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Tan K, Ingram SH, Lau LASL, South SC. Borderline Personality Traits and Romantic Relationship Dissolution. J Pers Disord 2022; 36:183-200. [PMID: 34427491 DOI: 10.1521/pedi_2021_35_533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many studies have found that borderline personality disorder (BPD) is associated with romantic relationship instability, with relationship dissolution being a recurring theme. Scant research, however, has examined the dissolution strategies and post-breakup outcomes for individuals with elevated levels of borderline traits. Findings from two studies revealed that there was an association between BPD criteria and tendency to employ less adaptive dissolution strategies when terminating a relationship. Furthermore, elevated levels of BPD traits were associated with less self-concept clarity and more unwanted pursuit of ex-partners. These findings both provide insight into how individuals with BPD traits experience relationship dissolution and suggest possible factors underlying the unstable relationship processes typically associated with borderline traits.
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Affiliation(s)
- Kenneth Tan
- School of Social Sciences, Singapore Management University, Singapore
| | - Samantha H Ingram
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
| | - Laura A S L Lau
- School of Social Sciences, Singapore Management University, Singapore
| | - Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
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2
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Houben M, Mestdagh M, Dejonckheere E, Obbels J, Sienaert P, van Roy J, Kuppens P. The Statistical Specificity of Emotion Dynamics in Borderline Personality Disorder. J Pers Disord 2021; 35:819-840. [PMID: 34124950 DOI: 10.1521/pedi_2021_35_509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persons with borderline personality disorder (BPD) experience heightened emotional instability. Different components underlie instability, and the relation between instability and well-being could be confounded by average emotionality and within-person standard deviation across emotional states, reflecting variability. Therefore, the goal was to examine which pattern of emotion dynamics parsimoniously captures the emotional trajectories of persons with BPD. Forty persons with BPD, 38 clinical controls in a major depressive episode, and 40 healthy controls rated the intensity of their emotions 10 times a day for 1 week. After correction for differences in average emotionality, persons with BPD showed heightened emotional instability compared to both control groups. When additionally correcting for emotional variability, the authors found that instability indices did not differ between groups anymore. This shows that persons with BPD differ from control groups in the magnitude of emotional deviations from the emotional baseline, and not necessarily in the degree of abruptness of these deviations.
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Affiliation(s)
| | | | | | - Jasmien Obbels
- University Psychiatric Center KU Leuven, Leuven, Belgium
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Development and Validation of the Mood Instability Questionnaire-Trait (MIQ-T). ACTA ACUST UNITED AC 2021; 57:medicina57080838. [PMID: 34441044 PMCID: PMC8399587 DOI: 10.3390/medicina57080838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
Background and objectives: Mood instability (MI) is a stable trait associated with psychiatric disorders, yet there is a lack of tools to measure MI. The purpose of this study was to develop and validate the Mood Instability Questionnaire-Trait (MIQ-T) to evaluate MI in mood disorder patients. Material and methods: Items were taken from various established questionnaires to create an initial list of MIQ-T questions. Data from 309 psychiatric patients (n = 309; 62 major depressive disorder, 58 bipolar I disorder, and 189 bipolar II disorder) were gathered from their medical records and were utilized in an exploratory factor analysis to clarify the underlying components of MI. Then, anonymous survey data from 288 individuals from the general population were included in the analysis as a comparison group. Associations between MIQ-T and other previously validated clinical instruments for mood disorders were examined to test external validity. Results: The exploratory factor analysis demonstrated that the five-factor structure (Lability, Upward Tendency, Downward Tendency, Childhood Instability, and Seasonality) of 59 items was the most appropriate with clear, cohesive features. MIQ-T exhibited high internal consistency (α = 0.96) and moderate to strong correlations with other previously validated clinical instruments, which were consistent with theoretical predictions, providing evidence of criterion validity. Short forms were also created to address the high internal consistency value, which can indicate redundancy, and to increase the approachability of the measure. We found that the patients with bipolar II disorder had higher MIQ-T scores than the patients with bipolar I disorder or major depressive disorder and the comparison group. Conclusion: Together, these findings validate the newly developed MIQ-T as an instrument of mood instability. MIQ-T can be a potential research tool for mood disorder.
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Semborski S, Henwood B, Rhoades H, Mason T, Wenzel S, Rice E. Construct, concurrent, and real-world predictive validity of the Difficulties in Emotion Regulation (DERS-18) among young adults with history of homelessness. Psychol Assess 2021; 33:385-394. [PMID: 33630634 PMCID: PMC8418354 DOI: 10.1037/pas0000991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Skills in emotional regulation are vitally important for enabling homeless young adults to navigate the complex and chaotic settings associated with homelessness. The current study seeks to test the construct, concurrent, and predictive validity of the Difficulties in Emotional Regulation Scale (DERS-18) in a sample of formerly and currently homeless young adults. Data come from a study of HIV risk among young adults who have experienced homelessness, including both those currently experiencing homelessness (n = 99) and in permanent housing (n = 120), collected between 2017 and 2019 in Los Angeles, CA. Structural Equation Modeling was used to complete Confirmatory Factor Analysis and Path Models focused on the relationship between mental health symptomatology and emotional regulation. Linear regression models tested the link between affective intensity and instability and the DERS-18. Model fit indices pointed to the five-factor solution of the DERS-18, excluding the Awareness subscale. Clinical scores of anxiety, depression, and PTSD were found to have a significant, positive correlation with DERS. Both intensity and instability of negative affect were associated with greater difficulty in emotional regulation, while the increased intensity of positive affect was associated with increased skills in emotional regulation. This study addressed several gaps in both homelessness and emotional regulation literature. The DERS-18 was found to have construct, concurrent, and predictive validity in our sample. Future work should consider the use of the DERS-18 to assess skills in emotional regulation, understand outcomes, and better tailor interventions for young adults who have experienced homelessness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Sara Semborski
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Tyler Mason
- Department of Preventive Medicine, University of Southern California
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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5
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Comparing Signal-Contingent and Event-Contingent Experience Sampling Ratings of Affect in a Sample of Psychotherapy Outpatients. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 42:13-24. [PMID: 33664551 DOI: 10.1007/s10862-019-09766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Experience sampling methods are widely used in clinical psychology to study affective dynamics in psychopathology. The present study examined whether affect ratings (valence and arousal) differed as a function of assessment schedule (signal- versus event-contingent) in a clinical sample and considered various approaches to modeling these ratings. A total of 40 community mental health center outpatients completed ratings of their affective experiences over a 21-day period using both signal-contingent schedules (random prompts) and event-contingent schedules (ratings following social interactions). We tested whether assessment schedules impacted 1) the central tendency (mean) and variability (standard deviation) of valence or arousal considered individually, 2) the joint variability in valence and arousal via the entropy metric, and 3) the between-person differences in configuration of valence-arousal landscapes via the Earth Mover's Distance (EMD) metric. We found that event-contingent schedules, relative to signal-contingent schedules, captured higher average levels of pleasant valence and emotional arousal ratings. Moreover, signal-contingent schedules captured greater variability within and between individuals on arousal-valence landscapes compared to event-contingent schedules. Altogether, findings suggest that the two assessment schedules should not be treated interchangeably in the assessment of affect over time. Researchers must be cautious in generalizing results across studies utilizing different experience sampling assessment schedules.
