Acute, Chronic, and Everyday Physical Pain in Borderline Personality Disorder.

PURPOSE OF REVIEW: Physical pain is an underrecognized area of dysregulation among those with borderline personality disorder (BPD). Disturbances are observed within the experience of acute, chronic, and everyday physical pain experiences for people with BPD. We aimed to synthesize research findings on multiple areas of dysregulation in BPD in order to highlight potential mechanisms underlying the association between BPD and physical pain dysregulation. RECENT FINDINGS: Potential biological mechanisms include altered neural responses to painful stimuli within cognitive-affective regions of the brain, as well as potentially low basal levels of endogenous opioids. Emotion dysregulation broadly mediates dysregulation of physical pain. Certain psychological experiences may attenuate acute physical pain, such as dissociation, whereas others, such as negative affect, may exacerbate it. Social challenges between patients with BPD and healthcare providers may hinder appropriate treatment of chronic pain. Dysregulated physical pain is common in BPD and important in shaping health outcomes including elevated BPD symptoms, chronic pain conditions, and risk for problematic substance use.

Pain before, during, and after nonsuicidal self-injury: Findings from a large web study.

Competing models suggest that physical pain may play an important role in nonsuicidal self-injury (NSSI) via pain onset or pain offset, or that pain may be absent (analgesia). Few studies have tested these models in the same sample or examined factors that could explain differences in NSSI pain experience. We assessed 1,630 individuals with NSSI histories in an online survey. We descriptively examined pain during NSSI and tested preregistered hypotheses that NSSI frequency, NSSI severity, borderline personality disorder (BPD) features, emotional pain, and dissociation during NSSI are associated with experiencing less NSSI pain. Exploratorily, we also tested whether self-punishment motives were associated with less NSSI pain. Almost all participants reported recent and frequent NSSI. Participants were heterogenous in their report of NSSI pain. We found minimal support for analgesia (reported by only 4.3% of participants). More participants reported pain onset than offset, but offset was associated with reductions in emotional pain. Emotional pain was elevated prior to NSSI and decreased significantly during and after NSSI. We found that higher dissociation during NSSI was associated with less NSSI pain. Contrary to hypotheses, NSSI severity, emotional pain prior to NSSI, and self-punishment motives were associated with greater NSSI pain. NSSI frequency and BPD features were not associated with NSSI pain. BPD features interacted with dissociation and emotional pain prior to NSSI. Findings contrast with laboratory pain induction work, suggesting that, though people who self-harm may have heightened pain tolerance, they may seek to self-injure in a manner that results in pain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Negative affect provides a context for increased distrust in the daily lives of individuals with a history of childhood maltreatment.

Evidence on individuals affected by posttraumatic stress disorder (PTSD) following childhood maltreatment (CM) supports cognitive models suggesting that trauma engenders distrust and interpersonal threat sensitivity. We examined the associations between CM and both distrust and interpersonal threat sensitivity in daily life and investigated whether momentary negative affect (NA) provides a context that strengthens this association. Hypotheses were based on cognitive models of trauma and the feelings-as-information theory. In a 7-day ambulatory assessment study with six semirandom daily prompts (2,295 total), we measured self-reported momentary NA and assessed behavioral trust as well as interpersonal threat sensitivity via facial emotion ratings with two novel experimental paradigms in 61 participants with varying levels of CM (45,900 total trials). As hypothesized, NA was associated with increased momentary distrust, ß = .03, p = .002, and interpersonal threat sensitivity, ß = -.01, p = .021. Higher levels of CM were associated with more negative emotion ratings, independent of affective context, ß = -.07, p = .003. Momentary behavioral distrust was associated with CM at high levels of momentary NA, ß = .02, p = .027. The findings for both tasks support the feelings-as-information theory and suggest that cognitive alterations surrounding distrust and interpersonal threat, which were originally proposed for PTSD, likely also affect individuals with a history of CM.

