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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has been shown to increase levels of psychological distress among healthcare workers. Little is known, however, about specific positive and negative individual and organizational factors that affect the mental health of emergency physicians (EP) during COVID-19. Our objective was to assess these factors in a broad geographic sample of EPs in the United States. Methods: We conducted an electronic, prospective, cross-sectional national survey of EPs from October 6–December 29, 2020. Measures assessed negative mental health outcomes (depression, anxiety, post-traumatic stress, and insomnia), positive work-related outcomes, and strategies used to cope with COVID-19. After preliminary analyses and internal reliability testing, we performed four separate three-stage hierarchical multiple regression analyses to examine individual and organizational predictive factors for psychological distress. Results: Response rate was 50%, with 517 EPs completing the survey from 11 different sites. Overall, 85% of respondents reported negative psychological effects due to COVID-19. Participants reported feeling more stressed (31%), lonelier (26%), more anxious (25%), more irritable (24%) and sadder (17.5%). Prevalence of mental health conditions was 17% for depression, 13% for anxiety, 7.5% for post-traumatic stress disorder (PTSD), and 18% for insomnia. Regular exercise decreased from 69% to 56%, while daily alcohol use increased from 8% to 15%. Coping strategies of behavioral disengagement, self-blame, and venting were significant predictors of psychological distress, while humor and positive reframing were negatively associated with psychological distress. Conclusion: Emergency physicians have experienced high levels of psychological distress during the COVID-19 pandemic. Those using avoidant coping strategies were most likely to experience depression, anxiety, insomnia, and PTSD, while humor and positive reframing were effective coping strategies.

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.

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).

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.

Posttraumatic stress disorder (PTSD) is highly prevalent, with recent evidence suggesting that 8.30%, or approximately 27 million Americans according to the recent U.S. Census data (2018), will develop PTSD in their lifetime (Kilpatrick et al., 2013). Unsurprisingly, PTSD is both widely researched and a key consideration in clinical practice. One important clinical and empirically-established correlate of PTSD is engagement in reckless and self-destructive behaviors (RSDBs; Lusk, Sadeh, Wolf, & Miller, 2017; Tull, Weiss, & McDermott, 2015; Weiss, Tull, Sullivan, Dixon-Gordon, & Gratz, 2015). Among theoretical explanations for the PTSD-RSDB link, the disinhibition viewpoint indicates that individuals with PTSD may have difficulties inhibiting rewarding RSDBs (Casada & Roache, 2005); the emotion dysregulation perspective indicates that individuals engage in RSDBs to reduce the negative affect or increase the blunted positive affect characteristic of PTSD (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004); and the cognitive explanation suggests the trauma’s effects on decreasing attention span and information processing capacity may increase the likelihood of impulsive RSDBs (Ben-Zur & Zeidner, 2009). Of clinical salience, engagement in RSDBs among trauma-exposed samples has a detrimental impact on physical and mental health outcomes. For instance, in a study of veterans receiving treatment for PTSD, a significant number of deaths were related to RSDBs such as substance misuse and suicide (Drescher, Rosen, Burling, & Foy, 2003). Additionally, another study found that engagement in RSDBs was associated with greater psychological, emotional, and behavioral problems (Contractor, Weiss, Dranger, Ruggero, & Armour, 2017). With this empirical, theoretical, and clinically-significant foundation, the E2 symptom assessing posttrauma RSDBs was added to the DSM-5 PTSD diagnostic criteria (American Psychiatric Association, 2013). However, the lack of a comprehensive (yet brief) validated screening measure to assess E2 poses a barrier to its measurement and consideration in treatment. In fact, existing assessments of PTSD’s E2 criterion lack clinical utility and empirical support in a number of ways. First, the assessment of PTSD’s E2 criterion in adults has relied either on a single-item (E2 symptom) included in PTSD assessments or requires a time-intensive battery of multiple distinct measures of a range of specific RSDBs (e.g., substance use, aggressive behaviors). With evidence supporting the co-occurrence of RSDBs (Cooper, 2002) representing an underlying unified latent factor (Shaw, Wagner, Arnett, & Aber, 1992; Weiss, Tull, Dixon-Gordon, & Gratz, 2016), using multiple RSDB measures may have less utility than a measure assessing a unified RSDB construct. Second, one could use existing comprehensive risky behavior measures such as the Risky Impulsive and Self-Destructive Questionnaire (Sadeh & Baskin-Sommers, 2017), the Risky Behaviors Questionnaire (Weiss et al., 2016), and the Risk-Taking Behavior Scale (Pat-Horenczyk et al., 2007). However, these are lengthy (e.g., 38, 29, and 87 items), assess more than just frequency of engaging in RSDBs (e.g., functionality of RSDBs), and/or are restricted to a specific developmental period (e.g., adolescence). Further, these measures do not include items to specifically examine posttrauma manifestations of RSDBs, a necessary criterion for evaluating PTSD’s E2. Indeed, while the types of RSDBs may be similar among trauma-exposed and non-trauma-exposed samples, there is a demonstrated uniqueness in the presentation, function, and course of RSDBs among trauma-exposed populations. For instance, trauma-exposed individuals may functionally engage in RSDBs as an emotion regulation strategy to cope with PTSD symptoms/distress (Marshall-Berenz, Vujanovic, & MacPherson, 2011; Weiss et al., 2015; Weiss, Tull, Viana, Anestis, & Gratz, 2012), implying their onset after trauma/PTSD symptoms. Given the aforementioned limitations of existing measures, we need a comprehensive (yet brief enough to ensure clinical utility) and validated screening measure to examine the unidimensional E2 criterion. We developed the Posttrauma Risky Behaviors Questionnaire (PRBQ) to assess extent of engagement in posttrauma RSDBs and examined its factor structure, reliability, and validity (content, convergent, construct, incremental) in a trauma-exposed community sample recruited via Amazon’s MTurk platform. We further replicated this factor structure and examined its validity (construct and convergent) with a different trauma-exposed sample of college students (Hinkin, 1998; Holmbeck & Devine, 2009). We hypothesized good psychometric properties and ability to represent distinct RSDBs as a unidimensional construct.

