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Borderline Personality Features Moderate Emotion Reactivity and Emotion Regulation in Response to a Fear Stressor

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Abstract

This study examined emotional reactivity and emotion regulation strategies used by participants high (n = 41) and low (n = 55) in borderline personality (BP) features. Participants were randomly assigned to a neutral or fear emotion induction, and emotional responses (self-report and psychophysiological) were assessed. Participants also reported the types of strategies they used to regulate their emotions during the emotion induction. The high-BP (but not low-BP) participants reported greater fear, Upset, and hostility in the fear condition compared with the neutral condition. The participants in the fear condition evidenced vagal withdrawal, relative to the neutral condition, although there was some evidence of vagal withdrawal among the high-BP group in the neutral condition as well. Further, the high-BP (vs. low-BP) participants reported greater use of distraction, cognitive reappraisal, and emotion suppression, and less use of emotional acceptance. Reported use of acceptance partially mediated the moderation effect of BP features on the relationship between condition and reported hostility.

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... Moreover, results revealed significant indirect relations of BPD symptoms to both the reported use of reassurance-seeking and social comparison strategies on the DIRE and the invivo use of downward social comparison in response to the online social interaction task through upward SCO within the young adult sample. These findings are consistent with theories emphasizing both the centrality of interpersonal sensitivity to BPD (Dixon-Gordon et al., 2013;Gunderson & Lyons-Ruth, 2008) and the interplay of interpersonal and emotional functioning within BPD (Hughes et al., 2012), and suggest the importance of expanding extant (primarily intrapersonal and intra-individual) models of ER in BPD to include a focus on more sociallyoriented ER strategies as well. ...
... Although not the primary focus of this research, results of these studies both replicate and extend past research documenting the greater use of avoidance strategies among individuals with BPD symptoms (Aldao & Dixon-Gordon, 2014;Chapman et al., 2011Chapman et al., , 2013. Specifically, BPD symptoms were significantly associated with the reported use of avoidance strategies on the DIRE among the older sample of community women in Study 1 (although not the younger women in Study 2). ...
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Introduction: Theory and research suggest the need to expand research on emotion regulation (ER) within borderline personality disorder (BPD). This research examined the relations of BPD symptoms to interpersonal (venting, reassurance-seeking) and socially-oriented (social comparison) ER strategies (in addition to acceptance and avoidance), and explored the role of trait social comparison orientation (SCO) in these relations. Methods: In Study 1, a nationwide community sample of women completed questionnaires. In Study 2, a university sample of young women completed questionnaires and an online social interaction task (following which they reported on the strategies they used to regulate emotions during the task). Results: Results revealed significant indirect relations of BPD symptoms to venting and reassurance-seeking through trait SCO, reassurance-seeking and social comparison through upward SCO, and the in-vivo use of downward social comparison and avoidance strategies during the social interaction task through upward SCO. Discussion: Results highlight the relevance of trait SCO (particularly upward SCO) to socially-oriented ER strategies among women with heightened BPD symptoms.
... 4 Chapman and colleagues 167 suggest that learning to use acceptance-based strategies in BPD may require more practice time to understand the benefits for emotional functioning. Research has found that people with BPD also make more attempts to regulate their emotions and endorse a mix of both effective and ineffective strategies during ER, 83,186,198 potentially limiting the effectiveness of a single strategy. In one mood-induction study, individuals with BPD continued to report higher negative mood than healthy controls despite endorsing, on average, a higher number of ER strategies to regulate their emotions. ...
... 198 Increased attempts at ER may be the result of depleted cognitive resources that leave individuals implementing suboptimal strategies and, in turn, more vulnerable to subsequent stressors. 17,83 Moreover, several studies indicate that people with BPD can implement effective ER strategies (i.e., acceptance, cognitive reappraisal) when instructed to do so in the laboratory. 111,160,[168][169][170][173][174][175]200 It is possible, however, that people with BPD are less persistent in applying effective ER strategies over time, although research has not investigated this hypothesis. ...
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Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.