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Lydon-Staley DM, Xia M, Mak HW, Fosco GM. Adolescent Emotion Network Dynamics in Daily Life and Implications for Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:717-729. [PMID: 30203118 PMCID: PMC6411453 DOI: 10.1007/s10802-018-0474-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Emotion network density describes the degree of interdependence among emotion states across time. Higher density is theorized to reflect rigidity in emotion functioning and has been associated with depression in adult samples. This paper extended research on emotion networks to adolescents and examined associations between emotion network density and: 1) emotion regulation and 2) symptoms of depression. Data from a daily diary study (t = 21 days) of adolescents (N = 151; 61.59% female; mean age = 14.60 years) were used to construct emotion network density scores. Emotion regulation was measured using The Difficulties in Emotion Regulation Scale Short Form (DERS-SF). Depression was measured using the Revised Child Anxiety and Depression Scale-Short Version (RCADS-SV). Associations between emotion network density and DERS-SF were examined through Pearson correlations. Multiple regression analyses examined associations between emotion network density and depression. Emotion network density was not associated with the DERS-SF. Follow-up analyses showed that it was positively associated with non-acceptance of emotions (a subscale of the DERS-SF). Emotion network density was positively associated with RCADS-SV depression. Non-acceptance of emotions may encourage the spread of emotion across time and states given that a feature of non-acceptance is to have secondary emotional responses to one's emotions. Emotion networks that are self-predictive may be a risk factor for adolescent depression.
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Affiliation(s)
- D M Lydon-Staley
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA.
- Department of Bioengineering, University of Pennsylvania, 311 Hayden Hall, Philadelphia, PA, 19104, USA.
| | - M Xia
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
| | - H W Mak
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
| | - G M Fosco
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
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Peter M, Arntz A, Klimstra T, Vingerhoets AJJM. Crying in borderline personality disorder patients. Psychiatry Res 2019; 273:100-107. [PMID: 30640050 DOI: 10.1016/j.psychres.2019.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Abstract
Emotion dysregulation and hyperreactivity are considered central features of Borderline Personality Disorder (BPD). We assumed that such emotion dysregulation is also reflected in increased crying behavior of these patients and, consequently, hypothesized that BPD patients (N = 62), compared to Cluster C personality disorder patients (Cluster C-PD; N = 25) and non-patients (N = 54), would show higher scores on crying measures. To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears. They also reported less awareness of the influence of crying on others. However, Cluster C-PD patients showed a very similar pattern of findings. Overall, our results suggest that the increased crying of BPD patients likely results from environmental factors or the misperception of situations, rather than from stable traits. Remarkable is that the observed discrepancies in crying behavior compared to non-patients seem to be similar for Cluster-C PDs and BPD.
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Affiliation(s)
- Mathell Peter
- Department of Personality Disorders, GGz Breburg, Lage Witsiebaan 4, Tilburg, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam, the Netherlands
| | - Theo Klimstra
- Developmental Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
| | - Ad J J M Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
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8
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Köhling J, Moessner M, Ehrenthal JC, Bauer S, Cierpka M, Kämmerer A, Schauenburg H, Dinger U. Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology. J Pers Disord 2016; 30:776-795. [PMID: 26623534 DOI: 10.1521/pedi_2015_29_230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.
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Kirchner TR, Shiffman S. Spatio-temporal determinants of mental health and well-being: advances in geographically-explicit ecological momentary assessment (GEMA). Soc Psychiatry Psychiatr Epidemiol 2016; 51:1211-23. [PMID: 27558710 PMCID: PMC5025488 DOI: 10.1007/s00127-016-1277-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Overview of geographically explicit momentary assessment research, applied to the study of mental health and well-being, which allows for cross-validation, extension, and enrichment of research on place and health. METHODS Building on the historical foundations of both ecological momentary assessment and geographic momentary assessment research, this review explores their emerging synergy into a more generalized and powerful research framework. RESULTS Geographically explicit momentary assessment methods are rapidly advancing across a number of complimentary literatures that intersect but have not yet converged. Key contributions from these areas reveal tremendous potential for transdisciplinary and translational science. CONCLUSIONS Mobile communication devices are revolutionizing research on mental health and well-being by physically linking momentary experience sampling to objective measures of socio-ecological context in time and place. Methodological standards are not well-established and will be required for transdisciplinary collaboration and scientific inference moving forward.
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Affiliation(s)
- Thomas R Kirchner
- College of Global Public Health, New York University, 41 E. 11th St., 7th Floor, New York, NY, 10003, USA.
- Center for Urban Science and Progress, New York University, New York, NY, USA.
