An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression

Distress tolerance moderates the relationship between negative affect intensity with borderline personality disorder levels

A number of studies have suggested that negative emotionality and negative affect intensity play key roles in the development and maintenance of borderline personality disorder (BPD). However, more recent research indicates that one's response to affective discomfort may be an even more important variable in the pathogenesis of BPD than either negative emotionality or negative affect intensity per se. As such, the current study aimed to empirically test the moderating role of 2 well-validated laboratory measures of the ability to tolerate psychological distress (distress tolerance) in the relationship of negative emotionality and negative affect intensity with BPD levels. Results provide laboratory-based evidence for a moderating effect of distress tolerance on the relationship of negative emotionality and negative affect intensity with levels of BPD. Specifically, the 2 former variables were related to levels of BPD among those with low distress tolerance. The current results add support to existing developmental frameworks of BPD and suggest the importance of modifying one's response to affective distress along with levels of negative emotionality in treatment settings.

Validation of Measures of Biosocial Precursors to Borderline Personality Disorder: Childhood Emotional Vulnerability and Environmental Invalidation

Linehan’s biosocial theory suggests that borderline personality disorder (BPD) results from a transaction of two childhood precursors: emotional vulnerability and an invalidating environment. Until recently, few empirical studies have explored relationships between these theoretical precursors and symptoms of the disorder. Psychometrically sound assessment tools are essential to this area of research. The present study examined psychometric characteristics of recently developed self-report measures of childhood emotional vulnerability and parental invalidation. A large sample of undergraduates completed these measures; parent reports were collected to examine agreement between young adults’ and parents’ recollections of their emotional style in childhood and the parenting they received. Both measures were internally consistent, showed clear factor structures, and were significantly correlated with BPD features and related constructs. In addition, both showed modest, yet significant agreement between participants’ and parents’ reports. Overall, this study supports the utility of these measures of childhood emotional vulnerability and environmental invalidation.

An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: the role of shame

Despite the emphasis on emotional reactivity and delayed emotional recovery in prominent theoretical accounts of borderline personality disorder (BPD), research in this area remains limited. This study sought to extend extant research by examining emotional reactivity (and recovery following emotional arousal) to 2 laboratory stressors (one general, and the other involving negative evaluation) and exploring the impact of these stressors on subjective responding across the specific emotions of anxiety, irritability, hostility, and shame. We hypothesized that outpatients with BPD (compared to outpatients without a personality disorder; non-PD) would demonstrate heightened subjective emotional reactivity to both stressors, as well as a delayed return to baseline levels of emotional arousal. Results provide evidence for context- and emotion-specific reactivity in BPD. Specifically, BPD participants (compared to non-PD participants) evidenced heightened reactivity to the negative evaluation but not the general stressor. Furthermore, results provide support for shame-specific reactivity in BPD, with BPD participants (vs non-PD participants) evidencing a significantly different pattern of change in shame (but not in reported anxiety, irritability, or hostility) across the course of the study. Specifically, not only did BPD participants report higher levels of shame in response to the negative evaluation, their levels of shame remained elevated following this stressor (through the post-recovery period at the end of the study). Findings suggest the importance of continuing to examine emotional reactivity in BPD within specific contexts and across distinct emotions, rather than at the general trait level.

Experiential Avoidance and Problem Behavior: A Mediational Analysis

Despite their formal dissimilarity, problem behaviors (e.g., substance misuse, binge eating, self-harm) may share a common function. According to Acceptance and Commitment Therapy (ACT), this shared function is Experiential Avoidance, the process of avoiding, escaping or otherwise altering unwanted private events (e.g., thoughts, feelings, memories) and the contexts that elicit them. Structural Equation Modeling was used cross-sectionally with data from a clinical opportunity sample ( N = 290) to test (a) whether problem behavior covariance was associated with experiential avoidance, and (b) whether experiential avoidance mediated the relationships between historical and dispositional risk factors (childhood trauma and negative affect intensity, respectively) and the tendency to engage in problem behaviors. Analysis showed that experiential avoidance contributed to the covariation of problem behaviors, and that it fully mediated the relationships between both risk factors and problem behavior. Thus, experiential avoidance may be a key process to target in the management of individuals with behavior problems.

