Borderline personality disorder and learning: The influences of emotional state and social versus nonsocial feedback.

BACKGROUND: Borderline personality disorder (BPD) has been associated with decision-making deficits, yet such deficits may be context dependent, particularly emotional state and social context. Reinforcement learning models offer an avenue to pinpoint decision-making impairments. The current study used reinforcement learning models to examine whether feedback type (social vs. nonsocial) or emotional state (neutral vs. negative) influence the association between BPD and decision making. METHOD: Adults (N = 131) with a range of BPD symptoms completed a diagnostic interview and a computerized learning task after neutral and negative emotion inductions. We examined accuracy, learning rate, and exploration. RESULTS: We conducted linear models to examine the association between BPD criteria, feedback type, and emotional state on learning parameters and learning accuracy. We found that the negative emotion condition was associated with greater exploration, particularly for those with elevated BPD features. Furthermore, elevated BPD features were associated with impaired accuracy when aiming to avoid loss. A 3-way interaction between BPD, emotion, and feedback indicated that, for people with higher BPD features, learning performance was further impaired when receiving social feedback in the negative emotion condition. LIMITATIONS: Several limitations warrant mention, including a relatively homogenous sample, possible co-occurring diagnoses, and methodological consideration with the learning task. CONCLUSIONS: The present study underscored the link between BPD and learning impairments. Amplified learning alterations under negative social contexts have important implications for identifying optimal venues to teach new skills (of relevance to treatment) for those with BPD.

The Suicide Dot Probe Task: Psychometric properties and validity in relation to suicide-related outcomes.

BACKGROUND: Attentional biases to suicide-related stimuli have been linked to suicide-related outcomes. However, behavioral tasks that have been previously modified to capture suicide-specific attentional biases have demonstrated inconsistent reliability and validity. Adaptation of the Dot Probe Task, a computerized assessment that has been adapted to study a wide variety of biases, may be a promising candidate for assessing suicide-specific biases. METHODS: In 280 recently discharged inpatients (51% male; Mage = 40.22 years), we evaluated the psychometric properties of a modified Suicide Dot Probe Task. Participants completed this task and assessments of suicidal thoughts and behaviors at baseline and 6-month follow-up. RESULTS: The Suicide Dot Probe Task demonstrated poor-to-moderate internal consistency and poor test-retest reliability, and participant response times were slower to suicide-specific and dysphoric stimuli than positive stimuli. However, there were no differences based on the presence or characteristics of recent or lifetime suicidal ideation or attempts. Participants' suicide-specific biases were not predictive of suicidal ideation or attempts at follow-up. CONCLUSIONS: The Suicide Dot Probe Task exhibited questionable reliability, and differences in attentional biases were not associated with suicidal ideation or attempts. This study contributes to a body of research demonstrating the questionable utility of several behavioral tasks to study suicide-specific attentional biases.

Social stressors, emotional responses, and NSSI urges and behaviors in daily life.

BACKGROUND: The defective self model of nonsuicidal self-injury (NSSI) theorizes that individuals who are highly self-critical are more likely to choose NSSI to regulate emotions. This model indirectly suggests that individuals who engage in NSSI may experience more self-conscious emotions in response to negative social feedback, increasing risk for near-term NSSI. This study examined (1) whether individuals with a history of NSSI (vs. without) display greater self-conscious and negative emotional reactions to daily social stressors, and more problematic features of these daily social stressors, and (2) whether greater-than-usual negative emotional reactions and social stressor features predict NSSI urges and behaviors in daily life. METHODS: Participants were 134 female college students with recent, recurrent NSSI (n = 77) or no NSSI history (n = 57). Participants completed baseline measures of socioemotional functioning and a two-week daily diary protocol. RESULTS: The NSSI (vs. no NSSI) group reported significantly greater self-conscious and negative emotional reactions to daily social stressors, and social stressors characterized by greater dysfunction. In the NSSI group, experiencing social stressors characterized by greater distress than one's average during the daily diary period was associated with same-day NSSI urges and behavior, greater confusion than one's average predicted same-day NSSI urges, and greater conflict than one's average predicted same-day NSSI behavior. Greater self-conscious and negative emotional reactions to these stressors than one's average predicted same-day NSSI urges and behavior. LIMITATIONS: Limitations include reliance on self-report, a once-daily assessment, and lack of generalizability to other samples. CONCLUSIONS: Interpersonal conflict and increased self-conscious emotions pose vulnerability for NSSI. Prevention and intervention efforts would benefit from including a focus on interpersonal functioning.