... Recent work in laboratory settings suggests that spontaneous avoidance is predicted by both habitual avoidance (e.g., Egloff, Schmukle, Burns, & Schwerdtfeger, 2006;Shahar & Herr, 2011; c.f., Volokhov & Demaree, 2010) and symptoms of psychopathology (e.g., borderline personality, depression, bipolar disorder; e.g., Chapman, Dixon-Gordon, & Walters, 2013;Ehring, Tuschen-Caffier, Schnulle, Fischer, & Gross, 2010;Quigley & Dobson, 2013). A critical next step in this work involves incorporating elements of the Research Domain Criteria (RDoC) framework, namely the simultaneous modelling of dysfunctional activity across multiple units of analyses (e.g., self-reports, physiology, behaviour; Insel et al., 2010). ...
... In line with past research, we expected that individual differences in anxiety and depression symptoms would relate to greater spontaneous use of avoidance (e.g., Chapman et al., 2013;Ehring et al., 2010;Quigley & Dobson, 2013) in response to the disgust-eliciting stimuli. We further hypothesised that resting vagal tone would add to the prediction of spontaneous avoidance above and beyond symptoms. ...
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People often regulate their emotions by resorting to avoidance, a putatively maladaptive strategy. Prior work suggests that increased psychopathology symptoms predict greater spontaneous utilization of this strategy. Extending this work, we examined whether heightened resting cardiac vagal tone (which reflects a general ability to regulate emotions in line with contextual demands) predicts decreased spontaneous avoidance. In study 1, greater resting vagal tone was associated with reduced spontaneous avoidance in response to disgust-eliciting pictures, beyond anxiety and depression symptoms and emotional reactivity. In study 2, resting vagal tone interacted with anxiety and depression symptoms to predict spontaneous avoidance in response to disgust-eliciting film clips. The positive association between symptoms and spontaneous avoidance was more pronounced among participants with reduced resting vagal tone. Thus, increased resting vagal tone might protect against the use of avoidance. Our findings highlight the importance of assessing both subjective and biological processes when studying individual differences in emotion regulation.
... Furthermore, this emotional (hyper)reactivity does not only concern negative but may even result from neutral environmental stimuli (Sansone & Sansone, 2010). Individuals higher in BPD traits are also less likely to engage in emotional acceptance (Chapman et al., 2013) and may hence experience their emotions as more distressing. Meanwhile, an EMA study showed avoidance to be the most frequently used emotion regulation strategy by patients with PTSD and that maladaptive emotion regulation prospectively predicted increases in PTSD symptoms (Short et al., 2018). ...
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Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.
... For example, Chapman et al., (2015) examined emotional reactivity to a social rejection stressor versus a frustrating math task and found that those with higher BPD symptoms experienced significantly higher shame reactivity (but not irritability or hostility) during the frustrating math task and significantly higher hostility reactivity (but not irritability or shame) in the social rejection condition compared to controls. Those with high BPD (compared to low BPD) features also reported significantly higher upset, fear, and hostility reactivity following a fear inducing stimulus (Chapman et al., 2013), yet groups did not differ significantly in guilt, shame, nervousness, distress, irritability, or jittery emotional reactivity. Furthermore, in a study by Reichenberger et al. (2017), those with BPD and HCs were presented with interpersonal videographic stimuli in which actors presented rejecting, neutral, or appreciative sentences and were asked to report on specific emotions before and after the stimuli. ...
Article
Emotion dysregulation, including higher baseline emotional intensity and emotional reactivity (i.e., increased magnitude of change in emotional responding) is theoretically central to Borderline Personality Disorder (BPD). However, little research has examined which specific emotions individuals with BPD experience emotion dysregulation in. Interpersonal problems also theoretically drive emotion dysregulation in BPD. However, whether interpersonal problems elicit emotion dysregulation for some specific emotions but not others is unclear. This study aimed to assess whether interpersonal problems moderate the relationship between (1) baseline emotional intensity and (2) emotional reactivity in BPD across six specific emotions (i.e., sadness, disgust, fear, shame, guilt, and anger). Borderline Personality Disorder ( n = 30) and healthy control (HC; n = 30) groups reported their interpersonal problems at baseline and their emotions before and after listening to a laboratory stressor. For the BPD (but not HC) group, higher interpersonal problems were associated with greater baseline sadness, disgust, fear, shame, and guilt. Across groups, higher interpersonal problems were associated with greater sadness, fear, guilt, and anger, but not disgust, reactivity. Higher interpersonal problems were associated with higher shame reactivity specifically for those with BPD. Targeting interpersonal problems may reduce heightened baseline emotional intensity and emotional reactivity for those with BPD, particularly for shame reactivity in BPD.