Although diagnostically distinct, research indicates that antisocial personality disorder (ASPD) and borderline personality disorder (BPD) share common features, including anger impulses and emotion dysregulation. It is unclear, however, how these variables are expressed and experienced differentially. The current study sought to examine independent associations of forms of anger expression and emotion dysregulation among a sample of incarcerated males. Participants were 30 males incarcerated in a county jail who completed self-report measures of BPD and ASPD features, emotion dysregulation, and anger. Results revealed that when controlling for the co-occurrence of the other disorder, anger expression and emotion dysregulation were significantly associated with BPD. Difficulties engaging in goal-directed behavior were significantly associated with ASPD. BPD may confer unique clinical challenges among incarcerated samples.

Borderline personality disorder (BPD) symptoms and suicidal behaviors are prevalent among undergraduate students. Although rumination contributes to self-destructive behaviors in BPD, less research examines the role of rumination in distinct suicidal outcomes among individuals with BPD features instead focusing more on self-destructive behaviors as a latent variable. The present study examined the main and interactive effects of BPD features and two forms of rumination (brooding and anger) in the prediction of suicide-related outcomes (ideation and attempts) among college students. Participants (

BACKGROUND: The co-occurrence of depression and risky alcohol use is clinically-relevant given their high rates of comorbidity and reciprocal negative impact on outcomes. Emotion dysregulation is one factor that has been shown to underlie this association. However, literature in this area has been limited in its exclusive focus on emotion dysregulation stemming from negative emotions. OBJECTIVES: The goal of the current study was to extend research by exploring the role of difficulties regulating positive emotions in depression symptom severity, risky alcohol use, and their association. METHODS: Participants were 395 trauma-exposed adults recruited from Amazon’s Mechanical Turk (MTurk) platform (56.20% female, M(age) = 35.55) who completed self-report questionnaires. RESULTS: Zero-order correlations among depression symptom severity, the three subscales of difficulties regulating positive emotions, and risky alcohol use were positive. Two subscales of difficulties regulating positive emotions – nonacceptance of positive emotions and difficulties controlling impulsive behavior when experiencing positive emotions – accounted for the relationship between depression symptom severity and risky alcohol use. CONCLUSION: Results suggest the importance of incorporating techniques focused on improving positive emotion regulation skills in interventions for risky alcohol use among individuals with depression.

OBJECTIVES. Posttraumatic stress disorder (PTSD) often co-occurs with substance use (SU). Although there has been independent research on subgroups of participants based on their PTSD or SU responses, rarely are PTSD-SU typologies examined consistent with a precision medicine approach (and corresponding person-centered statistical approaches). The current study examined the nature and construct validity (covariates of depression, physical aggression, verbal aggression, anger, hostility, reckless and self-destructive behaviors [RSDB]) of the best-fitting latent class solution in categorizing participants based on PTSD (PTSD Checklist for DSM-5) and alcohol/drug use responses (Alcohol Use and Disorders Identification Test Alcohol Consumption Questions, Drug Abuse Screening Test). METHODS. The sample included 375 trauma-exposed participants recruited from Amazon’s Mechanical Turk online labor market. RESULTS. Latent class analyses indicated an optimal three-class solution (Low PTSD/SU, Moderate PTSD/Drug and High Alcohol, High PTSD/SU). Multinomial logistic regressions indicated that depression (OR = 1.22) and frequency of RSDBs (OR = 1.20) were significant predictors of the Moderate PTSD/Drug and High Alcohol Class versus the Low PTSD/SU Class. Depression (OR = 1.55) and frequency of RSDBs (OR = 1.19) were significant predictors of the High PTSD/SU Class versus the Low PTSD/SU Class. Only depression (OR = 1.27) was a significant predictor of the High PTSD/SU Class versus the Moderate PTSD/Drug and High Alcohol Class. CONCLUSIONS. Results provide construct validity support for three meaningful latent classes with unique relations with depression and RSDBs. These findings improve our understanding of heterogeneous PTSD-SU comorbidity patterns and highlight acknowledgment of such subtyping (subgrouping) in considering differential treatment options, treatment effectiveness, and resource allocation.

