Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations

Abstract

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal for Building a Life Worth Living.

Perfil psicopatológico y de personalidad en dolor crónico no oncológico nociceptivo y neuropático: Estudio transversal comparativo

“…As pain intensity increased so too did the irritable, negativistic, and antisocial attitudes (denial of chronic pain; Campbell et al, 2015 ), as well as the depressive and compulsive attitudes, which are inverse to the pain intensity and can exemplify how control and rigidity of obsession and compulsion serve as a tool to distract from and minimize the pain ( González et al, 2007 ; Ibrahim et al, 2020 ; Millon et al, 2009 ; Soriano & Monsalve, 2018 ). In the neuropathic group, there was no relationship with the intensity of the pain, but there was with the progression, showing dependent and paranoid tendencies (boosting both conditions with the passage of time), as well as schizoid, negativistic, and limiting behaviors, going from patterns with dysregulated affectivity (Cluster B) to inhibited and isolated patterns (Cluster A and C), which support the tendency to lability when faced with chronic pain ( Campbell et al, 2015 ; Cavicchioli et al, 2021 ; Shapiro et al, 2020 ). This group also shows a reverse association (as a possible tool for coping with chronic pain) regarding histrionic and narcissistic patterns with depressive and anxiety symptoms ( Ajo et al, 2020 ; Campbell et al, 2015 ; Soriano & Monsalve, 2018 ).…”

Short- and Long-Term Outcomes of an Adventure Therapy Programme on Borderline Personality Disorder: A Pragmatic Controlled Clinical Trial

“…The use of maladaptive emotional regulation strategies (toxicity, binge eating, sexual promiscuity, poor adherence to treatment, etc.) [ 61 ] and the psychotropic drugs used to treat this disorder [ 62 ] may directly increase the likelihood of developing physical illness. In addition, dysfunction of the parasympathetic component of the autonomic nervous system (ANS) [ 63 ] and hyperstimulation of the hypothalamic–pituitary–adrenal–cortisol axis [ 64 ] have been described in these patients, increasing the likelihood of developing these diseases.…”

The forgotten patient: A psychological perspective on the implementation of bariatric surgery guidelines

“…Chronic feelings of emptiness, strong emotional responses and impulsivity are all associated with a BPD diagnosis with binge eating specifically listed as one example of a behavior characterizing impulsivity in the list of DSM‐5 diagnostic criteria 60 . Therefore, it is conceptually unsurprising that maladaptive emotional regulation strategies are significant mediators of the relationship between BPD and dysfunctional behaviors, one of which is binge eating 77,78 . Based on our clinical experience and DSM‐5 criterions for both BPD and BED, there is clear overlap between the two presentations (i.e., chronic feelings of emptiness, strong emotional response, impulsivity).…”