Emotion dysregulation in young people with BPD

These three studies of Borderline Personality Disorder (BPD) were very helpful to me. First, Aleva et al. (2023) published “Emotion Dysregulation in Young People with Borderline Personality Disorder: One pattern or distinct subgroups? Personality Disorders: Theory, Research, and Treatment. Here’s the abstract with some information in bold:

Emotion dysregulation is a key feature of borderline personality disorder (BPD). Given the heterogeneity of BPD and emotion regulation, this study sought to define subgroups among a sample of young people with BPD based on their pattern of emotion regulation abilities. Baseline data from the Monitoring Outcomes of BPD in Youth (MOBY) clinical trial were used, in which 137 young people (Mage = 19.1, SDage = 2.8; 81% female) completed the self-report Difficulties in Emotion Regulation Scale (DERS), as a measure of emotion regulation abilities. Latent profile analysis (LPA) was conducted to identify subgroups, based upon response patterns on the six DERS subscales. Subsequent analysis of variance and logistic regression models were used to characterize the identified subgroups. LPA revealed three subgroups. A “low and unaware” (n = 22) subgroup, reporting the least emotion dysregulation, apart from high emotional unawareness. A “moderate and accepting” subgroup (n = 59), reporting high emotional acceptance within its own pattern, and moderate emotion dysregulation compared with the other subgroups. A “high and aware” subgroup (n = 56), reporting the highest level of emotion dysregulation, but with high emotional awareness. Some demographic, psychopathology, and functioning characteristics were associated with subgroup membership. The identification of distinct subgroups highlights the importance of considering the level of emotional awareness in the context of other regulatory abilities and suggests that therapies should not take a “one-size-fits-all” approach to emotion dysregulation. Future research should seek to replicate the identified subgroups given the relatively small sample size in the current study. In addition, examining the stability of subgroup membership and the influence upon treatment outcome will be interesting avenues for further exploration. 

I always like arguments against a “one-size-fits-all” approach to diagnosis. This work may be very helpful to clinicians working with young people with BPD symptoms. I have written before about Heekerens’ work on Arousal and perceived rejection in BPD. Here he looks at dissociation. Heekerens, Schulze, Enge, Renneberg & Roepke (2023) published “Affective Arousal Temporally Precedes Dissociation in Patients with Borderline Personality Disorder: A preliminary experience sampling study” in Psychological Trauma: Theory, Research, Practice, and Policy.  Here’s the edited abstract and impact statement:

Affective dysregulation is a core feature of borderline personality disorder (BPD), and some patients report dissociative symptoms. The present study investigated temporal dynamic relations between affective states and current experiences of depersonalization and derealization in daily life to test key theoretical premises of trauma models of dissociation. Patients with BPD (n = 42) or depressive disorders (n = 40), and nonclinical controls (n = 39) were assessed every 15 min for 13 hr within a single day using smartphone-based diaries. As expected, dynamic structural equation modeling results show the highest levels of average daily affective arousal, negative affective valence, and dissociation in the BPD group. As hypothesized, arousal and subsequent dissociation were significantly linked only in the BPD group, implying that momentary arousal above a person’s daily average is followed by higher dissociation in the next measurement (∼15 min later). In addition, some patients with BPD reported less negative affective valence following dissociation. Our findings suggest that changes in affective states play an important role at the onset of dissociation in patients with BPD. Subsequent relief from distress may explain maintenance. We recommend that clinicians provide means to regulate affect when dealing with dissociation. Patients with borderline personality disorder (BPD) often feel strongly tense and unwell, and some patients with BPD report transient feelings of being detached from one’s self and/or one’s surroundings (dissociation). We found that patients with BPD feel particularly tense before reporting increased dissociation. Shortly after increased dissociation, some patients with BPD report feeling less unwell. These relationships were not found in individuals with depressive disorders or nonclinical controls. Our findings suggest that one function of dissociation may be to regulate negative emotions. 

I love this study because, though their samples are small, they examined people with diagnoses of BPD, depressive disorders, and no clinical diagnoses. The findings make sense to me. It would be especially interesting to see if the subgroups Aleva et al. describe differ in likelihood of dissociation.

The final study emphasizes the importance of emotion dysregulation in predicting dropout behavior. Doyle, Smith, Watt, Cohen & Couture (2023) published “Higher Baseline Emotion Dysregulation Predicts Treatment Dropout in Outpatients with Borderline Personality Disorder” in Personality Disorders: Theory, Research, and Treatment.  

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. 

Although their sample is not identified by age, their findings make sense to me. Taken together, these studies offer good advice for examining specific features of BPD (emotion dysregulation, emotion awareness, distress tolerance, and dissociation before treatment planning.