Ann Berens

The Emotion Regulation Function of Nonsuicidal Self-Injury: A Momentary Assessment Study in Inpatients With Borderline Personality Disorder Features.

Studies using retrospective self-report or proxies of nonsuicidal self-injury (NSSI) in the lab have shown that NSSI is often preceded by intense negative emotions and followed by a decrease in negative emotions/tension, suggesting an emotion regulation function of NSSI. To investigate this emotion regulation function of NSSI in a more ecologically valid way, we used experience sampling methods to examine the temporal relationship between NSSI behavior and emotional experiences throughout the day in 30 inpatients currently staying in psychiatric hospitals. Because NSSI is especially prevalent and severe in patients with a borderline personality disorder (BPD), we focused on patients with high levels of BPD symptomatology. Results confirmed that high levels of negative emotion prospectively predicted a higher probability of engaging in NSSI in the next time interval. However, the occurrence of NSSI itself was related to concurrent increases in negative emotion and decreases in positive emotion, and even prospectively predicted an increase in negative emotion in the consecutive time interval. These preliminary results show that on a time scale of hours, instead of resulting in emotional relief, NSSI seems to be associated with a further increase in negative emotionality, shedding light on the cyclic nature of NSSI.

Emotional Switching in Borderline Personality Disorder: A Daily Life Study

Despite large efforts to understand emotional instability in borderline personality disorder (BPD), it is still unclear exactly how this is manifested in the daily lives of people suffering from the disorder. Building on theoretical and clinical observations of BPD, we propose that the emotional instability in BPD particularly consists of the occurrence of strong changes between positive and negative emotional states from 1 moment to the next, labeled emotional switching. We tested this proposal by means of an experience sampling study in which 30 BPD patients and 28 healthy controls reported in their daily lives the level of pleasantness/unpleasantness of their emotional states 10 times a day for 8 consecutive days using handheld palmtops. Results showed that although BPD patients did not differ from healthy controls regarding their overall tendency to switch from a positive to a negative emotional state or vice versa, the size of such changes between positive and negative states was found to be significantly larger in BPD patients. In contrast, the magnitude of emotional changes that remained within the negative emotional range or positive emotional range was not particularly larger for BPD patients compared with healthy participants. These findings imply that the emotional instability in BPD is particularly characterized by larger changes from positive to negative states and vice versa, rather than overall larger changes in intensity, providing insight into possible processes underlying emotion dysfunction in BPD.

Age of onset of non-suicidal self-injury in Dutch-speaking adolescents and emerging adults: An event history analysis of pooled data.

OBJECTIVE Non-Suicidal Self-Injury (NSSI) has emerged as an important mental-health concern. However, epidemiological features like age of onset of NSSI have remained understudied. Therefore, the current study investigated the distribution of age of onset of NSSI in pooled sample of Dutch-speaking adolescents and emerging adults using event history analysis. METHOD Eleven datasets measuring age at first NSSI in community and clinical participants collected by researchers in the Dutch-speaking part of Belgium were pooled together. The final dataset consisted of 1973 community males, 1901 community females, and 505 clinical females. Discrete-time event history analysis was used to model the effect of gender and psychiatric disorders on the age of onset of NSSI. RESULTS Twenty-one percent of adolescents from the community samples engaged in at least one episode of NSSI by the age of 25years. Irrespective of the type of sample (community or psychiatric disorder), the probability of age of onset peaked around the age of 14-15years. A second peak was observed around the age of 20 and 24years in the community and psychiatric samples respectively. CONCLUSIONS Psychosocial interventions for prevention of NSSI should not only target adolescence through school mental health programs but also target emerging adults at the university level.

Identity Processes and Statuses in Patients with and without Eating Disorders

Problems with identity formation are associated with a range of psychiatric disorders. Yet, the mechanisms underlying such problems and how they are refined into specific diagnostic presentations require further investigation. The present study investigated identity processes among 123 women with eating disorders (ED) and age-matched community controls via a newly developed identity model. Several clinical outcome variables were assessed. Patients with ED scored lower on committing to and identifying with identity-related choices and scored higher on maladaptive or ruminative exploration, identity diffusion and identity disorder. They also experienced less identity achievement as compared with controls. The identity disorder status was associated with the highest scores on anxiety, depression, borderline personality disorder symptoms, and non-suicidal self-injury and the lowest scores on need satisfaction. Results indicate that patients with ED experience more identity problems than community controls and those captured by an identity disorder status experience the most problematic psychosocial functioning. Copyright

The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder: “Actions instead of words”

