Perceived emotional invalidation and borderline personality disorder features: a test of theory

Differences in social support, emotion invalidation, psychological needs, cognitive emotion regulation in maritally adjusted and maladjusted women in Pakistan: A matched pairs design

The present study aimed to find out differences of social support, perceived emotion invalidation, psychological needs, and use of adaptive and maladaptive cognitive emotion regulation strategies in maritally adjusted and maladjusted after controlling for age, education, employment status, and depressive symptomatology. The cross-sectional study uses a matched pairs design. The sample was divided into two groups; maritally adjusted and maladjusted women (n = 40 pairs) on basis of scores obtained on revised-dyadic adjustment scale. Forty maritally adjusted women were matched with 40 maritally maladjusted women according to age, education, and employment status. Social support questionnaire, perceived invalidation of emotion scale, basic psychological need satisfaction frustration scale, cognitive emotion regulation questionnaire, and center for epidemiologic studies depression scale were administered. One-way ANCOVA revealed that maritally maladjusted women had lower level of social support [mean difference; -5.65(-9.97, -1.33), p < 0.05, partial η2 = 0.08] and more emotional invalidation [mean difference; 15.36(13.08, 17.65), p < 0.001, partial η2 = 0.71] compared to maritally adjusted women after controlling for the effect of depressive symptomatology. Maritally maladjusted women had more need frustration [mean difference; 10.75(7.59, 13.92), p < 0.001, partial η2 = 0.38] compared to maritally adjusted women. However, maritally adjusted women had more need satisfaction [mean difference; 13.36(9.67, 17.05), p < 0.001, partial η2 = 0.41] compared to maritally maladjusted women. Maritally adjusted women used more adaptive CER strategies (acceptance, refocus on planning and putting into perspective) [mean difference; 4.66(2.36, 6.95), p < 0.001, partial η2 = 0.18] compared to maritally maladjusted women whereas, maritally maladjusted women used more maladaptive strategies (self-blame, catastrophizing and blaming others) [mean difference; 4.66(2.77, 6.54), p < 0.001, partial η2 = 0.25] compared to maritally adjusted women. Maladjusted women had less social support and more emotional invalidation of emotions and psychological needs frustration. They used more maladaptive strategies to manage their negative emotions in comparison to maritally adjusted women. Identification of these cognitive emotion regulation strategies will help clinicians and counselors to devise psychological intervention targeting the use of adaptive strategies to minimize the negative mental health consequences.

Emotional Invalidation and Relationship Quality: A Mediational Model Through a Social Learning Lens

While we know childhood experiences are influential on a child's later socioemotional awareness and behavior, we are still searching for specific mechanisms that influence the transferability of childhood experiences and adult relationship functioning. In this study, we seek to further this area of investigation by examining the interpretation of ambiguous social interactions and perceptions of emotional invalidation as potential mediators of the relationship between perceptions of childhood emotional invalidation and current relationship quality. Participants completed online measures of hostile intent attributions, perceptions of childhood emotional invalidation, and current relationship quality with a significant other. They read emotionally provocative interpersonal scenarios and then reported likely emotionally invalidating reactions from their significant other to measure current perceptions of emotional invalidation. Results supported our hypotheses that perceptions of current emotional invalidation in a close, personal relationship would mediate the relationship between perceptions of childhood maternal emotional invalidation and both current relationship support and relationship conflict. Furthermore, the strength of this mediational pathway outweighed the influence of a more general hostile attribution bias. These findings have implications for prevention and intervention strategies designed to enhance interpersonal functioning.

Emerging adult college students' descriptions of exposure to childhood emotional abuse and associated factors: A qualitative exploration

BACKGROUND

Growing evidence on the long-term deleterious impacts of emotional abuse highlights the need to further understand childhood emotional abuse and its context to strengthen prevention efforts.

OBJECTIVE

To describe emerging adults' experiences of emotional abuse in their childhoods and the household context surrounding that abuse.

PARTICIPANTS AND SETTING

Fifty-eight interviews were conducted with emerging adults, ages 18-25, recruited from four 2- and 4-year institutions of higher education.

METHODS

Thematic analysis was conducted to identify and describe patterns in the data. A cyclical approach to codebook development and data analysis was followed by a team of four coders.

RESULTS

Themes related to participants' experiences of emotional abuse included: inability to meet parent expectations; parent attacks on the child's character; parent negative comparisons to siblings and others; parent invalidation of the child's emotions and mental health needs; and evolution over time in the parent-child relationship. Aspects of childhood family environments contemporaneous with the childhood emotional abuse included: financial stress; parent mental illness; parent divorce, separation, or volatile relationship; parent adversity or trauma; physical abuse; and young parent age. Many participants identified these aspects of their family environment, most of which could potentially be improved with sufficient support, as playing causal roles in the emotional abuse they experienced.

CONCLUSION

This descriptive qualitative study provides additional insight into child emotional abuse and its associated factors, providing invaluable insights that can enhance current measurement and intervention approaches.

