Interpersonal problems and negative affect in Borderline Personality and Depressive Disorders in daily life

Compatibility of Linehan's biosocial theory and the DSM-5 Alternative Model of Personality Disorders for borderline personality disorder

Borderline personality disorder (BPD) is characterized by affective, interpersonal, and identity instability, as well as marked impulsivity. There is evidence that BPD may be best operationalized dimensionally using models such as the Alternative Model for Personality Disorders (AMPD) described in Section III of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Moreover, biosocial theory is a well-known etiological theory of BPD emphasizing emotion dysregulation, inherited impulsivity, and development within invalidating contexts as key etiological mechanisms. Given that current research and clinical efforts for BPD are informed by both nosology and etiology, this narrative review examined how well biosocial theory (a) aligns with AMPD conceptualizations, (b) accounts for psychiatric comorbidity, and (c) accounts for heterogeneity in BPD presentation. Findings suggested that tenets of biosocial theory align well with Criteria A and B of the AMPD; however, biosocial theory focuses narrowly on roles of emotion dysregulation, impulsivity, and invalidating contexts, and empirical support is lacking in some ways for several etiological explanations proposed by biosocial theory. Additionally, although biosocial theory captures empirically supported features of BPD and emphasizes high-risk subgroups, the theory may not account for lower-risk subgroups. Finally, the theory accounts for diagnostic co-occurrence via the central role of emotion dysregulation, but biosocial theory may not be specific to BPD and may broadly apply to a range of psychopathology. Based on the literature reviewed, implications for future research and clinical efforts are highlighted.

Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype

Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.

Risk factors for internalizing symptoms: The influence of empathy, theory of mind, and negative thinking processes

Internalizing symptoms such as elevated stress and sustained negative affect can be important warning signs for developing mental disorders. A recent theoretical framework suggests a complex interplay of empathy, theory of mind (ToM), and negative thinking processes as a crucial risk combination for internalizing symptoms. To disentangle these relationships, this study utilizes neural, behavioral, and self-report data to examine how the interplay between empathy, ToM, and negative thinking processes relates to stress and negative affect. We reanalyzed the baseline data of N = 302 healthy participants (57% female, Mage  = 40.52, SDage  = 9.30) who participated in a large-scale mental training study, the ReSource project. Empathy and ToM were assessed using a validated fMRI paradigm featuring naturalistic video stimuli and via self-report. Additional self-report scales were employed to measure internalizing symptoms (perceived stress, negative affect) and negative thinking processes (rumination and self-blame). Our results revealed linear associations of self-reported ToM and empathic distress with stress and negative affect. Also, both lower and higher, compared to average, activation in the anterior insula during empathic processing and in the middle temporal gyrus during ToM performance was significantly associated with internalizing symptoms. These associations were dependent on rumination and self-blame. Our findings indicate specific risk constellations for internalizing symptoms. Especially people with lower self-reported ToM and higher empathic distress may be at risk for more internalizing symptoms. Quadratic associations of empathy- and ToM-related brain activation with internalizing symptoms depended on negative thinking processes, suggesting differential effects of cognitive and affective functioning on internalizing symptoms. Using a multi-method approach, these findings advance current research by shedding light on which complex risk combinations of cognitive and affective functioning are relevant for internalizing symptoms.

"I'm fighting with BPD instead of my partner": A dyadic interpretative phenomenological analysis of the lived experience of couples navigating borderline personality disorder

Borderline personality disorder (BPD) is associated with romantic relationship distress and dissolution. The complex interaction between BPD and romantic relationships warrants further attention. Dyadic interviews (N = 10) were conducted to examine the experience and impact of BPD on couples' relationships. The results of interpretative phenomenological analysis consisted of two superordinate themes describing the couple experience of navigating BPD: (a) the shared experience of BPD as a relational stressor; and (b) adaptive dyadic coping in the context of BPD. Although BPD was experienced as a relational stressor, dyadic coping and shared externalization of BPD emerged as central components to adaptive couple functioning. Most couples reported that therapy was a critical external resource in their journey toward adaptively functioning in the context of BPD, both intrapersonally and interpersonally. The lived experiences of these couples provides therapists with an increased understanding of the resources that support adaptive dyadic coping with BPD.

