Implementing an EMA burst design in community-engaged research: participant and researcher perspectives and recommendations.

Background: Implementing ecological momentary assessment (EMA) methodology to evaluate the substance use disorder (SUD) treatment pipeline has clear advantages, including learning about participants' day-to-day experiences to aid in the improvement of services and accessibility for those seeking treatment. Given that the SUD treatment pipeline spans long periods of time, EMA burst designs (deployment of multiple short EMA periods spread over time) can be advantageous for evaluating the treatment pipeline over time while keeping participant burden low.Objectives: This feasibility study describes (1) the process and study design of implementing EMA burst methodology to evaluate the SUD treatment pipeline experience; (2) study implementation from the perspective of researchers, including discussion of collaboration with community partners; and (3) participant feedback on the experience of engaging with this type of research.Method: EMA metrics, feasibility ratings, and general experience ratings in the study are presented from 22 participants (64% women) who participated in a parent EMA study evaluating the SUD treatment pipeline and 8 who provided feedback in a follow-up survey.Results: Participants found the EMA burst design to be acceptable and not burdensome, although technology issues were present for some participants. Steps to partnering with community treatment programs and implementation of a burst design are outlined.Conclusions: Strategies and recommendations for implementation of an EMA burst study with community partners are provided, including aspects of study design, technology issues, retention, and funding.

Combinatorial Optimization of Clustering Decisions: An Approach to Refine Psychiatric Diagnoses.

Using complete enumeration (e.g., generating all possible subsets of item combinations) to evaluate clustering problems has the benefit of locating globally optimal solutions automatically without the concern of sampling variability. The proposed method is meant to combine clustering variables in such a way as to create groups that are maximally different on a theoretically sound derivation variable(s). After the population of all unique sets is permuted, optimization on some predefined, user-specific function can occur. We apply this technique to optimizing the diagnosis of Alcohol Use Disorder. This is a unique application, from a clustering point of view, in that the decision rule for clustering observations into the "diagnosis" group relies on both the set of items being considered and a predefined threshold on the number of items required to be endorsed for the "diagnosis" to occur. In optimizing diagnostic rules, criteria set sizes can be reduced without a loss of significant information when compared to current and proposed, alternative, diagnostic schemes.

Ego-resiliency in borderline personality disorder and the mediating role of positive and negative affect on its associations with symptom severity and quality of life in daily life.

Borderline personality disorder (BPD) is a serious mental health condition associated with severe symptoms of distress and poor quality of life (QoL). Research outside the field of BPD suggests that ego-resiliency is negatively associated with psychopathology and positively associated with a range of positive life outcomes. Thus, ego-resiliency may be a valuable construct for furthering our understanding and treatment of BPD. However, the mechanisms linking ego-resiliency to psychopathology and QoL in relation to BPD have not been examined and explored by research. This study has addressed this gap in the collective knowledge by evaluating whether within-person associations between daily reports of positive affect (PA) and negative affect (NA) mediated the relationship between ego-resiliency, BPD symptom severity, and QoL. For 21 consecutive days, 72 women diagnosed with BPD completed end-of-day electronic assessments regarding ego-resiliency, PA and NA, symptom severity, and QoL. Multilevel structural equation modelling established that PA and NA were parallel mediators linking ego-resiliency with BPD symptom severity and QoL. As hypothesized, the path to QoL was stronger through PA than through NA. The mediation paths through NA and PA to BPD symptom severity were both significant, but their strength did not differ. Our findings align with the assertions of theories on emotion, thus suggesting a two-factor approach to PA and NA. Future research can build on these findings by developing psychotherapeutic interventions designed not only to reduce symptom severity but also to enhance PA in individuals with BPD and determine whether an increase in PA is associated with improved QoL.

Linking Daily-Life Interpersonal Stressors and Health Problems Via Affective Reactivity in Borderline Personality and Depressive Disorders.