Introduction and behavioral validation of the climate change distress and impairment scale.

Governmental agencies and the medical and psychological professions are calling for a greater focus on the negative mental health effects of climate change (CC). As a first step, the field needs measures to distinguish affective/emotional distress due to CC from impairment that requires further scientific and diagnostic attention and that may require treatment in the future. To this end, we constructed the climate change distress and impairment scale, which distinguishes CC distress (spanning anger, anxiety, and sadness) from impairment. In four studies (N = 1699), we developed and validated English and German versions of the scale. Across samples, spanning 2021-2022, CC distress was at least moderate, while we observed general moderate to high levels of distress and low to moderate levels of impairment. In three English-speaking samples, younger individuals and women were most affected by CC distress, whereas this was not the case in a German-speaking sample, suggesting sociopolitical influencing factors. We demonstrate convergent validity with previous measures and discriminant validity for general negative affectivity and depressive and generalized anxiety disorder symptoms, which underlines that CC distress is not in itself pathological. Employing a fully incentivized social dilemma paradigm, we demonstrate that CC distress and (to a lesser degree) CC impairment predict pro-environmental behavior, underscoring them as possible drivers, and targets, of climate-change mitigation efforts.

Experimental paradigms in personality disorder research: A review of covered RDoC constructs, methodological issues, and future directions.

Studies using experimental paradigms have been paramount in research on psychopathological processes in personality disorders (PDs). We review 99 articles that report experimental paradigms and that were published between 2017 and 2021 in 13 peer-reviewed journals. We structure the study content according to the National Institute of Mental Health Research Domain Criteria (RDoC), and report details on demographic variables, experimental design, sample size, and statistical analyses. We discuss unequal representation of the RDoC domains, representativeness of the recruited clinical groups, and a lack of sample diversity. Finally, we review issues regarding statistical power and the data analytic designs that were used. Based on the literature review, we draw implications for future experimental PD research, encouraging researchers to increase the breadth of represented RDoC constructs, the representativeness and diversity of the recruited samples, the statistical power to detect between-person effects, the reliability of estimators, the adequacy of statistical methods, and the transparency of experimental research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does self-harm have the desired effect? Comparing non-suicidal self-injury to high-urge moments in an ambulatory assessment design.

All theoretical models of non-suicidal self-injury (NSSI) posit that regulation of negative affect (NA) is a central motive for NSSI, and cross-sectional work supports this. However, previous ambulatory assessment (AA) studies that examined NSSI found mixed results. We investigated the affect regulation function of NSSI in 51 women with DSM-5 NSSI disorder in a 15-day AA study with five random daily prompts and self-initiated NSSI prompts. We extend previous work by i) comparing NSSI moments to moments of a high-urge for NSSI, ii) adding high-frequency sampling following NSSI and high-urge moments, and iii) including tension as a dependent variable. We hypothesized that NA and tension would show a steeper decrease following NSSI than following high-urge moments, if NSSI was effective in reducing NA and tension. Results showed that the significant linear NA decline following NSSI was not steeper than that following high-urge moments. For aversive tension, we found that NSSI was associated with a significant linear decrease in tension, whereas resisting an urge was not. High-urge moments were better described by an inverted U-shaped pattern, likewise leading to decreased NA and tension following the reported urge. In exploratory analyses, we provide visualized clustering of the NA and tension trajectories surrounding NSSI using k-means and relate these to participants' self-rated effectiveness of the NSSI events. Findings indicate that resisting an urge may also be effective in managing NA and tension and underline the utility of interventions such as urge-surfing.

Maladaptive personality traits as predictors of prosocial and trusting behavior in two economic games.

