Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review.

Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.

Characterizing the choice to disclose nonsuicidal self-injury.

OBJECTIVE: Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors. METHOD: Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI. RESULTS: Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure. CONCLUSIONS: Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

The role of therapeutic alliance in therapy for adults with problematic aggression and associated disorders.

The nature and quality of the relationship between therapist and client in psychotherapy, known as therapeutic alliance, have been proposed as one of the most important factors for successful treatment outcome, which has been has robustly supported across many types of treatment, populations, raters of alliance (i.e., client, therapist, or observer), and alliance measures. However, most research on alliance and treatment outcome has been conducted in children and adults with internalizing problems (e.g., mood and anxiety disorders) or children with externalizing problems (e.g., conduct disorder), despite the fact that alliance may be particularly important for adults with externalizing problems such as problematic aggression, who may have high levels of resistance, blaming, and interpersonal problems. Very limited research has examined the role of alliance in individuals who present to treatment due to high levels of aggressive behaviour specifically (e.g., those convicted of a violent offence). The current systematic review examined the extant research on the relationship between alliance and outcome in treatment of highly aggressive individuals, as well as those who are diagnosed with a disorder for which aggression is a primary symptom (i.e., post-traumatic stress disorder, antisocial personality disorder, and borderline personality disorder). Overall, it was shown that alliance has a positive impact on treatment outcome among those engaging in or at risk for problematic aggression. Additionally, the alliance-outcome relationship may be affected by therapy modality, alliance rater perspective, and potential mechanisms of alliance. Implications for future research, including utilizing more primarily aggressive samples, are discussed.

Reconsidering important outcomes of the nonsuicidal self-injury disorder diagnostic criterion A.

OBJECTIVE: The nonsuicidal self-injury (NSSI) disorder diagnostic criteria have been the focus of empirical study. However, Criterion A (i.e., required frequency and timeframe) has received relatively limited attention. The current study aimed to examine the relationship between past 12-month NSSI frequency and eight NSSI behavior features among individuals with past 12-month and 1-month NSSI. METHOD: Participants were 723 undergraduate students reporting at least 1 past 12-month NSSI act and completed online questionnaires. Decision trees and structural equation model trees were utilized to examine the relationship between NSSI frequency and behavior features. RESULTS: Results highlight several potential subgroups: high (i.e., greater than 49 acts), moderate-to-high (i.e., 19-48 acts), low-to-moderate (i.e., 7-18 acts), and low (i.e., fewer than 6 acts) frequency subgroups. CONCLUSIONS: Findings suggest that increasing the NSSI disorder criterion A frequency cutoff or requiring at least one past month NSSI act may better demarcate individuals with more severe NSSI behavior.

Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use.

Research has supported an association between suicidal thoughts/behaviors and risk taking, which may be particularly strong during adolescence when risk taking is known to increase. However, extant research has focused on individual risk-taking behaviors (e.g., alcohol use), limiting our ability to evaluate the unique association between different risk-taking behaviors and suicidal thoughts/behaviors. The current study aimed to fill this gap by examining the simultaneous influence of multiple risk-taking behaviors (i.e., risky sexual behavior, tobacco/alcohol use, illicit drug use, delinquent behavior, violent behavior) on adolescent suicidal thoughts/behaviors. Data from the National Longitudinal Study of Adolescent Health was utilized. The sample consisted of 4,834 adolescents who completed home interviews at two time points. At the first time point, participants' mean age was 15.15, with 48% (n = 2,315) identifying as male. Participants provided information about suicidal thoughts/behaviors and multiple risk-taking behaviors at an initial interview and at a second interview, approximately 11 months later. When independently examined, nearly all assessed risk-taking behaviors were independently associated with suicidal ideation concurrently and prospectively, and with suicide attempts concurrently. When all risk-taking behaviors were examined simultaneously, illicit drug use was the only significant concurrent and significant prospective, albeit negative, predictor of suicidal thoughts and only concurrent predictor of suicidal behavior. The current findings suggest that illicit drug use may have a stronger association with suicidal thoughts and behaviors than other risk-taking behavior. These findings have implications for prevention and intervention programs for adolescents.

The co-occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder.

We examined the lifetime prevalence of anxiety disorders (ADs) among adolescents with lifetime intermittent explosive disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.

Exploratory analysis of mediators of the relationship between childhood maltreatment and suicidal behavior.

