Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm.

BACKGROUND: Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups. METHODS: Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits. RESULTS: Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group. CONCLUSIONS: There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

A mixed methods examination of emotional expression and its impact on emotion regulation effectiveness in borderline personality disorder.

BACKGROUND AND OBJECTIVES: Emotional expression (i.e., identifying and labeling emotion using specific words), is theorized to reduce negative emotion and facilitate emotion regulation. However, it remains unclear how individuals with borderline personality disorder express emotion, and whether this influences their emotion regulation. This study examined whether: 1) emotional expression in borderline personality disorder differed from healthy controls based on word valence, emotionality, and vocabulary; and 2) whether such characteristics predict emotion regulation effectiveness across self-reported and physiological emotion domains differentially across these groups. METHODS: Individuals with borderline personality disorder (n = 29) and age and sex-matched healthy controls (n = 30) listened to an evocative story, expressed emotion, and regulated emotion by applying Mindfulness or Cognitive Reappraisal. Emotion regulation was measured by changes in self-report, parasympathetic, and sympathetic emotion, while implementing the emotion regulation strategies. The words used to express emotion were coded based on valence, emotionality, and depth of vocabulary. RESULTS: Generalized estimating equations revealed no differences between groups in valence, emotionality, and vocabulary. Additionally, using a larger emotional vocabulary predicted more effective sympathetic emotion regulation, and using more negatively valenced words predicted more effective parasympathetic emotion regulation across groups. LIMITATIONS: Among other things, this study is limited by its predominantly female sample, and that it does not determine whether valence, emotionality, or vocabulary independently predict emotional expression effectiveness. CONCLUSIONS: Emotional expression may not be deficient in borderline personality disorder across the indices studied. Using more negative words and broadening vocabulary while expressing emotion may offer emotion regulation benefits.

Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder.

This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.

Use your words: The role of emotion labeling in regulating emotion in borderline personality disorder.

Borderline personality disorder (BPD) treatments emphasize emotion labeling to decrease negative emotion and facilitate emotion regulation. However, no studies have examined emotion labeling in BPD or its impact on intentional emotion regulation. The present study examined the impact of emotion labeling on emotion and intentional emotion regulation attempts across self-reported and physiological indices (i.e., skin conductance response [SCR], respiratory sinus arrhythmia [RSA]) in BPD and healthy control (HC) groups. Participants listened to emotionally-evocative scripts and were either instructed to type the emotions that they were experiencing (labeling) or the objects they could imagine seeing in the script (control) into a computer. Following this, they were instructed to use either mindfulness or cognitive reappraisal to decrease their emotion. Self-reported, RSA, and SCR indices of negative emotion were collected throughout and analyzed using generalized estimating equations. Findings indicated that the BPD group experienced higher RSA during emotion labeling compared to the control task, but the HC group did not. HCs reported lower negative emotion after emotion labeling when implementing both emotion regulation strategies compared to the control task, but the BPD group did not. These findings suggest that emotion labeling may activate emotion regulatory systems in BPD and can potentiate intentional emotion regulation in HCs.

A laboratory examination of emotion regulation skill strengthening in borderline personality disorder.

This study examined whether individuals with borderline personality disorder (BPD; N = 25) exhibit deficits in their ability to strengthen their emotion regulation skills over time compared with healthy controls (HCs; N = 30). Participants were instructed to implement 1 of 2 different emotion regulation strategies (i.e., distraction and mindful awareness of the emotion) or to either react naturally (i.e., nonregulation condition) in response to BPD-relevant stimuli across multiple trials. Self-reported negativity and positivity, and physiological indices of emotion were collected throughout. Self-report results indicated that both groups displayed strengthening of distraction, but not mindful awareness, compared with the nonregulation condition over time. When comparing the 2 emotion regulation strategies to each other, heart rate data suggested that the rate of skill strengthening varied by group. Specifically, the BPD group evidenced strengthening of mindful awareness, but not distraction, over time whereas the HCs exhibited the opposite pattern. These findings suggest that individuals with BPD generally do not show deficits in their ability to strengthen emotion regulation skills and exhibit greater strengthening of mindful awareness than distraction over time. (PsycINFO Database Record

The impact of stimulus arousal level on emotion regulation effectiveness in borderline personality disorder.

Basic emotion theory suggests that the effectiveness of different emotion regulation strategies vary with the intensity of the emotionally-salient stimulus. Although findings from studies using healthy samples are concordant with what is proposed by theory, it is unclear whether these relationships hold true among individuals with borderline personality disorder (BPD). Twenty-five individuals with BPD and 30 HCs were exposed to negative images of varying levels of emotional arousal and were instructed to either react as they normally would, distract, or use mindful awareness. Self-reported negativity ratings, heart rate, and skin conductance level (SCL) were monitored throughout. SCL data indicated that increases in image arousal resulted in larger reductions in SCL when distracting but not when implementing mindful awareness. Self-report data suggested that, in HCs, the effectiveness of mindful awareness decreased to a greater extent than distraction when image arousal increased. These findings are consistent with basic emotion research and suggest that some forms of emotion regulation (distraction) are more suited to high emotion arousal contexts than others (mindful awareness) and that, compared with HCs, individuals with BPD may be more resilient to the deteriorating effectiveness of mindful awareness with respect to increasing emotional arousal.