... Interestingly, these findings are also consistent with those of a recent study on emotion regulation strategy use in borderline personality disorder (a disorder that commonly co-occurs with PTSD and is also thought to be characterized by broad deficits in emotion regulation; see Pagura et al., 2010;Zlotnick et al., 2003), which found that participants high (vs. low) in borderline personality disorder features reported the greater use of many emotion regulation strategies (including the putatively adaptive strategies of distraction and reappraisal) in response to a fear-eliciting stimulus in the laboratory (Chapman, Dixon-Gordon, & Walters, 2013). ...
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The co-occurrence of posttraumatic stress disorder (PTSD) pathology with a substance use disorder (SUD) is associated with emotion regulation deficits. However, studies in this area generally rely on trait-based emotion regulation measures, and there is limited information on the relation of PTSD pathology to the use of specific emotion regulation strategies in response to trauma-related distress among SUD patients or the consequences of these strategies for trauma cue reactivity. This study examined the relation of PTSD symptom severity to the use of specific emotion regulation strategies during trauma cue exposure among trauma-exposed SUD patients, as well as the indirect relations of PTSD symptom severity to changes in negative affect, cravings, and cortisol levels pre- to post-trauma cue exposure through different emotion regulation strategies. Participants were 133 trauma-exposed SUD patients. Participants listened to a personalized trauma script and reported on emotion regulation strategies used during the script. Data on negative affect, cravings, and cortisol were collected pre- and post-script. PTSD symptom severity related positively to the use of more adaptive (e.g., distraction) and maladaptive (e.g., suppression) regulation strategies. Moreover, evidence for the indirect effects of PTSD symptom severity on negative affect and cortisol reactivity through both adaptive and maladaptive emotion regulation strategies was found. Implications of findings are discussed.
... Cross-sectional studies consistently suggest that individuals with BPD report relying on emotion suppression, defined here as the direct inhibition of the experience of emotions (Feldner, Zvolensky, Eifert, & Spira, 2003), to regulate their emotional experiences. BPD symptoms have been positively associated with experiential avoidance (Chapman, Specht, & Cellucci, 2005), thought suppression (Rosenthal, Cheavens, Lejuez, & Lynch, 2005), and avoidant ER strategies (Bijttebier & Vertommen, 1999), and have been negatively associated with emotional acceptance (i.e., observing or experiencing emotions without engaging in suppression or control efforts ;Chapman, Dixon-Gordon, & Walters, 2013). ...
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Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and non-psychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (versus suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.
... BPD features have also been associated with self-criticism, thought suppression, avoidance, and alcohol use as strategies for regulating emotions (Aldao & Dixon-Gordon, 2014). Contrary to the expectation that participants with BPD may have access to fewer emotion regulation strategies, participants high in BPD features reported using more strategies in a laboratory situation than did those low in BPD features, with the exception of lower use of emotional acceptance (Chapman, Dixon-Gordon, & Walters, 2013). There is some evidence that putatively adaptive strategies for regulating emotions, such as reappraisal, may actually work less well for clients with BPD. ...
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Procesos emocionales en el trastorno límite de personalidad: una actualización para la práctica clínica A pesar de que se solía ver como un trastorno con mal pronóstico, el aumento de la investigación sobre el Trastorno de Personalidad Límite (TPL) en las últimas décadas muestra que es tratable y puede tener un buen pronóstico. Las teorías prominentes de TPL destacan la importancia de la disfunción emocional como núcleo de este trastorno. Sin embargo, recientes investigaciones empíricas sugieren una visión más matizada de la disfunción emocional en la TPL. Esta investigación se revisa en el presente artículo, con vistas a cómo estos hallazgos basados en el laboratorio pueden influir en el trabajo clínico con personas que sufren de TPL.
