Symptoms as rapidly fluctuating over time: Revealing the close psychological interconnections among borderline personality disorder symptoms via within-person structures.

Despite the clinical emphasis on processes happening within individuals, investigations into the psychological, structural connections between mental health symptoms have almost exclusively analyzed differences between people. These investigations have revealed important findings; however, they do not reveal the close connections among symptoms in an individuals' psychology. This study thus examined the psychological connections between symptoms directly, using borderline personality disorder (BPD) symptoms as an example. Participants (252; 74 with BPD) reported their momentary BPD symptoms five times daily, and 165 did so again 18 months later. In support of personalized medicine (Wright & Woods, 2020), individuals' BPD symptom structures differed considerably from each other and from the between-person structure. A novel technique revealed that differences were greater than expected by chance. Within-person structures tended to exhibit more symptom granularity (more factors and lower variance explained) and differing symptom meanings (patterns of loadings). For example, some individuals exhibited close connections between relationship turmoil and identity uncertainty, whereas other individuals exhibited close connections between relationship turmoil and impulsivity. Thus, conceptions of any given person's psychopathological processes using between-person structural findings will most likely be inaccurate. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Degree of Correspondence Between Retrospective and Proximal Reports of Borderline Personality Disorder Symptoms, Symptom Triggers, and Emotions.

This study investigated the degree of correspondence of retrospective reports of personality disorder symptoms, triggers, and emotions with reports closer in time to the actual experiences. Retrospective reports of symptoms, triggers, and emotions are heavily used in both clinical and research settings, yet no study has investigated the correspondence for symptoms or triggers of personality disorders. A total of 257 participants, including 75 with BPD, completed overlapping daily, weekly, monthly, and semi-annual questionnaires. Retrospective reports showed: (1) systematic biases, reporting fewer symptom and situational trigger occurrences, and greater emotion intensities; but (2) little unsystematic error, largely reproducing bias-adjusted individual levels of symptoms, situational triggers, and emotions (rs generally .70-.80). People with BPD did not retrospectively misremember their symptoms, triggers, or emotions much more than others. Thus, retrospective reports of symptoms, triggers, and emotions should be adjusted for systematic bias, but after such adjustment can be taken as relatively faithful accounts of individuals' experiences.

Mindfulness and negative affectivity in real time: a within-person process model.

To extend our understanding of the proximal etiology of personality pathology, this study examined the dynamic, in-the-moment relations between mindfulness and negative affectivity (NA; emotional lability, anxiousness, separation insecurity) as defined by the alternative model for personality disorders. We tested predictions based upon the Monitor and Acceptance Theory that when people monitored their attention judgmentally, their state NA would be higher than usual; by contrast, when they monitored their attention nonjudgmentally, their state NA would be lower than usual. Sixty-five undergraduates participated in an experience sampling study wherein they completed five reports per day for eight days about their states of mindfulness and NA. Multi-level models revealed an interaction wherein participants exhibited more state NA when they monitored their attention judgmentally than when they monitored their attention nonjudgmentally. Analyses of simple slopes revealed that participants exhibited more state NA than usual when they monitored their attention judgmentally. These findings emerged for only one of two attention monitoring processes, however: monitoring relations between thoughts, emotions, and behaviours, but not monitoring sensory stimuli. Analyses including non-reactivity instead of nonjudgment replicated these findings. Implications for theory, research, and treatment are discussed.

Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder.

A major barrier to the understanding of emotion dynamics in borderline personality disorder (BPD) lies in its substantial comorbidity with major depressive disorder (MDD) and bipolar disorder (BD). Whereas BPD has often been characterized in terms of dynamic emotional processes, including instability, reactivity, and inertia, its substantial comorbidity with MDD and BD makes it difficult to discern the specificity of these dynamics. To differentiate the emotion dynamics of BPD from those of MDD and BD, an experience sampling study of 38 participants with BPD, 15 participants with MDD, 14 participants with BD, and 62 healthy controls obtained reports of interpersonal challenges and emotions 5 times daily for 2 weeks. Interpersonal challenges included rejection, betrayal, abandonment, offense, disappointment, and self-image challenge; emotions included anger, excitement, guilt, happiness, irritability, and shame. Multilevel analyses revealed that heightened interpersonal reactivity of guilt and shame and heightened inertia of shame were relatively specific to BPD. These findings could not be accounted for by the presence of current MDD or BD. By contrast, heightened instability of anger and irritability and heightened inertia of irritability appeared to be largely transdiagnostic. Implications for clinical assessment, research, and theory are discussed. (PsycINFO Database Record

A Contingency-Oriented Approach to Understanding Borderline Personality Disorder: Situational Triggers and Symptoms.