- Department of Population Health, New York University Medical Center, New York, NY, USA.
| | - Saul Shiffman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Santangelo PS, Limberger MF, Stiglmayr C, Houben M, Coosemans J, Verleysen G, Kuppens P, Tuerlinckx F, Vanpaemel W, Ebner-Priemer UW. Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets. Borderline Personal Disord Emot Dysregul 2016; 3:5. [PMID: 27386138 PMCID: PMC4934004 DOI: 10.1186/s40479-016-0039-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affective dysregulation is widely regarded as being the core problem in patients with borderline personality disorder (BPD). Moreover, BPD is the disorder mainly associated with affective dysregulation. However, the empirical confirmation of the specificity of affective dysregulation for BPD is still pending. We used a validated approach from basic affective science that allows for simultaneously analyzing three interdependent components of affective dysregulation that are disturbed in patients with BPD: homebase, variability, and attractor strength (return to baseline). METHODS We applied two types of multilevel models on two e-diary datasets to investigate group differences regarding three subcomponents between BPD patients (n = 43; n = 51) and patients with posttraumatic stress disorder (PTSD; n = 28) and those with bulimia nervosa (BN; n = 20) as clinical control groups in dataset 1, and patients with panic disorder (PD; n = 26) and those with major depression (MD; n = 25) as clinical control groups in dataset 2. In addition, healthy controls (n = 28; n = 40) were included in the analyses. In both studies, e-diaries were used to repeatedly collect data about affective experiences during participants' daily lives. In study 1 a high-frequency sampling strategy with assessments in 15 min-intervals over 24 h was applied, whereas the assessments occurred every waking hour over 48 h in study 2. The local ethics committees approved both studies, and all participants provided written informed consent. RESULTS In contradiction to our hypotheses, BPD patients did not consistently show altered affective dysregulation compared to the clinical patient groups. The only differences in affective dynamics in BPD patients emerged with regard to one of three subcomponents, affective homebase. However, these results were not even consistent. Conversely, comparing the patients to healthy controls revealed a pattern of more negative affective homebases, higher levels of affective variability, and (partially) reduced returns to baseline in the patient groups. CONCLUSIONS Our results indicate that affective dysregulation constitutes a transdiagnostic mechanism that manifests in similar ways in several different mental disorders. We point out promising prospects that might help to elucidate the common and distinctive mechanisms that underlie several different disorders and that should be addressed in future studies.
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Affiliation(s)
| | | | - C. Stiglmayr
- />Consortium for Scientific Psychotherapy Berlin (AWP-Berlin), Berlin, Germany
| | - M. Houben
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - J. Coosemans
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - G. Verleysen
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - P. Kuppens
- />KU Leuven – University of Leuven, Leuven, Belgium
| | | | - W. Vanpaemel
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - U. W. Ebner-Priemer
- />Karlsruhe Institute of Technology, Karlsruhe, Germany
- />Central Institute of Mental Health, Mannheim, Germany
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Dixon-Gordon KL, Weiss NH, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence. Compr Psychiatry 2015; 62:187-203. [PMID: 26343484 PMCID: PMC4561853 DOI: 10.1016/j.comppsych.2015.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Katherine L. Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Nicole H. Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA,Correspondence concerning this article should be addressed to Kim L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216; Phone: (601) 815-6450;
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12
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Rosenthal MZ, Fang CM, Chapman AL. Ambulatory measurement of emotional dysfunction in borderline personality disorder. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Santangelo P, Reinhard I, Mussgay L, Steil R, Sawitzki G, Klein C, Trull TJ, Bohus M, Ebner-Priemer UW. Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:258-72. [PMID: 24661176 DOI: 10.1037/a0035619] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.
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Affiliation(s)
- Philip Santangelo
- Department of Sport and Sport Science, Karlsruhe Institute of Technology
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Mannheim
| | | | - Regina Steil
- Department of Psychology and Sports Sciences, Johann Wolfgang Goethe University
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg
| | - Christoph Klein
- Klein, Department of Child and Adolescent Psychiatry and Psychotherapy, Freiburg University
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri-Columbia
| | - Martin Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
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Santangelo P, Bohus M, Ebner-Priemer UW. Ecological momentary assessment in borderline personality disorder: a review of recent findings and methodological challenges. J Pers Disord 2014; 28:555-76. [PMID: 22984853 DOI: 10.1521/pedi_2012_26_067] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of Ecological Momentary Assessment (EMA) has led to increased insight into borderline personality disorder (BPD) symptoms, especially regarding affective instability. EMA is characterized by a series of repeated assessments of current affective, behavioral, and contextual experiences or physiological processes while participants engage in normal daily activities. EMA has several advantages. It enables researchers to avoid biased recollection, to investigate within-person processes, and to enhance real-life generalizability. This review is dedicated to four main objectives: (1) to discuss the characteristics of EMA in studying BPD symptomatology; (2) to provide an extensive overview of EMA findings in BPD structured into findings regarding DSM-IV criteria and findings regarding emotional dysregulation as stated in the biosocial theory of Linehan; (3) to discuss challenges of EMA and to give recommendations for the proper use of it; and (4) to highlight prospects and promising applications that should be addressed.
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15
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Herr NR, Rosenthal MZ, Geiger PJ, Erikson K. Difficulties with emotion regulation mediate the relationship between borderline personality disorder symptom severity and interpersonal problems. Personal Ment Health 2013; 7:191-202. [PMID: 24343962 DOI: 10.1002/pmh.1204] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/20/2012] [Accepted: 06/06/2012] [Indexed: 11/10/2022]
Abstract
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.
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Dixon-Gordon KL, Gratz KL, Tull MT. Multimodal assessment of emotional reactivity in borderline personality pathology: the moderating role of posttraumatic stress disorder symptoms. Compr Psychiatry 2013; 54:639-48. [PMID: 23375184 PMCID: PMC3644527 DOI: 10.1016/j.comppsych.2012.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 12/18/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022] Open
Abstract
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.