Emotional instability, poor emotional awareness, and the development of borderline personality

Emotional instability and poor emotional awareness are cardinal features of the emotional dysregulation associated with borderline personality disorder (BPD). Most models of the development of BPD include child negative emotional reactivity and grossly inadequate caregiving (e.g., abuse, emotional invalidation) as major contributing factors. However, early childhood emotional reactivity and exposure to adverse family situations are associated with a diverse range of long-term outcomes. We examine the known effects of these risk factors on early childhood emotional functioning and their potential links to the emergence of chronic emotional instability and poor emotional awareness. This examination leads us to advocate new research directions. First, we advocate for enriching the developmental assessment of children's emotional functioning to more closely capture clinically relevant aspects. Second, we advocate for conceptualizing children's early family experiences in terms of the proximal emotional environment to which young children may be or become sensitive. Such approaches should contribute to our ability to identify risk for BPD and guide preventive intervention.

The role of mindfulness in borderline personality disorder features

This study investigated whether deficits in mindfulness (attention, awareness, and acceptance of the present moment) underlie variability in borderline personality disorder (BPD) features and related impairments in interpersonal functioning, impulsivity, and emotion regulation. A path analytic approach was used to examine the relationships of trait mindfulness with BPD features, interpersonal effectiveness, impulsive and passive emotion-regulation, and neuroticism in a psychiatric sample of adults (N = 70). As hypothesized, mindfulness was associated inversely with BPD features and core areas of dysfunction, and these associations continued when controlling for neuroticism. Furthermore, mindfulness deficits continued to predict BPD features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. These findings suggest that mindfulness may be a unique predictor for the expression of BPD pathology. An emphasis on mindfulness may thus be crucial in enhancing the formulation and treatment of BPD.

Cascades of Emotion: The Emergence of Borderline Personality Disorder from Emotional and Behavioral Dysregulation

Theories of borderline personality disorder (BPD) have often considered it a disorder involving both emotional and behavioral dysregulation (Linehan, 1993), yet the connection between these phenomena has been elusive. The following paper proposes the Emotional Cascade Model, a model that attempts to establish a clear relationship between emotional dysregulation and the wide array of dysregulated behaviors found in BPD. In this model, subsequent to an emotional stimulus, ruminative processes result in a positive feedback loop that increases emotional intensity, and this emotional intensity leads to ensuing behavioral dysregulation. These behaviors then provide negative feedback, in the form of distraction, which induces temporary reduction of negative emotion and thus relief. The model is presented in a framework in which BPD is considered an emergent phenomenon (Lewin, 1992), where the disorder arises from the total interactions of a network containing emotional cascades and other important factors. The model is then evaluated in light of various theories and therapeutic traditions, including both cognitive-behavioral and psychodynamic, indicating that it is a model that may transcend traditional theoretical and therapeutic doctrines.

Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli

This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups.

Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation

The co-occurrence of borderline personality disorder (BPD) among individuals with substance use disorders is a common and clinically relevant phenomenon in need of further empirical investigation. The present study adds to the extant literature on the factors associated with co-occurring BPD among substance users, examining the relationships between childhood maltreatment (in the form of sexual, physical, and emotional abuse and emotional and physical neglect), negative affect intensity/reactivity, emotion dysregulation, and BPD pathology (both diagnostic status and symptom count) among a sample of 76 inner-city treatment-seeking substance users. Emotion dysregulation was expected to mediate the relationships between childhood maltreatment and negative affect intensity/reactivity (and their interaction) and BPD pathology. Results indicate that the presence of a BPD diagnosis was associated with higher levels of both childhood maltreatment and negative affect intensity/reactivity. However, only childhood maltreatment emerged as a unique predictor of BPD diagnostic status. Conversely, both childhood maltreatment and negative affect intensity/reactivity accounted for unique variance in the number of endorsed BPD symptoms. Moreover, emotion dysregulation fully mediated the relationships between maltreatment and negative affect intensity/reactivity and BPD symptom count, as well as the relationship between emotional abuse in particular and BPD diagnostic status. Contrary to hypotheses, results provided no support for the interaction between maltreatment and negative affect intensity/reactivity in the prediction of BPD pathology (diagnosis or symptom count), above and beyond the main effects of these factors.

Thought suppression and persecutory delusion-like beliefs in a nonclinical sample

INTRODUCTION

Thought suppression may play a role in the formation and/or maintenance of persecutory delusions, although this possibility has not yet been empirically studied. We investigated thought suppression levels in relation to the presence of persecutory delusion-like beliefs (PDLBs), and hypothesised that only when levels of anxiety or negative affect were high would thought suppression predict levels of PDLBs.

METHOD

Thought suppression, anxiety, negative affect, social desirability, and persecutory ideation were assessed in a nonclinical sample (N=183) using online questionnaires.