The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults

OBJECTIVE

The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults.

METHOD

This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder.

RESULTS

The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores.

CONCLUSION

This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.

Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

Hovering or invalidating? Examining nuances in the associations between controlling parents and problematic outcomes for college students

Objective: The purpose of these studies was to examine whether college students' beliefs about themselves (i.e., self-compassion and beliefs about emotions) could be mechanisms explaining the relationship between problematic parenting behaviors (helicopter parenting and parental invalidation) and outcomes including perfectionism, affective distress, locus of control, and distress tolerance. Participants: Respondents included 255 (Study 1) and 277 (Study 2) college undergraduates. Methods: Simultaneous regressions and separate path analyses with helicopter parenting and parental invalidation as predictors, with self-compassion and emotion beliefs as mediators. Results: Across both studies, parental invalidation predicted perfectionism, affective distress, distress tolerance, and locus of control, and these links were often mediated by self-compassion. Self-compassion emerged as the most consistent and strongest link between parental invalidation and negative outcomes. Conclusion: People who internalize their parents' criticism and invalidation such that they hold negative beliefs about themselves (i.e., low self-compassion) may be vulnerable to negative psychosocial outcomes.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis

BACKGROUND

Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology.

METHODS

A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender.

RESULTS

DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships.

LIMITATIONS

The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures.

CONCLUSIONS

The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.

Unraveling Prospective Reciprocal Effects between Parental Invalidation and Pre-Adolescents' Borderline Traits: Between- and Within-Family Associations and Differences with Common Psychopathology-Parenting Transactions

The etiology of borderline personality pathology has consistently been framed as an interactional process between child vulnerability (i.e. emotional sensitivity and reactivity; Linehan, 1993) and invalidating parenting strategies, which evolves into increased emotion dysregulation and disinhibited behavior of the child and in turn activates more parental invalidation. Despite the strong theoretical base in support of these high-risk parent-child transactions, invalidating parenting behaviors have mostly been explored as a cause of child dysregulation and disinhibition, rather than as a result of child-driven effects. Also, most transactional research in this regard focused at differences between families, thereby not addressing potential changes within families across time. The current study therefore examines bidirectional between- and within-family effects of childhood borderline-related traits and maternal invalidation in the sensitive developmental phase of pre-adolescence (n = 574; 54.4% girls) along three assessment points. Cross-Lagged Panel Models and Random-Intercept Cross-Lagged Panel Models indicated detrimental parenting effects of invalidation on subsequent development in borderline-related traits of the child both between and within families, and additional child-driven effects for subsequent invalidating parenting strategies within families. Beyond these transactions between borderline-related traits and parenting, the current study also indicates significant differences in the direction of effects when exploring transactions between more common dimensions of child internalizing/externalizing symptomatology and parental invalidation, suggesting a more substantial parenting etiology in the developmental process of borderline traits throughout pre-adolescence. Future longitudinal research may explore to what extent the transactional nature of borderline personality traits during important developmental stages indeed holds unique aspects compared to more common manifestations of symptomatology at young age.

The Emotional Dysregulation Questionnaire: Development and comparative analysis

OBJECTIVES

A widely used measure of emotion dysregulation, the Difficulties in Emotion Regulation Scale (DERS), may insufficiently cover a number of potentially important aspects of emotional dysregulation. A new measure of emotional dysregulation, the Emotional Dysregulation Questionnaire (EDQ) was therefore developed based upon an eight-factor model of the construct.

DESIGN AND METHOD

The DERS and the EDQ were administered to a community sample (N = 362; 183 female, 179 male), along with a number of measures of psychopathology associated with emotional dysregulation. The capacity of the EDQ and the DERS to account for the emotional dysregulation associated with these different types of psychopathology was then compared.

RESULTS

In several of the psychopathologies examined, the EDQ could account for more variation than the DERS, suggesting that it more comprehensively assessed the emotion regulation deficits associated with these issues.

CONCLUSIONS

Results suggest the EDQ possesses several advantages relative to the DERS, allowing for a more comprehensive and accurate assessment of emotional dysregulation.

PRACTITIONER POINTS

Emotional dysregulation is a common component of many psychological disorders. The Difficulties in Emotion Regulation Scale is one of the primary self-report measures used to asses these difficulties, however, concerns exist that it may not comprehensively assess the construct of emotional dysregulation. A new self-report measure of comparable length, the Emotional Dysregulation Questionnaire has been developed, with this new measure possessing several advantages relative to the DERS with regard to the assessment of emotional dysregulation. The use of this measure in clinical practice may more accurately identify the emotion regulation deficits present in clients.

Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders

OBJECTIVES

Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI.

METHOD

The sample included 171 outpatients (94.2% female; M_age  = 28.78, SD_age  = 11.19).

RESULTS

Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year.

CONCLUSIONS

Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.

A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder

Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.