OBJECTIVE: Borderline personality disorder (BPD) is associated with unstable interpersonal relationships, affective instability, and physical health problems. In individuals with BPD, intense affective reactions to interpersonal stressors may contribute to the increased prevalence of health problems. METHODS: BPD (n = 81) and depressed participants (DD; n = 50) completed six daily ambulatory assessment prompts for 28 days. At each prompt, participants reported interpersonal stressors (disagreements, rejections, feeling let down), negative affect, and health problems in four domains (gastrointestinal, respiratory, aches, depressive symptoms). In multilevel moderated mediation models, we examined the indirect effects of interpersonal stressors on health problems via negative affect, by group. RESULTS: Interpersonal stressors were positively associated with negative affect in both groups (ß values > 0.12, p values < .001), but more so for participants with BPD (ßDay = 0.05, p < .001). Negative affect was positively associated with health problems across all domains (ßMoment/Day values > 0.01, p values < .046), but associations were larger at the day level for respiratory symptoms in BPD (ß = 0.02, p = .025) and for depressive symptoms in DD (ß = 0.04, p < .001). Negative affect mediated the association of interpersonal stressors and health problems in both groups, with larger effects for the DD group for depressive problems (ß = 0.02, p = .092) and for the BPD group for the other three domains (ß values > 0.02, p values < .090). CONCLUSIONS: Interpersonal stressors may contribute to increased physical health problems via an inability to regulate affective responses to such events. This pathway may be stronger in several health domains for those with BPD and may contribute to an elevated risk of morbidity and mortality in this disorder, suggesting a target for intervention to reduce these risks.

Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders.

BACKGROUND: Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long-standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co-occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM-5 AUD and psychiatric symptoms of other DSM-IV and DSM-5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing). METHODS: The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past-year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC-III. RESULTS: Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM-5 AUD severity gradients. CONCLUSIONS: This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, "more severe" presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.

Genetic and Environmental Causes of Individual Differences in Borderline Personality Disorder Features and Loneliness are Partially Shared.

Loneliness is related to mental and somatic health outcomes, including borderline personality disorder. Here, we analyze the sources of variation that are responsible for the relationship between borderline personality features (including four dimensions, affective instability, identity disturbance, negative relationships, self-harm and a total score) and loneliness. Using genetically informative data from two large nonclinical samples of adult twin pairs from Australia and the Netherlands (N = 11,329), we estimate the phenotypic, genetic and environmental correlations between self-reported borderline personality features and loneliness. Individual differences in borderline personality and loneliness were best explained by additive genetic factors with heritability estimates h2 = 41% for the borderline personality total score and h2 = 36% for loneliness, with the remaining variation explained by environmental influences that were not shared by twins from the same pair. Genetic and environmental factors influencing borderline personality (total score and four subscales separately) were also partial causes of loneliness. The correlation between loneliness and the borderline personality total score was rph = .51. The genetic correlation was estimated at rg = .64 and the environmental correlation at re = .40. Our study suggests common etiological factors in loneliness and borderline personality features.

Psychosis risk is associated with decreased resting-state functional connectivity between the striatum and the default mode network.

Psychosis is linked to aberrant salience or to viewing neutral stimuli as self-relevant, suggesting a possible impairment in self-relevance processing. Psychosis is also associated with increased dopamine in the dorsal striatum, especially the anterior caudate (Kegeles et al., 2010). Critically, the anterior caudate is especially connected to (a) the cortical default mode network (DMN), centrally involved in self-relevance processing, and (b) to a lesser extent, the cortical frontoparietal network (FPN; Choi, Yeo, & Buckner, 2012). However, no previous study has directly examined striatal-cortical DMN connectivity in psychosis risk. In Study 1, we examined resting-state functional connectivity in psychosis risk (n = 18) and control (n = 19) groups between (a) striatal DMN and FPN subregions and (b) cortical DMN and FPN. The psychosis risk group exhibited decreased connectivity between the striatal subregions and the cortical DMN. In contrast, the psychosis risk group exhibited intact connectivity between the striatal subregions and the cortical FPN. Additionally, recent distress was also associated with decreased striatal-cortical DMN connectivity. In Study 2, to determine whether the decreased striatal-cortical DMN connectivity was specific to psychosis risk or was related to recent distress more generally, we examined the relationship between connectivity and distress in individuals diagnosed with nonpsychotic emotional distress disorders (N = 25). In contrast to Study 1, here we found that distress was associated with evidence of increased striatal-cortical DMN connectivity. Overall, the present results suggest that decreased striatal-cortical DMN connectivity is associated with psychosis risk and could contribute to aberrant salience.

Common genetic contributions to high-risk trauma exposure and self-injurious thoughts and behaviors.

BACKGROUND: Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences. METHODS: Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24-42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project. RESULTS: The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [rG = 0.59, 95% confidence interval (CI) (0.37-0.81)] and women [rG = 0.56 (0.49-0.63)]. Unique environmental influences were modestly correlated in women [rE = 0.23 (0.01-0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females. CONCLUSIONS: Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma.

