The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

Abstract

Background Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD). Objective This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms. Method A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses. Results Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding ‘impulse control difficulties’ ( F (1,299) = 38.97, p < .001, η p 2 = .115), ‘limited access to emotion regulation strategies’ ( F (1,299) = 4.66, p = .032, η p 2 = .015), and ‘lack of emotional clarity’ ( F (1,299) = 9.38, p = .002, η p 2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R 2 = .429). Subscale analyses revealed ‘impulse control difficulties’ as the aspect of difficulties in emotion regulation that has the greatest impact on this association ( B = .021, 95% CI [.003; .045]). Conclusions Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation

“…In line with earlier research, emotion regulation difficulties mediated the relationship between childhood emotional maltreatment and BPD psychopathology (Carvalho Fernando et al, 2014 ; Gratz et al, 2008 ; Peng et al, 2021 ; van Dijke et al, 2013 , 2018 ). Similar indirect effects were found in a wide variety of samples, including university students (Kuo et al, 2015 ), a community sample (Fossati et al, 2016 ), psychiatric outpatients (Rosenstein et al, 2018 ; Schaich et al, 2021 ), inpatients (Bertele et al 2022 ), and substance abusers (Gratz et al, 2008 ). Like most of these studies, we conceptualized emotion regulation as a multi-dimensional construct based on the model by Gratz and Roemer ( 2004 ).…”

“…These results are in line with our hypothesis and previous findings. Numerous studies have established links between childhood emotional maltreatment, emotional dysregulation, and BPD psychopathology (Carvalho Fernando et al, 2014 ; Fossati et al, 2016 ; Gratz et al, 2008 ; Kuo et al, 2015 ; Peng et al, 2021 ; Rosenstein et al, 2018 ; Schaich et al, 2021 ; van Dijke et al, 2013 , 2018 ) or BPD diagnosis (Bertele et al, 2022 ).…”

“…Numerous studies suggest that childhood emotional maltreatment is associated with more emotion dysregulation, which in turn is predictive of more severe BPD symptoms (Carvalho Fernando et al, 2014 ; Gratz et al, 2008 ; Peng et al, 2021 ; van Dijke et al, 2013 , 2018 ). Such associations were found in a wide variety of samples, including university students (Kuo et al, 2015 ), a community sample (Fossati et al, 2016 ), psychiatric outpatients (Rosenstein et al, 2018 ; Schaich et al, 2021 ) and inpatients (Bertele et al 2022 ), and substance abusers (Gratz et al, 2008 ). Two studies found a prominent role of impulse control difficulties (Oshri et al, 2015 ; Schaich et al, 2021 ) and limited access to regulation strategies (Guérin-Marion et al, 2020 ).…”

“…Such associations were found in a wide variety of samples, including university students (Kuo et al, 2015 ), a community sample (Fossati et al, 2016 ), psychiatric outpatients (Rosenstein et al, 2018 ; Schaich et al, 2021 ) and inpatients (Bertele et al 2022 ), and substance abusers (Gratz et al, 2008 ). Two studies found a prominent role of impulse control difficulties (Oshri et al, 2015 ; Schaich et al, 2021 ) and limited access to regulation strategies (Guérin-Marion et al, 2020 ).…”

The Impact of Childhood Maltreatment on Risk of Borderline Personality Disorder

“…In all the subscales of the Emotion Regulation Scale (DERS), the score of patients with BPD is higher than DD. Patients with BPD have significant difficulties in emotion regulation and impulse control [9]. Mindfulness refers to the ability to be aware of the presence.…”