Confirmatory Factor Analysis of the Invalidating Childhood Environment Scale in Spanish (ICES)

Background/Objective: The Invalidating Childhood Environment Scale (ICES) is an instrument designed to assess retrospectively parental invalidation experience, according to Marsha Linehan’s definition of invalidation. The main aim of this paper is to determine the factorial structure of the ICES. Three factor structures: Standard Model, Reduced Model, and 2 Factor Model are examined. Also, the association between invalidating experience and borderline symptoms is studied. Method: Data from a non-clinical, volunteer sample of 274 adults was collected. Participants completed 4 surveys: Demographic surveys, Invalidating Childhood Environment Scale (ICES), Borderline Symptoms List (BSL 23), and Parental Bonding Instrument (PBI). Statistical analyses included confirmatory factor analysis and multiple linear regression. Results: The results of the analysis presented indicate that the ICES is a reliable instrument, and that the 2 Factor Model is good fit and allows for a broader understanding of invalidation and it’s qualities. The results of the linear regression analysis indicated a mild but significant association between invalidation and BPD symptoms. Internal consistency was acceptable for all levels. Conclusion: The outcome of this study shows that the ICES is a useful instrument that can be used to make progress in uncovering the role of childhood invalidation in BPD.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale

PURPOSE

The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology.

METHODS

A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested.

RESULTS

Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology.

CONCLUSIONS

The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Childhood emotional invalidation and right hemispheric mu suppression during a pain empathy task: An EEG study

Empathy is a critical aspect of social behavior, and impairment in empathic processing is linked to hindered social interactions and several disorders. Despite much interest in this topic, our understanding of the developmental and neural involvement for empathic processing is limited. Recent evidence suggests the Mirror Neuron System (MNS) may play a role in this behavior, and that mu rhythm suppression found over the sensorimotor cortices may be a proxy for the MNS. Therefore, we aimed to measure mu rhythm oscillations in response to empathic processing during observation of painful action-based situations using electroencephalogram (EEG). Our second goal was to examine how perceived parental emotional invalidation (EI) during childhood may relate to empathy and influence mu suppression. Our results showed that mu rhythm suppression was strongest over the right hemisphere. EI had a significant influence on this suppression between painful and non-painful images, and was negatively correlated with behavioral measures of empathy. Our findings suggest that perceived childhood EI may decrease empathizing abilities and influence neural responses to the painful experiences of others. Implications from this study could entail clinical intervention targeted at emotional invalidation to foster the healthy development of empathy.

Association between childhood invalidation and borderline personality symptoms: self-construal and conformity as moderating factors

BACKGROUND

Linehan (1993)'s biosocial model posits that borderline personality disorder (BPD) symptoms develop as a result of a transactional relationship between pre-existing emotional vulnerability and an invalidating childhood environment. Little work, however, has investigated cultural factors that may influence the relationship between childhood invalidation and BPD symptoms. The present study investigated the association between parental invalidation and BPD symptoms, and the role of conformity and self-construal as potential moderators of this association.

METHODS

Two hundred and ninety undergraduate students were recruited from a large university in Singapore and administered questionnaires measuring Asian values, self-construal, parental invalidation, and BPD symptomatology.

RESULTS

Multiple regression analysis demonstrated a significant positive association between BPD symptoms and maternal invalidation. Moderation analyses revealed a 3-way interaction, indicating that the maternal invalidation and BPD symptoms association varied by degree of conformity and self-construal. Among participants with interdependent self-construal, maternal invalidation was associated with BPD symptoms only at high conformity levels. No significant moderating effect was found among participants with independent self-construal.

CONCLUSIONS

Overall, the study found empirical support for aspects of Linehan's biosocial model in an Asian context, and has implications for developing a culturally-informed understanding of BPD.

The neurobiology of self-knowledge in depressed and self-injurious youth

There is limited information regarding the neurobiology underlying non-suicidal self-injury (NSSI) in clinically-referred youth. However, the salience of disturbed interpersonal relationships and disrupted self-processing associated with NSSI suggests the neural basis of social processes as a key area for additional study. Adolescent participants (N=123; M=14.75 years, SD=1.64) were divided into three groups: NSSI plus depression diagnosis (NSSI), depression only (DEP), healthy controls (HC). In the scanner, participants completed an Interpersonal Self-Processing task by taking direct (own) and indirect (mothers', best friends', or classmates') perspectives regarding self-characteristics. Across all perspectives, NSSI showed higher BOLD activation in limbic areas, and anterior and posterior cortical midline structures versus DEP and HC, while HC showed greater activity in rostrolateral, frontal pole and occipital cortex than NSSI and DEP youth. Moreover, NSSI youth showed heightened responses in amygdala, hippocampus, parahippocampus, and fusiform when taking their mothers' perspective, which were negatively correlated with self-reports of the mother's support of adolescents' emotional distress in the NSSI group. NSSI youth also yielded greater precuneus and posterior cingulate cortex activity during indirect self-processing from their classmates' perspective. Findings suggest a role for disruptions in self- and emotion-processing, and conflicted social relationships in the neurobiology of NSSI among depressed adolescents.