The computational psychopathology of emotion

Mood and anxiety disorders involve recurring, maladaptive patterns of distinct emotions and moods. Here, we argue that understanding these maladaptive patterns first requires understanding how emotions and moods guide adaptive behavior. We thus review recent progress in computational accounts of emotion that aims to explain the adaptive role of distinct emotions and mood. We then highlight how this emerging approach could be used to explain maladaptive emotions in various psychopathologies. In particular, we identify three computational factors that may be responsible for excessive emotions and moods of different types: self-intensifying affective biases, misestimations of predictability, and misestimations of controllability. Finally, we outline how the psychopathological roles of these factors can be tested, and how they may be used to improve psychotherapeutic and psychopharmacological interventions.

Validation of the hyperbolic temperament questionnaire in Iran

OBJECTIVE

Because of the importance of the cross-cultural study of hyperbolic temperament in increasing knowledge related to borderline personality disorder (BPD), the present study was conducted to test the reliability, construct, criterion, and discriminant validity of the Hyperbolic Temperament Questionnaire (HTQ) in three Iranian samples.

METHODS

Using a cross-sectional design, the HTQ 11-item version translated into Farsi was provided to three selected samples (total N = 558, 72% female, 18 to 77 years old with an average of 30.2 and a standard deviation of 10.3). The samples included non-personality disorder samples (n = 194), samples with BPD symptoms (n = 104), and samples with other personality disorder symptoms (n = 260). Data were collected using multiple validating measurements. Factor analysis was used to verify that the HTQ is unidimensional and correlations and regression models were used to examine its associations with other constructs.

RESULTS

Factor analysis confirmed the single-factor structure of the HTQ in two non-personality disorder and BPD samples. The internal consistency of all items and the total scale were acceptable across the samples (α = 0.87 to 0.91). Positive correlations with maladaptive constructs such as negative affectivity and interpersonal sensitivity and negative correlations with adaptive constructs supported the criterion validity of HTQ. The HTQ was specifically related to borderline symptoms, even after controlling for similar constructs such as depression.

CONCLUSION

The 11-item version of HTQ has acceptable reliability and validity in Iranian samples. Using this short tool for rapid screening of cases with BPD before common procedures such as clinical interviews helps to save diagnostic time and costs.

"Feeling Invisible": Individuals With Borderline Personality Disorder Underestimate the Transparency of Their Emotions

The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients' social functioning.

Operationalizing undifferentiated affect: Validity and utility in clinical samples

Emotion differentiation is conceptualized as the process of categorizing one's general affective experiences into discrete emotions. The experience of undifferentiated affect or the inability to distinguish the particular emotion or combination of emotions that one is experiencing is often considered a hallmark of emotion dysregulation. Some past research has attempted to operationalize the general tendency to experience undifferentiated affect at the trait level using explicit questionnaire measures. More recently, indirect measures using intraclass correlation coefficients (ICCs) to estimate the consistency between simultaneous measures of different in-the-moment emotional experiences have become the favored method of quantifying undifferentiated affect. While the ICC method constitutes an advancement in estimating undifferentiated affect, which is theorized to be a dynamic process that occurs at a very granular level, prior investigations have used aggregate ICC measures or momentary ICC derivations that ignore multiple sources of dynamic variability to make inferences about in-the-moment experiences. We introduce a new, flexible method of calculating ICC measures of undifferentiated affect at different levels of experience that takes full advantage of time-intensive data measurement and more closely maps onto the theorized process. This method provides more refined estimates of undifferentiated affect and its associations with various behavioral outcomes, as well as uncovers more nuanced associations regarding the temporal process of emotional differentiation. It also elucidates potential conceptual issues in mapping empirical estimates of emotion undifferentiation onto their underlying theoretical interpretations.

Momentary interpersonal processes of suicidal surges in borderline personality disorder

BACKGROUND

Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives.

METHODS

A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent.

RESULTS

Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI.

CONCLUSION

This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.