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Dixon-Gordon KL, Yiu A, Chapman AL. Borderline personality features and emotional reactivity: the mediating role of interpersonal vulnerabilities. J Behav Ther Exp Psychiatry 2013; 44:271-8. [PMID: 23333423 DOI: 10.1016/j.jbtep.2012.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/02/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to examine the mediating role of interpersonal vulnerabilities in the association of borderline personality (BP) features with emotional reactivity to an interpersonal stressor. METHODS For this study, female university students with high (N = 23), mid (N = 23), and low (N = 22) BP features completed the Inventory of Interpersonal Problems-Personality Disorders-25 (IIP-PD-25). Self-reported emotions, skin conductance responses (SCRs), interbeat intervals, and heart rate variability measured emotional reactivity to a social rejection stressor. RESULTS BP features were positively associated with interpersonal dysfunction and predicted greater SCR reactivity and self-reported emotional reactivity. Interpersonal dysfunction mediated the association between BP features and physiological (SCRs), but not self-reported, emotional reactivity. In particular, scores on the interpersonal ambivalence subscale of the IIP-PD-25 mediated the association of BP features with SCR reactivity. LIMITATIONS This study examined BP features in a non-clinical sample, and relied on a relatively small sample. Furthermore, the design of the present study does not capture the potential transaction between interpersonal vulnerabilities and emotional dysfunction. CONCLUSIONS The findings of this study illuminate one potential mechanism underlying the heightened reactivity of persons with BP features to rejection, suggesting that interpersonal ambivalence plays a particularly important role in physiological reactivity.
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Svaldi J, Dorn C, Matthies S, Philipsen A. Effects of suppression and acceptance of sadness on the urge for non-suicidal self-injury and self-punishment. Psychiatry Res 2012; 200:404-16. [PMID: 22819783 DOI: 10.1016/j.psychres.2012.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/08/2012] [Accepted: 06/10/2012] [Indexed: 11/20/2022]
Abstract
The present study wanted to test the course of the urge for non-suicidal self-injury (UNSSI) and the urge for self-punishment (USP) when suppressing or accepting upcoming emotions in response to a sadness-inducing film clip in female participants with borderline personality disorder (BPD). Thirty-six women with BPD were allocated either to a condition in which they were asked to engage in expressive suppression or acceptance while watching a sadness-inducing film clip. Ratings of UNSSI, USP, and positive and negative emotions were assessed prior to the clip (baseline), immediately after it (t1) and after a 5min waiting period (t2), during which participants viewed landscape pictures. Additionally, physiological measures were obtained. Main results revealed a significant increase in UNSSI from baseline to t2 in the acceptance, but not in the suppression group. Furthermore, USP scores significantly increased from baseline to t2 in the acceptance, but not in the suppression condition. However, there was no differential impact on the sympathetic and parasympathetic branch depending on strategy. The results are in line with recent literature showing that expressive suppression in BPD may also have an adaptive function.
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Affiliation(s)
- Jennifer Svaldi
- University of Freiburg, Department of Clinical Psychology and Psychotherapy, Engelbergerstrasse 41, 79106 Freiburg, Germany.
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Physiological and self-assessed emotional responses to emotion-eliciting films in borderline personality disorder. Psychiatry Res 2012; 200:437-43. [PMID: 22884218 DOI: 10.1016/j.psychres.2012.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 06/18/2012] [Accepted: 07/15/2012] [Indexed: 11/23/2022]
Abstract
According to Linehan's biosocial model, the core characteristic of borderline personality disorder (BPD) is emotional dysregulation. In the present study, we investigated two components of this model: baseline emotional intensity and emotional reactivity. A total of 60 women, 30 with BPD diagnosis and 30 age and sex-matched healthy subjects (HCs), participated in two experiments. In the first experiment, we evaluated emotional responses to six films designed to elicit discrete emotions (anger, fear, sadness, disgust, amusement and neutral). The second experiment evaluated emotional reactions to three emotion-eliciting films containing BPD-specific content (sexual abuse, emotional dependence and abandonment/separation). Skin conductance level, heart rate, and subjective emotional response were recorded for each film. Although self-reported data indicated that negative emotions at baseline were stronger in the BPD group, physiological measures showed no differences between the groups. Physiological results should be interpreted with caution since most BPD participants were under pharmacological treatment. BPD subjects presented no subjective heightened reactivity to most of the discrete emotion-eliciting films. Subjective responses to amusement and "BPD-specific content" films revealed significant between-group differences. These findings suggest that the main characteristic of BPD might be negative emotional intensity rather than heightened emotional reactivity.
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Smoski MJ, Salsman N, Wang L, Smith V, Lynch TR, Dager SR, LaBar KS, Linehan MM. Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder. Personal Disord 2012; 2:230-41. [PMID: 22448769 DOI: 10.1037/a0022228] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an "oddball" task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions.
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Affiliation(s)
- Moria J Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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21
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Neacsiu AD, Ward-Ciesielski EF, Linehan MM. Emerging Approaches to Counseling Intervention. COUNSELING PSYCHOLOGIST 2012. [DOI: 10.1177/0011000011421023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its development, DBT has been adapted to various populations and has been successfully used in a wide array of settings. This article presents the approaches used in DBT with a particular emphasis on (a) the philosophy and assumptions on which the treatment is based, (b) the major theoretical constructs and the DBT conceptualization of the client, (c) the intervention and specific techniques used, (d) research supporting the theory and treatment, and (e) the integration of diversity, culture, and social justice.
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Sadikaj G, Russell JJ, Moskowitz DS, Paris J. Affect dysregulation in individuals with borderline personality disorder: persistence and interpersonal triggers. J Pers Assess 2011; 92:490-500. [PMID: 20954051 DOI: 10.1080/00223891.2010.513287] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We hypothesized that affect dysregulation among individuals with borderline personality disorder (BPD) would involve greater persistence of negative affect between interpersonal events and heightened reactivity to stimuli indicating risk of rejection or disapproval, specifically perceptions of others' communal (agreeable-quarrelsome) behaviors. A total of 38 participants with BPD and 31 controls collected information about affect and perceptions of the interaction partner's behavior during interpersonal events for a 20-day period. Negative and positive affect persisted more across interpersonal events for individuals with BPD than for controls. In addition, individuals with BPD reported a greater increase in negative affect when they perceived less communal behavior and a smaller increase in positive affect when they perceived more communal behavior in others. Findings indicate the importance of interpersonal perceptions in the affect dysregulation of individuals with BPD.