RESULTS

When gender, anxiety, and negative affect were controlled, the interaction between thought suppression and anxiety predicted levels of PDLBs. Further analysis of this interaction showed that thought suppression was positively associated with PDLBs only when anxiety was high. Neither thought suppression by itself, nor the two-way interaction between negative affect and thought suppression, nor the three-way interaction between negative affect, anxiety, and thought suppression, were predictors of PDLB levels.

CONCLUSION

The results are consistent with a proposed interaction between thought suppression and anxiety in the development of PDLBs. Possible causal mechanisms underlying this relation are considered further, future research in the area proposed, and potential clinical implications examined.

A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment

The concept of emotion dysregulation has been integrated into theory and treatment for borderline personality disorder (BPD), despite limited empirical support. Expanding upon existing research on the relationship between emotion dysregulation and BPD, the present study utilized a multimodal approach to the assessment of emotion dysregulation (including two behavioral measures of the willingness to tolerate emotional distress, and a self-report measure of emotion dysregulation broadly defined) to examine the relationship between emotion dysregulation and BPD among inner-city substance users in residential treatment (n=76, with 25 meeting criteria for BPD). Results provide laboratory-based evidence for heightened emotion dysregulation in BPD, extending extant research on BPD to underserved clinical populations. Specifically, the presence of a BPD diagnosis among a sample of inner-city inpatient substance users was associated with both higher scores on the self-report measure of emotion dysregulation and less willingness to tolerate emotional distress on the behavioral measures of emotion dysregulation. Moreover, both self-report and behavioral measures of emotion dysregulation accounted for unique variance in BPD status, suggesting the importance of utilizing comprehensive assessments of emotion dysregulation within studies of BPD. Findings suggest the need to further explore the role of emotion dysregulation in the development and maintenance of BPD among inner-city substance users in residential treatment.

Preliminary data on the relationship between anxiety sensitivity and borderline personality disorder: the role of experiential avoidance

Although research on the temperamental vulnerabilities associated with borderline personality disorder (BPD) has focused primarily on the role of impulsive-aggression, affective instability, and emotional vulnerability, growing evidence suggests that anxiety sensitivity (AS) also may increase vulnerability for BPD. This study provides preliminary data on the relationship between AS and BPD, examining whether AS distinguishes outpatients with BPD from outpatients without a personality disorder (non-PD), and whether the relationship between AS and BPD is mediated by experiential avoidance (i.e., attempts to avoid unwanted internal experiences, such as anxiety). Findings indicate that BPD outpatients reported higher levels of AS than non-PD outpatients and AS reliably distinguished between these two groups. Furthermore, the relationship between AS and BPD was mediated by experiential avoidance. Finally, results indicate that AS (and experiential avoidance as a mediator) accounted for a significant amount of additional variance in BPD status above and beyond both negative affect and two well-established temperamental vulnerabilities for BPD (affect intensity/reactivity and impulsivity). Findings suggest the need to further explore the role of AS in the pathogenesis of BPD.

An experimental pilot study of response to invalidation in young women with features of borderline personality disorder

One of the leading biosocial theories of borderline personality disorder (BPD) suggests that individuals with BPD have biologically based abnormalities in emotion regulation contributing to more intense and rapid responses to emotional stimuli, in particular, invalidation [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford, New York.]. This study used a 2 by 2 experimental design to test whether young women with features of BPD actually show increased physiological arousal in response to invalidation. Twenty-three women ages 18 to 29 who endorsed high levels of BPD symptoms and 18 healthy controls were randomly assigned to hear either a validating or invalidating comment during a frustrating task. Although we found preliminary support for differential response to these stimuli in self-report of valence, we found neither self-report nor physiological evidence of hyperarousal in the BPD features group, either at baseline or in response to invalidation. Interestingly, the BPD features group reported significantly lower comfort with emotion, and comfort was significantly associated with affective valence but not arousal. We discuss implications for understanding and responding to the affective intensity of this population.

Borderline personality disorder and emotional responding: A review of the research literature

Although problems with emotional functioning are considered central to borderline personality disorder (BPD), it is only recently that studies have begun utilizing laboratory biobehavioral measures (including neuroimaging and psychophysiological measures) to examine emotional responding in BPD. The application of basic science methodologies used in a systematic program of research to investigate clinically relevant phenomena, often called translational research, holds much promise in advancing the assessment and treatment of BPD. In this paper, we begin with an overview of the research on self-reported emotional responding in BPD. Next, we outline the advantages that translational research has over traditional self-report methodology in furthering an understanding of emotional responding in BPD, and review the extant laboratory studies of emotional responding in BPD. Finally, problems commonly encountered when conducting translational research on emotion in BPD are outlined, and solutions to these problems are offered.