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Objectives Many theoretical models pinpoint emotional dysregulation not only as a symptom of borderline personality disorder (BPD) but also as a component in the development and maintenance of the disorder. In this meta-analysis, results from studies that examined the association between emotion regulation strategies and BPD symptoms were systematically analysed. Design A quantitative meta-analysis approach was used to systematically assess previous research studies and conduct subgroup and meta-regression analysis to test for theoretical, methodological and demographic moderating variables. Results Emotion regulation strategies are significantly and largely associated with BPD symptoms. Negative associations were found between BPD symptoms and acceptance (r = −.558), mindfulness (r = −.581) and reappraisal (r = −.303) and positive associations were found between BPD symptoms and avoidance (r = .528), distraction (r = .336), rumination (r = .551) and suppression (r = .449). As heterogeneity was high, moderating variables (clinical status, type of reporting, comorbidity control, type of population, mean age, percentage of females) were also investigated. Conclusion The findings highlight the need for active involvement of emotion regulation in explaining BPD psychopathology, as well as promoting interventions focused on individual emotion regulation strategies. KEY POINTS • What is already known about this topic: (1) The biosocial model of BPD and dialectical behaviour therapy focuses on emotion dysregulation as a core characteristic of BPD. • (2) Emotional dysregulation is a core feature of BPD and is strongly involved in the appearance and maintenance of BPD pathology. • (3) Emotional regulation difficulties in BPD are also well reflected in the diagnostic criteria according to DSM-5 (APA, 2013). • What this topic adds: (1) In the present review, acceptance and mindfulness are considered different emotion regulation strategies. • (2) Problem solving is not seen as an emotion regulation strategy because it refers to meta-cognitive processes of dealing with emotions and does not target direct attempts to regulate emotions. • (3) Psychological treatments that target the reduction of BPD associated symptoms should continue to focus on emotional dysregulation as a core component of BPD psychopathology.
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Ethnographic descriptions suggest that compared to European Americans, Chinese Americans place a greater emphasis on emotional moderation. To assess whether such cultural differences influence actual emotional responding, we compared the physiological responses and reported affect of 22 Chinese American and 20 European American college-age dating couples in an interpersonal context, that is, during conversations about areas of conflict in their relationship. Although some of our findings were consistent with ethnographic notions of greater emotional moderation in Chinese culture (Chinese Americans demonstrated less variable and less positive reported affect and less variable cardiac interbeat intervals than European Americans), other findings were not (Chinese Americans and European Americans did not differ in most measures of physiological responding and in reported negative affect).
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This paper takes a deconstructive approach to the historical, clinical, and social context of the diagnosis of borderline personality disorder (BPD). This is undertaken by providing an overview of pertinent literature, an examination of the diagnostic criteria, a discussion of the development of the shame affect, a discussion of women's narratives and a reinterpretation of the symptoms of BPD as an overwhelming shame response. An argument is developed that shame is an integral but neglected feature in the experiences of mental distress that are characteristic of BPD. This discussion is supported with evidence of shame in narrative quotes from women with a diagnosis of BPD. There are striking similarities between what is currently pathologized as BPD and an overwhelming shame response. Recognizing the influence of shame may assist mental health nurses to provide mental health nursing care that best meets the needs of women experiencing these symptoms.