Suicide is a leading cause of death in the US, with suicide rates increasing annually. Passive screening of suicidal ideation is vital to provide referrals to at-risk individuals. We study to what degree smartphone-based communication, in particular, text messages, could be leveraged for passively screening for suicidal ideation. We analyze the screening ability of texts sent in different time periods prior to reported ideation, namely, texts from specific weeks only versus accumulative over several weeks. Our approach involves performing comprehensive feature engineering and identifying influential features to train machine learning models. With just the prior week of texts, we were able to predict the existence of suicidal ideation with AUC = 0.88, F1 = 0.84, accuracy = 0.81, sensitivity = 0.94, and specificity = 0.68. The most influential features include word frequencies of words in the car, clothing, affection, confusion, driving, real estate, and journalism categories. This research, demonstrating the potential of text messages to screen for suicidal ideation, will guide the development of screening technologies.

Borderline personality disorder (BPD) and depression are characterized by negative emotionality, yet BPD is also theorized to be linked with emotional variability. The present study extends past work to a larger time scale and notes the degree to which stress-related emotional responses are variable or persistent across stressors using novel analytic models. Participants (N = 164) were undergraduate students who completed daily assessments of negative emotional responses to interpersonal stressors for 2 weeks. BPD and depression were associated with greater negative emotional intensity and greater emotional variability in response to nonsocial stressors. Only BPD features were associated with greater emotional variability in response to social stressors. This study is limited by its reliance on self-report in a nonclinical sample and limited within-person assessments. Data point to distinct constellations of emotional dysfunction in BPD and depression. Pending replication, these data may inform targeting of emotional dysfunction in treatment.

Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives.A subset of participants from our previous study (Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder.Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.

Objective This study examined the presence of posttraumatic stress disorder (PTSD) as a predictor of treatment response to dialectical behavior therapy (DBT) across the primary outcomes of interest within DBT (i.e., borderline personality disorder [BPD] symptoms, deliberate self-harm, emotion regulation [ER] difficulties) and PTSD symptoms. Method Participants (N = 56) were consecutive admissions to an outpatient DBT clinic that completed diagnostic interviews at intake and self-report outcome measures at intake and every 3 months throughout the treatment. Results Patients with (vs. without) a PTSD diagnosis did not report greater clinical severity at intake on most outcome measures, with the exception of PTSD symptom severity and, among older patients only, ER difficulties. The presence of a PTSD diagnosis was not associated with poorer treatment response to DBT. Instead, PTSD was associated with better response on the measure of BPD symptom severity. Conclusions The results suggest that patients with PTSD can benefit from DBT.

Background Research over the past two decades supports emotion regulation as a transdiagnostic factor related to the etiology, maintenance, and treatment of a wide range of psychiatric difficulties and risky behaviors. However, prior investigations are limited by their focus on difficulties regulating negative (but not positive) emotions. Further, research has not accounted for the heterogeneity in difficulties regulating emotions. Methods Participants were 210 female victims of domestic violence (DV; M age = 36.14, 48.6% African American) who completed measures assessing emotion regulation (Difficulties in Emotion Regulation Scale; Difficulties in Emotion Regulation Scale – Positive), posttraumatic stress disorder (PTSD; Posttraumatic Stress Diagnostic Scale), depression (Center for Epidemiologic Studies-Depression Scale), alcohol misuse (Alcohol Use Disorder Identification Test) and drug misuse (Drug Abuse Screening Test). Latent profile analysis was utilized to identify subgroups of DV-victimized women who were similar in endorsed difficulties in regulating negative and positive emotions. Differences in psychiatric difficulties (i.e., PTSD and depressive symptom severity) and risky behaviors (i.e., alcohol and drug misuse) were examined across these classes. Results Three classes of DV-victimized women differentiated by levels of difficulties regulating negative and positive emotions were identified. Greater psychiatric difficulties were found among classes defined by higher levels of difficulties regulating emotions, regardless of emotion valence. Risky behaviors were more prevalent among the class defined by higher levels of difficulties regulating both negative and positive emotions. Limitations Although results add to the literature on difficulties regulating emotions and their correlates, findings must be interpreted in light of limitations present including use of a cross-sectional and correlation design, reliance on self-report measures, and assessment of a select sample of women victims of DV. Conclusions Results highlight the potential importance of tailoring interventions accounting for the heterogeneity in negative and positive emotion regulation dimensions among DV-victimized women.

Despite the prevalence of anger management programs in correctional settings, there is mixed support for their effectiveness, and little is known about who benefits most. This preliminary study aim...