INTRODUCTION: Suicide is a major public health concern. One consistently cited risk factor for suicide is childhood maltreatment, which also may play a role in the transition from suicidal ideation to suicidal behavior. METHOD: The current study aimed to examine the relationship between childhood maltreatment and suicide attempts during adolescence (N = 4834; 52.1% female; 67.5% Caucasian). Data from the U.S. National Longitudinal Study of Adolescent Health were utilized. Forty-six theoretically-relevant risk factors were explored as potential mediators of this relationship using an exploratory mediation data analytic method. RESULTS: Results demonstrated a significant childhood maltreatment - suicide attempt relationship only among females. After considering demographics and suicidal ideation, having received counseling in the previous 12 months was the most influential mediator, followed by having a friend attempt suicide in the previous 12 months. CONCLUSIONS: These findings highlight potential gender differences in the relationship between childhood maltreatment and later suicide attempts, and, moreover, the importance of assessing for recent exposure to peer suicidal behavior in suicide risk assessments.

Development of a screening questionnaire for DSM-5 intermittent explosive disorder (IED-SQ).

OBJECTIVE: This study was designed to develop and test a screening approach to identify individuals with DSM-5 Intermittent Explosive Disorder (IED), a disorder of recurrent, problematic, impulsive aggression. METHODS: A screening approach to diagnose DSM-5 IED (IED-SQ) was developed by combining items related to life history of aggression and items related to the DSM-5 diagnostic criteria for IED. In study 1, the IED-SQ was studied in 72 adult participants; 33 that met DSM-5 criteria for lifetime IED and 39 that did not. In study 2, the IED-SQ was given to 740 undergraduates at a US university. Measures of aggression and anger expression and anger control were assessed in both studies. RESULTS: In study 1, the IED-SQ demonstrated strong concordance with the best estimate diagnoses (Kappa =.80) for lifetime IED by DSM-5 criteria and good test-retest reliability (kappa =0.71). In study 2, the IED-SQ identified 4.3% of the undergraduate sample as meeting DSM-5 criteria for lifetime IED, a rate comparable to that in recent epidemiological studies. Participants identified as meeting DSM-5 criteria for lifetime IED, in both studies, had higher aggression scores, and higher anger expression, and lower anger control scores, compared to participants that did not meet DSM-5 criteria for lifetime IED. CONCLUSIONS: These data suggest that the IED-SQ is a useful screening tool that can quickly identify the presence of IED by DSM-5 criteria in adults.

Behavioral evidence of emotion dysregulation in binge eaters.

Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ2 = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (rpb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.

Addiction Vulnerability and Binge Eating in Women: Exploring Reward Sensitivity, Affect Regulation, Impulsivity & Weight/Shape Concerns.

Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor "addiction vulnerability" (i.e., impairments in reward sensitivity, affect regulation and impulsivity) and binge eating. Undergraduate women (n=272) with either high or low weight/shape concerns completed self-report measures examining reward sensitivity, emotion regulation, impulsivity and disordered (binge) eating. Results showed that (1) reward sensitivity, affect regulation and impulsivity all loaded onto a latent "addiction vulnerability" factor for both women with high and with low weight/shape concerns, (2) women with higher weight/shape concerns reported more impairment in these areas, and (3) weight/shape concerns moderated the relation between addiction vulnerability and binge eating. These findings suggest that underlying processes identified in addiction are present in individuals who binge eat, though weight/shape concerns may be a unique characteristic of disordered eating.

Forms of non-suicidal self-injury as a function of trait aggression.

To date, the considerable body of research on predictors of non-suicidal self-injury (NSSI) has conceptualized NSSI as a unitary construct despite the fact that NSSI can exist in many forms (e.g., hitting, cutting, burning). The goal of the present study is to examine differential prediction of forms of NSSI. Specifically, we examined trait aggression as a predictor of more aggressive forms of NSSI (i.e., hitting). We hypothesized that higher trait aggression would differentiate those who engaged in hitting forms of NSSI from those who did not, whereas other factors (i.e., emotion regulation and trait anger) would serve as a non-specific predictor of NSSI. We also hypothesized that higher trait aggression would be related to lifetime frequency of hitting NSSI, but not other forms of NSSI, whereas emotion regulation and anger would act as predictors of other forms of NSSI. To test these hypotheses, a large sample of young adults completed measures of trait aggression, trait anger, emotion regulation, and NSSI behaviors. Results were generally in line with our hypotheses. Higher levels of trait aggression differentiated those who engaged in hitting NSSI from those who did not and was also associated with greater frequency of hitting NSSI. These results imply that different factors predict different forms of NSSI and that NSSI may be best examined as a multi-faceted construct.

