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

Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends

Borderline personality disorder (BPD), a complex and severe psychiatric disorder, has become a topic of considerable interest to current researchers due to its high incidence and severity of consequences. There is a lack of a bibliometric analysis to visualize the history and developmental trends of researches in BPD. We retrieved 7919 relevant publications on the Web of Science platform and analyzed them using software CiteSpace (6.2.R4). The results showed that there has been an overall upward trend in research interest in BPD over the past two decades. Current research trends in BPD include neuroimaging, biological mechanisms, and cognitive, behavioral, and pathological studies. Recent trends have been identified as "prevention and early intervention", "non-pharmacological treatment" and "pathogenesis". The results are like a reference program that will help determine future research directions and priorities.

Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation

BACKGROUND

Borderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts.

METHODS

This cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED.

RESULTS

Linear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED.

CONCLUSIONS

Our results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.

Attentional Tendencies That Impact Emotion Regulation Success Within a Borderline Personality Disorder Framework

Emotion regulation difficulties are key to borderline personality disorder (BPD) symptomatology. Literature indicates that attentional distraction, particularly within an interpersonal context, is common in BPD. Conversely, reappraisal tactics are less prevalent. The goal of the current study was to examine whether this discrepancy is observed when individuals reporting varying levels of BPD tendencies are given the choice of a preferred emotion regulation tactic when confronted with BPD-relevant stressors. Attentional engagement patterns, affective responses, and strategy success were also examined. Participants (N = 103) reported BPD tendencies as assessed by the Personality Assessment Inventory and were instructed to choose either to "distract" or to "reappraise" in response to affective images. Results revealed more instances of failing to implement distraction among individuals with higher BPD tendencies, which was also reflected in greater fixation biases to distressing content within those images. Results are discussed in terms of the malleability of emotion regulation in BPD contexts.

Catastrophizing, negative affectivity, and borderline personality disorder

The core features of borderline personality disorder (BPD) include problematic interpersonal relationships, behavioral and affective dysregulation, identity problems, and cognitive dysregulation. Cognitive dysregulation, such as catastrophizing, rumination, and thought suppression, contributes to emotion dysregulation in BPD. Previous research suggested that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD symptoms. We predicted that catastrophizing similarly will serve as a mediator between negative affect intensity/reactivity and BPD symptoms. Two samples completed the study. First, students (N = 191) self-selected to participate in an online study through the university psychology research recruitment system. Additionally, a second sample using Amazon Mechanical Turk (MTurk; N = 172) was utilized. Catastrophizing partially mediated the relationship between negative affect intensity/reactivity and BPD symptoms. Across these samples, results suggest that catastrophizing may have a significant role in understanding BPD symptoms, which is similar with rumination. Limitations and future directions are also discussed.

Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD)

BACKGROUND

Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients.

METHODS

Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data.

RESULTS

ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED.

CONCLUSIONS

Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.

Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial

BACKGROUND

Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it.

OBJECTIVES

The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation.

METHODS

We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program.

RESULTS

Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation.

CONCLUSIONS

This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.

The Perceived Invalidation of Emotion Scale (PIES): Development and psychometric properties of a novel measure of current emotion invalidation

Emotion invalidation is theoretically and empirically associated with mental and physical health problems. However, existing measures of invalidation focus on past (e.g., childhood) invalidation and/or do not specifically emphasize invalidation of emotion. In this article, the authors articulate a clarified operational definition of emotion invalidation and use that definition as the foundation for development of a new measure of current perceived emotion invalidation across a series of five studies. Study 1 was a qualitative investigation of people's experiences with emotional invalidation from which we generated items. An initial item pool was vetted by expert reviewers in Study 2 and examined via exploratory factor analysis in Study 3 within both college student and online samples. The scale was reduced to 10 items via confirmatory factor analysis in Study 4, resulting in a brief but psychometrically promising measure, the Perceived Invalidation of Emotion Scale (PIES). A short-term longitudinal investigation (Study 5) revealed that PIES scores had strong test-retest reliability, and that greater perceived emotion invalidation was associated with greater emotion dysregulation, borderline features and symptoms of emotional distress. In addition, the PIES predicted changes in relational health and psychological health over a 1-month period. The current set of studies thus presents a psychometrically promising and practical measure of perceived emotion invalidation that can provide a foundation for future research in this burgeoning area. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Isolating the effect of opposite action in borderline personality disorder: A laboratory-based alternating treatment design