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Axelrod SR, Perepletchikova F, Holtzman K, Sinha R. Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 37:37-42. [PMID: 21091162 DOI: 10.3109/00952990.2010.535582] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dialectical behavior therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. OBJECTIVE Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. METHOD Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. RESULTS Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. CONCLUSION AND SCIENTIFIC SIGNIFICANCE This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. SIGNIFICANCE AND FUTURE RESEARCH: Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dysregulation such as BPD and substance dependence and to further explore emotion regulation as a potential mechanism of change for clinical interventions.
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Affiliation(s)
- Seth R Axelrod
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut 06511, USA.
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24
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Anestis MD, Selby EA, Crosby RD, Wonderlich SA, Engel SG, Joiner TE. A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. Behav Res Ther 2010; 48:607-13. [PMID: 20392437 DOI: 10.1016/j.brat.2010.03.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 03/05/2010] [Accepted: 03/15/2010] [Indexed: 11/18/2022]
Abstract
Affective lability has been linked to several maladaptive behaviors (Anestis et al., 2009; Coccaro, 1991). Methodology for measuring affective lability varies and includes retrospective self-report and ecological momentary assessment (EMA). In this study, we sought to test these methodologies by examining which better predicted binge eating episodes and general eating disorder symptoms in a sample (n = 131) of women diagnosed with bulimia nervosa (BN). We hypothesized that, while the two forms of measurement would be correlated with one another and predict binge eating episodes, EMA affective lability would be the stronger predictor. Results supported several hypotheses. Specifically, both EMA affective lability and retrospective self-report affective lability significantly predicted global eating disorder symptoms, even when controlling for depression, age, body mass index, and level of education, EMA affective lability exhibited a significantly stronger correlation with binge eating episodes than did retrospective self-report affective lability, and EMA affective lability predicted number of binge eating episodes on any given day controlling for the same list of covariates. Limitations include the use of a clinical sample that may limit the generalizability of our findings. Findings highlight the importance of affect in such behavior.
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Affiliation(s)
- Michael D Anestis
- Florida State University, Clinical Psychology, Tallahassee, FL, USA.
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25
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Hopwood CJ, Newman DA, Donnellan MB, Markowitz JC, Grilo CM, Sanislow CA, Ansell EB, McGlashan TH, Skodol AE, Shea MT, Gunderson JG, Zanarini MC, Morey LC. The stability of personality traits in individuals with borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 118:806-15. [PMID: 19899850 DOI: 10.1037/a0016954] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD.
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Glaser JP, Van Os J, Thewissen V, Myin-Germeys I. Psychotic reactivity in borderline personality disorder. Acta Psychiatr Scand 2010; 121:125-34. [PMID: 19555465 DOI: 10.1111/j.1600-0447.2009.01427.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD). METHOD Fifty-six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences. RESULTS All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups. CONCLUSION These results are the first to ecologically validate stress-related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.
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Affiliation(s)
- J-P Glaser
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, 6200 MD Maastricht, the Netherlands
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27
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Emotional reactions to standardized stimuli in women with borderline personality disorder: stronger negative affect, but no differences in reactivity. J Nerv Ment Dis 2009; 197:808-15. [PMID: 19996718 DOI: 10.1097/nmd.0b013e3181bea44d] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emotional dysregulation is hypothesized to be a core feature of borderline personality disorder (BPD). In this study, we investigated the course of emotions in response to standardized emotion inductions in BPD. A total of 26 female BPD patients, 28 matched healthy control subjects, and 15 female patients with major depressive disorder listened to short stories inducing an angry, joyful, or neutral mood. Before and immediately after each story as well as 3 and 6 minutes later, participants rated their current anger, joy, anxiety, shame, and sadness. All 3 groups showed the same increase and decrease of emotions. However, strong group differences in the general level of all negative emotions occurred. While sadness was stronger both in BPD and major depressive disorder as compared with healthy controls, all other negative emotions were significantly increased in BPD only independent of comorbid depression. Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity.
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28
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Myin-Germeys I, Oorschot M, Collip D, Lataster J, Delespaul P, van Os J. Experience sampling research in psychopathology: opening the black box of daily life. Psychol Med 2009; 39:1533-1547. [PMID: 19215626 DOI: 10.1017/s0033291708004947] [Citation(s) in RCA: 479] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A growing body of research suggests that momentary assessment technologies that sample experiences in the context of daily life constitute a useful and productive approach in the study of behavioural phenotypes and a powerful addition to mainstream cross-sectional research paradigms. Momentary assessment strategies for psychopathology are described, together with a comprehensive review of research findings illustrating the added value of daily life research for the study of (1) phenomenology, (2) aetiology, (3) psychological models, (4) biological mechanisms, (5) treatment and (6) gene-environment interactions in psychopathology. Overall, this review shows that variability over time and dynamic patterns of reactivity to the environment are essential features of psychopathological experiences that need to be captured for a better understanding of their phenomenology and underlying mechanisms. The Experience Sampling Method (ESM) allows us to capture the film rather than a snapshot of daily life reality of patients, fuelling new research into the gene-environment-experience interplay underlying psychopathology and its treatment.
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Affiliation(s)
- I Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
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Kuo JR, Linehan MM. Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:531-44. [PMID: 19685950 PMCID: PMC4277483 DOI: 10.1037/a0016392] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Janice R Kuo
- Department of Psychology, Stanford University, Stanford, CA 94305, USA.
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30
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Nica EI, Links PS. Affective instability in borderline personality disorder: experience sampling findings. Curr Psychiatry Rep 2009; 11:74-81. [PMID: 19187713 DOI: 10.1007/s11920-009-0012-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Affective instability, defined as repeated, rapid, and abrupt shifts in mood, is considered the core pathology in borderline personality disorder. The temporal pattern of affective instability can be best captured with the experience sampling method-longitudinal assessment of people's affective states as they occur in real time and in their natural environment. A review of the experience sampling studies published to date for borderline personality disorder suggests the following mood variability pattern: intense negative mood, more frequent and abrupt mood changes than healthy controls and patients with major depression, and partial triggering of affect by external events. The method also has great potential to investigate the links between affective instability and other psychological and behavioral correlates of the disorder, such as suicide, lack of self-esteem, and erratic behaviors. However, the method requires systematic study to determine best data collection designs and mathematical models of mood variability.