Ambulatory Assessment of Borderline Personality Disorder.

Ambulatory assessment (AA) is an important tool that promises to minimize retrospective biases while gathering ecologically valid data, including self-reports, physiological or biological data, and observed behavior, for example, from daily life experiences. AA is well suited for studying borderline personality disorder (BPD) because it can measure moods and emotion (as well as dynamic mood processes, mood changes, and mood instability), problematic behaviors (including interpersonal conflicts, addictive behaviors, binge and purge episodes, and motoric activity), and problematic cognitions/expectancies/urges (e.g., rejection sensitivity, cravings, and self-harm urges) as they occur in daily life. In this article, I review existing AA research on BPD, and I discuss future applications of AA as well as limitations and considerations for future use.

The Association of Genetic Predisposition to Depressive Symptoms with Non-suicidal and Suicidal Self-Injuries.

Non-suicidal and suicidal self-injury are very destructive, yet surprisingly common behaviours. Depressed mood is a major risk factor for non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. We conducted a genetic risk prediction study to examine the polygenic overlap of depressive symptoms with lifetime NSSI, suicidal ideation, and suicide attempts in a sample of 6237 Australian adult twins and their family members (3740 females, mean age = 42.4 years). Polygenic risk scores for depressive symptoms significantly predicted suicidal ideation, and some predictive ability was found for suicide attempts; the polygenic risk scores explained a significant amount of variance in suicidal ideation (lowest p = 0.008, explained variance ranging from 0.10 to 0.16 %) and, less consistently, in suicide attempts (lowest p = 0.04, explained variance ranging from 0.12 to 0.23 %). Polygenic risk scores did not significantly predict NSSI. Results highlight that individuals genetically predisposed to depression are also more likely to experience suicidal ideation/behaviour, whereas we found no evidence that this is also the case for NSSI.

Countering Craving with Disgust Images: Examining Nicotine Withdrawn Smokers' Motivated Message Processing of Anti-Tobacco Public Service Announcements.

There is a lack of research examining whether smoking cues in anti-tobacco advertisements elicit cravings, or whether this effect is moderated by countervailing message attributes, such as disgusting images. Furthermore, no research has examined how these types of messages influence nicotine withdrawn smokers' cognitive processing and associated behavioral intentions. At a laboratory session, participants (N = 50 nicotine-deprived adults) were tested for cognitive processing and recognition memory of 12 anti-tobacco advertisements varying in depictions of smoking cues and disgust content. Self-report smoking urges and intentions to quit smoking were measured after each message. The results from this experiment indicated that smoking cue messages activated appetitive/approach motivation resulting in enhanced attention and memory, but increased craving and reduced quit intentions. Disgust messages also enhanced attention and memory, but activated aversive/avoid motivation resulting in reduced craving and increased quit intentions. The combination of smoking cues and disgust content resulted in moderate amounts of craving and quit intentions, but also led to heart rate acceleration (indicating defensive processing) and poorer recognition of message content. These data suggest that in order to counter nicotine-deprived smokers' craving and prolong abstinence, anti-tobacco messages should omit smoking cues but include disgust. Theoretical implications are also discussed.

Early onset alcohol use and self-harm: a discordant twin analysis.

BACKGROUND: Self-harm has considerable societal and economic costs and has been extensively studied in relation to alcohol involvement. Although early onset alcohol use (EAU) has been causally linked to maladaptive clinical outcomes, its association with self-harm is less well characterized. This study aimed to further examine the link between EAU and both nonsuicidal self-injury (NSSI) and suicide attempt (SA), and elucidate shared familial and causal/individual-specific pathways that explain this co-occurrence. METHODS: Using data from 6,082 Australian same-sex twin pairs (1,732 monozygotic [MZ] and 1,309 dizygotic [DZ]), ages 23 to 40, we examined prevalence rates of NSSI and SA among twin pairs concordant and discordant for EAU. Conditional logistic regression, controlling for early clinical covariates and the influence of zygosity on EAU, was used to examine the odds ratio (OR) of self-harm within twin pairs discordant for EAU. RESULTS: Prevalence rates of both NSSI and SA were highest among twin pairs concordant for EAU and for twins who reported EAU within discordant twin pairs. Results from discordant twin analyses revealed nearly 4-fold increased odds of SA for the twin who endorsed EAU, and this OR was equal across MZ and DZ twins. EAU also was associated with elevated odds of NSSI (OR = 7.62), although this was only the case for DZ twins in discordant pairs. CONCLUSIONS: The equivalent increase in odds of SA for both MZ and DZ twins suggests that causal or individual-specific influences explain the link between EAU and SA. For NSSI, elevated odds for DZ twins and nonsignificant findings for MZ twins implicate correlated genetic factors in the association between EAU and NSSI. Future studies should test mechanisms through which EAU may causally influence SA, as well as examine whether genetic risk for third variables (e.g., negative urgency, stress reactivity) may explain the genetic overlap between EAU and NSSI.