Evaluating the unique effects of each component included in treatment protocols for borderline personality disorder (BPD) is a necessary step in refining these interventions so that they only include skills that drive therapeutic change. One strategy, included in several prominent treatments for BPD, is acting opposite to emotion-driven behavioral urges; engaging in behaviors that are inconsistent with an experienced emotion is thought to lead to reductions in its intensity, though this has not been empirically-tested. The present study was a single-case experiment, specifically an alternating treatment design, that explored the effects of a laboratory-based adaptation of opposite action (versus acting consistent) on emotional intensity. Sixteen individuals with BPD attended six laboratory sessions in which they were instructed to act consistent with an induced emotion in half the sessions and opposite in the other half. Participants were randomly assigned to the specific emotion (i.e., anxiety, sadness, anger, and shame/guilt) that was induced across all study sessions. Findings from visual inspection and percentage of non-overlapping data suggest that acting opposite (versus consistent) leads to significantly greater decreases in emotional intensity for those in the sadness and guilt/shame conditions, but not those in the anxiety or anger conditions. Possible interpretations of these findings are presented. Replication outside of the laboratory context is necessary to draw further conclusions of the clinical implications of these findings.

Process and impact of dialectical behaviour therapy: A systematic review of perceptions of clients with a diagnosis of borderline personality disorder

PURPOSE

To identify, appraise, and synthesize findings from qualitative studies of individuals diagnosed with borderline personality disorder who have experienced dialectical behaviour therapy, to gain further understanding of their perceptions of the process and impact of therapy.

METHODS

We conducted a comprehensive systematic search of the literature from several online databases, and appraised them using an adapted version of the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize the data.

RESULTS

Seven studies met the criteria to be included and their quality subsequently appraised. Four main themes were identified through the synthesis process: life before DBT; the relationships that support change; developing self-efficacy; and a shift in perspectives.

CONCLUSIONS

The findings of the synthesis highlight the importance of a number of key factors in the process of DBT, and the impact that the therapy has both on day-to-day life and on individuals' identity.

PRACTITIONER POINTS

Existing outcome measures may not capture the complexity and magnitude of impact of DBT on individuals with BPD. Exploring first-hand accounts of individuals undertaking DBT can offer unique insight into the processes of therapy.

Parental Expressed Emotion-Criticism and Neural Markers of Sustained Attention to Emotional Faces in Children

There is growing evidence for the role of environmental influences on children's information-processing biases for affectively salient stimuli. The goal of this study was to extend this research by examining the relation between parental criticism (expressed emotion-criticism, or EE-Crit) and children's processing of facial displays of emotion. Specifically, we examined the relation between EE-Crit and children's sensitivity in detecting facial displays of emotion. We also examined a neural marker of sustained attention, the late positive potential (LPP) event-related potential component (ERP). Participants were 87 children (ages 7-11 years; 53.3% female, 77.8% Caucasian) and their parents (ages 24-71; 90% female, 88.9% Caucasian). Parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child. Children completed a morphed faces task during which behavioral and ERP responses were assessed. Although there were no group differences in sensitivity in detecting facial displays of emotion, we found that children of parents exhibiting high, compared to low, EE-Crit displayed less attention (smaller LPP magnitudes) to all facial displays of emotion (fearful, happy, sad). These results suggest that children of critical parents may exhibit an avoidant pattern of attention to affectively-salient interpersonal stimuli.

Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression

Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.

Behaviour vs. perception: An investigation into the components of emotional invalidation

BACKGROUND

The negative effects of emotionally invalidating environments are theorized by the biosocial theory of borderline personality disorder to be vast and severe. However, findings from studies on the impact of emotional invalidation (EI) vary, perhaps due to different operational definitions of EI. The current investigation seeks to explore the relationship between the objective behavioural observations of EI and recipient's subjective perceptions of experiencing these behaviours.

METHOD

First, 58 participants watched scripted interactions between a confederate and a mock participant and identified the presence of invalidating and/or neutral behaviours. Next, 92 participants engaged in one-on-one interactions with a confederate utilizing the same scripted interactions observed by the first set of participants.

RESULTS

While the first set of participants identified invalidating behaviours accurately and consistently, the participants who experienced the behaviours demonstrated more variability in their perceptions of the behaviours as emotionally invalidating.

CONCLUSION

These preliminary findings demonstrate that the objective existence of emotionally invalidating behaviours are likely not the same as the experienced perception of EI across individuals, highlighting the need to examine how EI is operationally defined and measured. Future research should examine what individual characteristics may play a role in perceiving behaviours as emotionally invalidating. Copyright © 2017 John Wiley & Sons, Ltd.

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.

Self and informant report across the borderline personality disorder spectrum

Individuals with borderline personality disorder (BPD) features may be unaware of or unwilling to report their own personality or maladaptive behaviors, which complicates the assessment of BPD. Informants who know the individuals with BPD features may be uniquely suited to aid in the personality assessment of these individuals. The present study analyzed the comparative ability of individuals (targets) and informants to report BPD features across the continuum of BPD severity. The sample consisted of 1387 targets, ages 55 to 65 (56% women), who were recruited for an epidemiological longitudinal study examining the effects of PDs on health and social functioning. Each target nominated an informant who provided information about the target's personality. Results indicated relatively low levels of agreement between perspectives and that informants reported BPD symptoms with more precision and at lower levels of BPD severity than targets. The benefits of including an informant perspective when measuring the BPD continuum are discussed; these benefits may include gains in reliability and improvement in the prediction of outcomes. (PsycINFO Database Record

Borderline Personality Disorder and the Effects of Instructed Emotional Avoidance or Acceptance in Daily Life

This study examined the effects of avoidance- versus acceptance-oriented emotion regulation instructions among individuals with borderline personality disorder (BPD; n = 48), major depressive disorder (MDD; n = 54), and non-psychiatric controls (NPC; n = 50) using ecological momentary assessment. Participants were randomly assigned to either accept or avoid negative emotions, and monitored their moods, urges, and distress tolerance several times per day over 6 days. Avoidance instructions resulted in reduced negative affect and urges for maladaptive behaviors uniquely among BPD participants. Together with past research, and consistent with treatment approaches emphasizing the short-term use of skills to avoid or distract from emotions (e.g., DBT; Linehan, 1993b, 2015), these findings suggest that avoidance of negative emotions may have temporary benefits for individuals with BPD. Acceptance-oriented strategies may take longer or may require more extensive training to be beneficial for emotional functioning in everyday life in BPD.

The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls

BACKGROUND

Research has supported the notion that emotion dysregulation is a core feature of BPD. However, given that this feature is typical of healthy adolescents as well as adolescents with other psychiatric disorders, the specificity of emotion dysregulation to BPD in this age group has not yet been determined. The overall aim of this study was to examine emotion dysregulation in adolescent inpatients with BPD compared with non-BPD inpatient adolescents and healthy non-clinical adolescents, taking into account both global emotion dysregulation deficits and more specific impairments.