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Borderline personality disorder (BPD) is a genetically influenced psychiatric illness with disruptions in neural systems supporting cognition and emotion regulation. Volumetric decreases of the hippocampus and amygdala may characterize BPD and serve as putative endophenotypes for the illness. The purpose of the present study was to evaluate whether the magnitude of these volume reductions and their associations with state-of-illness factors and psychiatric disorders which often co-occur with BPD warrant their consideration as potential endophenotypes. Volumetric magnetic resonance imaging results from 11 studies comprising 205 BPD patients and 222 healthy controls were quantitatively synthesized using meta-analytic techniques. Patients showed an average 11% and 13% decrease in the size of the hippocampus and amygdala, respectively. These volumetric differences were not attenuated in patients being treated with psychotropic medications. Comorbid depression, post-traumatic stress disorder, and substance use disorders were unrelated to volumetric decreases in either structure. These findings suggest modest volume reductions of the amygdala and hippocampus bilaterally in BPD which cannot be attributed to illness state or comorbid psychopathology. Decreased volumes of these key limbic structures may hold promise as candidate endophenotypes for BPD.
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Dysfunctional coping strategies can be expected to be among the criteria distinguishing personality disorders from normal personality functioning. In the present study the relationship between the basic coping modes problem-solving, social support seeking and avoidance was investigated in a sample of 137 psychiatric in-patients, using both a dimensional and a categorical approach. The general pattern of association found was that of a lack of social support seeking, together with an excess of avoidant coping.
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A pathology of affect regulation and of object relations (the cognitive and affective processes that mediate interpersonal functioning in close relationships) are two features that define much of borderline pathology. Cognitive-behavioral interventions that target self-regulation and social-cognitive processes (such as perspective-taking and attribution) can be usefully integrated into psychodynamically oriented treatment of borderline patients. Strictly psychodynamic approaches tend to be limited by factors such as a lack of attention to processes by which conscious insight and coping strategies can be transformed into automatic or adaptive unconscious procedures in these patients. Cognitive approaches tend to be limited by rationalistic assumptions about motivation and an underestimation of the complexities of cognitive-affective interactions and unconscious processes.
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Humor is a complex phenomenon of human social cognition with large inter-individual variability. Gender differences in emotion processing are a common finding in functional neuroimaging studies, and have been documented in behavioral studies of humor, but have received limited attention in functional neuroimaging studies on humor. Using blood oxygenation level dependent (BOLD) contrasts with high-field (3T) functional magnetic resonance imaging (fMR) we investigated 29 healthy subjects (14 female, 15 male) during the processing of humorous cartoons. In women, the ventral system implicated ín detection and appraisal of emotion was activated, including amygdala, insula, and Anterior Cingulate Cortex (ACC). Men showed activation in both the ventral and dorsal processing systems. The results indicate that women process humor though limbic reactivity, involving appraisal of its emotional features, while men apply more evaluative, executive resources to humor processing.
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Borderline personality disorder has been characterized by enhanced emotional reactivity and deficient emotion regulation in behavioral and functional imaging studies. We aimed to validate patients' difficulties in the cognitive regulation of negative emotions and investigated if emotion regulation deficits are restricted to the decrease of negative emotions. A cognitive reappraisal paradigm was used and hence a regulation strategy that is typically applied in cognitive-behavioral therapy. Fifteen unmedicated female borderline patients with affective instability and 15 healthy female control subjects underwent functional magnetic resonance imaging during a delayed reappraisal paradigm. Hemodynamic responses were measured in response to aversive pictures in an initial viewing phase and a subsequent reappraisal phase with three different conditions: decreasing, increasing, and maintaining the initial emotional reaction. Patients demonstrated enhanced activation of left amygdala and right insula during the initial viewing of aversive stimuli. During attempting to decrease the initial emotional reaction, patients showed attenuated activation of the left orbitofrontal cortex and increased activation of the bilateral insula. The attempt to increase negative emotions resulted in enhanced activity in amygdala and insula, whereas no group differences were found. The results point to the role of two distinguishable processes of emotional difficulties in borderline personality disorder: enhanced emotional reactivity as well as deficits of voluntarily decreasing aversive emotions by means of cognitive reappraisal. The results suggest the neuronal substrate of deficits in explicit emotion regulation in the orbitofrontal cortex, which is in line with previous findings of a dysfunctional prefrontal network in borderline personality disorder.