INTRODUCTION Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to effectively regulate emotions. A large amount of BPD patients engage in non-suicidal self-injury (NSSI). Given the NSSI contributes to serious health risks, it is important to know why some BPD patients engage in NSSI and others do not. A possible associated factor of NSSI in BPD may be alexithymia, which reflects difficulties in identifying and communicating feelings. Therefore the aim of the present study was to investigate whether NSSI was associated with alexithymia and whether this association still stood when controlling for gender and depression. METHODS The current study explored the relationship between NSSI and alexithymia in 185 BPD patients by means of the Self-Injury Questionnaire-Treatment Related and the Toronto Alexithymia Scale-20 (TAS). RESULTS Of the 185 BPD inpatients, 82.7% reported life-time NSSI, of whom 52.9% were still engaging in current NSSI; and 71.3% scored in the alexithymic range (cut-off score≥61). Current NSSI was significantly associated with TAS-total. Additionally, when considering the separate TAS subscales Difficulties Describing Feelings (DDF), Difficulties Identifying Feelings (DIF) and Externally Oriented Thinking (EOT), only DDF was significantly associated with NSSI, even after controlling for gender and depression. CONCLUSION These results suggest that NSSI in BPD patients is associated with alexithymia. More specific, difficulties describing feelings can lead to NSSI, independently of the depressive status of the BPD patient. The implications for clinical treatment of self-injurious BPD patients will be discussed.

The affect stabilization function of nonsuicidal self injury in borderline personality disorder: An ecological momentary assessment study.

Nonsuicidal Self-Injury (NSSI) is prominent in individuals with Borderline Personality Disorder (BPD), and there is abundant evidence that affect regulation plays an important role in NSSI in the majority of patients. Affective variability is a core feature of BPD, and thus, we hypothesize that NSSI has an affect stabilization function in BPD. Affect stabilization is a process through which individuals attempt to make their affect more stable by reducing affective variability. We tested this hypothesis in 32 participants with BPD who reported on their NSSI and affect -using a displeasure-pleasure (valence) and activation-deactivation (activation) dimension- in an experience sampling study with 10 random signals scheduled per day for 8 days. Results indicated that individuals who engaged in NSSI show more Within Subject (WS) variance in valence and activation than individuals who did not engage in NSSI. However, within the NSSI patients, individuals who engaged more frequently in NSSI during the study showed less WS variance in valence and activation than patients who engaged less frequently in NSSI. This suggests that NSSI may be reinforced by its affect stabilization function. In the discussion, we explore alternative explanations for the relation between NSSI and affective variability, and consider the clinical implications.

Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients

ABSTRACT Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory—2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.

Autobiographical Memory Specificity and Non-Suicidal Self-Injury in Borderline Personality Disorder

It has been suggested that patients diagnosed with borderline personality disorder (BPD) use a variety of maladaptive affect-regulation strategies, including non-suicidal self-injury (NSSI). Another, cognitive manner considered to regulate negative affect, is overgeneral memory (OGM). OGM refers to the tendency to recall categories of events, rather than specific episodes. OGM is frequently observed in depressed and traumatised patients. Contrary to the expectations, patients with BPD only inconsistently show OGM. This study investigated how NSSI and OGM relate to each other in BPD patients. Based on earlier findings (Startup et al., 2001), we hypothesized that NSSI and OGM would be inversely related. Fifty three BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Autobiographical Memory Test to assess OGM, and the Self-Injury Questionnaire – Treatment Related (SIQ-TR) to assess NSSI. We found no significant differences in OGM between patients with and without NSSI. However, we found that participants who used more NSSI methods showed less OGM, but this association disappeared when we controlled for age. We propose a balance-model of affect-regulation as one possible explanation for the negative relationship between these two affect-regulation strategies.

Are emotional action tendencies and attentional bias related to temperament dimensions in patients with borderline personality disorder

Disturbances in emotion regulation have been identified as a core feature of patients with a borderline personality disorder (BPD). Findings of studies using experimental measures of emotion processing are mixed, which may be partially explained by the heterogeneity of the BPD population. To address this issue, we investigated differences in experimental measures of emotional action tendencies (approach-avoidance behaviour) and attentional bias to emotional stimuli in BPD subtypes. Data of the Approach-Avoidance Task (AAT) and the Emotional Stroop Task (EST) were collected in 140 BPD patients, previously clustered into four BPD subtypes based on temperament dimensions. We investigated (1) the relationship between temperament dimensions and the performance on the AAT and EST and (2) compared performance on these tasks in previous defined BPD subtypes. The results of the present study demonstrated a positive relationship between effortful control (EC) and AAT effect-scores. A higher level of EC was positively associated with a general emotional action tendency towards faces with directed gaze, even when controlling for gender, age and BPD severity. Preliminary results on the comparison of the BPD subtypes demonstrated no significant differences in AAT and EST performance. These findings emphasize the relevance of EC in emotional action tendencies in BPD patients.