METHOD

The sample included 185 adolescent inpatients with BPD (M = 15.23, SD = 1.52), 367 non-BPD psychiatric inpatient adolescents (M = 15.37, SD = 1.40), and 146 healthy adolescents (M = 15.23, SD = 1.22), all of whom were between the ages of 12 and 17. Borderline personality features were assessed, along with emotion dysregulation and psychiatric severity.

RESULTS

After controlling for age, gender, and psychiatric severity, results revealed that adolescents with BPD had higher overall emotional dysregulation compared with non-BPD psychiatric controls and healthy controls. These differences were apparent in only two domains of emotion dysregulation including limited access to emotion regulation strategies perceived as effective and impulse control difficulties when experiencing negative emotions.

CONCLUSIONS

Findings suggest BPD-specific elevations on emotion dysregulation generally, and subscales related to behavioral regulation specifically.

Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice

Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.

Self-compassion and emotional invalidation mediate the effects of parental indifference on psychopathology

This study investigated whether self-compassion and emotional invalidation (perceiving others as indifferent to one's emotions) may explain the relationship of childhood exposure to adverse parenting and adult psychopathology in psychiatric outpatients (N=326). Path analysis was used to investigate associations between exposure to adverse parenting (abuse and indifference), self-compassion, emotional invalidation, and mental health when controlling for gender and age. Self-compassion was strongly inversely associated with emotional invalidation, suggesting that a schema that others will be unsympathetic or indifferent toward one's emotions may affect self-compassion and vice versa. Both self-compassion and emotional invalidation mediated the relationship between parental indifference and mental health outcomes. These preliminary findings suggest the potential utility of self-compassion and emotional schemas as transdiagnostic treatment targets.

Exploration of emotion regulation experiences associated with borderline personality features in a non-clinical sample

BACKGROUND

Emotion dysregulation is a core feature associated with borderline personality features (BPF). Little research has explored how individuals with high levels of BPF regulate their emotions. This study aimed to explore how individuals with high versus low levels of BPF compare on the strategies they use to regulate emotions and in their experiences of emotion regulation.

METHODS

Twenty-nine university students were recruited and assessed for the presence of BPF using self-report questionnaires. Each participant took part in a semi-structured interview about their experiences of emotion regulation. All interview transcripts then underwent thematic analysis. In addition chi square analyses were conducted to explore the association between level of BPF (High vs Low) and each qualitative theme identified.

RESULTS

Findings indicated similarities in the types of emotion regulation strategies used by the high and low-BPF groups. However, the groups differed in their experiences and thought processes surrounding emotion regulation. High-BPF participants were found to describe a need to communicate negative emotions with others and demonstrated difficulty maintaining attention on positive experiences. In addition there was a trend towards High-BPF participants demonstrating less forward-planning in emotion regulation.

CONCLUSIONS

This study provides insights into some of the unique aspects of emotion regulation in individuals with high BPF that may make emotion regulation attempts less successful.

Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence

This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.

Reduced neural differentiation between self-referential cognitive and emotional processes in women with borderline personality disorder

Borderline personality disorder (BPD) is associated with disturbed emotion regulation. Psychotherapeutic interventions using mindfulness elements have shown effectiveness in reducing clinical symptoms, yet little is known about their underlying neurobiology. In this functional magnetic resonance imaging (fMRI) study, 19 female BPD patients and 19 healthy controls were compared during mindful introspection, cognitive self-reflection and a neutral condition. The activation pattern in the right dorsomedial prefrontal cortex (DMPFC) in BPD patients was different from that in healthy subject when directing attention onto their emotions and bodily feelings in contrast to cognitively thinking about themselves. Mindful introspection compared with the neutral condition was associated with higher activations in bilateral motor/pre-motor regions, left inferior frontal gyrus (IFG), and left posterior cingulate cortex (PCC), while cognitive self-reflection activated the right motor and somatosensory cortex, extending into the right supramarginal gyrus (SMG) and superior temporal gyrus (STG) in BPD patients compared with the controls. Results indicate that self-referential cognitive and emotional processes are not clearly differentiated in BPD patients at the neurobiological level. In particular, altered neural mechanism underlying self-referential thinking may be related to some aspects of the typical emotion dysregulation in BPD. Current data support the finding that mindful self-focused attention is effective in regulating amygdala activity in BPD as well as in healthy subjects.