This article tested a contingency-oriented perspective to examine the dynamic relationships between in-the-moment borderline personality disorder (BPD) symptom events and in-the-moment triggers. An experience sampling study with 282 adults, including 77 participants with BPD, obtained reports of situational triggers and BPD symptom events five times daily for 2 weeks. Triggers included being rejected, betrayed, abandoned, offended, and disappointed; having one's self-concept threatened; being in a boring situation; and being alone. BPD was associated with increased situational triggers. Multilevel models revealed significant within-person associations between situational triggers and BPD symptoms for the average participant in the study, with significant individual variance in the strength and direction of trigger-symptom contingencies. Most trigger-symptom contingencies were stronger for individuals with greater borderline symptomatology, suggesting that triggers are meaningfully related to BPD. These findings highlight possible proximal mechanisms that maintain BPD and help explain the course of a disorder often described as chaotic and unpredictable.

Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, the authors evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with borderline personality disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A control assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week main observation phase. During the same observation period, an intensive suicide assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the main observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the main observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and nonrobust. However, given the seriousness of some outcomes, the authors recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks.

The structure of borderline personality disorder symptoms: a multi-method, multi-sample examination.

We examined the factor structure of borderline personality disorder (BPD) symptoms by using a multimethod, multisample approach. The factorial structure of BPD has previously been examined through the lens of broad retrospective reports of symptoms without directly contrasting results from different samples of participants, with studies producing inconsistent patterns of results. We go beyond previous work by examining symptoms from multiple timeframes and by examining results across and within 2 diagnostic groups-individuals with and without BPD. Participants (n = 281) completed a structured clinical interview for personality disorders, 2 weekly reports of BPD symptoms, and 2 weeks of in-the-moment "immediate" symptom reports, assessed 5 times daily. Across all participants, results revealed a robust 1-factor structure that replicated across all assessment methods. Moreover, these results replicated within each diagnostic group, with the lone exception of an unclear structure in interview assessment among participants who had a BPD diagnosis. Results have implications regarding the nature, assessment, and treatment of BPD.

Emotional valence and arousal effects on memory and hemispheric asymmetries.

This study examined predictions based upon the right hemisphere (RH) model, the valence-arousal model, and a recently proposed integrated model (Killgore & Yurgelun-Todd, 2007) of emotion processing by testing immediate recall and recognition memory for positive, negative, and neutral verbal stimuli among 35 right-handed women. Building upon methodologies of previous studies, we found that words presented to the right visual field/left hemisphere (RVF/LH) were recalled and recognized more accurately than words presented to the left visual field/right hemisphere (LVF/RH), and we found significant valence by visual field interactions. Some findings were consistent with one of the models evaluated whereas others were consistent with none of the models evaluated. Our findings suggest that an integration of the RH and valence-arousal models may best account for the findings with regard to hemispheric lateralization of memory for emotional stimuli.

Affective ratings and startle modulation in people with nonclinical depression.

This study tested predictions based on the emotion context insensitivity (ECI) hypothesis of Rottenberg, Gross, and Gotlib (2005) that a nonclinical sample of people with depressive symptoms would show reduced responses to both positive and negative stimuli relative to people without depression and would show an enhanced response to novelty. Seventy individuals completed diagnostic questionnaires, made ratings of 21 affectively valenced pictures, and then viewed the same 21 pictures and 21 novel pictures while startle blink responses were recorded from electromyographic activity of the orbicularis oculi. People with scores on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) indicative of depression demonstrated a lack of affective startle modulation compared to the nondepression group. For all participants, the startle response was larger for novel pictures than for previously viewed pictures, but scores on the BDI were not related to response to novelty. Taken together, the results suggest that nonclinical depression is associated with a lack of affective modulation of startle, as has been shown for clinical depression.