BACKGROUND: Dimensional models of personality disorders postulate interpersonal dysfunction as the core feature of personality pathology, and describe maladaptive personality traits that characterize the specific pattern of dysfunction that is experienced. Herein, we examined whether maladaptive traits predict prosocial and trusting behavior, both of which are highly relevant behaviors for interpersonal functioning. Specifically, we examined antagonism as a predictor of prosocial behavior in a dictator game, and suspiciousness as a predictor of trust in the faith game. MATERIALS AND METHODS: The study was preregistered and conducted online. The preregistration protocol is available at https://osf.io/er43j . Data and code are available at https://osf.io/2rvbg/ . Participants (N = 445) completed the German version of the Personality Inventory for DSM-5 to measure antagonism and suspiciousness. Additionally, they played the dictator game (more money taken away from another person indicates less prosocial behavior) and the faith game (choosing the sure choice instead of the faith choice indicates less trust). We conducted a linear regression model to test whether antagonism is associated with prosocial behavior in the dictator game and a logistic regression model to test whether suspiciousness predicts selection of the sure choice in the faith game. RESULTS: As hypothesized, higher levels of antagonism were associated with less prosocial behavior in the dictator game. The remaining hypotheses were not supported, as suspiciousness was not significantly associated with the likelihood of choosing the sure choice in the faith game. Exploratory analyses on participants' estimates of the sure choice amount suggest successful experimental manipulation in the faith game. CONCLUSIONS: The results on antagonism and prosocial behavior are consistent with those of previous studies that used categorial classification systems of personality disorders or examined non-pathological personality traits. Potential explanations for the non-significant effects of suspiciousness are discussed, including the small size and range of the sure choice payoff and that the anonymity of the game may have precluded suspicious traits from expressing. Future research with higher stakes and known interaction partners is needed to further probe the effects of suspiciousness.

Prosociality in personality disorders: Status quo and research agenda.

Personality disorders (PDs) are characterized by interpersonal dysfunction and deficits in prosociality are theorized to contribute to this. We review studies linking categorical PDs to prosocial and antagonistic traits and highlight studies that assessed prosocial behavior in PDs via economic games. We structure our review based on the recently proposed affordance framework of prosocial behavior, summarizing the evidence for exploitation, reciprocity, temporal conflict, and dependence under uncertainty as situational affordances that allow the expression of personality in prosocial behavior. We conclude that some of the inconsistencies in the literature may be due to studies focusing on different situational affordances and the reliance on categorical PDs. We suggest a research agenda and a set of testable hypotheses based on maladaptive personality traits included in the newly implemented dimensional PD diagnoses in ICD-11 and DSM-5.

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.

The roles of personality traits and close social contact in the expression of momentary borderline personality disorder symptoms in daily life.

Dimensional models of personality, such as the five-factor model (FFM), have demonstrated strong coherence with the presentation of personality disorders, including borderline personality disorder (BPD). Given that select personality trait elevations have been linked to impairments in multiple life domains across diagnostic groups, we sought to replicate findings from a previous investigation of the utility of the FFM in predicting BPD-relevant outcomes (i.e., negative affect intensity and instability, impulsivity, and interpersonal disagreements) in the daily lives of those with BPD (Hepp et al., 2016) and community participants. As interpersonal context is instrumental in determining the strength of effects observed in studies examining individuals with BPD, we utilized ecological momentary assessment across 3 weeks (6 times daily; ntotal = 15,889) to test whether close social contact (CSC) would moderate the effects of personality on momentary outcomes. Overall, results suggest that CSC is an important moderator between the effects of personality and daily life outcomes for individuals with BPD (N = 56), but not for community individuals (N = 60). For individuals with BPD, CSC may function as both a protective buffer and a risk factor, depending on outcome. For example, CSC attenuates experience of negative affect intensity for individuals with elevated neuroticism, but CSC may predict more frequent disagreements for individuals who report lower agreeableness. We replicated approximately half of the original study's findings, and results support that FFM personality is predictive of BPD-relevant outcomes broadly. However, interpersonal context is key to understanding these relationships for individuals with BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Real-time reports of drinking to cope: Associations with subjective relief from alcohol and changes in negative affect.