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The newly developed Dissoziations-Spannungs-Skala (Dissociation Tension Scale; DSS) is a self-rating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as aversive inner tension occurring within the past 7 days. The DSS contains 21 items assessing dissociative symptoms and 1 additional item assessing aversive inner tension. Ratings are made on a time-oriented scale ranging from 0% (never) to 100% (constantly). We measured the psychometric qualities of the DSS in a total of 294 patients and healthy controls. Internal consistency of the DSS was high (Cronbach's alpha = .92; Gutmann's split-half r = .92). We found good support for convergent, discriminant, and differential validity. There was clear evidence for the DSS being a sensitive instrument for the assessment of changing symptomatology. Assessment of dissociation and other psychopathological features over the same period of time are now possible.
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Emotional dysregulation is one of the key symptoms of patients with borderline personality disorder (BPD). In the present study it is hypothesized that borderline patients display a cortical hyper-responsivity to emotional stimuli compared with a healthy control group. Further, we aimed to examine whether BPD patients were able to suppress stimuli with negative emotional valence as well as healthy control participants could. This is the first study addressing the electrophysiological processing of emotional stimuli in BPD. The electrophysiological response to emotional information was studied among 30 BPD patients and compared with the response in 30 normal controls using event-related potentials (ERPs). Participants were shown pictures selected from the International Affective Picture System with neutral, positive, and negative valence. After performing an attentional task, the participants were asked to perform a reappraisal task. The assignment was to consciously suppress emotions that might occur after viewing pictures with an unpleasant content. Borderline patients displayed larger late positive potentials (LPP) to pictures with an unpleasant valence as compared with the control group, indicating an enhanced elaborative processing of unpleasant stimuli. However, they did not differ on the reappraisal task. Borderline patients show an enhanced emotional cortical reactivity to unpleasant stimuli as compared with a control group. This suggests an emotional dysfunctioning in BPD patients. This feature might be an important focus in the treatment of BPD.
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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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Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n=12) and healthy controls (n=28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.
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This study examined the effects of suppressing emotions in the natural environment among individuals who were high (high-BPD; n = 30) and low (low-BPD; n = 39) in borderline personality disorder (BPD) features. Participants responded to prompts from a personal data assistant eight times per day over a four-day period. The first day was a baseline day, followed by instructions to observe emotions on the second day, suppress emotions on the third day, and observe emotions on the fourth day. Findings ran counter to the notion that emotion suppression is a maladaptive emotion regulation strategy for individuals with BPD features, and also contradict some laboratory research in this area. Specifically, high-BPD participants reported higher positive emotions on the suppress day compared with the observe days, and lower urges to engage in impulsive behavior on the suppress day compared with both the baseline and observe days. On the contrary, for low-BPD participants, negative emotions were higher on the suppress day than they were on the observe or baseline days. Overall, findings indicate the need to further examine when and how emotion suppression leads to positive versus negative effects for persons with BPD features.
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Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
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Forty-six patients with borderline personality disorder with and without major depression and 27 normal volunteers completed the Buss-Durkee Hostility Inventory, a self-rating scale of anger and hostility. The patients with borderline personality had significantly higher scores than the normal volunteers. The scores of the patients with borderline personality disorders were not related to gender, treatment or research setting, the degree of acute distress, or the presence of major depression. These findings suggest that a proneness to anger and hostility are enduring characteristics of borderline personality disorder and that anger and depression may represent independent clinical conditions with independent biological mechanisms regulating these two affective states.
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The ensemble averaged impedance cardiogram was evaluated during rest and during vocal mental arithmetic stress in samples of female (n = 17) and male (n = 40) undergraduates. Measures of myocardial performance determined from ensemble averaged signals were compared to those determined by simple beat-to-beat averaging over 60-s and 20-s sampling intervals. In addition, the influence of cardiac interval variability on dZ/dt amplitude measures was assessed. As expected, measures derived by the two averaging techniques corresponded closely, with correlations ranging from r = 0.882 to r = 1.000 for the 60-s sampling intervals, and from r = 0.726 to r = 1.000 for the 20-s sampling intervals. Inverse relationships of comparable magnitude were found between cardiac interval variability and dZ/dt amplitude measures determined by both averaging techniques, suggesting that these relationships did not result simply from artifacts introduced by the ensemble averaging technique. The results support the validity of ensemble averaging as a method for deriving impedance cardiographic measures of myocardial performance.
