchers and theoreticians
alike, a person’s capacity to manage one’s view of
self, as well as self in relation to other, would
appear to have a particular relevance for applied
practice. For example, Brown, Comtois, and
Linehan (2002) found that persons with BPD self-
report interpersonal concerns as a major precipi-
tant of suicide attempts. These studies highlight
the importance of a careful understanding of the
interpersonal aspects of BP. Of additional impor-
tance is past research that has reported the impor-
tance of the therapeutic relationship with this
specific clinical population (Cohen & Sherwood,
1989; Gunderson et al., 1989; Hilsenroth, Hold-
wick, Castlebury, & Blais, 1998; Kernberg, Selzer,

Borderline IIP

373

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Koenigsberg, Carr, & Appelbaum, 1989; Sandell
et al., 1993; Steiger & Stotland, 1996; Summers,
1999; Yeomans, Selzer, & Clarkin, 1993; Yeomans
et al., 1994). As such, improved understanding
of the interpersonal characteristics of BPD may
help clinicians more effectively navigate the rela-
tional intricacies inherent to the development of
an effective working alliance (see e.g., Gurtman,
1996). In addition, recent treatment process and
outcome research with borderline patients indi-
cates that a developed understanding of interper-
sonal functioning has substantial clinical utility
(e.g., Hilsenroth, DeFife, Blake, & Cromer, 2007;
Levy, Clarkin, et al., 2006; Levy, Meehan, et al.,
2006).

In sum, this research contributes to the BPD lit-

erature in multiple ways. Most notable was the use
of a naturalistic sample seeking treatment for Axis
I and II psychopathology. Another distinctive
aspect is the use of a non-BPD clinical comparison
group, allowing for more accurate interpretation
and greater generalizability of the findings to mul-
tiple outpatient settings. This study also responds
to limitations in the existing literature by including
patients with comorbid diagnoses. This is impor-
tant, as contemporary research indicates that Axis
I problems are often intertwined with Axis II per-
sonality processes greater than 50% of the time
(Westen & Arkowitz-Westen, 1998; Westen et al.,
2004). As such, our naturalistic sample lends
greater credence to findings of specific interper-
sonal patterns that might better differentiate BP
individuals from other treatment-seeking indi-
viduals. Such differentiation may reflect the inter-
personal consequences of significant needs for
relatedness, fears of abandonment and the intoler-
ance of being alone exhibited by borderline
patients relative to those without BP.

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