Katherine L. Dixon-Gordon

Broadening the scope of research on emotion regulation strategies and psychopathology.

Despite the increasing interest in the study of emotion regulation strategies and psychopathology, researchers have predominantly focused on covert emotion regulation strategies—that is, those strategies that occur within the individual (e.g., cognitive reappraisal, suppression). Conversely, less attention has been devoted to the examination of the relationship between psychopathology and overt emotion regulation strategies (e.g., drinking alcohol, seeking advice). This has resulted in a limited understanding of the complex repertoire of emotion regulation strategies that individuals possess, and how patterns in the use of strategies might relate to psychopathology. We asked 218 undergraduates to report on their habitual use of 15 covert and overt emotion regulation strategies and symptoms of seven different mental disorders. Overt strategies were associated with symptoms and, at times, they predicted psychopathology above and beyond the more frequently studied covert strategies. These findings have implications for developing a more sophisticated understanding of patterns of adaptive and maladaptive emotion regulation.

Non-Suicidal Self-Injury Within Offender Populations: A Systematic Review

Non-suicidal self-injury (NSSI), defined as deliberate self-directed tissue damage, presents a serious health concern for offender populations. Approximately one-third of offenders report a history of NSSI, and it is the most common reason for mental health treatment within correctional settings. To date, no review exists with a specific focus on NSSI in criminal justice contexts. Therefore, the primary aim of this article is to review research on NSSI within correctional settings. Specifically, we explore the role of risk factors for NSSI. We also examine the functions of NSSI within correctional contexts. In addition, we evaluate the evidence for potential assessment tools and treatments for NSSI. Taken together, our review suggests that risk factors for NSSI must be considered differently in correctional settings, due to the high base rates of these vulnerabilities. Further, although environmental control is a more salient function of NSSI within correctional settings, the primary motive for engaging in this behavior remains emotion regulation. Finally, despite the emergence of several promising treatments for NSSI within correctional settings, larger scale studies are necessary to determine the efficacy of these interventions.

Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index.

Despite the inclusion of nonsuicidal self-injury disorder (NSSID) in the DSM-5, research on NSSID is limited and no studies have examined the full set of DSM-5 NSSID diagnostic criteria. Thus, this study examined the reliability and validity of a new structured diagnostic interview for NSSID (the Clinician-Administered NSSI Disorder Index; CANDI) and provides information on the clinical characteristics and features of DSM-5 NSSID. Data on the interrater reliability, internal consistency, and construct validity of the CANDI and associated characteristics of NSSID were collected in a community sample of young adults (N = 107) with recent recurrent NSSI (≥10 lifetime episodes of NSSI, at least one episode in the past year). Participants completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, as well as diagnostic interviews of borderline personality disorder (BPD) and lifetime mood, anxiety, and substance use disorders. The CANDI demonstrated good interrater reliability and adequate internal consistency. Thirty-seven percent of participants met criteria for NSSID. NSSID was associated with greater clinical and diagnostic severity, including greater NSSI versatility, greater emotion dysregulation and psychopathology, and higher rates of BPD, bipolar disorder, posttraumatic stress disorder, social anxiety disorder, and alcohol dependence. Findings provide support for the reliability, validity, and feasibility of the CANDI.

Self-injurious behaviors in posttraumatic stress disorder: An examination of potential moderators

BACKGROUND Despite increasing evidence for a relation between posttraumatic stress disorder (PTSD) and self-injurious behaviors (SIB), limited research has examined the factors that may moderate the associations between PTSD and both nonsuicidal SIB (deliberate self-harm; DSH) and suicidal SIB (suicide attempts). Nonetheless, research suggests that characteristics of the traumatic event, co-occurring borderline personality disorder (BPD), and emotion dysregulation may influence the relations between PTSD and SIB. METHODS Thus, the aim of this study was to examine the moderating role of these factors in the association between PTSD and SIB (including history and frequency of DSH and suicide attempts, and DSH versatility) among a sample of substance use disorder inpatients with (n=116) and without (n=130) a history of PTSD. RESULTS Results from stepwise regression analyses indicate that sexual assault-related PTSD predicted suicide attempt frequency and DSH versatility among those with PTSD. Furthermore, results from hierarchical linear and logistic regression analyses suggest that co-occurring BPD moderates the relationship between PTSD and both DSH history and versatility and emotion dysregulation moderates the relationship between PTSD and DSH frequency. Specifically, the relations between PTSD and DSH outcomes were stronger among participants with co-occurring BPD and higher levels of emotion dysregulation. LIMITATIONS This study is limited by its reliance on cross-sectional, self-report data. CONCLUSIONS Despite limitations, findings suggest distinct risk factors for suicide attempts and DSH, and highlight the importance of examining characteristics of the trauma and associated BPD and emotion dysregulation in assessing risk for SIB in PTSD.