Self-injury motives: A person-centered examination.

INTRODUCTION: People report multiple motives for nonsuicidal self-injury (NSSI), but few studies have examined how these motives relate to one another. This study identified person-centered classes of NSSI motives, their NSSI and psychopathological correlates, and their utility in predicting future NSSI across two samples. METHODS: Participants were adolescents and young adults (aged 15-35) with recent NSSI recruited from online forums (n = 155, Sample 1) or the community (n = 127, Sample 2). Participants completed measures of NSSI, emotion regulation difficulties, borderline personality disorder (BPD), depression, and reported on their NSSI over 12 months. RESULTS: Latent profile analyses yielded five classes in each sample: low interpersonal, self-punishment/interpersonal, moderate intra/interpersonal, high intra/interpersonal, and mainly interpersonal motives. Classes were not associated with lifetime NSSI characteristics, but highly motivated participants reported more severe depression and BPD symptoms, and greater emotion dysregulation than low-motivated participants. Those in the mainly interpersonal (Sample 1) and self-punishment/interpersonal (Sample 2) motives classes reported greater NSSI frequency during follow-up. CONCLUSIONS: This study identified five classes of NSSI motives. Participants who report multiple motives for NSSI may be more clinically severe, whereas those who report strong desires to communicate with others or punish themselves may be at the highest risk for more frequent NSSI over time.

Learning from gain and loss: Links to suicide risk.

Despite preliminary evidence that people with suicide attempt histories demonstrate deficits in processing feedback, no studies have examined the interrelations of learning from feedback and emotional state on suicide risk. This study examined the influence of suicide risk and negative emotions on learning accuracy and rates among individuals with a range of borderline personality features (N = 145). Participants completed a reinforcement learning task after neutral and negative emotion inductions. Results revealed interactions between suicide risk and emotion condition, with elevated risk linked to greater increases in loss learning rate (training phase models) and gain learning rate (test phase models) post-negative emotion induction. Emotion-dependent fluctuations in learning performance may be markers of decision-making that are associated with greater suicide risk. This line of work has the potential to identify the contexts that confer greater risk for suicidal behaviors.

Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students.

Suicidal behaviors are increasingly prevalent among college students. Although emotion dysregulation is theorized to increase suicide risk, research supporting this relationship is mixed. Engagement in self-damaging behaviors may play a role in the relationship between emotion dysregulation and suicide risk, theoretically by increasing one's capability of engaging in suicidal behaviors. Such behaviors may interact with emotion dysregulation to predict suicide risk. Alternatively, engaging in self-damaging behaviors may mediate the emotion dysregulation-suicide risk relationship. We examined the potential moderating and mediating roles of engagement in multiple self-damaging behaviors in the relationship between emotion dysregulation and suicide risk among college students. Participants were 181 undergraduate students who reported a history of self-damaging behaviors (i.e., non-suicidal self-injury, alcohol misuse, drug misuse, disordered eating), overall emotion dysregulation, and suicide risk. Findings revealed an interactive effect of emotion dysregulation and self-damaging behaviors on suicide risk, with engagement in more forms of self-damaging behaviors conferring higher risk for suicide, particularly in the context of greater emotion dysregulation. The model testing self-damaging behaviors as a mediator was also significant, such that greater emotion dysregulation had an indirect effect on elevated suicide risk via number of self-damaging behaviors. These findings help clarify associations among emotion dysregulation, self-damaging behaviors, and suicide risk, and have implications for specific targets of intervention and for the prevention of suicide by college students.

Association of Positive Emotion Dysregulation to Resting Heart Rate Variability: The Influence of Positive Affect Intensity.

BACKGROUND: A fast-growing body of research provides support for the role of positive emotion dysregulation in the etiology and maintenance of a wide range of psychiatric difficulties and clinically relevant behaviors. However, this work has exclusively relied on the subjective assessment of positive emotion dysregulation. Advancing research, the current study examined associations between physiological and subjective indices of positive emotional responding in the laboratory. Specifically, we explored the relation of the Difficulties in Emotion Regulation Scale - Positive (Weiss, Gratz, & Lavender, 2015) to resting heart rate variability (HRV) at high and low state positive affect intensity. METHODS: Participants were 122 individuals recruited from college and community settings (M age = 23.39, 84.4% female, 68.0% White). RESULTS: Findings indicated a positive relation between positive emotion dysregulation and resting HRV at high state positive affect and a negative relation between positive emotion dysregulation and resting HRV at low state positive affect. CONCLUSIONS: Results extend our understanding of the associations among subjective and physiological indices of positive emotional processes. These findings have key implications for the conduct of research on positive emotion dysregulation.