Recent attention has focused on the role of interpersonal emotion regulation (IER) in the development and maintenance of a range of forms of psychopathology, including anxiety, depression, and borderline personality disorder (BPD). Despite the relevance of IER in psychopathology, few measures exist to characterize patterns of maladaptive IER. Our aim was to (1) develop a measure of maladaptive IER, (2) begin to explore the factor structure of this new measure, the difficulties in interpersonal regulation of emotions (DIRE), and (3) examine its association with symptoms of psychopathology. In Study 1, 853 Mechanical Turk workers completed the DIRE and measures of psychopathology symptoms. We identified two factors each in the IER and intrapersonal emotion regulation scales. In Study 2, 142 undergraduate students completed the DIRE and daily measures of emotion regulation and coping for 14 days. Preliminary findings suggest that the DIRE has adequate internal consistency and construct and predictive validity. This measure has the potential to supplement future efforts in assessing IER in psychopathology.

This study examined the effects of avoidance- versus acceptance-oriented emotion regulation instructions among individuals with borderline personality disorder (BPD; n = 48), major depressive disorder (MDD; n = 54), and non-psychiatric controls (NPC; n = 50) using ecological momentary assessment. Participants were randomly assigned to either accept or avoid negative emotions, and monitored their moods, urges, and distress tolerance several times per day over 6 days. Avoidance instructions resulted in reduced negative affect and urges for maladaptive behaviors uniquely among BPD participants. Together with past research, and consistent with treatment approaches emphasizing the short-term use of skills to avoid or distract from emotions (e.g., DBT; Linehan, 1993b, 2015), these findings suggest that avoidance of negative emotions may have temporary benefits for individuals with BPD. Acceptance-oriented strategies may take longer or may require more extensive training to be beneficial for emotional functioning in everyday life in BPD.

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).

Background : Despite theories that negative reinforcement in the form of relief from negative emotions maintains nonsuicidal self-injury (NSSI), no studies have examined the extent to which specific emotional consequences of NSSI predict the maintenance of NSSI over time or explain the greater risk for NSSI found among individuals with borderline personality disorder (BPD) pathology. This study examined whether specific emotional consequences of NSSI relate to the continuance of NSSI behavior over a 12-month period and explain the relation of baseline BPD pathology to future NSSI. Methods : Participants with a history of recent repeated NSSI (N = 84) completed baseline measures of BPD pathology, NSSI, and the emotional antecedents and consequences of NSSI, including self-conscious emotions, undifferentiated negative affect, anger, emptiness, sadness, and anxiety; follow-up data on NSSI were collected every three months for one year. Results : Of the emotional consequences of NSSI examined here, only self-conscious emotions significantly predicted the presence and frequency of NSSI during the 12-month follow-up period. Likewise, whereas BPD pathology was not directly associated with later NSSI, both overall BPD pathology and the specific BPD feature of identity problems were indirectly related to the presence of 12-month NSSI through the greater frequency of post-NSSI self-conscious emotions. Limitations : Emotional consequences of NSSI were assessed using a retrospective self-report measure. Only frequency, and not intensity, of emotions before and after NSSI were assessed. Conclusions : Results suggest a distinct role of post-NSSI self-conscious emotions in the maintenance of NSSI among individuals with and without BPD pathology.

Although parent emotion socialization and child temperament are theorized to interact in the prediction of borderline personality disorder (BPD) features, few studies have directly examined these relationships. The present study examined whether parental emotion socialization interacted with behavioral ratings and physiological indicators of emotional vulnerability in the prediction of BPD features among preadolescent children. Participants were 125 children (10–12 years; 55% female) and their parents recruited from the community. Parents and children reported on children’s BPD features and parents completed a measure of supportive and non-supportive emotion socialization. Children’s emotional vulnerability was assessed based on parent-rated negativity/lability and emotion regulation skills and children’s respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity to a social stressor. Several significant interactions of parent supportive reactions, non-supportive reactions, and child emotional reactivity emerged. Children were lowest in BPD features when parents were high in supportive reactions and/or low in non-supportive reactions and the child was low in emotional vulnerability (e.g., low negativity/lability, good emotion regulation skills, or low SCL reactivity to stress). These findings suggest that specific emotion socialization factors in interaction with children’s emotional reactivity may predict risk for BPD features in preadolescence. Future research is needed to replicate these findings and examine whether this interaction prospectively predicts trajectories of BPD features.