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Suicide is analyzed in terms of motivations to escape from aversive self-awareness. The causal chain begins with events that fall severely short of standards and expectations. These failures are attributed internally, which makes self-awareness painful. Awareness of the self's inadequacies generates negative affect, and the individual therefore desires to escape from self-awareness and the associated affect. The person tries to achieve a state of cognitive deconstruction (constricted temporal focus, concrete thinking, immediate or proximal goals, cognitive rigidity, and rejection of meaning), which helps prevent meaningful self-awareness and emotion. The deconstructed state brings irrationality and disinhibition, making drastic measures seem acceptable. Suicide can be seen as an ultimate step in the effort to escape from self and world.
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We examined the effects of hyperventilation and other manipulations of respiratory pace on parasympathetic nervous system function and subjective reactivity in 15 patients with panic disorder, 15 patients with social phobia, and 15 healthy control subjects. After a 30-minute rest period subjects completed a 2.5-minute trial of each of hypoventilation, normoventilation, and hyperventilation. Trials were separated by a 3 minute inter-trial interval. Incidence of panic attacks, symptom severity, vagal tone, heart rate, end-tidal carbon dioxide level, and respiratory frequency were measured throughout. Resting physiological measures did not differ between groups. Each respiratory manipulation resulted in the expected physiological changes (e.g., hyperventilation attenuated vagal tone), however, groups did not exhibit differential physiological reactivity to the manipulations. There were no panic attacks reported during either the hypoventilation or normoventilation phases; however, two social phobic subjects (13.3%) and two panic disorder patients (13.3%) reported panic attacks during hyperventilation. Although both groups of anxiety patients reported greater severity of hyperventilation-induced symptoms than did control subjects, symptom severity did not correlate significantly with vagal tone or heart rate. These results suggest that parasympathetic function is unlikely to be aberrant in PD patients and that diminished parasympathetic activity is not sufficient for the experience of panic attacks.
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Patients with borderline personality disorder provide an ideal sample for a study of impulsive sexual behavior and factors related to it in psychiatrically ill women. Even though impulsive sexual behavior is one of the DSM-III-R criteria for borderline personality disorder, not all patients with the disorder manifest such behavior. While controlling for diagnosis, we identified factors related to sexual impulsivity of these patients. Our results suggest that impulsive sexual behavior is common in some women with borderline personality disorder. Forty-six percent of the women in our sample reported that they had impulsively entered into sexual relationships with partners they did not know well. Al though many axis I conditions that could contribute to impaired judgment were present, only alcohol abuse correlated with sexual impulsivity. Patients with impulsive sexual behavior were more likely to receive a comorbid axis II diagnosis of histrionic personality disorder, were more likely to have general problems with impulsivity, were more extraverted, and suffered less from anxiety. They appeared to be very different from another group women with borderline personality disorder who complained of severe anxiety and chronic emptiness and boredom and who were likely to exhibit symptoms of anorexia and selfmutilation. For the practicing clinician, one implication of these findings is that exposure to HIV through sexual contact may be a pressing concern with only some patients with borderline personality disorder. Our findings suggest that practitioners should be especially concerned with more extraverted, histrionic patients who experience low levels of anxiety and who abuse alcohol. Other patients with borderline personality disorder who are more anxious and who have symptoms of anorexia and self-mutilation may be at lower risk for infection. One limitation of this study is the difficulty of reliably assessing what is essentially private and unobserved behavior. Subjects are likely to deny behaviors, including sexual practices, that they feel are socially unacceptable. Future research should investigate whether the impulsive sexual behavior these patients exhibit is also unsafe sexual behavior that is likely to put them at risk for HIV infection. Also of importance will be studies of HIV seroprevalence among patients with borderline personality disorder, although as Coyle and associates (10) have pointed out, rates of seropositivity do not accurately measure risk behavior.