The influence of narcissistic vulnerability and grandiosity on momentary hostility leading up to and following interpersonal rejection

Wide empirical support exists for 2 aspects of narcissism-grandiosity and vulnerability. Hostility is a form of interpersonal antagonism, which is considered central to narcissism broadly. Though it has often been subsumed by the concept of narcissistic grandiosity, interpersonal antagonism is associated with vulnerability as well. Rejection represents an interpersonal stressor that evokes hostility to a greater degree in those high in narcissism, with mixed evidence regarding whether it stems from threat to one's egotism (grandiosity) or low self-esteem (vulnerability). Therefore, investigating the associations between narcissistic dimensions and individuals' trajectories of hostility leading up to and following rejection may provide a basis for a more unified conceptualization. In this study, we leverage the wide range of narcissistic expression displayed in a combined sample of borderline personality disorder (N = 56) and community (N = 60) individuals who completed ambulatory assessments approximately 6 times per day for 21 consecutive days. We examine whether narcissistic vulnerability and grandiosity, as measured by NEO Personality Inventory facet combinations constructed based on the Five-Factor Narcissism Inventory, moderate trajectories and overall levels of hostility surrounding self-reported interpersonal rejections. Grandiosity and vulnerability were independently positively associated with a faster rise in hostility leading up to rejection; however, greater grandiosity was uniquely associated with a greater spike in hostility at the occasion of rejection and subsequent faster recovery. These results are consistent with both the idea that grandiosity is proportionately more central to interpersonal antagonism and that antagonism serves as a bridge, connecting and reinforcing both narcissistic grandiosity and vulnerability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Affective Instability and Emotion Dysregulation as a Social Impairment

Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association (APA), 2013, p. 663]. Typically, of the instability triad—instability in (1) self, (2) affect and emotion, and (3) interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment.

Borderline personality disorder: stress reactivity or stress generation? A prospective dimensional study

BACKGROUND

Individuals diagnosed with borderline personality disorder (BPD) often describe their lives as stressful and unpredictable. However, it is unclear whether the adversity faced by those with BPD is a product of stress reactivity or stress generation. Here, we examined the dynamic, prospective associations between BPD and stressful life events over 3 years. Given the heterogeneity present in BPD, we sought to understand which empirically derived dimensions of this heterogeneous disorder explain stress reactivity v. stress generation.

METHODS

Participants included 355 individuals diagnosed with BPD and followed longitudinally at three annual assessments. Auto-regressive cross-lagged panel models were used to examine prospective associations between stressful life events and three latent dimensions implicated in BPD: negative affect, disinhibition, and antagonism.

RESULTS

Antagonism and disinhibition, but not negative affect, prospectively predicted dependent stressful life events (events the individual may have some role in). Evidence for decompensation under stress was more tenuous, with independent stressful life events (those presumably outside the individual's control) predicting increases in negative affect.

CONCLUSIONS

Our longitudinal study of a well-characterized clinical sample found more evidence for stress generation than for stress-induced decompensation in BPD. Stress generation in BPD is driven by externalizing dimensions: antagonism and disinhibition. These results highlight the utility of empirically derived dimensions for parsing heterogeneity present in BPD, leading to improvements in diagnostic evaluation, clinical prediction, and individualized approaches to treatment planning.

Relations between lab indices of emotion dysregulation and negative affect reactivity in daily life in two independent studies

BACKGROUND

We investigated the extent to which physiological/biological measures of emotion dysregulation collected in the lab, resting respiratory sinus arrhythmia (RSA) in Study 1 and amygdala activation in response to negative stimuli in Study 2, combined with daily measures of interpersonal stressors predicted negative emotional states in outpatients better than the stressors alone.

METHODS

Participants were adult outpatients with emotional distress disorders (N=30 individuals in Study 1, and N=26 women in Study 2). After completing a laboratory session that collected physiological/biological measures of emotion dysregulation, participants then completed 1-3 weeks of ambulatory assessment during which they reported on interpersonal stressors and negative affective states several times per day.

RESULTS

Laboratory measures of emotion dysregulation were largely unrelated to either momentary or mean levels of daily-life hostility, sadness, and fear in both studies. However, resting RSA significantly moderated the association between day-level interpersonal stressors and momentary fear such that low resting RSA strengthened this association. Similarly, amygdala activation tended to moderate this relationship in the predicted direction.

LIMITATIONS

Both samples were relatively small and focused on only a limited set of diagnoses associated with emotion dysregulation. Only two possible physiological/biological markers of emotion dysregulation were examined.

CONCLUSIONS

The current studies support the collection of physiological/biological data on emotion dysregulation when indexing daily-life emotion dysregulation as the degree of emotional reactivity to stressors in daily life among outpatients with emotional distress disorders.