Objective Emotion dysregulation is a transdiagnostic construct with relevance to a wide range of mental health outcomes. A growing literature highlights the contribution of positive emotion dysregulation to mental health outcomes. However, there remains limited understanding of the interplay of negative and positive emotion dysregulation on mental health outcomes. To address this limitation, the current study examined whether the association of positive emotion dysregulation to the mental health outcomes of posttraumatic stress disorder (PTSD), depression, and alcohol and drug misuse was attenuated by negative emotion dysregulation. Method Participants were 373 trauma-exposed individuals recruited from Amazon's MTurk (Mage = 35.74 years; 57.1% female; 75.9% White). Results Both negative and positive emotion dysregulation were positively related to PTSD, depression, and alcohol and drug misuse. Moderation analyses showed that negative emotion dysregulation did not attenuate the relations between positive emotion dysregulation and PTSD, depression, and alcohol and drug misuse. Discussion These findings suggest that the relation of positive emotion dysregulation to mental health outcomes may not be dependent on negative emotion dysregulation, supporting the utility of both negative and positive emotion dysregulation in identifying and treating mental health outcomes in trauma-exposed individuals. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Theories of borderline personality disorder (BPD) highlight the central role of emotional dysfunction in this disorder, with a particular emphasis on emotional reactivity and emotion regulation (ER) difficulties. However, research on emotion-related difficulties in BPD has produced mixed results, often related to the particular indices of emotional responding used in the studies. As such, the specific nature of emotional dysfunction in BPD, as well as the extent to which subjective emotion-related difficulties map onto corresponding physiological deficits, remains unclear. This study examined both subjective and physiological indices of emotional reactivity and ER difficulties in response to a social rejection emotion induction (relative to a neutral emotion induction) across three groups of participants: self-harming young adults with BPD, self-harming young adults without BPD, and clinical controls with no self-harm history or BPD. Consistent with the hypotheses, results revealed a lack of convergence between subjective and physiological indices of emotional reactivity and ER difficulties among participants with BPD. Whereas participants with BPD reported both greater emotional reactivity and greater ER difficulties in response to the negative emotion induction than participants without self-harm or BPD, there were no significant differences in physiological indices of emotional reactivity or ER between participants with BPD and either of the control groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This study examined the main and interactive effects of MDD and lifetime nonsuicidal self-injury (NSSI) on current suicide risk and past suicide attempts. We predicted that individuals with a history of NSSI and current MDD would be at greater suicide risk than those with either risk factor alone. An interaction between lifetime MDD and NSSI was hypothesized for past suicide attempts. 204 substance dependent inpatients completed self-report measures and a diagnostic interview. Patients with both a history of NSSI and current MDD, relative to all other groups, had the greatest suicide risk. No support was found for the lifetime MDD by NSSI interaction. Conclusion: Findings suggest the relevance of both NSSI and MDD in suicide risk.

Emotion dysregulation has been theorized to either directly or indirectly drive many of the symptoms associated with borderline personality disorder. In this chapter, several current controversies in this body of work are reviewed. The chapter presents the role of emotion dysregulation in theories of the development and maintenance of borderline personality disorder. Further, it reviews the state of research on emotional responding in borderline personality disorder, focusing on any evidence of emotional sensitivity, reactivity, and time course. Building on this review, the chapter summarizes recent advances in the study of difficulties in emotion regulation capacities and strategies in the context of this disorder. In addition, it outlines the links between emotion dysregulation and other problems in borderline personality disorder. Finally, this chapter highlights the limitations and future directions in this line of work.

BackgroundAlthough Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. The commonly researched 12-month version of DBT is lengthy; this can pose a barrier to its adoption in many health care settings. Further, there are no data on the optimal length of psychotherapy for BPD. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12months of DBT for chronically suicidal individuals with BPD. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment.Methods/designPowered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12months of standard DBT. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Assessments are scheduled at pretreatment and at 3-month intervals until 24months.DiscussionThis is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Examining both clinical and cost effectiveness in 6 versus 12months of DBT will produce answers to the question of how much treatment is good enough. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment.Trial registrationNCT02387736 . Registered February 20, 2015.

Within the United States, risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon’s MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (a) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (b) Impulse was significantly positively associated with risky anal sex acts; and (c) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.

Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.

This pilot study examined the effects of dialectical behavior therapy (DBT) emotion regulation (ER) skills training for borderline personality disorder (BPD). To date, studies have yet to reveal whether specific DBT skill modules uniquely improve ER problems - one of the putative factors considered to underlie clinical problems in BPD. This preliminary examination aimed to characterize the effect sizes of DBT-ER compared to DBT interpersonal effectiveness (DBT-IE) skills training. Women with BPD (N = 19) were randomized to 6-weeks of DBT-ER, DBT-IE, or a control group. BPD symptoms, emotion regulation, and other BPD-relevant outcomes were assessed using self-report and laboratory-based measures. The DBT-ER group demonstrated large effect sizes for improved self-reported reactivity to an emotional stressor, generation of active rather than passive solutions to interpersonal problems, as well as self-reported distress tolerance, mindfulness, and BPD symptoms following treatment. At follow-up, DBT-ER training was also associated with large improvements in ER, social problem solving, and depression. Similarly large effect sizes, however, were sometimes also achieved in the DBT-IE and control condition. Significant condition x time interactions were detected for non-suicidal self-injury and mindfulness, with significant improvements occurring only in the DBT-ER group, whereas such interactions were not detected for other outcomes. These findings, although preliminary, can stimulate future research examining the specificity of DBT skills.