Daily Associations Between Injunctive Drinking Norms and Alcohol Consumption.

OBJECTIVE: Perception of others' approval of alcohol use (i.e., injunctive drinking norms) is strongly predictive of alcohol use, particularly among young adults (Krieger et al., 2016). While between-person injunctive norms predict alcohol use (Neighbors et al., 2008), there is evidence of within-person fluctuations in the relationship between norms and drinking (Graupensperger et al., 2021). The current study used ecological momentary assessment (EMA) to test within-person, day-level associations between injunctive norms and alcohol use, and to test whether social context moderated this association. METHOD: Participants (n=83, M age=24.0, 50.9% female) completed a two-week EMA protocol using a smartphone application. Injunctive norms, social context (type and gender of companions), and number of drinks consumed were assessed each morning following a drinking event. Multilevel models with repeated measures nested within participants tested main effects and interactions of between- and within-person injunctive norms, type of drinking companions, and gender of drinking companions on number of drinks consumed. RESULTS: Day-level injunctive norms were positively associated with drinking quantity over and above baseline norms. The effect of norms differed by social context such that norms were only positively related to drinking quantity when drinking with a friend or romantic partner (vs. drinking alone). Gender of friends with whom participants drank did not moderate the effect of norms on quantity. CONCLUSIONS: This study provides one of the first examinations of daily fluctuations in injunctive drinking norms. As norms represent a malleable target for intervention (White et al., 2019), results offer new information regarding possible intervention targets.

Momentary impulsivity interferes with emotion regulation strategy prioritization in everyday life in remitted depression.

BACKGROUND: Selectively prioritizing some emotion regulation (ER) strategies over others has been shown to predict well-being; however, it is unclear what mechanisms underlie this process. Impulsivity, which captures both top-down control of and bottom-up reactivity to emotions, is one potential mechanism of interest. METHODS: Using multilevel mediation modeling, we investigated whether lower ER strategy prioritization (i.e., lower between-strategy variability) mediates the relationship between greater momentary impulsivity and lower ER success in 82 individuals with remitted depression or no history of a mental disorder (1558 observations). To determine the specific effect of impulsivity, we covaried for mean regulatory effort and negative affect. RESULTS: The indirect effect of impulsivity on ER success was significant at the within-person, but not between-person, level. Specifically, in moments when individuals endorsed more impulsivity than usual, they showed less ER strategy prioritization than usual, which predicted less successful ER. Individuals who, on average, reported more impulsivity indicated lower ER strategy prioritization, but no difference in ER success. CONCLUSION: ER strategy prioritization mediated the within-person relationship between greater impulsivity and lower ER success. Interventions focused on training individuals to selectively prioritize ER strategies may improve ER success, particularly when individuals are feeling more impulsive than usual.

The Brief Emotion Dysregulation Scale: Development, Preliminary Validation, and Recommendations for Use.

Emotion dysregulation is a multi-faceted, transdiagnostic construct, and its assessment is crucial for characterizing its role in the development, maintenance, and treatment of psychiatric problems. We developed the Brief Emotion Dysregulation Scale (BEDS) to capture four components of emotion dysregulation: sensitivity, lability, reactivity, and consequences. We examined factor structure and construct validity in four independent samples of college students (N = 1,485). We elected to treat consequences as a separate index of problems associated with emotion dysregulation. Exploratory and confirmatory factor analyses did not support the reactivity subscale and instead supported a well-fitting two-factor solution for sensitivity and lability. Multi-group analyses demonstrated strong factorial invariance by gender. The resulting 12-item BEDS includes sensitivity and lability subscales and a separate consequences scale to indicate associated problems. Convergent correlations suggested good construct validity. This provides preliminary support for the BEDS as a brief transdiagnostic screening tool for emotion dysregulation and associated consequences.

Using mobile technology to influence alcohol-impaired driving risk perceptions and decisions.