Implementation of a Mobile DBT App and Its Impact on Suicidality in Transitional Age Youth with Borderline Personality Disorder: A Qualitative Study

Contemporary performance and accessibility are features that enable mobile devices to be increasingly beneficial in the context of optimizing the treatment of psychiatric disorders. Smartphones have the potential to effectively support psychotherapeutic interventions among adolescents and young adults who require them. In the present study, the use and subjective influence of a smartphone app with content from dialectical behavior therapy (DBT) was investigated among transitional age youth (TAY) with borderline personality disorder, focusing on suicidality and non-suicidal self-injury (NSSI), in a natural setting. A longitudinal qualitative approach was used by means of individual semi-structured interviews, where participants were asked about their experiences and associated emotions before and after a testing period of 30 days. A total of 13 TAY with a diagnosed borderline personality disorder between the ages of 18 and 23 were included. Six overarching themes were identified through qualitative text analysis: (1) experiences with DBT skills, (2) phenomenon of self-harm, (3) feelings connected with self-harm, (4) dealing with disorder-specific symptoms, (5) prevention of self-harm, and (6) attitude toward skills apps. In general, the provision of an app with DBT content achieved a positive response among participants. Despite a small change in the perception of suicidality and NSSI, participants could imagine its benefits by integrating their use of the app as a supportive measure for personal psychotherapy sessions.

A daily-life study of interpersonal stressors and alcohol use in individuals with borderline personality disorder and community controls

BACKGROUND

Interpersonal stressors (ISs) are major factors in relapse in alcohol use disorder (AUD) and are theorized to play a role in drinking behaviors. Past work has examined this association using ecological momentary assessment (EMA), but the unique effects of rejections and disagreements on alcohol use are unknown. Research suggests the two ISs functionally differ and may display distinct associations with drinking. Further, these associations may differ in people with borderline personality disorder (BPD), a population reporting frequent IS and co-occurring AUD.

METHODS

113 drinkers (community: n = 59; BPD: n = 54) reported alcohol use and ISs using EMA for 21 days. Using generalized estimating equations, we expected that rejection and disagreement would predict increased likelihood of drinking each day. We examined both cumulative (throughout each day) and immediate momentary effects of ISs predicting subsequent drinking on that same day. Further, we predicted that these associations would be stronger in individuals with BPD.

RESULTS

Greater rejections throughout the day were associated with a reduced likelihood of drinking that day (OR = 0.56, 95 % CI:[0.32, 0.97], p < .040). In contrast, disagreements immediately prior to drinking were associated with an increased likelihood of drinking that day (OR = 0.60, 95 % CI:[1.02, 2.50], p = .039). However, the effect of disagreement on drinking was moderated by BPD diagnosis (OR = 2.56, 95 % CI:[1.13, 5.80], p = .025), such that the effect was only present for individuals with BPD.

CONCLUSIONS

Assessing ISs as an aggregate predictor may mask potentially opposite effects on alcohol use. Additionally, disagreements may be a risk factor for subsequent alcohol use in BPD.

Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences

BACKGROUND

Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation.

METHODS

N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected.

RESULTS

Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts.

CONCLUSIONS

The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.

Metacognitive Beliefs Uniquely Contribute to Interpersonal Problems: A Test Controlling for Adult Attachment, Big-5 Personality Traits, Anxiety, and Depression

Interpersonal difficulties are common across psychological disorders and are a legitimate target of treatment. Psychotherapeutic models differ in their understanding of interpersonal problems and how these problems are formulated and treated. It has been suggested that they are both the cause and effect of emotional distress symptoms, that they result from early attachment experiences, and that they are related to personality dimensions. However, the metacognitive model of psychopathology predicts that emotion disorder symptoms and interpersonal problems are linked to a common set of factors involving dysfunctional metacognition. In support of this view, metacognitive therapy has substantially reduced interpersonal problems in patients with anxiety and depression even though interpersonal problems are not directly targeted, indicating a role for metacognitive change. Nevertheless, the relationship between interpersonal problems and metacognitive beliefs remains underexplored, and the statistical control of emotion symptoms, personality, and attachment is important in substantiating any metacognition effects. The aim of the present study was therefore to test metacognitive beliefs as statistical predictors of interpersonal problems while controlling for anxiety/depression, adult attachment, and the Big-5 personality dimensions. In a cross-sectional study, 296 participants completed a battery of self-report questionnaires. We found that positive- and negative-metacognitive beliefs, cognitive confidence, and cognitive self-consciousness accounted for significant and unique variance in interpersonal problems together with avoidant attachment and conscientiousness when the overlap between all predictors was controlled. These findings support the notion that metacognitive beliefs are relevant to interpersonal problems with the potential implication that metacognitive therapy could have particularly broad effects on both emotion disorder symptoms and interpersonal problems.

Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder

Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA). Consequently, little is known about how PA in daily life covaries with symptoms of BPD. The authors assessed the effects of both PA and NA levels on BPD symptom severity in a sample of 81 treatment-seeking women diagnosed with BPD over a period of 21 days, employing a daily diary design. Using multivariate multilevel modeling, the authors obtained negative associations between PA levels and daily BPD severity in total and at the level of the individual symptoms inappropriate anger, affective instability, emptiness, identity disturbance, and paranoid ideation/dissociation. Moreover, the authors replicated previously reported positive associations between NA and BPD severity for all nine symptoms. Future research can address whether increasing PA in the treatment of BPD may potentially help reduce symptom burden.

Associations between physiological and self-reported indices of emotion dysregulation across varying levels of alcohol use among individuals with and without borderline personality disorder

Emotional functioning can be assessed across multiple levels of analysis (e.g., subjective, physiological). The degree of concordance/discordance across such indices may mark psychopathology risk. The current study assessed associations between physiological and subjective indices of emotional responding among drinkers, with (n = 39) and without (n = 42) borderline personality disorder. Subjective changes in affect were assessed by calculating difference scores on the Positive and Negative Affective Schedule, administered before and following a lab-based stress task. Physiological dysregulation was indexed by respiratory sinus arrhythmia (RSA) reactivity. We created Discordance Index scores to examine the direction and magnitude of misalignment. More frequent alcohol use was associated with greater discordance between RSA and positive affect changes (β = -0.07, p-value = 0.009). Findings were confirmed with a response surface modeling analysis. Results highlight that individuals with greater discordance between indices of emotional responding may be at elevated risk for frequent alcohol use.

Initially Negative Affect Predicts Lower Satisfaction With Future Social Contact: A Time-Lagged Analysis Using Ecological Momentary Assessment

OBJECTIVES

Prior research has linked subjective features of social situations with short-term changes in affect (e.g., across days, hours), but little is known about the directionality of such links. Our study examined the concurrent and lead-lag relationships between social contact satisfaction and affect in the flow of daily life.

METHOD

Using ecological momentary assessment (EMA), wherein 78 late-middle-aged and older adults reported on 2,739 social contacts (average 5.02 per day, SD = 2.95) across seven consecutive days, we examined how the level of social contact satisfaction was concurrently and prospectively associated with affect (high-arousal and low-arousal positive affect [PA], high-arousal and low-arousal negative affect [NA]).

RESULTS

Higher contact satisfaction was concurrently associated with more high- and low-arousal PA and less high- and low-arousal NA. The influence of contact satisfaction remains for predicting greater low-arousal PA (quietness, calmness) during the next social contact. NA (either high- or low-arousal) predicted lower satisfaction during the next social contact, but such sustainable influence was not observed for PA.

DISCUSSION

The study reveals a cycle in which elevated NA may trigger unsatisfactory social contact, which subsequently predicted less low-arousal PA such as quietness and calmness. Our study provided a more nuanced and differentiated picture of the temporal sequencing of everyday social contact and momentary affect. Practitioners may gain insights from our study into the development of just-in-time adaptive interventions that aim for the betterment of affective well-being in old age.

Towards formal models of psychopathological traits that explain symptom trajectories

BACKGROUND

A dominant methodology in contemporary clinical neuroscience is the use of dimensional self-report questionnaires to measure features such as psychological traits (e.g., trait anxiety) and states (e.g., depressed mood). These dimensions are then mapped to biological measures and computational parameters. Researchers pursuing this approach tend to equate a symptom inventory score (plus noise) with some latent psychological trait.

MAIN TEXT

We argue this approach implies weak, tacit, models of traits that provide fixed predictions of individual symptoms, and thus cannot account for symptom trajectories within individuals. This problem persists because (1) researchers are not familiarized with formal models that relate internal traits to within-subject symptom variation and (2) rely on an assumption that trait self-report inventories accurately indicate latent traits. To address these concerns, we offer a computational model of trait depression that demonstrates how parameters instantiating a given trait remain stable while manifest symptom expression varies predictably. We simulate patterns of mood variation from both the computational model and the standard self-report model and describe how to quantify the relative validity of each model using a Bayesian procedure.