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Affiliation(s)
- Elena Irina Nica
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Shuter Wing, Room 2010d, Toronto, Ontario M5B1W8, Canada.
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31
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Johnson EI, Grondin O, Barrault M, Faytout M, Helbig S, Husky M, Granholm EL, Loh C, Nadeau L, Wittchen HU, Swendsen J. Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity. Int J Methods Psychiatr Res 2009; 18:48-57. [PMID: 19195050 PMCID: PMC6878313 DOI: 10.1002/mpr.276] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Computerized ambulatory monitoring overcomes a number of methodological and conceptual challenges to studying mental disorders, however concerns persist regarding the feasibility of this approach with severe psychiatric samples and the potential of intensive monitoring to influence data quality. This multi-site investigation evaluates these issues in four independent samples. Patients with schizophrenia (n = 56), substance dependence (n = 85), anxiety disorders (n = 45), and a non-clinical sample (n = 280) were contacted to participate in investigations using computerized ambulatory monitoring. Micro-computers were used to administer electronic interviews several times per day for a one-week period. Ninety-five percent of contacted individuals agreed to participate in the study, and minimum compliance was achieved by 96% of these participants. Seventy-eight percent of all programmed assessments were completed overall, and only 1% of micro-computers were not returned to investigators. There was no evidence that missing data or response time increased over the duration of the study, suggesting that fatigue effects were negligible. The majority of variables investigated did not change in frequency as a function of study duration, however some evidence was found that socially sensitive behaviors changed in a manner consistent with reactivity.
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Glaser JP, Van Os J, Mengelers R, Myin-Germeys I. A momentary assessment study of the reputed emotional phenotype associated with borderline personality disorder. Psychol Med 2008; 38:1231-1239. [PMID: 18047769 DOI: 10.1017/s0033291707002322] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Stress is postulated to play an essential role in the expression of core borderline symptoms. However, the phenomenology of stress reactivity in borderline personality disorder remains unclear. The current study investigated the phenomenology of stress sensitivity in borderline personality disorder in the flow of daily life and compared this with stress sensitivity in patients suffering from psychotic disorders, a group so far known to report the largest reactivity to stress. METHOD A total of 44 borderline patients, 42 patients with psychotic disorder and 49 healthy controls were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess: (1) appraised subjective stress related to daily events and activities; and (2) emotional reactivity conceptualized as changes in positive and negative affect. RESULTS Multilevel regression analysis revealed that subjects with borderline personality disorder experienced significantly more emotional reactivity to daily life stress compared with both patients with psychosis and healthy controls, as evidenced by a larger increase in negative affect and a larger decrease in positive affect following stress. CONCLUSION These results are the first to ecologically validate the incorporation of stress reactive symptoms in the diagnosis of borderline personality disorder. Borderline patients continually react stronger than patients with psychosis and healthy controls to small disturbances that continually happen in the natural flow of everyday life. Altered emotional stress reactivity may define borderline personality disorder.
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Affiliation(s)
- J-P Glaser
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, The Netherlands
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33
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Reisch T, Ebner-Priemer UW, Tschacher W, Bohus M, Linehan MM. Sequences of emotions in patients with borderline personality disorder. Acta Psychiatr Scand 2008; 118:42-8. [PMID: 18582346 DOI: 10.1111/j.1600-0447.2008.01222.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate sequences of emotions (temporal dependence of emotions) to identify specific patterns of borderline personality disorder (BPD). METHOD The perceived emotions of 50 BPD patients and 50 healthy controls (HC) were monitored by using a hand-held computer system for a 24-h period in a daily life setting. Participants were prompted four times per hour to assess their current perceived emotions. Differences between BPD patients and HC in terms of activation, persistence and down-regulation of emotions were analyzed. RESULTS Healthy controls in contrast to BPD patients more often activated joy and interest. BPD patients more often experienced persistence of anxiety and sadness. BPD patients more frequently switched from anxiety to sadness, from anxiety to anger and from sadness to anxiety. Anger was predominantly preceded by anxiety. CONCLUSION Persistence of sadness and anxiety, as well as emotional oscillating between anxiety, sadness and anger are important aspects of the emotional dysregulation in BPD patients.
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Affiliation(s)
- T Reisch
- University Psychiatric Services, Bern, Switzerland.
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34
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Rosenthal MZ, Gratz KL, Kosson DS, Cheavens JS, Lejuez CW, Lynch TR. Borderline personality disorder and emotional responding: A review of the research literature. Clin Psychol Rev 2008; 28:75-91. [PMID: 17544188 DOI: 10.1016/j.cpr.2007.04.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 03/28/2007] [Accepted: 04/05/2007] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
| | - Kim L Gratz
- Center for Addictions, Personality, and Emotion Research and the University of Maryland, United States
| | - David S Kosson
- Rosalind Franklin University of Medicine and Science, United States
| | | | - C W Lejuez
- Center for Addictions, Personality, and Emotion Research and the University of Maryland, United States
| | - Thomas R Lynch
- Duke University and Duke University Medical Center, United States
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Ebner-Priemer UW, Welch SS, Grossman P, Reisch T, Linehan MM, Bohus M. Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder. Psychiatry Res 2007; 150:265-75. [PMID: 17321599 DOI: 10.1016/j.psychres.2006.04.014] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 11/28/2005] [Accepted: 04/21/2006] [Indexed: 11/16/2022]
Abstract
Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.
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Affiliation(s)
- Ulrich W Ebner-Priemer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Postfach 122120, 68072 Mannheim, Germany.