Many individuals report drinking alcohol to cope or relieve negative affective states, but existing evidence is inconsistent regarding whether individuals experience negatively reinforcing effects after drinking to cope (DTC). We used ecological momentary assessment to examine the effects of DTC during daily-life drinking episodes in a sample of current drinkers (N = 110; 52 individuals with borderline personality disorder and 58 community individuals). Multilevel models were used to test whether momentary and episode-level endorsement of DTC-depression and DTC-anxiety motives would be related to increased subjective drinking-contingent relief and decreased depression and anxiety during drinking episodes. Momentary DTC-anxiety predicted greater subsequent drinking-contingent relief, and greater episode-level DTC-anxiety and DTC-depression predicted greater drinking-contingent relief during the episode. However, we did not find decreased depression and anxiety following endorsement of DTC-depression and DTC-anxiety. Instead, we found that greater episode-level DTC-depression was associated with increased depression. Thus, findings suggest that individuals' negative affective states may not improve during DTC despite endorsing drinking-contingent relief. This discrepancy warrants further attention because subjective relief likely reinforces DTC, whereas awareness of one's change (or lack of change) in affect may provide valuable counterevidence for whether alcohol use is an effective coping strategy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The effect of momentary mood on appraisal of facial affect and distrust: an experimental approach using ambulatory assessment.

Previous laboratory studies have demonstrated that an observer's current mood can influence their processing of facial stimuli, for instance, the appraisal of facial affect. The aim of the present study was to explore the association between current mood and face processing in participants' daily lives, thereby making use of naturally occurring affective states. We employed Ambulatory Assessment (AA) and included two experimental tasks to test whether current mood predicts how participants evaluate (i) the valence of emotional faces and (ii) facial trustworthiness. We hypothesised a mood-congruent processing, such that individuals would rate pictures of faces more negatively and less trustworthy, the more negative their current mood was. We recruited 42 participants who completed a 7-day AA study with six random prompts per day. At each prompt, participants provided self-reports on momentary mood and completed an emotion rating task and a hypothetical distrust game. Results show that negative momentary mood was significantly associated with higher levels of distrust, but was not significantly associated with more negative emotion ratings. We discuss the incremental value and feasibility of implementing experimental tasks in AA contexts and the opportunities this opens for assessing affective and cognitive processes in natural environments.

A test of the interpersonal function of non-suicidal self-injury in daily life.

Theoretical models of non-suicidal self-injury (NSSI) posit that individuals use NSSI to influence others, but this remains largely untested. We used ambulatory assessment to test the interpersonal function of NSSI in the daily lives of 51 women with DSM-5 NSSI disorder. Participants reported NSSI events, urges, motives, and positive/negative interpersonal events (IPEs) for 14 days, providing five semi-random daily assessments and event-related NSSI reports. We analyzed 3,498 data-points, including 155 NSSI events, using multilevel models. We observed a positive concurrent association between the number of negative IPEs and NSSI engagement. Additionally, perceived distress of negative IPEs was positively associated with concurrent NSSI events and urges, and predicted later events. We saw no reduction in negative or increase in positive IPEs following NSSI. In a trait-level interview, participants endorsed interpersonal motives only minimally, but indicated that others often trigger NSSI. In daily life, participants rarely endorsed the motive 'get help/attention'. The results suggest that negative IPEs trigger NSSI, but that individuals in this sample rarely used NSSI for interpersonal motives and did not experience interpersonal reinforcement of NSSI. We discuss limitations of and possible solutions for under-reporting of interpersonal motives and benefits of studying interpersonal triggers (rather than outcomes) in future studies.

Mouse-tracking reveals cognitive conflict during negative impression formation in women with Borderline Personality Disorder or Social Anxiety Disorder.