Emotional hyperreactivity in response to childhood abuse by primary caregivers in patients with borderline personality disorder

BACKGROUND

One of the core postulated features of borderline personality disorder (BPD) is extreme emotional reactivity to a wide array of evocative stimuli. Findings from previous experimental research however are mixed, and some theories suggest specificity of hyper emotional responses, as being related to abuse, rejection and abandonment only.

OBJECTIVE

The current experiment examines the specificity of emotional hyperreactivity in BPD.

METHOD

The impact of four film clips (BPD-specific: childhood abuse by primary caregivers; BPD-nonspecific: peer bullying; positive; and neutral) on self-reported emotional affect was assessed in three female groups; BPD-patients (n = 24), cluster C personality disorder patients (n = 17) and non-patient controls (n = 23).

RESULTS

Results showed that compared to the neutral film clip, BPD-patients reacted with more overall negative affect following the childhood abuse clip, and with more anger following the peer bullying clip than the two other groups.

LIMITATIONS

The current study was restricted to assessment of the impact of evocative stimuli on self-reported emotions, and the order in which the film clips were presented to the participants was fixed.

CONCLUSIONS

Results suggest that BPD-patients only react generally excessively emotional to stimuli related to childhood abuse by primary caregivers, and with excessive anger to peer-bullying stimuli. These findings are thus not in line with the core idea of general emotional hyperreactvity in BPD.

Severity of borderline personality symptoms in adolescence: relationship with maternal parenting stress, maternal psychopathology, and rearing styles

The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress has not been examined in this group. The current study examined 101 adolescents (14-19 years old) with BPD symptoms and their mothers. Assessments were made on severity of BPD symptoms, youth-perceived maternal rearing styles, and psychopathology and parenting stress in mothers. Multiple regression analyses were used to examine potential predictors of borderline severity. No correlation was found between severity of BPD symptoms in adolescents and parenting stress. Only youth-perceived maternal overprotection was significantly related to BPD severity. The combination of perceived maternal rejection with cluster B traits in mothers was significantly related to BPD severity in adolescents. This study provides a contribution to the disentanglement of the developmental pathways that lead to BPD.

Parenting, relational aggression, and borderline personality features: associations over time in a Russian longitudinal sample

Crick, Murray-Close, and Woods (2005) encouraged the study of relational aggression as a developmental precursor to borderline personality features in children and adolescents. A longitudinal study is needed to more fully explore this association, to contrast potential associations with physical aggression, and to assess generalizability across various cultural contexts. In addition, parenting is of particular interest in the prediction of aggression or borderline personality disorder. Early aggression and parenting experiences may differ in their long-term prediction of aggression or borderline features, which may have important implications for early intervention. The currrent study incorporated a longitudinal sample of preschool children (84 boys, 84 girls) living in intact, two-parent biological households in Voronezh, Russia. Teachers provided ratings of children's relational and physical aggression in preschool. Mothers and fathers also self-reported their engagement in authoritative, authoritarian, permissive, and psychological controlling forms of parenting with their preschooler. A decade later, 70.8% of the original child participants consented to a follow-up study in which they completed self-reports of relational and physical aggression and borderline personality features. The multivariate results of this study showed that preschool relational aggression in girls predicted adolescent relational aggression. Preschool aversive parenting (i.e., authoritarian, permissive, and psychologically controlling forms) significantly predicted aggression and borderline features in adolescent females. For adolescent males, preschool authoritative parenting served as a protective factor against aggression and borderline features, whereas authoritarian parenting was a risk factor for later aggression.