Emerging research suggests that two features of emotional contexts (emotion intensity, emotion type) predict spontaneous use of emotion regulation (ER) strategies. However, prior work has not examined the interactive effects of emotion intensity and emotion type on the selection of specific ER strategies. This is a noteworthy omission because in real life, emotional situations are characterized by a combination of emotion intensity and type. We recruited 562 participants and asked them to report their use of 7 ER strategies across self-identified stressful contexts that varied in emotion intensity (moderate, high) and primary emotion elicited (anger, anxiety, sadness). Participants reported using ER strategies to a greater extent in high versus moderate emotionally intense contexts, and in response to sadness (versus anger). Further, high intensity sadness prompted greater use of expressive suppression than other contexts. Our findings underscore the importance of taking into account emotional contextual features as predictors of spontaneous ER.

The transaction of adolescent’s expressed negative affect and parental interpersonal emotion regulation are theoretically implicated in the development of borderline personality disorder (BPD). Although problem solving and support/validation are interpersonal strategies that foster emotion regulation, little is known about whether these strategies are associated with less BPD severity among adolescents. Adolescent girls (age 16; N = 74) and their mothers completed a conflict discussion task, and maternal problem solving, support/validation, and girls’ negative affect were coded. Girls’ BPD symptoms were assessed at four time points. A 3-way interaction of girls’ negative affect, problem solving, and support/validation indicated that girls’ negative affect was only associated with BPD severity in the context of low maternal support/validation and high maternal problem solving. These variables did not predict changes in BPD symptoms over time. Although high negative affect is a risk for BPD severity in adolescent girls, maternal interpersonal emotion regulation strategies moderate this link. Whereas maternal problem solving coupled with low support/validation is associated with a stronger negative affect-BPD relation, maternal problem solving paired with high support/validation is associated with an attenuated relationship.

African American women are at heightened risk for intimate partner violence (IPV) and its negative consequences, including health-compromising behaviors. Deliberate self-harm (DSH) is one clinically-relevant behavior that has been understudied among African American women generally and those with exposure to IPV in particular. To date, no studies have examined factors that may account for the relationship between IPV and DSH. Therefore, the goal of the present study was to examine the intercorrelations among IPV (physical, psychological, and sexual), PTSD, and DSH history and versatility, and the potentially mediating role of PTSD symptoms in the IPV-DSH relation. Participants were 197 African American community women currently experiencing IPV. Sixty participants (31%) reported a history of DSH. Among participants who reported DSH, there was an average endorsement of 2.3 unique forms of deliberate self-harm (i.e., DSH versatility). Significant positive associations were detected among physical IPV severity, psychological IPV severity, PTSD symptom severity, and DSH history and versatility. PTSD symptom severity mediated the relationships between physical and psychological IPV severity and DSH history and versatility. Results highlight the relevance of PTSD symptoms to DSH and suggest that treatments targeting PTSD symptoms may be useful in reducing DSH among IPV-exposed African American women.

Despite growing evidence for the efficacy of Gratz and colleagues' emotion regulation group therapy (ERGT) for deliberate self-harm (DSH) among women with borderline personality disorder (BPD), the proposed mechanism of change in this treatment (i.e., emotion regulation) remains largely unexamined. This study examined change in emotion dysregulation as a mediator of the effects of this ERGT on DSH and BPD symptoms, as well as the extent to which change in emotion dysregulation during treatment predicts further improvements in DSH during a 9-month follow-up. Participants included 61 female outpatients with BPD and recent DSH who were randomly assigned to receive this ERGT in addition to their ongoing outpatient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of emotion dysregulation, DSH, and BPD symptoms were administered pre- and post-treatment or -waitlist, and at 9-months post-treatment (for participants in both conditions who received ERGT). Results from a series of mediation analyses provide further support for emotion regulation as a mechanism of change in this treatment. Specifically, results revealed that improvements in emotion dysregulation over the course of treatment mediated the observed reductions in BPD cognitive and affective symptoms during treatment and predicted further improvements in DSH during follow-up.

Despite the inclusion of nonsuicidal self-injury disorder (NSSID) in the DSM-5, research on NSSID is limited and no studies have examined the full set of DSM-5 NSSID diagnostic criteria. Thus, this study examined the reliability and validity of a new structured diagnostic interview for NSSID (the Clinician-Administered NSSI Disorder Index; CANDI) and provides information on the clinical characteristics and features of DSM-5 NSSID. Data on the interrater reliability, internal consistency, and construct validity of the CANDI and associated characteristics of NSSID were collected in a community sample of young adults ( N = 107) with recent recurrent NSSI (≥10 lifetime episodes of NSSI, at least one episode in the past year). Participants completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, as well as diagnostic interviews of borderline personality disorder (BPD) and lifetime mood, anxiety, and substance use disorders. The CANDI demonstrated good interrater reliability and adequate internal consistency. Thirty-seven percent of participants met criteria for NSSID. NSSID was associated with greater clinical and diagnostic severity, including greater NSSI versatility, greater emotion dysregulation and psychopathology, and higher rates of BPD, bipolar disorder, posttraumatic stress disorder, social anxiety disorder, and alcohol dependence. Findings provide support for the reliability, validity, and feasibility of the CANDI.