OBJECTIVE: Despite significant individual and societal risk, alcohol-impaired driving (AID) remains prevalent in the United States. Our aim was to determine whether breathalyzer-cued warning messages administered via mobile devices in the natural drinking environment could influence real-world AID cognitions and behaviors. METHOD: One hundred twenty young adults (53% women; mean age = 24.7) completed 6 weeks of ecological momentary assessment (EMA) and provided breathalyzer samples using a BACtrack Mobile Pro linked to their mobile device. On mornings after drinking episodes, participants reported their driving activities from the previous evening (787 episodes). Participants were randomly assigned to receive warning messages if they reached a breath alcohol concentration (BrAC) ≥ .05, or no messages. Participants in the warnings condition reported their willingness to drive and perceived danger of driving at EMA prompts (1,541 reports). RESULTS: We observed a significant effect of condition, such that the association between cumulative AID engagement and driving after reaching a BrAC of .05 was dampened among individuals in the warnings condition, compared to those in the no warnings condition. Receiving a warning message was associated with increased momentary perceived danger of driving and decreased willingness to drive. CONCLUSIONS: We found that BrAC-cued warning messages reduced the probability of AID and willingness to drive while impaired, and increased the perceived danger of driving after drinking. These results serve as proof-of-concept for the use of mobile technology to deliver an adaptive just-in-time intervention to reduce the probability of AID. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trait impulsivity moderates rate of alcohol consumption in daily life.

INTRODUCTION: Rate of alcohol consumption, the speed with which people drink, has been linked to a range of outcomes, including alcohol use disorder symptoms and increased positive affect. However, minimal work has identified who is most likely to drink at elevated rates. Impulsivity is associated with increased attention to positive reinforcers specifically (e.g., positive affect). We therefore examined whether people higher in trait impulsivity engage in faster consumption during drinking episodes. METHODS: Participants were current drinkers (N = 113; 54 people with borderline personality disorder [BPD], a disorder that involves elevated impulsivity, and 59 community people) who completed a 21-day ecological momentary assessment (EMA) protocol. Multilevel models of drinking episodes (Nobservations = 3,444) examined whether self-reported trait impulsivity, measured at baseline, was associated with faster rise in estimated blood alcohol concentration (eBAC) at each follow-up period. RESULTS: All UPPS sub-scales were associated with faster rise in eBAC across a drinking episode. In a multivariate model including all sub-scales as simultaneous predictors, sensation seeking and (lack of) perseverance were independently positively associated with rate of consumption. Additional analyses indicated that greater negative urgency and sensation seeking were associated with faster rises in eBAC in participants with BPD, relative to community comparisons. CONCLUSION: In a sample that captured a wide spectrum of impulsivity, greater impulsivity was associated with drinking alcohol at a faster rate. People higher in sensation seeking and (lack of) perseverance may be prone to drink at faster rates out of a desire to maximize the hedonic effects of alcohol. PUBLIC SIGNIFICANCE STATEMENT: This study finds that people who are more impulsive tend to drink alcohol faster, putting them at greater risk for negative consequences. This may explain, in part, why impulsivity is linked to experiencing alcohol-related problems.

Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults.

Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.

Refining the notion of maturing out: results from the national epidemiologic survey on alcohol and related conditions.

OBJECTIVES: Our aim was to determine if the decrease in drug use disorders with age is attributable to changes in persistence, as implied by the notion of maturing out. Also, we examined the association between role transitions and persistence, recurrence, and new onset of drug use disorders. METHODS: We performed secondary analysis of the 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions data (baseline assessment 2001-2002, follow-up conducted 2004-2005). We conducted logistic regressions and multinomial logistic regression to determine the effect of age on wave 2 diagnosis status, as well as the interaction between age and role transitions. RESULTS: Rates of persistence were stable over the life span, whereas rates of new onset and recurrence decreased with age. Changes in parenthood, marital, and employment status were associated with persistence, new onset, and recurrence. We found an interaction between marital status and age. CONCLUSIONS: Our findings challenge commonly held notions that the age-related decrease in drug use disorders is attributable to an increase in persistence, and that the effects of role transitions are stronger during young, compared with middle and older, adulthood.

Components of emotion dysregulation in borderline personality disorder: a review.

Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies. We review the evidence supporting each of these components. Given the complexity of the construct of emotion dysregulation and its involvement in many disorders, there is a need for research that specifies which components of emotion dysregulation are under study and also examines the interplay amongst these emotion dysregulation components.