Individuals with Borderline Personality Disorder (BPD) or Social Anxiety Disorder (SAD) suffer from substantial interpersonal dysfunction and have difficulties establishing social bonds. A tendency to form negative first impressions of others could contribute to this by way of reducing approach behavior. We tested whether women with BPD or SAD would show negative impression formation compared to healthy women (HCs). We employed the Thin Slices paradigm and showed videos of 52 authentic target participants to 32 women with BPD, 29 women with SAD, and 37 HCs. We asked participants to evaluate whether different positive or negative adjectives described targets and expected BPD raters to provide the most negative ratings, followed by SAD and HC. BPD and SAD raters both agreed with negative adjectives more often than HCs (e.g., 'Yes, the person is greedy'), and BPD raters rejected positive adjectives more often (e.g., 'No, the person is not humble.'). However, BPD and SAD raters did not differ significantly from each other. Additionally, we used the novel process tracing method mouse-tracking to assess the cognitive conflict (via trajectory deviations) raters experienced during decision-making. We hypothesized that HCs would experience more conflict when making unfavorable (versus favorable) evaluations and that this pattern would flip in BPD and SAD. We quantified cognitive conflict via maximum absolute deviations (MADs) of the mouse-trajectories. As hypothesized, HCs showed more conflict when rejecting versus agreeing with positive adjectives. The pattern did not flip in BPD and SAD but was substantially reduced, such that BPD and SAD showed similar levels of conflict when rejecting and agreeing with positive adjectives. Contrary to the hypothesis for BPD and SAD, all three groups experienced substantial conflict when agreeing with negative adjectives. We discuss therapeutic implications of the combined choice and mouse-tracking results.

Childhood maltreatment is associated with distrust and negatively biased emotion processing.

BACKGROUND: Cognitive models of post-traumatic stress disorder (PTSD) propose that trauma entails cognitive alterations of increased distrust and perceived threat from others. We tested whether these predictions also hold in individuals with varying levels of childhood maltreatment (CM), which is much more prevalent than traumatic events as required for a PTSD diagnosis. We hypothesized that higher levels of CM would entail greater distrust and perceived threat, and that distrust would be more change-resistant in participants with more CM. METHODS: The study was pre-registered; the pre-registration protocol, data, and code are available at https://osf.io/pufy2/ . We recruited 549 participants (M age = 29.2, 74.5% women) for an online study via websites related to CM, Borderline Personality Disorder, and via snowball method on social media. Participants self-reported their level of CM on the childhood trauma questionnaire (CTQ). Next, they played two rounds of a hypothetical distrust game, indicating the perceived trustworthiness of avatars by way of estimating expected monetary deductions from them (i.e. higher amounts indicating greater distrust). After the first round, we provided participants with the feedback that very little money was taken from them. We expected those with more CM to be less responsive to the positive feedback and to adapt their estimates less in the subsequent round. Following the distrust game, participants completed an emotion rating task in which they rated the emotional expressions of 60 faces on a scale from 'very negative' to 'very positive'. We included angry, fearful, and happy facial expressions, and expected individuals with higher CM levels to provide more negative ratings. We conducted linear mixed effects models with random intercepts for raters and stimuli (crossed), and modelled random slopes for all within-person predictors. RESULTS: As hypothesized, higher levels of CM were associated with higher levels of distrust and a weaker decrease in distrust following positive feedback. Further supporting our hypotheses, individuals with higher levels of CM showed more negatively shifted emotion ratings. CONCLUSIONS: Increased distrust and perceived interpersonal threat following trauma, as proposed in cognitive models of PTSD, likely also apply to individuals with CM, following a dose-response relationship. We discuss clinical implications of considering any level of CM as a potentially relevant treatment-factor, even when a trauma-related disorder is not the main diagnosis, and propose future research avenues.

Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study.

