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.

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.

Pretty crowds are happy crowds: the influence of attractiveness on mood perception.

Empirical findings predominantly support a happiness superiority effect in visual search and emotion categorization paradigms and reveal that social cues, like sex and race, moderate this advantage. A more recent study showed that the facial attribute attractiveness also influences the accuracy and speed of emotion perception. In the current study, we investigated whether the influence of attractiveness on emotion perception translates into a more general evaluation of moods when more than one emotional target is presented. In two experiments, we used the mood-of-the-crowd (MoC) task to investigate whether attractive crowds are perceived more positively compared to less attractive crowds. The task was to decide whether an array of faces included more angry or more happy faces. Furthermore, we recorded gaze movements to test the assumption that fixations on happy expressions occur more often in attractive crowds. Thirty-four participants took part in experiment 1 as well as in experiment 2. In both experiments, crowds presenting attractive faces were judged as being happy more frequently whereas the reverse pattern was found for unattractive crowds of faces. Moreover, participants were faster and more accurate when evaluating attractive crowds containing more happy faces as well as when judging unattractive crowds composed of more angry expressions. Additionally, in experiment 1, there were more fixations on happy compared to angry expressions in attractive crowds. Overall, the present findings support the assumption that attractiveness moderates emotion perception.

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.

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.

Design factors in mouse-tracking: What makes a difference?

Investigating cognitive processes by analyzing mouse movements has become a popular method in many psychological disciplines. When creating mouse-tracking experiments, researchers face many design choices-for example, whether participants indicate responses by clicking a button or just by entering the button area. Hitherto, numerous different settings have been employed, but little is known about how these methodological differences affect mouse-tracking data. We systematically investigated the influences of three central design factors, using a classic mouse-tracking paradigm in which participants classified typical and atypical exemplars. In separate experiments, we manipulated the response indication, mouse sensitivity, and starting procedure. The core finding that mouse movements deviate more toward the nonchosen option for atypical exemplars was replicated in all conditions. However, the size of this effect varied. Specifically, it was larger when participants indicated responses via click and when they were instructed to initialize the movement early. Trajectory shapes also differed between setups. For example, a dynamic start led to mostly curved trajectories, responses via click led to a mix of straight and "change-of-mind" trajectories, and responses via touch led to mostly straight trajectories. Moreover, the distribution of curvature indices was classified as bimodal in some setups and as unimodal in others. Because trajectory curvature and shape are frequently used to make inferences about psychological theories, such as differentiating between dynamic and dual-system models, this study shows that the specific design must be carefully considered when drawing theoretical inferences. All methodological designs and analyses were implemented using open-source software and are available from https://osf.io/xdp7a/.

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.

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).

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.

Affective state and event-based prospective memory.

Event-based prospective memory tasks require the realisation of a delayed intention at the occurrence of a specific target event. The present research investigates how performance in this kind of prospective memory task is influenced by the current affective state. By manipulating participants' mood during intention realisation we tested two competing models of mood effects on memory (i.e., a capacity consuming account and a processing style account). Furthermore, we manipulated the valence of the target event to investigate mood-congruency effects in prospective memory. No evidence was found for a mood-congruency effect, but the results showed that prospective memory performance increased with a sad mood. This effect is consistent with recent theories on mood-dependent processing-style regulation, postulating that a sad mood produces a more analytic and detailed processing style whereas a happy mood produces a more global and less detailed processing style.

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.

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.

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).

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.

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.

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).

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).

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.