1
|
Fitzpatrick S, Varma S, Kuo JR. Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm. Psychol Med 2022; 52:2319-2331. [PMID: 33198829 DOI: 10.1017/s0033291720004225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups. METHODS Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits. RESULTS Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group. CONCLUSIONS There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.
Collapse
Affiliation(s)
| | - Sonya Varma
- Department of Psychology, York University, Canada
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, USA
| |
Collapse
|
2
|
Fitzpatrick S, Kuo JR. Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder. Cogn Emot 2021; 36:473-491. [PMID: 34931942 DOI: 10.1080/02699931.2021.2018291] [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: 10/19/2022]
Abstract
Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.
Collapse
Affiliation(s)
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| |
Collapse
|
3
|
Fitzpatrick S, Liebman RE, Monson CM. The borderline interpersonal-affective systems (BIAS) model: Extending understanding of the interpersonal context of borderline personality disorder. Clin Psychol Rev 2021; 84:101983. [PMID: 33517245 DOI: 10.1016/j.cpr.2021.101983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
Prominent explanatory models for borderline personality disorder (BPD) are intrapersonal in nature and hold that it is an emotional disorder. However, the empirical support for emotional models of BPD is mixed. Refinements to BPD explanatory models are needed to increase the precision with which BPD can be understood and treated. Drawing on existing theoretical and empirical research in BPD, this manuscript presents the Borderline Interpersonal-Affective Systems (BIAS) model. The BIAS model purports that harmful early life relationships and subsequent conflictual relationships lead individuals with BPD to develop a sensitivity to interpersonal threat in the form of attentional and appraisal biases. Individuals with BPD are posited to 1) experience heightened emotional reactivity specifically to perceived interpersonal threat and 2) engage in destructive behaviors both to regulate increasing emotion and to meet interpersonal needs. We review the empirical support for each component of the BIAS model, along with the role of the cognitions, emotions, and behaviors of significant others in influencing BIAS model processes in individuals with BPD over time. The BIAS model highlights a novel way of understanding and integrating interpersonal and emotional components of the disorder. Key directives for future research and clinical implications are discussed.
Collapse
Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
| | - Rachel E Liebman
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| |
Collapse
|
4
|
Bortolla R, Cavicchioli M, Fossati A, Maffei C. Emotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory Studies. J Pers Disord 2020; 34:64-87. [PMID: 30355020 DOI: 10.1521/pedi_2018_32_382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Emotional hyperreactivity (Linehan, 1993) is the most investigated construct in borderline personality disorder (BPD). However, experimental studies revealed mixed results on the topic. Our main objective is to comprehensively summarize the results on emotional reactivity in BPD compared to healthy controls (HCs), using a meta-analytic approach, considering different emotional response systems (physiology, behavior, self-report). We included 31 experimental studies (1,675 subjects). We observed null to small effect sizes for several physiological and behavioral outcomes. Conversely, BPD subjects revealed a moderate to large difference in valence attributed to emotional stimuli and a small difference in self-reported arousal. Significant differences in pooled effect sizes were found between self-report and physiological outcomes. Several sources of heterogeneity were explored. In general, the hyperreactivity hypothesis was not supported. Additional dysfunctional processes should be taken into consideration to understand BPD emotional responsiveness.
Collapse
Affiliation(s)
| | | | | | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Hospital, Milan
| |
Collapse
|
5
|
Yaroslavsky I, Napolitano SC, France CM. Ruminative responses to interpersonal precipitants mediate borderline personality disorder features’ effects on distress reactivity and recovery in daily life. J Clin Psychol 2019; 75:2188-2209. [DOI: 10.1002/jclp.22839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ilya Yaroslavsky
- Department of PsychologyCleveland State University Cleveland Ohio
| | | | | |
Collapse
|
6
|
Bachmann K, Schulze M, Sörös P, Schmahl C, Philipsen A. Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study. BMJ Open 2019; 9:e027063. [PMID: 31122985 PMCID: PMC6538202 DOI: 10.1136/bmjopen-2018-027063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe psychiatric disorder that is characterised by major problems in emotion regulation. Affected persons frequently engage in non-suicidal self-injury (NSSI) to regulate emotions. NSSI is associated with high emotionality in patients with BPD and it can be expected that stimuli depicting scenes of NSSI elicit an emotional response indicative of BPD. The present study protocol describes the development and validation of an emotional picture set of self-injury (EPSI) to advance future research on emotion regulation in BPD. METHODS AND ANALYSIS The present validation study aims to develop and validate an emotional picture set relevant for BPD. Emotional responses to EPSI as well as to a neutral picture set will be investigated in a sample of 30 patients with BPD compared with 30 matched, healthy controls and to 30 matched depressive controls. Emotional responses will be assessed by heart rate variability, facial expression and Self-Assessment Manikin. ETHICS AND DISSEMINATION Ethics approval was obtained by the medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-044). The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03149926; Pre-results.