Brief report: Borderline personality symptoms and perceived caregiver criticism in adolescents

Despite findings of an association between adolescent psychopathology and perceived parental criticism, the relation between adolescent borderline personality disorder (BPD) symptoms and perceived parental criticism has not been examined. Given the centrality of interpersonal sensitivity to BPD (relative to other forms of psychopathology), we hypothesized that adolescent BPD symptoms would be uniquely related to perceived caregiver criticism, above and beyond other forms of psychopathology and general emotion dysregulation. Adolescents (N = 109) in a residential psychiatric treatment facility completed self-report measures of BPD symptoms, perceived caregiver criticism, emotion dysregulation, and symptoms of depression, anxiety, and posttraumatic stress disorder. Results revealed a unique relation of adolescent BPD symptoms to perceived caregiver criticism, above and beyond age, gender, and other forms of psychopathology. Findings suggest that adolescent BPD symptoms may have unique relevance for adolescents' perceptions of caregivers' attitudes and behaviors, increasing the likelihood of negative perceptions.

Emotional hyper-reactivity in borderline personality disorder is related to trauma and interpersonal themes

Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD.

Emotional reactivity to social rejection and negative evaluation among persons with borderline personality features

The present study examined the emotional reactivity of persons with heightened borderline personality (BP) features to social rejection and negative evaluation in the laboratory. Individuals with high levels of BP features (n = 30) and controls with low levels of BP features (n = 44) were randomly assigned to a condition involving negative evaluation based on writing (negative evaluation/academic), or a condition involving negative evaluation based on personal characteristics as well as social rejection (negative evaluation/social rejection). Hypothesis 1 was that high-BP individuals, but not low-BP controls, would show greater emotional reactivity to the negative evaluation/social rejection stressor, compared with the negative evaluation/academic (writing) stressor. Hypothesis 2 was that high-BP individuals would specifically show greater reactivity of shame- and anger-related emotions to the negative evaluation/social rejection stressor compared with the negative evaluation/academic stressor. Findings indicated that high-BP individuals showed heightened emotional reactivity to the social rejection stressor but not to the negative evaluation stressor, but the opposite pattern occurred for controls. In addition, there was evidence for heightened reactivity of irritability, distress, and shame for the high-BP group, specifically in the social rejection condition.

Construct Validity of the Five Factor Borderline Inventory

The Five Factor Borderline Inventory (FFBI) is a new self-report measure developed to assess traits of borderline personality disorder (BPD) from the perspective of the Five Factor Model of general personality. The current study sought to first replicate initial validity findings for the FFBI and then to further validate the FFBI with predispositional risk factors of the biosocial theory of BPD and with commonly associated features of BPD (e.g., depression, low self-esteem) utilizing two samples of young adults ( N = 87; 85) who have engaged in nonsuicidal self-injury. The FFBI showed strong convergent and discriminant validity across two measures of the Five Factor Model and also correlated strongly with measures of impulsivity, emotion dysregulation, and BPD. The FFBI also related to two measures of early childhood emotional vulnerability and parental invalidation and measures of depression, anxiety, and self-esteem. Overall, the results provide support for the FFBI as a measure of BPD.

Investigating the role of executive attentional control to self-harm in a non-clinical cohort with borderline personality features

Self-injurious behavior (or self-harm) is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD). Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.

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

Contemporary theories of borderline personality disorder (BPD) have detailed the functional importance of emotional invalidation in meaningful relationships as an aetiological and perpetuating factor of its core disturbances. The purpose of our study was to test aspects of Linehan's (1993) biosocial and Fruzzetti (1996) and Fruzzetti, Shenk, and Hoffman's (2005) validation/invalidation family interactions transactional theories in a community sample of 186 participants. Results indicated that a multi-mediational path model of invalidation in meaningful relationships, emotion dysregulation, poor distress tolerance and BPD symptoms provided a perfect fit to the data and accounted for a substantial amount of variance in BPD (38%). The results provided support for these complimentary theories of BPD, which hold promise for clinical applications and future research.