CONCLUSIONS

Ultimately, we would urge a tempering of a reliance on self-report inventories and recommend a shift towards developing mechanistic trait models that can explain within-subject symptom dynamics.

Attachment and Borderline Personality Disorder: Differential Effects on Situational Socio-Affective Processes

Insecure attachment and borderline personality disorder (BPD) are defined by similar affective and interpersonal processes. Individuals diagnosed with BPD, however, represent only a subset of those described as insecurely attached, suggesting that attachment may hold broader relevance for socio-affective functioning. Based on a 21-day ecological momentary assessment protocol in a mixed clinical and community sample (N = 207) oversampled for BPD, we evaluate the discriminant validity of each construct as it influences daily interpersonal interactions. We find that insecure attachment is associated with elevated perceptions of interpersonal disaffiliation and maladaptive strategies for affect regulation, whereas enacted interpersonal hostility is more distinctive for BPD. In a series of sensitivity analyses, we further highlight potential caveats to these findings when studying both constructs concurrently. Together, our results suggest that both insecure attachment and BPD contribute to problematic affective and interpersonal processes, but that they do so at different stages of the unfolding social interaction, which has important implications for their maintenance and treatment.

Is It Personal? Context Moderates BPD Effects on Spontaneous Rumination and Distress

Borderline personality disorder (BPD) is associated with the use of maladaptive emotion regulation (ER) that predicts unstable interpersonal relationships and emotion dysregulation. Rumination, a maladaptive cognitive ER response, may be one mechanism by which those with BPD experience emotion dysregulation. However, it remains unclear whether emotion dysregulation is linked to rumination in general, or to rumination during interpersonal situations that often prove challenging for those with BPD. The present study examined whether interpersonal exclusion conferred an increased risk to spontaneously ruminate among those with elevated BPD features relative to an impersonal negative mood induction, and whether spontaneous rumination mediated the effects of BPD features on distress reactivity. Overall, BPD features predicted stronger tendencies to spontaneously ruminate and higher levels of distress following interpersonal exclusion; spontaneous rumination following interpersonal exclusion mediated the effects of BPD features on distress. These findings highlight the importance of context when examining ER outcomes.

Personalized models of psychopathology as contextualized dynamic processes: An example from individuals with borderline personality disorder

OBJECTIVE

Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case formulation involve understanding and developing a personalized model for each patient's contextualized dynamic processes, and research would benefit from a similar focus on the individual.

METHOD

We use group iterative multiple model estimation, which estimates a model for each individual and identifies general or shared features across individuals, in both a mixed-diagnosis sample (N = 78) and a subsample with a single diagnosis (n = 24).

RESULTS

We found that individuals vary widely in their dynamic processes in affective and interpersonal domains both within and across diagnoses. However, there was some evidence that dynamic patterns relate to transdiagnostic baseline measures. We conclude with descriptions of 2 person-specific models as an example of the heterogeneity of dynamic processes.

CONCLUSIONS

The idiographic models presented here join a growing literature showing that the individuals differ dramatically in the total patterning of these processes, even as key processes are shared across individuals. We argue that these processes are best estimated in the context of person-specific models, and that so doing may advance our understanding of the contextualized dynamic processes that could identify maintenance mechanisms and treatment targets. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

I Want You to Want Me: Interpersonal Stress and Affective Experiences as Within-Person Predictors of Nonsuicidal Self-Injury and Suicide Urges in Daily Life

OBJECTIVE

To investigate near-term risk for self-injurious urges, we evaluated how within-person changes in internalizing and externalizing negative affect, as well as interpersonal rejection and criticism, impact subsequent nonsuicidal self-injury (NSSI) and suicide urges in daily life.

METHOD

Young adult women (N = 62) from an ongoing community cohort study with past-year self-injurious thoughts completed a 21-day ecological momentary assessment protocol. We used multilevel path analyses to model within-person effects of negative affect and interpersonal stress on subsequent suicide and NSSI urges within several hours.

RESULTS

When modeled simultaneously, within-person changes in internalizing, but not externalizing, negative affect predicted later self-injurious urges. Rejection and criticism predicted later self-injurious urges, with rejection showing a unique relationship to NSSI urges specifically. Effects of rejection and criticism on later NSSI and suicide urges were mediated by internalizing negative affect; rejection also retained a significant direct effect on NSSI urges.

