Increases in negative affective arousal precede lower self-esteem in patients with borderline personality disorder but not in patients with depressive disorders: an experience sampling approach.

BACKGROUND: Instability in self-esteem and instability in affect are core features of borderline personality disorder (BPD). For decades, researchers and theorists have been interested in the temporal dynamics between these constructs. Some hypothesize that changes in affective states should precede changes in self-esteem (Linehan, Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993), while others suggest that changes in self-esteem should precede changes in affective states (Kernberg, Borderline conditions and pathological narcissism, 1975). METHODS: In this study, we investigated the temporal relations between negative affective arousal states and current self-esteem in daily life. Patients with BPD (n = 42) or depressive disorders (DD; n = 40), and non-clinical controls (NCC; n = 40) were assessed every 15 min for 13 h. RESULTS: As expected, dynamic structural equation modeling showed higher levels of average daily negative affective arousal and lower levels of average daily self-esteem in the BPD group compared with the NCC group, and scores in the DD group were in-between the BPD and the NCC groups. In line with predictions based on Linehan's (Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993) model of affective dysregulation in BPD, negative affective arousal (t) and subsequent self-esteem (t+ 1) were significantly linked only in the BPD group, implying that higher negative affective arousal is followed by lower current self-esteem in the next measurement (ca. 15 min later). Importantly, self-esteem (t) and subsequent negative affective arousal (t + 1) were not significantly related (Kernberg, Borderline conditions and pathological narcissism, 1975). CONCLUSIONS: Our findings suggest close dynamic temporal relations between affective instability and self-esteem instability in BPD, which highlights the importance of providing patients with means to effectively modulate high negative affective arousal states.

Affective arousal temporally precedes dissociation in patients with borderline personality disorder: A preliminary experience sampling study.

OBJECTIVE: Affective dysregulation is a core feature of borderline personality disorder (BPD), and some patients report dissociative symptoms. The present study investigated temporal dynamic relations between affective states and current experiences of depersonalization and derealization in daily life to test key theoretical premises of trauma models of dissociation. METHOD: Patients with BPD (n = 42) or depressive disorders (n = 40), and nonclinical controls (n = 39) were assessed every 15 min for 13 hr within a single day using smartphone-based diaries. RESULTS: As expected, dynamic structural equation modeling results show the highest levels of average daily affective arousal, negative affective valence, and dissociation in the BPD group. As hypothesized, arousal and subsequent dissociation were significantly linked only in the BPD group, implying that momentary arousal above a person's daily average is followed by higher dissociation in the next measurement (∼15 min later). In addition, some patients with BPD reported less negative affective valence following dissociation. CONCLUSIONS: Our findings suggest that changes in affective states play an important role at the onset of dissociation in patients with BPD. Subsequent relief from distress may explain maintenance. We recommend that clinicians provide means to regulate affect when dealing with dissociation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between baseline dissociation levels and stress-induced state dissociation in patients with posttraumatic-stress disorder, borderline personality disorder, and major depressive disorder.

INTRODUCTION: Dissociative symptoms are highly prevalent in patients with trauma-related disorders such as borderline personality disorder (BPD) and posttraumatic-stress disorder (PTSD), and also occur in patients with depressive disorders. Acute dissociative states are theorized to be stress-related, and some individuals experience recurring patterns of dissociation. The relationship between the intensity of dissociative episodes (trait-like dissociation) and acute dissociative states, however, is incompletely understood. In the present study, we investigated how levels of baseline (trait-like) dissociation relate to changes in dissociative states during a laboratory stress induction. METHODS: Our female sample comprised 65 patients with BPD and/or PTSD, 84 patients with major depressive disorder (MDD) and 44 non-clinical controls (NCC). Baseline dissociation was assessed at the start of the study using the Dissociation Tension Scale past week version (DSS-7). All participants underwent the Trier Social Stress Test (TSST) and a placebo version (P-TSST). Before and after the TSST or P-TSST, state dissociation was assessed using the Dissociation Tension Scale acute (DSS-4). We used structural equation models to estimate changes in state dissociation items (somatoform dissociation, derealization, depersonalization, analgesia), and to test whether these changes relate to levels of baseline dissociation. RESULTS: We found significant increases in all state dissociation items in response to the TSST in patients with BPD and/or PTSD and patients with MDD, but not in NCCs. Increases in somatoform dissociation and derealization during the TSST were significantly related to higher levels of baseline dissociation in patients with BPD and/or PTSD, but not in patients with MDD or NCCs. Results indicate no significant changes in state dissociation during the P-TSST. CONCLUSION: Our results replicate earlier findings that patients with BPD and/or PTSD report higher levels of stress-related state dissociation than NCC and extend them to patients with MDD. In addition, our findings indicate that baseline levels of dissociation relate to stress-induced changes in state dissociation among patients with BPD and PTSD, but not patients with MDD. In clinical applications, measures of baseline dissociation could be used to facilitate the prediction and treatment of stress-related dissociative states in patients with BPD and/or PTSD.

The temporal relation of arousal and perceived rejection in patients with borderline personality disorder and depressive disorders: An experience sampling approach.

Borderline personality disorder (BPD) is characterized by high levels of arousal and perceived rejection by others. The temporal relation between these constructs, however, remains largely unclear. Based on predictions derived from the dynamic affect model and the rejection sensitivity model, we expected increases in arousal and perceived rejection to predict subsequent increases in perceived rejection and arousal, respectively. To investigate this topic, we assessed current self-reported affective arousal and perceived rejection in patients with BPD (n = 42), patients with depressive disorders (DDs; n = 43), and healthy controls (HCs; n = 40) for 52 times within 13 hr (ca. every 15 min). In line with previous studies, dynamic structural equation model results indicate significantly higher trait levels of arousal and perceived rejection in patients with BPD compared with participants in the DD and HC groups. In addition, we found substantial autoregressive and cross-lagged effects for arousal and perceived rejection. Other than expected, the magnitude of these effects did not significantly differ across diagnostic groups. Our findings suggest close temporal relations between arousal and perceived rejection. In patients with BPD, these effects unfold against the background of substantially elevated trait levels of arousal and perceived rejection. Future experience sampling studies should provide additional context information (e.g., through monitoring rejection events) to investigate how patients with BPD perceive rejection in everyday life and how this affects subsequent levels of arousal. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive-affective responses to online positive-psychological interventions: The effects of optimistic, grateful, and self-compassionate writing.

Growing evidence suggests that online positive-psychological interventions effectively increase well-being, and a wealth of evidence describes cognitive-affective responses to such interventions. Few studies, however, have directly compared responses across popular exercises such as the best-possible-self intervention, the gratitude letter, or self-compassionate writing. In addition, current evidence is ambiguous regarding the effects of potential moderator variables such as trait gratitude and emotional self-awareness. To address these issues, we randomized 432 German adults to perform either optimism, gratitude, self-compassion, or control writing interventions in an online setting. Participants reported trait gratitude and trait emotional self-awareness before the interventions, as well as momentary optimism, gratitude, self-compassion, positive affect, and current thoughts immediately after the interventions. Results indicate higher momentary optimism after the best-possible-self intervention and higher momentary gratitude after the gratitude letter than after the control task. There were no differences when comparing the best-possible-self intervention with the gratitude letter. Both interventions increased the number of positive self-relevant thoughts. The self-compassion condition showed no effects. Moderation analysis results indicate that neither emotional self-awareness nor trait gratitude moderated the intervention effects. Future studies should compare responses across different positive-psychological interventions using more comprehensive exercises to ensure larger effects.