Beliefs about unmet interpersonal needs mediate the relation between conflictual family relations and borderline personality features in young adult females

BACKGROUND

Central to most theories of borderline personality disorder (BPD) is the notion that the family environment interacts with genetically-based vulnerabilities to influence the development of BPD, with particular attention given to risk conferred by conflictual familial relations. However, the extent to which family conflict may relate to the development of BPD via related interpersonal beliefs is currently unknown. This study sought to test the hypothesis that the concurrent relation between conflictual family relations and borderline features in female college students is explained by beliefs associated with real or perceived unmet interpersonal needs (captured by Joiner's [2005] Interpersonal Psychological Theory, specifically thwarted belongingness and perceived burdensomeness).

METHOD

The sample included 267 female undergraduates ages 18-25 years (M = 20.86; SD = 1.80). Level of borderline personality features, unmet interpersonal needs, and family conflict were assessed.

RESULTS

Bivariate analyses revealed significant relations between both thwarted belongingness and perceived burdensomeness, conflictual family relations, and borderline features. Multivariate analyses revealed that thwarted belongingness and perceived burdensomeness both mediated the relation between family conflict and borderline personality features, thus supporting a multiple mediation model.

CONCLUSIONS

This cross-sectional study is a preliminary step towards confirming the broad theoretical hypothesis that conflictual family relations relate to beliefs about thwarted belongingness and perceived burdensomeness, which, in turn, relate to borderline personality pathology. Limitations and areas of future research are discussed.

Difficulties with emotion regulation mediate the relationship between borderline personality disorder symptom severity and interpersonal problems

Problems with interpersonal functioning and difficulties with emotion regulation are core characteristics of borderline personality disorder (BPD). Little is known, however, about the interrelationship between these areas of dysfunction in accounting for BPD symptom severity. The present study examines a model of the relationship between difficulties with emotion regulation and interpersonal dysfunction in a community sample of adults (n = 124) with the full range of BPD symptoms. Results showed that difficulties with emotion regulation fully mediated the relationship between BPD symptom severity and interpersonal dysfunction. An alternative model indicated that interpersonal problems partially mediated the relationship between difficulties with emotion regulation and BPD symptom severity. These findings support existing theories of BPD, which propose that difficulties with emotion regulation may account for the types of interpersonal problems experienced by individuals with BPD and suggest further examination of the possibility that interpersonal dysfunction may worsen these individuals' difficulties with emotion regulation.

The effect of anger rumination in the relationship between borderline personality disorder symptoms and precursors

Previous research has identified an invalidating childhood environment and a biological predisposition for affective instability to be two precursors for the development of borderline personality disorder (BPD). In addition, rumination, particularly in response to anger, is significantly associated with symptom severity and dysregulated behavior in BPD. This study examined whether a significant relationship between childhood precursors and current BPD symptom severity could be accounted for by the tendency to engage in anger rumination in a sample of undergraduate students (N = 342), including many with high BPD features. Results showed a significant indirect effect of anger rumination in the relationship between self-reported childhood emotional vulnerability (but not invalidating childhood environment) and BPD symptom severity. This finding suggests that anger rumination could be a risk factor for BPD. These results suggest the importance of continued research on the role of anger rumination in the development and exacerbation of BPD symptoms.