A mediational model of trait negative affectivity, dispositional thought suppression, and intrusive thoughts following laboratory stressors

Two studies examined the relationships among trait negative affectivity, dispositional thought suppression, and intrusions in non-clinical samples. In Study 1 (N=87), participants were presented with a series of emotionally evocative images and intrusions were examined 48 h after presentation via self-report. In Study 2 (N=118), intrusions were examined using a behavioral Key-press and self-report at two time points (5 and 20 min) following exposure to a series of emotionally evocative images. In each study, participants were assessed for trait negative affectivity and the tendency to engage in thought suppression in response to unpleasant cognitions. Results from both studies support a model in which chronic thought suppression fully mediates the relationship between negative affectivity and the frequency of intrusions.

How does dialectical behavior therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders?

For individuals presenting with comorbid borderline personality disorder (BPD) and substance use disorders (SUD), rates of treatment dropout from combined mental health and substance abuse treatment centers approach 80%, rendering dropout the rule rather than the exception. Several studies indicate that utilizing a more comprehensive treatment such as Dialectical Behavior Therapy (DBT) may be useful for client retention; however, given the scope and effort required to conduct this treatment, it may be more practical to determine which specific components within DBT are useful in retaining clients in substance use treatment. Thus, the purpose of the current paper is first to determine what exact deficits underlie treatment dropout among the BPD-SUD comorbidity. Second, we review and evaluate effectiveness of DBT retention-enhancing strategies by assembling work from other samples and literatures that also tests retention-enhancing strategies discussed in DBT. As a last step, the paper will conclude with a discussion on methodological limitations and potential future directions in this line of research.

The effects of sexual assault-related intrusion suppression in the laboratory and natural environment

Individuals with a history of sexual victimization often experience enduring intrusive thoughts associated with their assault history. Research suggests that the characteristic ways in which sexually assaulted individuals respond to aversive internal experiences (i.e., thoughts, emotions, etc.) can influence the psychological distress associated with these intrusions. This study investigated the effects of suppressing sexual assault-related intrusions in a sample of 61 female college students with a history of adolescent or adult sexual assault and recent assault-related intrusions. Participants were randomly assigned to suppress or monitor intrusions during a laboratory task and for 48 h outside the laboratory. In contrast to study hypotheses, findings indicated that intrusion monitoring was associated with higher subjective distress than suppression both in the laboratory and in the natural environment. No differences were found for the frequency of intrusions between groups in the laboratory. However, modest evidence for a rebound effect in intrusion frequency was found outside the laboratory.

Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations

Dialectical behavior therapy (DBT) can be considered a well-established treatment for borderline personality disorder (BPD) as evidenced by seven well-controlled randomized clinical trials across four independent research teams. The primary purpose of this article is to address a variety of potential mechanisms of change that may be associated with those aspects of DBT that are unique to the treatment and its theoretical underpinnings. Based on the biosocial theory of BPD, many of these mechanisms can be distilled down to the following process: the reduction of ineffective action tendencies linked with dysregulated emotions. Specifically we address the following interventions and associated mechanisms of change: mindfulness, validation, targeting and chain analysis, and dialectics. Patient change in BPD is conceptualized primarily as helping the patient to engage in functional, life-enhancing behavior, even when intense emotions are present. Ultimately, our goal was to provide guidance for theoretically and empirically grounded research on the mechanisms of change in DBT.

Impulsivity as a common process across borderline personality and substance use disorders

Borderline personality disorder (BPD) is a significant public health problem characterized by persistent problems with emotional, behavioral, cognitive, and interpersonal functioning. Research indicates an especially high rate of comorbidity between BPD and Substance Use Disorders (SUD). In trying to better understand, and therefore improve the assessment, prevention, and treatment of these disorders, researchers have considered the role of impulsivity. Indeed, impulsivity consistently has been shown to be a biologically-based, heritable characteristic with emergent psychological properties linked to the development and maintenance of BPD and SUD. Following from a previous review of the comorbidity between BPD and SUD (Trull, T. J., Sher, K. J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20, 235-253), the current manuscript revisits the role of impulsivity as a common process across these disorders with a specific focus on the multidimensional nature of impulsivity and its interaction with trait and state negative affectivity.