Multimodal assessment of emotional reactivity in borderline personality pathology: the moderating role of posttraumatic stress disorder symptoms

Emotional reactivity has been theorized to play a central role in borderline personality (BP) pathology. Although growing research provides evidence for subjective emotional reactivity in BP pathology, research on physiological or biological reactivity among people with BP pathology is less conclusive. With regard to biological reactivity in particular, research on cortisol reactivity (a neurobiological marker of emotional reactivity) in response to stressors among individuals with BP pathology has produced contradictory results and highlighted the potential moderating role of PTSD-related pathology. Thus, this study sought to examine the moderating role of PTSD symptoms in the relation between BP pathology and both subjective (self-report) and biological (cortisol) emotional reactivity to a laboratory stressor. Participants were 171 patients in a residential substance use disorder treatment center. Consistent with hypotheses, results revealed a significant main effect of BP pathology on subjective emotional reactivity to the laboratory stressor. Furthermore, results revealed a significant interaction between BP pathology and PTSD symptoms in the prediction of cortisol reactivity, such that BP pathology was associated with heightened cortisol reactivity only among participants with low levels of PTSD symptoms. Similar findings were obtained when examining the interaction between BP pathology and the reexperiencing and avoidance/numbing symptoms of PTSD specifically. Results highlight the moderating role of PTSD symptoms in the BP-reactivity relation.

An investigation of the relationship between borderline personality disorder and cocaine-related attentional bias following trauma cue exposure: The moderating role of gender

Elevated rates of borderline personality disorder (BPD) have been found among individuals with substance use disorders (SUDs), especially cocaine-dependent patients. Evidence suggests that cocaine-dependent patients with BPD are at greater risk for negative clinical outcomes than cocaine-dependent patients without BPD and BPD-SUD patients dependent on other substances. Despite evidence that cocaine-dependent patients with BPD may be at particularly high risk for negative SUD outcomes, the mechanisms underlying this risk remain unclear. The present study sought to address this gap in the literature by examining cocaine-related attentional biases among cocaine-dependent patients with (n = 22) and without (n = 36) BPD. On separate days, participants listened to both a neutral and a personally-relevant emotionally evocative (i.e., trauma-related) script and then completed a dot-probe task with cocaine-related stimuli. Findings revealed a greater bias for attending to cocaine-related stimuli among male cocaine-dependent patients with (vs. without) BPD following the emotionally evocative script. Study findings suggest the possibility that cocaine use may have gender-specific functions among SUD patients with BPD, with men with BPD being more likely to use cocaine to decrease contextually induced emotional distress. The implications of our findings for informing future research on cocaine use among patients with BPD are discussed.

The role of executive attention in deliberate self-harm

Although a wealth of literature has examined the role of emotion-related factors in deliberate self-harm (DSH), less is known about neurocognitive factors and DSH. In particular, despite theoretical literature suggesting that deficits in executive attention may contribute to engagement in DSH, studies have not yet examined the functioning of this attentional network among individuals with DSH. The present study sought to address this gap in the literature by examining the functioning of the alerting, orienting, and executive attentional networks among participants with a recent history of DSH (n=15), a past history of DSH (n=18), and no history of DSH (n=21). Controlling for borderline personality pathology and depression symptoms, participants with a recent history of DSH exhibited deficits in executive attention functioning relative to participants without any history of DSH. No differences were found in terms of performance on the alerting or orienting attentional networks. These results provide preliminary support for the association between executive attention deficits and DSH.

Self-Injurious Behaviors in Adolescents with Borderline Personality Disorder

Adolescence marks a period of high-risk for the onset of self-injurious behaviors (SIB), including both deliberate self-harm (DSH) and suicidal behaviors. Adolescents with BPD constitute a particularly vulnerable population for SIB, with research revealing robust associations between SIB and BPD pathology in adolescents. Further, developmental theories suggest that SIB may be an early indicator of BPD in adolescents, reflecting a key step for some youth in the developmental trajectory toward BPD. According to Crowell and colleagues’ (2008; 2009) developmental model of SIB and BPD, trait impulsivity and emotion dysregulation are the key features underlying the development of both BPD and SIB. A review of the research literature supports this theory, revealing significant associations between SIB and both self-reported and biological indices of emotion dysregulation and, with a few exceptions, trait impulsivity among adolescents in general (as well as adolescents with BPD in particular). As such, both theoretical and empirical literature support the role of impulsivity and emotion dysregulation as key mechanisms contributing to SIB among adolescents with BPD. Clinical implications of this research are discussed, as are needed future directions in this line of inquiry.