CONCLUSION

Interpersonal stressors may be potent near-term risk factors for self-injurious urges by increasing internalizing negative affect among vulnerable individuals. The direct role of rejection and criticism on self-injurious urges is less clear, particularly for suicide. These findings have implications for understanding processes underlying self-injurious urges, as well as designing real-time interventions for these experiences in daily life.

The NIMH Research Domain Criteria (RDoC) Initiative and Its Implications for Research on Personality Disorder

PURPOSE OF REVIEW

We discuss the implications of the Research Domain Criteria (RDoC) initiative for neuroscience research on personality disorder (PD). To organize our review, we construct a preliminary conceptual mapping of PD symptom criteria onto RDoC constructs. We then highlight recent neuroscience research, often built around concepts that correspond to RDoC elements, and discuss the findings in reference to the constructs we consider most pertinent to PD.

RECENT FINDINGS

PD symptoms were strongly conceptually tied to RDoC constructs within the Social Processes domain, implicating brain systems involved in interpersonal rejection, facial emotion perception, and self-referential processes. Negative and Positive Valence Systems were conceptually associated with many PD symptoms, with particular relevance ascribed to the latter's Reward Valuation construct, which could reflect a more widespread disruption of computational processes involved in estimating the probability and benefits of a future outcome. Within the Cognitive Systems domain, the Cognitive Control construct mainly related to PD symptoms associated with impulse control, suggesting a connection to neural circuits that underlie goal selection and behavioral control. Arousal and Regulatory Systems could only be conceptually mapped onto PD symptoms through the Arousal construct, with different symptoms reflecting either a higher or lower biological sensitivity to internal and external stimuli. The RDoC framework has promise to advance neuroscience research on PD. The Social Processes domain is especially relevant to PD, although constructs falling within the other RDoC domains could also yield important insights into the neurobiology of PD and its connections with other forms of psychopathology. Identifying RDoC constructs (e.g., habit formation) that subserve more fundamental processes relevant to personality functioning warrants further investigation.

Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review

Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are alternative approaches to retrospective self-reports and face-to-face treatments, and they make it possible to repeatedly assess patients in naturalistic settings and extend psychological support into real life. The increase in smartphone applications and the availability of low-cost wearable biosensors have further improved the potential of EMA and EMI, which, however, have not yet been applied in clinical practice. Here, we conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to explore the state of the art of technology-based EMA and EMI for major depressive disorder (MDD). A total of 33 articles were included (EMA = 26; EMI = 7). First, we provide a detailed analysis of the included studies from technical (sampling methods, duration, prompts), clinical (fields of application, adherence rates, dropouts, intervention effectiveness), and technological (adopted devices) perspectives. Then, we identify the advantages of using information and communications technologies (ICTs) to extend the potential of these approaches to the understanding, assessment, and intervention in depression. Furthermore, we point out the relevant issues that still need to be addressed within this field, and we discuss how EMA and EMI could benefit from the use of sensors and biosensors, along with recent advances in machine learning for affective modelling.

Effects of Childhood Maltreatment on Social Cognition and Brain Functional Connectivity in Borderline Personality Disorder Patients

Borderline personality disorder (BPD) is a chronic condition characterized by high levels of impulsivity, affective instability, and difficulty to establish and manage interpersonal relationships. However, little is known about its etiology and neurobiological substrates. In our study, we wanted to investigate the influence of child abuse in the psychopathology of BPD by means of social cognitive paradigms [the Movie for the Assessment of Social Cognition (MASC) and the reading the mind in the eyes test (RMET)], and resting state functional magnetic resonance imaging (rs-fMRI). For this, we recruited 33 participants, 18 BPD patients, and 15 controls. High levels of self-reported childhood maltreatment were reported by BPD patients. For the sexual abuse subdimension, there were no differences between the BPD and the control groups, but there was a negative correlation between MASC scores and total childhood maltreatment levels, as well as between physical abuse, physical negligence, and MASC. Both groups showed that the higher the level of childhood maltreatment, the lower the performance on the MASC social cognitive test. Further, in the BPD group, there was hypoconnectivity between the structures responsible for emotion regulation and social cognitive responses that have been described as part of the frontolimbic circuitry (i.e., amygdala). Differential levels of connectivity, associated with different types and levels of abuse were also observed.