Nonsuicidal self-injury (NSSI) is a prevalent and impairing behavior, affecting individuals with and without additional psychopathology. To shed further light on biological processes that precede and result from NSSI acts, we built on previous cross-sectional evidence suggesting that the endogenous opioid system, and especially ß-endorphin, is involved in the psychopathology of NSSI. This is the first study assessing salivary ß-endorphin in daily life in the context of NSSI acts. Fifty-one female adults with repetitive NSSI participated over a period of 15 days in an ambulatory assessment study. Salivary ß-endorphin was assessed before and after engagement in NSSI, during high urge for NSSI, and on a non-NSSI day. Furthermore, NSSI specific variables such as pain ratings, as well as method, severity, and function of NSSI were assessed. We found that ß-endorphin levels immediately before an NSSI act were significantly lower than directly after NSSI. However, there was no difference between ß-endorphin during high urge for NSSI and post NSSI measures. We found a positive association between severity of the self-inflicted injury and ß-endorphin levels, but no significant association between ß-endorphin levels and subjectively experienced pain. The results of the present study indicate that it is possible to assess salivary ß-endorphin in daily life in the context of NSSI. Furthermore, our results provide a first indication that NSSI acts could be associated with a momentary increase of ß-endorphin, and this might reinforce NSSI engagement. More research is needed to replicate and extend our findings on peripheral ß-endorphin in daily life.

Negativity on two sides: Individuals with borderline personality disorder form negative first impressions of others and are perceived negatively by them.

Impression formation is vital for social interactions and theorized to be negatively biased in borderline personality disorder (BPD). We assessed 2 sides of impression formation in BPD: BPD individuals as raters who form first impressions and as targets of others' first impressions. We further investigated BPD-Rater × Target interactions. We showed videos of 52 targets (26 BPD, 26 healthy controls [HC], 46% male) to unmedicated women with BPD (n = 32), a clinical control group with social anxiety disorder (SAD; n = 29), and a HC group (n = 37). We hypothesized (a) that BPD raters would evaluate targets more negatively than SAD and HC raters. Indeed, BPD raters evaluated targets as significantly less trustworthy, less approachable, and less similar to themselves than HC raters. Descriptively, rater groups showed a pattern of BPD < SAD < HC, but the differences between SAD and both other rater groups failed to reach statistical significance. We further expected (b) HC raters to evaluate BPD targets more negatively than HC targets, and results supported this hypothesis. Lastly, we hypothesized (c) that BPD raters would perceive BPD targets more positively than HC targets, which was not supported. We discuss how negative first impressions by and of BPD individuals could contribute to loneliness and interpersonal dysfunction and suggest potential interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The environmental, interpersonal, and affective context of nonsuicidal self-injury urges in daily life.

Urges for nonsuicidal self-injury (NSSI) are important precursors to NSSI acts and may serve as a point of intervention. A close understanding of the phenomenology of NSSI urges and the contexts in which they occur is therefore warranted. We used ambulatory assessment to examine the environmental, interpersonal, and affective contexts of NSSI urges. We recruited 56 participants with borderline personality disorder who reported on urges and contexts for 21 days with six random daily prompts, resulting in 5,750 completed assessments. Twenty-two participants reported 160 NSSI urges. We provide extensive descriptive results characterizing the interaction partners, activities, and events participants reported in association with NSSI urges. Results from a logistic multilevel model using the full sample (testing associations between all contexts and urges simultaneously) revealed that urges were more likely to occur at higher levels of negative affect, when rejection was experienced, and later in the day. Urges were not associated with disagreements or feeling let down, being at home versus away, being alone versus in company, socializing versus doing another activity, and it being a weekday versus weekend. Additional growth curve analysis for negative affect using the subsample of 22 participants who reported urges showed that, over the course of urge days compared with nonurge days, negative affect increased before urges, peaked during the urge, and then decreased, approximating a quadratic curve. We conclude that urges occurred primarily in the context of negative affect and rejection, which is consistent with theories on intra- and interpersonal functions of NSSI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).