Emotion regulation deficits in intermittent explosive disorder.

Intermittent explosive disorder (IED) is a psychiatric disorder characterized by repeated acts of affective aggression. Despite the diagnostic emphasis on the failure to control aggressive impulses, there is little research on affective processes and emotion regulation in IED; however, this research suggests possible dysfunctions in experiences of emotional intensity and lability. The hypothesis in the present study was that compared to individuals with other psychiatric disorders, and psychologically healthy individuals, individuals with IED experience greater negative affect intensity and emotional lability. Participants (N = 373) consisted of 202 individuals diagnosed with IED, 68 non-IED psychiatric controls (PC), and 103 healthy volunteers (HV). Emotion regulation was assessed using the General Behavior Inventory, the Affective Lability Scale, and the Affect Intensity Measure. Results showed that IED participants reported greater negative affect intensity and greater emotional lability across several emotion domains (e.g., anger, anxiety, depression) than PC and HV participants. These findings suggest that IED is characterized by more global emotion regulation deficits than those associated with anger alone. Aggr. Behav. 41:25-33 2015. © 2014 Wiley Periodicals, Inc.

The relationship between intentional self-injurious behavior and the loudness dependence of auditory evoked potential in research volunteers.

OBJECTIVE: Serotonergic (5-HT) functioning has been shown to be inversely associated with intentional self-injurious behaviors. The purpose of this study was to examine the association between three related self-report measures of intentional self-injurious behaviors (suicidal thoughts/behavior, history of nonsuicidal self-injury, history of severe self-harm when angry) and a putative electrophysiological index of 5-HT activity, the loudness dependence of auditory evoked potential (LDAEP). METHOD: Auditory evoked potentials were recorded from 41 men (mean age = 20.69, standard deviation [SD] = 2.98) during the administration of various tone loudness stimuli, followed by completion of the self-report measures. RESULTS: The component slope was associated with all measures of self-injurious behavior in the expected direction. CONCLUSION: The LDAEP has the potential to be used as a noninvasive index of intentional self-harm disposition. Additional studies are needed using other populations, including women and treatment-seeking individuals, to determine if the LDAEP more broadly discriminates risk of self-injuring.

Validity of the new A1 and A2 criteria for DSM-5 intermittent explosive disorder.

A disorder of impulsive aggression has been in the Diagnostic and Statistical Manual for Mental Disorders (DSM) since the first edition. In DSM-III, this disorder was codified as Intermittent Explosive Disorder (IED) and was thought to be rare. However, DSM criteria for IED were poorly operationalized and empiric research in IED was limited until the past decade when research criteria were developed. Subsequently, renewed interest in disorders of impulsive aggression led to a recent series of community based studies that have now documented IED to be as common as many other psychiatric disorders. Recent research indicates that the core of IED (A criteria) can be captured with new criteria that identify high frequency/low intensity aggressive outbursts (A1) and low frequency/hi intensity outbursts (A2). This paper presents new data regarding the phenomenology, comorbidity/life course of IED as a function of A1 and A2 criteria. Together with reanalysis of previously published data regarding family history, biomarkers, and treatment response in individuals with recurrent, problematic, impulsive aggression, these data provide empirical support for both A1 and A2 criteria for DSM-5 IED.

Relationship between psychopathy, aggression, anger, impulsivity, and intermittent explosive disorder.

Intermittent explosive disorder (IED) in DSM-5 represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive behavior that, over the lifetime, affects about 5-6% of individuals in the United States. While aggression is also observed in those with psychopathic personality, aggression in this context is frequently proactive rather than reactive, and neurobiological study suggests important differences between those with proactive aggression/psychopathy and those with reactive aggression. In this paper, we conducted two sets of analyses. First, a phenomenologic study to explore the frequency of psychopathic personality defined by the Psychopathology Checklist-Screening Version (PCL-SV) among IED and comparator participants and to explore differences in measures of aggression, anger, and impulsivity as a function of IED and psychopathic personality. Second, we re-analyzed data from five published studies to determine if psychopathic personality accounted for differences between IED and comparator participants. The first study found that only a modest proportion of IED participants display clinically substantial features of psychopathy and that measures of trait aggression and anger, rather than those of psychopathy, are the strongest correlates of IED. The second study found little evidence for any impact of psychopathy on reported findings in IED compared with various control participants.