Multimodal assessment of emotional reactivity in borderline personality pathology: the moderating role of posttraumatic stress disorder symptoms

Emotional reactivity has been theorized to play a central role in borderline personality (BP) pathology. Although growing research provides evidence for subjective emotional reactivity in BP pathology, research on physiological or biological reactivity among people with BP pathology is less conclusive. With regard to biological reactivity in particular, research on cortisol reactivity (a neurobiological marker of emotional reactivity) in response to stressors among individuals with BP pathology has produced contradictory results and highlighted the potential moderating role of PTSD-related pathology. Thus, this study sought to examine the moderating role of PTSD symptoms in the relation between BP pathology and both subjective (self-report) and biological (cortisol) emotional reactivity to a laboratory stressor. Participants were 171 patients in a residential substance use disorder treatment center. Consistent with hypotheses, results revealed a significant main effect of BP pathology on subjective emotional reactivity to the laboratory stressor. Furthermore, results revealed a significant interaction between BP pathology and PTSD symptoms in the prediction of cortisol reactivity, such that BP pathology was associated with heightened cortisol reactivity only among participants with low levels of PTSD symptoms. Similar findings were obtained when examining the interaction between BP pathology and the reexperiencing and avoidance/numbing symptoms of PTSD specifically. Results highlight the moderating role of PTSD symptoms in the BP-reactivity relation.

The role of experiential avoidance, psychopathology, and borderline personality features in experiencing positive emotions: a path analysis

BACKGROUND AND OBJECTIVES

Experiential avoidance (EA) is an important factor in maintaining different forms of psychopathology including borderline personality pathology (BPD). So far little is known about the functions of EA, BPD features and general psychopathology for positive emotions. In this study we investigated three different anticipated pathways of their influence on positive emotions.

METHODS

A total of 334 subjects varying in general psychopathology &/or BPD features completed an online survey including self-ratings of BPD features, psychopathology, negative and positive emotions, and EA. Measures of positive emotions included both a general self-rating (PANAS) and emotional changes induced by two positive movie clips. Data were analyzed by means of path analysis.

RESULTS

In comparing the three path models, one model was found clearly superior: In this model, EA acts as a mediator of the influence of psychopathology, BPD features, and negative emotions in the prediction of both measures of positive emotions.

DISCUSSION

EA plays a central role in maintaining lack of positive emotions. Therapeutic implications and study limitations are discussed.

Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design

We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing and externalizing symptoms were all correlated, the discordant twin analyses and biometric modeling showed little to no evidence that was consistent with a causal effect of childhood abuse on BPD traits. Instead, our results indicate that the association between childhood abuse and BPD traits stems from common genetic influences that, in some cases, also overlap with internalizing and externalizing disorders. These findings are inconsistent with the widely held assumption that childhood abuse causes BPD, and they suggest that BPD traits in adulthood are better accounted for by heritable vulnerabilities to internalizing and externalizing disorders.

Components of emotion dysregulation in borderline personality disorder: a review

Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies. We review the evidence supporting each of these components. Given the complexity of the construct of emotion dysregulation and its involvement in many disorders, there is a need for research that specifies which components of emotion dysregulation are under study and also examines the interplay amongst these emotion dysregulation components.

Mindfulness skills in borderline personality disorder patients during dialectical behavior therapy: preliminary results

OBJECTIVE

One of the components of dialectical behavior therapy (DBT) is the use of mindfulness skills as a core component of treatment for subjects with borderline personality disorder (BPD). In this study, we investigated changes in and correlates of mindfulness skills over a 1-year follow-up including a 4-week session of intensive DBT followed by 10 months of standard DBT.

METHODS

Fifty-two BPD subjects were assessed several times using the Kentucky Inventory of Mindfulness Skills (KIMS) which describes mindfulness in four discrete dimensions: observing (Obs), describing (Des), acting with awareness (AwA) and accepting without judgment (AwJ).

RESULTS

AwJ was the only dimension that increased significantly over time after adjustment for potential confounding factors (β = 0.24; P = 0.0002). Increases in AwJ correlated with improvement in BPD symptoms.

CONCLUSIONS

This study highlights the usefulness of investigating changes in mindfulness dimensions during DBT. AwJ is a possible mechanism for positive change. Encouraging this skill should lead to a more adaptive response to problematic situations and counteract impulsive and problematic behaviors. The lack of specific control groups means that these findings are preliminary and replication is required.