Problematic internet use and borderline personality features: A systematic review informed by the alternative model of personality disorders.

Clinical Snapshot

Key Findings

• P Value: Not reported at review level; individual study-level statistics not synthesised

• Effect Size: Not quantified; narrative synthesis only. Emotional lability and impulsivity described as showing the most consistent positive associations with PIU across outcome types. Dissociation and detachment showed relatively weak and inconsistent associations.

• Primary Outcome: Association between BPD-relevant pathological personality traits (AMPD Criterion B) and impairments in personality functioning (AMPD Criterion A) with problematic internet use severity and patterns

• Nnt Or Sensitivity: Not applicable; no quantitative synthesis. Identity disturbance noted as a prospective predictor of PIU in longitudinal studies. Interpersonal dysfunction associated with greater online reassurance-seeking and emotion regulation via internet use.

• Confidence Interval: Not reported; no meta-analytic pooling performed

Clinical Application

The AMPD framework is increasingly integrated into clinical practice following DSM-5 Section III inclusion and ICD-11 adoption of dimensional personality disorder classification. Screening for PIU in patients with BPD features is feasible using validated tools (e.g., Internet Addiction Test, Problematic Use of Mobile Phones scale). However, no specific clinical protocol or intervention is derivable from this review alone. In Australia, BPD is recognised as a priority area under the National Mental Health Strategy, and Dialectical Behaviour Therapy (DBT) — the gold-standard treatment for BPD — is increasingly available through public mental health services and private providers. The RACGP does not currently have specific guidelines addressing PIU in BPD populations. The TGA has not approved any pharmacological treatment specifically for PIU. The ICD-11 (adopted in Australia) includes Gaming Disorder as a formal diagnosis, providing a regulatory framework for one PIU subtype. Clinicians using the AMPD-aligned dimensional approach in Australian practice (consistent with ICD-11) may find this review's framework directly applicable to formulation. PBS-listed medications for BPD comorbidities (e.g., mood stabilisers, antipsychotics for emotional dysregulation) are not addressed by this review. Adults presenting with BPD or subthreshold BPD features, particularly those with prominent emotional lability, impulsivity, or identity disturbance. Clinically relevant for individuals presenting with excessive social media use, gaming disorder, or smartphone dependency in the context of personality pathology.

Abstract

BACKGROUND AND AIMS: Associations between problematic internet use (PIU) and borderline personality disorder (BPD) have been reported, but the literature is highly heterogeneous, with some studies assessing overall BPD severity and others examining individual traits (e.g., emotional lability, impulsivity, dissociation). This review synthesizes these approaches using the Alternative Model of Personality Disorders (AMPD), examining how BPD-relevant pathological personality traits (Criterion B) and impairments in self and interpersonal functioning (Criterion A) relate to PIU. METHODS: Following PRISMA 2020 guidelines, we searched PsycINFO, Web of Science, PubMed, Embase, and Scopus for studies examining associations between PIU (e.g., general use, social media, gaming, smartphone use) and personality traits or functioning in adults. Study quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Thirty studies (N = 21,358) met inclusion criteria. Emotional lability and impulsivity showed the most consistent associations with PIU across outcome types. Few studies examined impairments in personality functioning, but available evidence suggests that identity disturbance may predict PIU over time and that interpersonal dysfunction is associated with greater use of online environments for reassurance and emotion regulation. Associations involving dissociation and detachment were relatively weak and less consistent. DISCUSSION AND CONCLUSIONS: Studies varied widely in design, measures, and theoretical approach, limiting direct comparison across studies. Despite this heterogeneity, findings indicate that emotional lability, impulsivity, and identity disturbance appear to represent transdiagnostic vulnerabilities that increase risk for PIU and shape patterns of online engagement.

References

1. 1.Chesivoir, E., Hernandez, E., & Dolan, S. (2026). Problematic internet use and borderline personality features: A systematic review informed by the alternative model of personality disorders. Journal of Behavioral Addictions. https://doi.org/10.1521/pedi.17.6.568.25355