Emotion regulation and borderline personality features in daily life: The role of social context.

BACKGROUND: Borderline personality disorder (BPD) is associated with emotional dysfunction and interpersonal sensitivity. Yet, little work has characterized how BPD features predicts emotional reactivity and emotion regulation behaviors in response to interpersonal stress relative to other forms of stress. METHODS: Participants were 152 university students who completed baseline measures of BPD features and complied with two-week daily diary procedures assessing daily emotion regulation strategy use in response to social and non-social stressors. RESULTS: Generalized estimating equations revealed that BPD features predicted greater negative and positive emotions in response to daily stressors, and interacted with type of stressor in predicting urges and behaviors. Elevated BPD features was associated with greater urges for dysfunctional emotion regulatory behaviors and fewer functional emotion regulatory behaviors to a greater extent in response to social (versus non-social) stressors. LIMITATIONS: This study was limited by its focus on past-day retrospective recall. Further, the student sample limits the generalizability of these findings. CONCLUSIONS: These findings suggest that individuals with elevated BPD features may have less functional emotion regulation in social contexts.

Emotion regulation difficulties and interpersonal conflict in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by both emotion regulation (ER) and interpersonal difficulties. Although the link between ER difficulties and interpersonal problems in BPD is well documented, less work has examined the directionality of these associations. The present study examined the temporal relationship between ER difficulties and interpersonal problems among individuals with BPD features in daily life. Participants were 173 undergraduate students who completed daily questionnaires for 2 weeks. Participants were prompted to identify their most stressful events each day and report their use of maladaptive ER strategies (i.e., expressive suppression, worry/rumination, and avoidance) and interpersonal conflict behaviors (i.e., argue, hit someone/throw things). BPD features were associated with greater interpersonal conflict and ER difficulties. Unexpectedly, maladaptive ER strategy use did not predict next-day interpersonal conflict. Interpersonal conflict significantly predicted next-day maladaptive ER strategy use; however, this association was weaker among those with elevated BPD features. Implications of these findings for treatment are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emotion regulation difficulties and borderline personality disorder: The moderating role of race.

Borderline personality disorder (BPD) is a disorder characterized by emotion regulation (ER) difficulties. Although research indicates that patterns of ER differ across racial groups, few studies have examined the role of race in the ER-BPD association. This study sought to address this gap. Participants in this study identified as either East Asian, White, or Black, and were recruited from sites in Western Canada and the Southern United States. Two samples were included in this study: (a) 194 university students who self-reported BPD features and (b) 88 adults from the community who underwent diagnostic interviews and had a BPD diagnosis. All participants self-reported ER difficulties. Results revealed that race moderated the link between some aspects of ER difficulties and BPD. For instance, relations between (a) nonacceptance of emotions and BPD affect instability, (b) limited access to ER strategies and BPD identity disturbance, and (c) low emotional awareness and BPD diagnosis were stronger among White (vs. Black or East Asian) participants. Implications of these findings for the diagnosis and treatment of BPD across racial groups are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Comparing Two Models of Integrated Behavioral Health Programs in Pediatric Primary Care.

This study examined how to design, staff, and evaluate the feasibility of 2 different models of integrated behavioral health programs in pediatric primary care across primary care sites in the Bronx, NY. Results suggest that the Behavioral Health Integration Program model of pediatric integrated care is feasible and that hiring behavioral health staff with specific training in pediatric, evidence-informed behavioral health treatments may be a critical variable in increasing outcomes such as referral rates, self-reported competency, and satisfaction.

Dialectical Behavior Therapy for Suicidal Latina Adolescents: Supplemental Dialectical Corollaries and Treatment Targets.

The primary aim of this paper is to describe extreme behavioral patterns that the authors have observed in treating Latina adolescents who are suicidal and their parents within the framework of dialectical behavior therapy (DBT). These extreme patterns, called dialectical corollaries, serve to supplement the adolescent/family dialectical dilemmas described by Rathus and Miller (2002) as part of dialectical behavior therapy for suicidal adolescents with borderline personality features. The dialectical corollaries proposed are "old school versus new school" and "overprotecting" versus "underprotecting," and they are described in-depth. We also identify specific treatment targets for each corollary and discuss therapeutic techniques aimed at achieving a synthesis between the polarities that characterize each corollary. Lastly, we suggest clinical strategies to use when therapists reach a therapeutic impasse with the parent-adolescent dyad (i.e., dialectical failures).