Collapse
Affiliation(s)
- Katharina Bachmann
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy, Carl von Ossietzky Universitat Oldenburg, Bad Zwischenahn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Peter Sörös
- Department of Neurology, University of Oldenburg, Oldenburg, Germany
| | - Christian Schmahl
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
7
|
Drews E, Fertuck EA, Koenig J, Kaess M, Arntz A. Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis. Neurosci Biobehav Rev 2018; 96:316-334. [PMID: 30500331 DOI: 10.1016/j.neubiorev.2018.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 12/29/2022]
Abstract
Borderline Personality Disorder (BPD) has been associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. However, evidence is inconsistent. Therefore, the present series of meta-analyses aimed to quantify HPA axis functioning in BPD patients based on singular and continuous cortisol assessments and measures of reactivity to pharmacological and psychosocial stress. Case-control studies comparing adult BPD patients and healthy and clinical controls were considered for inclusion. The search resulted in 804 publications, of which 37 studies (k = 81; BPD n = 803, controls n = 1092) were included. Analyses were based on random effect models using standardized mean differences. BPD patients displayed elevated continuous cortisol output and blunted cortisol following psychosocial challenges. Singular cortisol assessments and cortisol after pharmacological challenges were not significantly different. Meta-analyses were limited by inconsistent reporting in individual studies and small samples for some comparisons. Due to the debilitating nature of stress-related symptoms in BPD, more research on elevated continuous cortisol output and blunted cortisol responses to psychosocial stress is warranted.
Collapse
Affiliation(s)
- Elisa Drews
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States.
| | - Eric A Fertuck
- The City College and Graduate Center of the City University of New York, New York, United States; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
8
|
Limonero JT, Fernández-Castro J, Soler-Oritja J, Álvarez-Moleiro M. Emotional intelligence and recovering from induced negative emotional state. Front Psychol 2015; 6:816. [PMID: 26150794 PMCID: PMC4472988 DOI: 10.3389/fpsyg.2015.00816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/29/2015] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to examine the relationship between emotional intelligence (EI) and recovering from negative emotions induction, using a performance test to measure EI. Sixty seven undergraduates participated in the procedure, which lasted 75 min and was divided into three stages. At Time 1, subjects answered the State-Trait Anxiety Inventory (STAI)-S, Profile of Mood States (POMS)-A, and EI was assessed by Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). At Time 2, negative emotions were induced by nine pictures taken from the International Affective Picture System and participants were asked to complete a second STAI-S and POMS-B questionnaires. At Time 3 participants were allowed to rest doing a distracting task and participants were asked to complete a third STAI-S and POMS-A questionnaires. Results showed that the branches of the MSCEIT emotional facilitation and emotional understanding are related to previous mood states and mood recovery, but not to mood reactivity. This finding contrasts nicely with studies on which emotional recovery was assessed in relation to EI self-reported measures, highlighting the perception and emotional regulation.
Collapse
Affiliation(s)
- Joaquín T Limonero
- Research Group on Stress and Health, Facultat de Psicologia, Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Jordi Fernández-Castro
- Research Group on Stress and Health, Facultat de Psicologia, Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Jordi Soler-Oritja
- Research Group on Stress and Health, Facultat de Psicologia, Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Universitat Autònoma de Barcelona Barcelona, Spain ; Facultat de Psicologia, Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona Barcelona, Spain
| | - María Álvarez-Moleiro
- Research Group on Stress and Health, Facultat de Psicologia, Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Universitat Autònoma de Barcelona Barcelona, Spain
| |
Collapse
|
9
|
Guerino MR, Briel AF, Araújo MDGR. Hippotherapy as a treatment for socialization after sexual abuse and emotional stress. J Phys Ther Sci 2015; 27:959-62. [PMID: 25931769 PMCID: PMC4395753 DOI: 10.1589/jpts.27.959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Hippotherapy is a therapeutic resource that uses the horse as a kinesiotherapy
instrument to elicit motor and cognitive improvements in individuals with special needs.
[Subjects and Methods] This research evaluated two women aged 18 and 21 years, who had
suffered sexual violence when they were children between the ages of 6 and 7 years old.
The subjects did not have mental dysfunction but they were regular students registered at
a school of special education. The patients presented severe motor limitation, difficulty
with coordination, significant muscular retractions, thoracic and cervical kyphosis,
cervical protrusion wich was basically a function of the postures they had adopted when
victims of the sexual violence suffered in childhood. The patients performed twenty
sessions of 30 minutes of hippotherapy on a horse. The activities were structured to
stimulate coordination, proprioception, the vestibular and motor-sensorial systems for the
improvement of posture, muscle activity and cognition. [Results] The activities provided
during the hippotherapy sessions elicited alterations in postural adjustment resulting in
30% improvement, 80% improvement in coordination in, 50% improvement in corporal balance
and in sociability and self-esteem. [Conclusion] Hippotherapy proved to be an effective
treatment method for coordination, balance and postural correction, and also improved the
patients’ self-esteem that had suffered serious emotional stress.
Collapse
Affiliation(s)
- Marcelo R Guerino
- Department of Physical Therapy, UFPE-Federal University of Pernambuco, Brazil
| | | | | |
Collapse
|
10
|
Sauer C, Arens EA, Stopsack M, Spitzer C, Barnow S. Emotional hyper-reactivity in borderline personality disorder is related to trauma and interpersonal themes. Psychiatry Res 2014; 220:468-76. [PMID: 25066960 DOI: 10.1016/j.psychres.2014.06.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/30/2014] [Accepted: 06/22/2014] [Indexed: 11/28/2022]
Abstract
Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD.
Collapse
Affiliation(s)
- Christina Sauer
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | - Elisabeth A Arens
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | - Malte Stopsack
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | | | - Sven Barnow
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| |
Collapse
|