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36
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Theunissen C. It's important to see the wood for the trees: a reply to Andover, Pepper, Ryabchenko, Orrico, & Gibb (2005). Suicide Life Threat Behav 2007; 37:113-5. [PMID: 17397285 DOI: 10.1521/suli.2007.37.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Ebner-Priemer UW, Sawitzki G. Ambulatory Assessment of Affective Instability in Borderline Personality Disorder. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2007. [DOI: 10.1027/1015-5759.23.4.238] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Affective instability is an essential criterion for borderline personality disorder (BPD) but studies using diaries have rendered conflicting results. Discrepant findings may be caused by differences in the time-based design, especially in the diverse length of the time intervals between self-reports. Even though there is consensus that the time-based design should fit the temporal dynamics of the processes of interest, no general conventions exist. We used 24 h ambulatory monitoring to repeatedly assess subjective ratings of distress in 50 BPD-patients and in 50 healthy controls. We investigated if the chosen time-based design with a time interval of 15 min between self-reports (1) reveals within subject variability in BPD-patients and (2) taps the process of interest. Using graphical and statistical evaluation, we demonstrate that the time-based design (15 min/24 h) does catch within-person variability in the BPD-patients. Comparison of the original data with randomly distributed data (simulation) and autocorrelation analyses prove that we tapped a specific process and did not randomly pick states of distress. Using increasing lags between self-reports reveals that short intervals, especially, (15 min, 30 min) tap a specific process. We recommend using short time intervals to study temporal dynamics of affective instability.
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Affiliation(s)
- Ulrich W. Ebner-Priemer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Germany
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg, Germany
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38
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Glaser JP, van Os J, Portegijs PJM, Myin-Germeys I. Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitioners. J Psychosom Res 2006; 61:229-36. [PMID: 16880026 DOI: 10.1016/j.jpsychores.2006.04.014] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Revised: 02/22/2006] [Accepted: 04/25/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Childhood trauma (CT) has consistently been associated with neuroticism--a personality trait reflecting vulnerability to stress. However, not much is known about the impact of a history of trauma on moment-to-moment emotions and experiences in the flow of daily life. The relationship between CT and emotional reactivity to daily life stress was investigated. METHODS Ninety frequent attenders of general practitioners, of which 29 fulfilled criteria for CT (sexual and/or physical trauma before the age of 19 years), were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess: (a) appraised subjective stress related to daily events and activities, and (b) emotional reactivity conceptualized as changes in negative affect (NA). RESULTS Multilevel regression analysis revealed that subjects with a history of CT reported significantly increased emotional reactivity to daily life stress, as reflected in an increase in NA. This effect was significantly stronger for subjects who experienced trauma before the age of 10 years. CONCLUSION These results confirm that CT may have long-lasting and enduring effects on adult psychological functioning, as exposed individuals continually react more strongly to small stressors occurring in the natural flow of everyday life. The finding that emotional stress reactivity is most pronounced for subjects who experienced trauma early in life confirms prior evidence suggesting that the effects of trauma are more detrimental when trauma occurs at a younger age.
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Affiliation(s)
- Jean-Paul Glaser
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
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39
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Bradley R, Westen D. The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Dev Psychopathol 2006; 17:927-57. [PMID: 16613425 DOI: 10.1017/s0954579405050443] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article provides a contemporary view of the psychodynamics of borderline personality disorder (BPD) from a developmental psychopathology perspective. We first briefly describe the evolution of the borderline construct in psychoanalysis and psychiatry. Then we provide clinically and empirically informed model of domains of personality function and dysfunction that provides a roadmap for thinking about personality pathology from a developmental psychopathology standpoint and examine the nature and phenomenology of BPD in terms of these domains of functioning. Next, we describe prominent dynamic theories of etiology of BPD and examine these in relation to the available research. Finally, we describe psychodynamic conceptions of treatment and the way BPD phenomena manifest in treatment, followed again by consideration of relevant research, particularly on transference-countertransference constellations empirically identified in the treatment of patients with BPD.
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40
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Putnam KM, Silk KR. Emotion dysregulation and the development of borderline personality disorder. Dev Psychopathol 2006; 17:899-925. [PMID: 16613424 DOI: 10.1017/s0954579405050431] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We review the role of emotion regulation in borderline personality disorder (BPD). We briefly discuss the historical development of BPD as a disorder where emotional regulation plays a key role. We review the concept of emotion regulation in general and explore both one-factor and two-factor models of emotion regulation. We discuss cognitive and attentional aspects of emotion regulation, and explore these regulatory controls as operating as both voluntary as well as automatic processes. We then turn to other neurophysiological models of emotion regulation in general and examine how those models, both neurophysiologically and neuroanatomically, are expressed in individuals with BPD. We examine how neuroimaging, both anatomical and functional, reveals the roles that various neuroanatomical structures play in the regulation of emotion in BPD. We conclude by creating a neurodevelopmental model that describes how a complex matrix involving the interplay of constitutional/biological predispositions with environmental stressors as well as with parental effectiveness in response to the child's emotion expression can impact key aspects of adult cognitive, affective, interpersonal, and behavioral functioning that culminate in a diagnosis of BPD.
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Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2006. [DOI: 10.1007/s10879-006-9009-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zeigler–Hill V, Abraham J. Borderline Personality Features: Instability of Self–Esteem and Affect. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2006. [DOI: 10.1521/jscp.2006.25.6.668] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behav Res Ther 2005; 43:1173-85. [PMID: 16005704 DOI: 10.1016/j.brat.2004.08.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 07/29/2004] [Accepted: 08/25/2004] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to examine the relationships among negative affect, childhood sexual abuse (CSA), thought suppression, and diagnostic symptoms of borderline personality disorder (BPD) in a community sample (n=127). Findings suggest that the temperamental variable negative affect intensity/reactivity was a stronger predictor of BPD symptoms than CSA. In addition, results indicated that higher thought suppression mediated the relationship between negative affective intensity/reactivity and BPD symptoms, after controlling for a history of CSA. Overall, findings suggest that (a) negative affectivity may be a better predictor of BPD symptoms than CSA, and (b) chronic efforts to suppress unpleasant thoughts may be a regulation strategy underlying the relationship between intense negative emotions and BPD symptoms.
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Affiliation(s)
- M Zachary Rosenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Box 3026, Durham, NC 27710, USA.