Theory of mind disturbances in borderline personality disorder: A meta-analysis

Impairments of theory of mind (ToM) are widely accepted underlying factors of disturbed relatedness in borderline personality disorder (BPD). The aim of this meta-analysis a was to assess the weighted mean effect sizes of ToM performances in BPD compared to healthy controls (HC), and to investigate the effect of demographic variables and comorbidities on the variability of effect sizes across the studies. Seventeen studies involving 585 BPD patients and 501 HC were selected after literature search. Effect sizes for overall ToM, mental state decoding and reasoning, cognitive and affective ToM, and for task types were calculated. BPD patients significantly underperformed HC in overall ToM, mental state reasoning, and cognitive ToM, but had no deficits in mental state decoding. Affective ToM performance was largely task dependent in BPD. Comorbid anxiety disorders had a positive moderating effect on overall and affective ToM in BPD. Our results support the notion that BPD patients' have specific ToM impairments. Further research is necessary to evaluate the role of confounding factors, especially those of clinical comorbidities, neurocognitive functions, and adverse childhood life events. Complex ToM tasks with high contextual demands seem to be the most appropriate tests to assess ToM in patients with BPD.

Attributions for Rejection and Acceptance in Young Adults With Borderline and Avoidant Personality Features

Individuals with borderline and avoidant personality disorders show interpersonal dysfunction that includes maladaptive responses to rejection and reduced emotional benefits from acceptance. To identify the attributional styles that may underlie these difficulties, we examined causal attributions for rejection and acceptance among undergraduates high in features of each disorder and a healthy comparison group. In Study 1, participants rated how likely they were to attribute hypothetical rejection and acceptance experiences to positive and negative qualities of the self and others, as well as external circumstances. In Study 2, we examined these same attributions in daily diary assessments of real rejection and acceptance experiences. Although the two studies showed some differences in results, they both linked borderline personality features with suspicious, selfbolstering responses and avoidant personality features with perceived inferiority. Distinct attributional styles may contribute to the distinct interpersonal problems characteristic of these conditions.

Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension

Affective instability and interpersonal stress are key features of borderline personality disorder (BPD). They were shown to covary in the daily lives of patients in a recent ambulatory assessment study (Hepp et al., 2017) that observed comparatively larger positive associations between interpersonal stressors and negative affect in individuals with BPD than those with depressive disorders. The present study sought to replicate these findings, collecting data on hostility, sadness, fear, and rejection or disagreement events from 56 BPD and 60 community control participants for 21 days, 6 times a day. Using identical statistical procedures, the positive associations between momentary rejection/disagreement and hostility, sadness, and fear were replicated. Again replicating the original study, the rejection-hostility, rejection-sadness, and disagreement-hostility associations were significantly stronger in the BPD group. Time-lagged analyses extended the original study, revealing that rejection was associated with subsequent hostility and sadness more strongly in the BPD group, as was disagreement with subsequent hostility and fear. Though small, we argue that the observed group differences reflect meaningful pervasive responses in a daily life context. Future research should consider these when implementing affect regulation strategies that are applicable in interpersonal contexts for all individuals, but particularly those with BPD. (PsycINFO Database Record

Emotional reactivity to appraisals in patients with a borderline personality disorder: a daily life study

BACKGROUND

Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD.

METHODS

Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others.

RESULTS

Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group.

CONCLUSIONS

These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life.

Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing

Borderline personality disorder (BPD) is characterized by affective instability and interpersonal problems. In the context of social interaction, impairments in empathy are proposed to result in inadequate social behavior. In contrast to findings of reduced cognitive empathy, some authors suggested enhanced emotional empathy in BPD. It was investigated whether ambiguity leads to decreased cognitive or emotional empathy in BPD. Thirty-four patients with BPD and thirty-two healthy controls were presented with video clips, which were presented through prosody, facial expression, and speech content. Experimental conditions were designed to induce ambiguity by presenting neutral valence in one of these communication channels. Subjects were asked to indicate the actors' emotional valence, their decision confidence, and their own emotional state. BPD patients showed increased emotional empathy when neutral stories comprised nonverbally expressed emotions. In contrast, when all channels were emotional, patients showed lower emotional empathy than healthy controls. Regarding cognitive empathy, there were no significant differences between BPD patients and healthy control subjects in recognition accuracy, but reduced decision confidence in BPD. These results suggest that patients with BPD show altered emotional empathy, experiencing higher rates of emotional contagion when emotions are expressed nonverbally. The latter may contribute to misunderstandings and inadequate social behavior.