An exploration of the emotional cascade model in borderline personality disorder.

Abstract

The Emotional Cascade Model proposes that the emotional and behavioral dysregulation of individuals with borderline personality disorder (BPD) may be fundamentally linked through emotional cascades, vicious cycles of intense rumination and negative affect that may induce aversive emotional states. In order to reduce this aversive emotion, dysregulated behaviors such as nonsuicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in a sample enriched with subjects meeting diagnostic criteria for BPD. The first part of the study explored a structural equation model that examined the mediational effects of emotional cascades on the relationship between BPD symptoms and dysregulated behavior and found evidence for full mediation, even after controlling for symptoms of depression and other Cluster B disorders. The second part of the study examined the effects of a rumination induction conducted with the intention of eliciting emotional cascades in those diagnosed with BPD. The results demonstrated that individuals with BPD experienced greater reactivity and intensity of negative affect, but not of positive affect, following the procedure -even when controlling for current depressive symptoms. Future directions and clinical implications for the Emotional Cascade Model are discussed. Keywordsborderline personality disorder; emotion regulation; rumination; suicide attempts; binge-eating An Exploration of the Emotional Cascade Model in Borderline Personality DisorderBorderline personality disorder (BPD) is a disorder in which affected individuals experience difficulties with affective instability and regulation (Koenigsberg, et al., 2002;Yen, Zlotnick, & Costello, 2002) as well as dysregulated behaviors, such as non-suicidal self-injury (NSSI) and binge-eating (Brown, Comtois, & Linehan, 2002;Marino & Zanarini, 2001). Yet, the specific nature of this relationship between emotional and behavioral dysregulation has been somewhat elusive. A recent theoretical model, the Emotional Cascade Model (Selby & Joiner, in press;Selby, Anestis, & Joiner, 2008), suggests that the relationship between emotional and behavioral dysregulation in BPD may be explained by rumination. This is because intense Address correspondence to: Thomas E. Joiner, Jr., Florida State University, Tallahassee, Florida 32306-1270, joiner@psy.fsu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2...

Cognitive Emotion Regulation Strategies in Borderline Personality Disorder: Diagnostic Comparisons and Associations with Potentially Harmful Behaviors

“…Results suggest that the maintenance of emotion dysregulation in BPD may stem from the selection of maladaptive ER strategies more often than adaptive ER strategies [25]. These findings also extend previous studies showing significant associations between higher BPD symptoms, higher frequencies of maladaptive ER strategies, and lower frequencies of adaptive ER strategies [10, 12, 26-34] by using diagnostically interviewed samples.…”

“…Consistent with this notion are studies indicating that higher self-reported and clinician-rated levels of BPD symptoms are associated with a lower frequency of using cognitive reappraisal, problem-solving, and acceptance [26-30]. Associations have also been found between higher BPD symptoms and more frequent utilization of suppression, rumination, and avoidance [9, 10, 31-34]. People with BPD may also have more limited emotional and physiological benefits when using more adaptive cognitive ER strategies.…”

“…We hypothesized that individuals with BPD would report more frequent maladaptive cognitive ER strategies and potentially harmful behaviors compared to MAD and HC, as well as fewer adaptive cognitive ER strategies. Extending the emotional cascade theory of Selby et al [10], we also anticipated that higher frequencies of maladaptive and fewer adaptive cognitive ER strategies would be correlated with potentially harmful behaviors, lending greater precision to the model by specifying which types of cognitive ER strategies could lead individuals with BPD to engage in harmful behaviors (and whether this relationship is specific to BPD compared to MAD).…”

“…Disruptions to the development of normal ER abilities include a reduced ability to understand, label, regulate, or tolerate emotional responses [1, 2], leading to a difficulty regulating intense negative emotions using cognitive ER strategies alone. Individuals with BPD may therefore turn to behavioral strategies to regulate their emotions, although the more problematic ones include potentially dangerous behaviors (e.g., self-injury, binge eating, and substance use), which might perpetuate symptoms of emotion dysregulation over the long-term [9, 10]. Questions remain as to why individuals with BPD engage in such dangerous regulatory behaviors despite clearly safer options, including those that occur primarily at the level of cognition.…”

“…Crucially, there may also be a connection between rates of cognitive ER strategies in individuals with BPD and their likelihood of engaging in harmful behaviors. Selby et al [10] have suggested that “emotional cascades” in BPD occur when rumination on negative emotions produces a positive feedback loop between rumination and negative affect. According to the model, harmful dysregulated behaviors (e.g., self-injury, substance use) are considered effective distractions from ruminating on negative emotions and work to “short-circuit” the emotional cascade.…”