This paper reviews current literature on the links between personality pathology and intentional self-harm, including nonsuicidal self-injury (NSSI) and suicidal behaviors. Specifically, this review highlights recent advances stemming from longitudinal, epidemiological, and health registry studies, as well as emerging research on pathological personality traits and intentional self-harm, and integrates current knowledge across dimensional and categorical frameworks to provide recommendations for clinical practice and future research. This review provides strong evidence that personality disorders marked by intense and unstable negative affect, detachment/low extraversion, aggression/hostility, and specific facets of impulsivity may be considered risk factors for suicidal behaviors. Further, there is some evidence of a stronger relation between maladaptive personality traits and suicidal versus non-suicidal intentional self-harm.

Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.

Despite preliminary evidence that individuals with borderline personality disorder (BPD) demonstrate deficits in learning from corrective feedback, no studies have examined the influence of emotional state on these learning deficits in BPD. This laboratory study examined the influence of negative emotions on learning among participants with BPD (n = 17), compared with clinical (past-year mood/anxiety disorder; n = 20) and healthy (n = 23) controls. Participants completed a reinforcement learning task before and after a negative emotion induction. The learning task involved presenting pairs of stimuli with probabilistic feedback in the training phase, and subsequently assessing accuracy for choosing previously rewarded stimuli or avoiding previously punished stimuli. ANOVAs and ANCOVAs revealed no significant between-group differences in overall learning accuracy. However, there was an effect of group in the ANCOVA for postemotion induction high-conflict punishment learning accuracy, with the BPD group showing greater decrements in learning accuracy than controls following the negative emotion induction.

Despite growing research on emotion regulation (ER) strategies and psychopathology, research has primarily focused on identifying one-to-one associations between ER strategies and symptoms. Thus, little is known about how patterns in the repertoires of ER strategies are associated with different mental disorders. We utilised latent class analysis to identify distinct repertoires of ER strategies, and their links with various psychopathology domains (i.e., anxiety, depression, disordered eating, borderline personality). Participants (N = 531) reported on their use of seven ER strategies in six recalled stressful contexts, as well as on their symptoms of psychopathology. We identified five classes of ER strategies: Low Regulators (n = 168), High Regulators (n = 140), Adaptive Regulators (n = 99), Worriers/Ruminators (n = 96) and Avoiders (n = 28). Generally, High Regulators and Worriers/Ruminators endorsed greater levels of psychopathology, relative to Low and Adaptive Regulators. Our findings underscore the importance of characterising the dynamics of ER repertoires when seeking to understand links between ER strategies and psychopathology.

Although a wealth of literature has examined the role of emotion-related factors in deliberate self-harm (DSH), less is known about neurocognitive factors and DSH. In particular, despite theoretical literature suggesting that deficits in executive attention may contribute to engagement in DSH, studies have not yet examined the functioning of this attentional network among individuals with DSH. The present study sought to address this gap in the literature by examining the functioning of the alerting, orienting, and executive attentional networks among participants with a recent history of DSH (n=15), a past history of DSH (n=18), and no history of DSH (n=21). Controlling for borderline personality pathology and depression symptoms, participants with a recent history of DSH exhibited deficits in executive attention functioning relative to participants without any history of DSH. No differences were found in terms of performance on the alerting or orienting attentional networks. These results provide preliminary support for the association between executive attention deficits and DSH.

Introduction The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement. Method The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (Mage = 35.62, 55.4% women, 77.0% White). Results Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model. Conclusions Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.

Elevated rates of borderline personality disorder (BPD) have been found among individuals with substance use disorders (SUDs), especially cocaine-dependent patients. Evidence suggests that cocaine-dependent patients with BPD are at greater risk for negative clinical outcomes than cocaine-dependent patients without BPD and BPD-SUD patients dependent on other substances. Despite evidence that cocaine-dependent patients with BPD may be at particularly high risk for negative SUD outcomes, the mechanisms underlying this risk remain unclear. The present study sought to address this gap in the literature by examining cocaine-related attentional biases among cocaine-dependent patients with (n = 22) and without (n = 36) BPD. On separate days, participants listened to both a neutral and a personally-relevant emotionally evocative (i.e., trauma-related) script and then completed a dot-probe task with cocaine-related stimuli. Findings revealed a greater bias for attending to cocaine-related stimuli among male cocaine-dependent patients with (vs. without) BPD following the emotionally evocative script. Study findings suggest the possibility that cocaine use may have gender-specific functions among SUD patients with BPD, with men with BPD being more likely to use cocaine to decrease contextually induced emotional distress. The implications of our findings for informing future research on cocaine use among patients with BPD are discussed.