Predictors of treatment outcome in cognitive behavioral therapy for intermittent explosive disorder: A preliminary analysis.

OBJECTIVE: The present study examined potential treatment outcome predictors of a multicomponent cognitive behavioral intervention for intermittent explosive disorder (IED). METHOD: The sample (n = 64; 22 female) consisted of individuals with a current diagnosis of IED that completed treatment across three study trials. Treatment outcome predictors assessed included demographic variables, psychiatric comorbidity, symptom severity, and treatment motivation/engagement. Treatment outcomes were (a) change in number of past-week aggressive acts from pretreatment to posttreatment and (b) presence of IED diagnosis at posttreatment. RESULTS: Results indicated those who endorsed lower trait anger were more likely to remit from IED diagnosis at posttreatment. No other variables were found to significantly predict treatment outcome. CONCLUSIONS: These findings support the notion that cognitive behavioral therapy can be effective for a wide range of individuals with IED, with little variation in efficaciousness based on presence of demographic characteristics, comorbid disorders, or treatment motivation/engagement. This seems to be particularly the case for individuals with lower levels of trait anger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A latent class analysis of cognitive-affective heterogeneity in current intermittent explosive disorder.

Intermittent Explosive Disorder (IED) is a common, chronic, and impairing psychological condition characterized by recurrent, affective aggressive behavior. IED is associated with a host of cognitive and affective symptoms not included in the diagnostic criteria which may be a valuable indicator of heterogeneity in IED-such information can be useful to enhance understanding and treatment of this disorder in mental health settings. A preliminary investigation conducted on cognitive-affective symptom heterogeneity in individuals with a history of IED demonstrated that level of emotional dysregulation primarily differentiated IED subgroups, however the sample size was limited, and almost half of the individuals did not have current IED (only lifetime IED). The present study addressed these limitations by conducting a latent class analysis of cognitive-affective symptoms among a large (n = 504) sample of individuals diagnosed with current IED. The latent IED classes were then externally validated on several adverse outcomes, historical precursors, and demographic variables. Statistical and clinical indicators supported a four-class model, with classes primarily distinguished by patients' severity of emotion dysregulation. The two moderate emotion-dysregulated classes both endorsed callous-unemotional traits and low empathy relative to other classes, a finding which differs from the initial investigation. An external validation of the four classes revealed that they significantly differed on severity outcomes (e.g., aggression, suicide attempts, antisocial behavior, global functioning, comorbidities) and historical precursors (e.g., aversive parental care, childhood maltreatment). These findings provide further insight into the heterogeneity within IED and the associations of such variability with important precursors and clinical outcomes.

Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis.

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.

Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review.

INTRODUCTION: Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. METHODS: The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. RESULTS: A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. CONCLUSION: Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

Trait Reward Sensitivity Modulates Connectivity with the Temporoparietal Junction and Anterior Insula during Strategic Decision Making.

Many decisions happen in social contexts such as negotiations, yet little is understood about how people balance fairness versus selfishness. Past investigations found that activation in brain areas involved in executive function and reward processing was associated with people offering less with no threat of rejection from their partner, compared to offering more when there was a threat of rejection. However, it remains unclear how trait reward sensitivity may modulate activation and connectivity patterns in these situations. To address this gap, we used task-based fMRI to examine the relation between reward sensitivity and the neural correlates of bargaining choices. Participants (N = 54) completed the Sensitivity to Punishment (SP)/Sensitivity to Reward (SR) Questionnaire and the Behavioral Inhibition System/Behavioral Activation System scales. Participants performed the Ultimatum and Dictator Games as proposers and exhibited strategic decisions by being fair when there was a threat of rejection, but being selfish when there was not a threat of rejection. We found that strategic decisions evoked activation in the Inferior Frontal Gyrus (IFG) and the Anterior Insula (AI). Next, we found elevated IFG connectivity with the Temporoparietal junction (TPJ) during strategic decisions. Finally, we explored whether trait reward sensitivity modulated brain responses while making strategic decisions. We found that people who scored lower in reward sensitivity made less strategic choices when they exhibited higher AI-Angular Gyrus connectivity. Taken together, our results demonstrate how trait reward sensitivity modulates neural responses to strategic decisions, potentially underscoring the importance of this factor within social and decision neuroscience.