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Arntz A. Introduction to special issue: cognition and emotion in borderline personality disorder. J Behav Ther Exp Psychiatry 2005; 36:167-72. [PMID: 16018875 DOI: 10.1016/j.jbtep.2005.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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45
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Ehrensaft MK. Interpersonal relationships and sex differences in the development of conduct problems. Clin Child Fam Psychol Rev 2005; 8:39-63. [PMID: 15898304 DOI: 10.1007/s10567-005-2341-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article investigates the role of interpersonal relationships in shaping sex differences in the manifestation, etiology, and developmental course of conduct problems and their treatment needs. The review examines whether: (1) Girls' conduct problems are more likely than boys' to manifest as a function of disrupted relationships with caretakers and peers; (2) For girls more than for boys, the outcomes of conduct problems in adolescence and adulthood, and related treatment needs, are more likely to be a consequence of the quality of interpersonal relationships with others, particularly opposite-sex peers and partners. Evidence reviewed suggests that boys and girls share many similarities in their expression of conduct problems, but that a relational perspective does unify important differences. There is fair evidence that girls with conduct problems are more likely to come to the attention of authorities because of chaotic, unstable family relationships, and to express antisocial behavior in the context of close relationships; there is stronger evidence that the course and outcomes of conduct problems in females versus males pertain to interpersonal relationship impairments. Those sex differences map onto specific differences in treatment needs. Further empirical testing of the proposed relational model is indicated.
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Affiliation(s)
- Miriam K Ehrensaft
- Division of Child Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Unit 47, New York 10032, USA.
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46
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Bland AR, Rossen EK. Clinical supervision of nurses working with patients with borderline personality disorder. Issues Ment Health Nurs 2005; 26:507-17. [PMID: 16020065 DOI: 10.1080/01612840590931957] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (Pesut & Herman, 1999). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.
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Affiliation(s)
- Ann R Bland
- Eastern Kentucky University, Baccalaureate and Graduate School & Nursing, Richmond, Kentucky 40475-3102, USA.
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Cheavens JS, Zachary Rosenthal M, Daughters SB, Nowak J, Kosson D, Lynch TR, Lejuez CW. An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression. Behav Res Ther 2005; 43:257-68. [PMID: 15629754 DOI: 10.1016/j.brat.2004.01.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 01/12/2004] [Accepted: 01/16/2004] [Indexed: 11/16/2022]
Abstract
The current study examined the relationships among biological predisposition, social environment, emotion regulation, and features characteristic of Borderline Personality Disorder (BPD). Using an analogue sample, we examined whether thought suppression mediated the relationship of negative affective intensity/reactivity and perceived parental criticism with a composite of BPD features including impulsivity, interpersonal sensitivity, and aggression. Results indicated that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD features and partially mediated the relationship between BPD features and perceived parental criticism. Clinical implications, directions for further research, and limitations of the present study are discussed.
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Affiliation(s)
- Jennifer S Cheavens
- Duke University Medical Center, Trent Drive, Durham, North Carolina 27710, USA
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48
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Ebner-Priemer UW, Badeck S, Beckmann C, Wagner A, Feige B, Weiss I, Lieb K, Bohus M. Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. J Psychiatr Res 2005; 39:85-92. [PMID: 15504426 DOI: 10.1016/j.jpsychires.2004.05.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Revised: 03/30/2004] [Accepted: 05/13/2004] [Indexed: 11/30/2022]
Abstract
Affective dysregulation and dissociation are currently discussed as core features of borderline personality disorder (BPD). Affective dysregulation is hypothesized to be correlated with increased amygdala functioning and dissociation is linked to inhibited processing on the amygdala and dampened autonomic output, according to the corticolimbic disconnection model of dissociation from Sierra and Berrios [Biological Psychiatry 44 (1998) 898]. We assessed startle response, which is mainly mediated by the amygdala, to investigate the relationship between affective dysregulation and dissociation. We hypothesized that patients with BPD would reveal enhanced responses to startling tones, but that these would be lessened by the presence of state dissociative experiences. 21 unmedicated female patients with BPD and 21 healthy female controls listened to 15 startling tones (95-dB, 500-ms, 1000-Hz) while heart rate, skin conductance and orbicularis oculi electromyogram responses were measured. Covariance analysis showed that the BPD group had a significantly higher startle response in the electromyogram as compared to controls. Furthermore, present-state dissociative experiences significantly influenced the startle response. Patients with low dissociative experiences revealed enhanced startle responses whereas patients with high dissociative experiences showed reduced responses. Our data support affective dysregulation in BPD as well as the corticolimbic disconnection model of dissociation, at least for EMG. Furthermore, it highlights the importance of assessing present-state dissociation in basic research as well as psychotherapy.
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Affiliation(s)
- Ulrich W Ebner-Priemer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Postfach 12 21 20, 68072 Mannheim, Germany
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Abstract
This study examined relationships between the ability to recognize facial affect and affective intensity in women with Borderline Personality Disorder. Women hospitalized with borderline personality disorder and community women without psychiatric disorder (n s = 35/group) were recruited via convenience sampling. The Pictures of Facial Affect and the Affect Intensity Measure were administered to consenting women. Hypotheses related to differences in recognizing facial affect were supported, but further exploration indicated that selected negative emotions accounted for the statistical significance. Implications for practice and research are explored.
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Affiliation(s)
- Ann R Bland
- University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
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Puttonen S, Keltikangas-Järvinen L, Ravaja N, Viikari J. Affects and autonomic cardiac reactivity during experimentally induced stress as related to precursors of insulin resistance syndrome. Int J Behav Med 2003; 10:106-24. [PMID: 12763705 DOI: 10.1207/s15327558ijbm1002_02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examined the association of insulin resistance syndrome (IRS) precursors with state affects and autonomic reactivity in randomly selected healthy young adults. It was asked whether IRS precursors are able to predict a person's mental and physiological coping with acute stress over an 11-year follow-up period. IRS parameters were serum insulin, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, body-mass index, and subscapular skinfold thickness. In the psychophysiological experiment, state affects and cardiac responses (heart rate, respiratory sinus arrhythmia, and pre-ejection period) were measured during different challenges. The main result was that IRS precursors predicted high levels of negative emotions during the challenges; IRS accounted for 19% of the variance in tiredness. IRS was unrelated to cardiac reactivity. Mechanisms underlying the associations found are discussed.
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