Emotional reactivity has been theorized to play a central role in borderline personality (BP) pathology. Although growing research provides evidence for subjective emotional reactivity in BP pathology, research on physiological or biological reactivity among people with BP pathology is less conclusive. With regard to biological reactivity in particular, research on cortisol reactivity (a neurobiological marker of emotional reactivity) in response to stressors among individuals with BP pathology has produced contradictory results and highlighted the potential moderating role of PTSD-related pathology. Thus, this study sought to examine the moderating role of PTSD symptoms in the relation between BP pathology and both subjective (self-report) and biological (cortisol) emotional reactivity to a laboratory stressor. Participants were 171 patients in a residential substance use disorder treatment center. Consistent with hypotheses, results revealed a significant main effect of BP pathology on subjective emotional reactivity to the laboratory stressor. Furthermore, results revealed a significant interaction between BP pathology and PTSD symptoms in the prediction of cortisol reactivity, such that BP pathology was associated with heightened cortisol reactivity only among participants with low levels of PTSD symptoms. Similar findings were obtained when examining the interaction between BP pathology and the reexperiencing and avoidance/numbing symptoms of PTSD specifically. Results highlight the moderating role of PTSD symptoms in the BP–reactivity relation.

This study examined emotional reactivity and emotion regulation strategies used by participants high (n = 41) and low (n = 55) in borderline personality (BP) features. Participants were randomly assigned to a neutral or fear emotion induction, and emotional responses (self-report and psychophysiological) were assessed. Participants also reported the types of strategies they used to regulate their emotions during the emotion induction. The high-BP (but not low-BP) participants reported greater fear, Upset, and hostility in the fear condition compared with the neutral condition. The participants in the fear condition evidenced vagal withdrawal, relative to the neutral condition, although there was some evidence of vagal withdrawal among the high-BP group in the neutral condition as well. Further, the high-BP (vs. low-BP) participants reported greater use of distraction, cognitive reappraisal, and emotion suppression, and less use of emotional acceptance. Reported use of acceptance partially mediated the moderation effect of BP features on the relationship between condition and reported hostility.

This study sought to build upon existing research on interpersonal sensitivity in borderline personality disorder (BPD) by examining whether emotion dysregulation mediates the relationship between BPD and cognitive and emotional responses to social rejection. Participants with (n = 53) and without (n = 34) BPD reported on levels of negative affect and threat to four social needs (perceived control, belonging, selfesteem, and meaningful existence) in response to a laboratory-based social ostracism task (Cyberball). Results revealed heightened interpersonal (rejection) sensitivity among BPD (vs. non-BPD) participants, as evidenced by heightened threat to all social needs and nonspecific distress (although not overall negative affect) in response to the task. Furthermore, both overall emotion dysregulation and the specific dimensions involving emotion modulation strategies, emotional clarity, and the control of behaviors when distressed mediated the relationship between BPD status and several cognitive (threats to meaningful existence, belonging, and self-esteem) and emotional (nonspecific distress) responses to the task.

Objective Intimate partner violence (IPV) is associated with heightened psychopathology symptoms and risky behaviors. However, extant investigations are limited by their focus on IPV victimization, despite evidence to suggest that victimization and aggression frequently co-occur. Further, research on these correlates often has not accounted for the heterogeneity of women who experience victimization. Method The present study utilized latent profile analysis to identify patterns of physical, psychological, and sexual victimization and aggression in a convenience sample of 212 community women experiencing victimization (Mage = 36.63, 70.8% African American), as well as examined differences in psychopathology symptoms (i.e., posttraumatic stress symptoms [PTSS] and depressive symptoms) and risky behaviors (i.e., drug problems, alcohol problems, deliberate self-harm (DSH), HIV-risk behaviors) across these classes. Results Four classes of women differentiated by severities of victimization and aggression were identified. Greater psychopathology symptoms were found among classes defined by greater victimization and aggression, regardless of IPV type. Risky behaviors were more prevalent among classes defined by greater sexual victimization and aggression in particular. Conclusions Findings highlight the importance of developing interventions that target the particular needs of subgroups of women who experience victimization. (PsycINFO Database Record

Despite literature highlighting the relevance of negative and positive emotions to risky behaviors, little research has examined the emotion-dependent context of risky behaviors. This study sought to develop and validate a comprehensive measure of the frequency and emotion-dependent context of distinct clinically-relevant risky behaviors (the Risky Behavior Questionnaire [RBQ]), as well as to examine the unique relations of the RBQ Negative and Positive Scales (which assess the general tendency to engage in risky behaviors in the context of negative versus positive emotions, respectively) to specific risky behaviors. Participants were 176 patients in a residential substance use disorder treatment facility (M age = 34.18; 65.3% White, 53.4% female). Results provided support for the construct and incremental validity (relative to extant measures of related constructs) of the RBQ Scales, as well as the differential relevance of RBQ Negative and Positive Scales to specific risky behaviors.

Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and nonpsychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (vs. suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.