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

Abstract

Background: Although difficulties in emotion regulation (ER) are considered a core feature of borderline personality disorder (BPD), the specific strategies that individuals with BPD most commonly use, their diagnostic specificity, and their associations with harmful behaviors have not been firmly established. Sampling and Methods: Individuals with BPD (n = 30), mixed anxiety and/or depressive disorders (MAD; n = 30), and healthy controls (HC; n = 32) completed questionnaires assessing both cognitive ER strategies (e.g., cognitive reappraisal) and potentially harmful behaviors that individuals might use to regulate their emotions (e.g., self-injury). Results: BPD subjects endorsed more maladaptive cognitive ER strategies and fewer adaptive strategies compared to HC. Compared to MAD subjects, BPD individuals endorsed more maladaptive cognitive ER strategies, but only when those with subthreshold symptoms in the MAD group were excluded. BPD also endorsed engaging in potentially harmful behaviors more often than both HC and MAD. Discriminant analysis revealed that MAD endorsed lower rates of problem-solving and cognitive reappraisal compared to both HC and BPD. Higher maladaptive and lower adaptive ER strategies were associated with higher rates of potentially harmful behaviors, although the specific strategies differed for MAD versus BPD. Conclusions: BPD and MAD endorse cognitive ER strategies with a comparable frequency, although BPD subjects engage in potentially harmful behaviors more often. Subthreshold BPD symptoms may also affect rates of ER strategy use in individuals with other mental disorders.

Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD)

“…Our results thus suggest that, similar to BPD, poor cognitive emotion regulation strategies such as 'rumination' as well as others such as 'self-blame' , 'blaming others' and 'catastrophizing' to a lesser extent, play a role in ED in ADHD [17]. Of note, our results also suggest that ADHD patients mainly differ from controls by a higher tendency to use nonadaptive cognitive strategies rather than adaptive ones, similar to BPD patients [18,51]. Nonetheless, ADHD patients still had overall less emotion sensitivity, less emotion arousal and intensity, and less persistence of the emotion than BPD and BPD + ADHD patients.…”

“…ADHD patients were compared to a sample of controls extracted from published data that have used the ERS, the CERQ or the BES-A [18,39,40,45,47,48]. Of note, controls were not matched for age or gender.…”

“…Univariate comparisons between clinical groups were conducted using the chi square test for qualitative variables (gender, comorbidity, treatment) or Fisher's exact test when assumption of frequencies for chi square test were not met, and a one-way ANOVA for quantitative variables (age, clinical scales). T-tests were used to compare ADHD patients to a sample of controls extracted from published data that have used the ERS, the CERQ or the BES-A [18,39,40,45,47,48]. Statistical significance was accepted for p < 0.05.…”

“…Besides the usual description of ED in BPD, namely heightened emotional reactivity to environmental stimuli, inadequate cognitive emotion regulation strategies resulting form difficulty identifying, differentiating, and labeling emotions have also been suggested as important components of ED [17][18][19][20][21][22]. BPD patients indeed engage in more maladaptive cognitive emotion regulation strategies such as 'thought suppression' (efforts to suppress emotional response to a subjective experience) and 'rumination' (disproportionate focus on emotional experiences) and show fewer adaptive strategies such as 'cognitive reappraisal' (have a different perspective on a situation to change oneself feeling) or 'acceptance' (endorse a nonjudgmental stance toward internal experiences) compared to healthy individuals [18][19][20][21][22]. The use of more maladaptive cognitive strategies has been associated, in BPD, with higher severity of the disorder (more harmful behaviours) [18].…”

“…BPD patients indeed engage in more maladaptive cognitive emotion regulation strategies such as 'thought suppression' (efforts to suppress emotional response to a subjective experience) and 'rumination' (disproportionate focus on emotional experiences) and show fewer adaptive strategies such as 'cognitive reappraisal' (have a different perspective on a situation to change oneself feeling) or 'acceptance' (endorse a nonjudgmental stance toward internal experiences) compared to healthy individuals [18][19][20][21][22]. The use of more maladaptive cognitive strategies has been associated, in BPD, with higher severity of the disorder (more harmful behaviours) [18]. Finally, poor mentalizing capacities (the process sustaining our understanding of human action as driven by mental states including, among other dimensions, empathy) are also considered to underlie ED in BPD.…”