Sarah L. Tragesser

The role of affective instability and UPPS impulsivity in borderline personality disorder features.

Current theories of borderline personality disorder (BPD) suggest that extreme levels of affective instability/emotional dysregulation, impulsivity, or a combination of these traits account for the symptoms of BPD. The present study tested the extent to which personality measures of affective instability and impulsivity could account for BPD features in a nonclinical sample. One hundred forty-one undergraduates completed the Affective Lability Scale, the UPPS Impulsive Behavior Scale, and the Personality Assessment Inventory for Borderlines. Both affective instability and impulsivity were uniquely associated with BPD features. Shifts between euthymia and anger, and between anxiety and depression, were associated with BPD features, as were the urgency and (lack of) premeditation scales. Results indicated that specific BPD features may be differentially accounted for by affective instability vs. impulsivity, consistent with perspectives on BPD emphasizing combinations of affective instability and impulsivity as underlying dimensions of the disorder.

Distinguishing General and Specific Personality Disorder Features and Implications for Substance Dependence Comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.

Parental Monitoring, Peer Drug Involvement, and Marijuana Use Across Three Ethnicities

The purposes of the present study were to test differences in parental monitoring and marijuana use rates and relationships among constructs across three ethnicities, and to use Structural Equation Modeling (SEM) and Van de Vijver and Leungs Analysis of Variance (ANOVA) technique to test for cultural equivalence and item bias in the measurement of these constructs. Participants included 7,500 Mexican American, African American, and non-Hispanic White 10th-12th graders. African American participants showed higher levels of parental monitoring, lower levels of marijuana use, and a stronger relationship between parental monitoring and peer influence. SEM results indicated lack of cultural equivalence for each latent factor. ANOVA results indicated item bias for specific items. Putative cultural differences in the relations between parental monitoring and peer influence, as well as potential sources of bias in measuring family, peer, and drug involvement factors among participants from different cultural groups are discussed.

BORDERLINE PERSONALITY DISORDER FEATURES AND RISK FOR PRESCRIPTION OPIOID USE DISORDERS

Although there is evidence for high comorbidity between borderline personality disorder (BPD) and substance use disorders, particularly alcohol use, more research is needed on the associations between BPD and prescription opioid use because of the increasing national problem of prescription opioid misuse. The purpose of the present study was to examine relationships between BPD features and prescription opioid use, risk for misuse, consequences, and dependence features, and to determine which aspects of BPD account for these associations. As predicted, BPD features were associated with greater quantity and frequency of opioid use, risk for pain medication misuse, consequences, and dependence features. Additional analyses indicated that most of these effects were accounted for by the self-harm/impulsivity component of BPD. The authors conclude that individuals with more pronounced BPD features may be at risk for use and dependence on prescription opioids, and that this association may be primarily associated with the impulsivity features of BPD.

Borderline personality disorder features and mate retention tactics.

The purpose of the present study was to examine the association between features of borderline personality disorder (BPD) and mate retention tactics as a means of examining an evolutionary perspective on the association between BPD features and interpersonal problems and violence in romantic relationships. Two-hundred twenty-five college student participants completed the Personality Assessment Inventory for Borderlines (PAI-BOR; Morey, 1991) and the Mate Retention Inventory-Short Form (MRI-SF; Buss, Shackelford, & McKibbin, 2008) embedded within other measures. There was a strong association between BPD features and cost-inflicting mate retention tactics, including the specific tactics of vigilance, punishing mates infidelity threat, intrasexual threats, and sexual inducements for both men and women. There were also gender-specific associations for additional tactics. These results contribute to our understanding of problems in romantic relationships among men and women with BPD features, including violence, and to our understanding of impulsive sexual behavior among individuals with BPD features by showing how these behaviors are used as extreme, maladaptive attempts at mate retention.

Teasing: For Superiority or Solidarity?

Humor among friends is typically regarded as a means of strengthening friendships. However, there may be a side of humor that is used to compete rather than bond (R. D. Alexander, 1986; C. R. Gruner, 1997). In the present studies, the participants were asked to imagine that they were sitting with a group of mixed-sex peers. One of the group (a same-sex friend) made a comment about the participant. Different groups of participants were told that the remark did or did not involve teasing. While the participants imagined they were the target of the remark, they rated their emotional reactions as well as their perceived relationship with the teaser and the character traits attributed to the teaser. The outcomes from analyses of variance of perceived competitiveness, emotional responses, and expected social outcomes largely supported superiority perspectives of humor.

Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample

Misuse of, and addiction to, prescription opioid pain relievers is a growing concern, in both non-clinical samples and chronic pain patients receiving opioid analgesic therapy. Research is needed to identify which patients may be more prone to misuse or dependence on opioids in a chronic pain treatment setting. Based on literature showing the role of impulsivity in substance use disorders generally, we predicted that impulsivity may also be important to understanding which individuals may be at risk for opioid misuse when opioids are prescribed for pain. The present study examined associations between impulsivity facets and measures of prescription opioid misuse and symptoms. Four facets of impulsivity were examined: urgency, sensation seeking, lack of premeditation, and lack of perseverance. 143 patients receiving treatment for chronic pain at a regional pain clinic completed a series of questionnaires including the UPPS and measures of opioid risk and misuse. Consistent with predictions, urgency was associated with risk for future misuse (β=0.246, p<0.05), current misuse (β=0.253, p<0.01), and symptoms of current opioid use disorder (OUD; β=0.206, p<0.05). Sensation seeking was also associated with current misuse (β=0.279, p<0.01). These results suggest that identifying facets of impulsivity is important to understanding and assessing for risk of prescription opioid misuse in the context of chronic pain treatment. These data indicate that patients who react impulsively to negative mood states and cravings may be especially prone to developing aberrant use patterns when taking prescription opioids. This is the first known study to identify the role of urgency in predicting risk for OUDs in chronic pain patients.

Accounting for the Association Between BPD Features and Chronic Pain Complaints in a Pain Patient Sample: The Role of Emotion Dysregulation Factors.

Although borderline personality disorder (BPD) features consistently show strong relations with chronic pain, the mechanisms underlying this association remain unclear. BPD is characterized by dysregulated emotion. Given previously observed relationships between emotion dysregulation and pain, we hypothesized that components of this dysregulation—elevated and labile negative affect and emotion sensitivity—would account for the relationship between BPD features and various pain complaints in a chronic pain patient sample. Specifically, we hypothesized that negative affect would indirectly predict pain through higher emotion sensitivity to pain, operationalized as pain anxiety sensitivity. To test these hypotheses, we administered a series of self-report measures to 147 patients at a chronic pain treatment facility. As expected, BPD features predicted pain severity (&bgr; = .19, p = .029), activity interference from pain (&bgr; = .22, p = .015), and affective interference from pain (&bgr; = .41, p < .001). Using path analyses, we found that the associations between BPD features and pain severity and interference were accounted for by serial indirect pathways through affective lability then pain anxiety and, to a lesser extent, through trait anxiety then pain anxiety. This is the first study to demonstrate roles for affective lability and pain anxiety sensitivity in the association between BPD features and chronic pain complaints in a chronic pain sample. We discuss implications for the relationship between dysregulated emotion and pain as well as for psychologically-focused treatment interventions for pain.

Development and validation of the opioid prescription medication motives questionnaire: a four-factor model of reasons for use.

There is considerable evidence that understanding reasons for using substances is important for understanding patterns of use and related consequences as well as for developing assessment and intervention strategies. Despite increases in prescription opioid use and related problems (e.g., overdose deaths), a comprehensive measure of prescription opioid motives has yet to be developed. As such, the current study sought to develop and provide validation evidence for a measure of prescription opioid motives. One hundred eleven male and 226 female undergraduate students completed an initial pool of motive items based on the current literature and measures of prescription opioid use and related problems. Confirmatory factor analysis results demonstrated that the predicted 4-factor model provided a good fit to the data. The 4 motives-pain, social, enhancement, and coping-each showed differential patterns of associations with prescription opioid-related contextual and use variables. Enhancement motives were associated with quantity of use (past 3 months and maximum use in 1 day), frequency of use, in multiple contexts, misuse, and related problems. Coping motives demonstrated relations with maximum pills (in 1 day), frequency of use, and prescription opioid misuse, consequences, and dependence features. For social motives, significant associations were found with frequency of use (in past 3 months), typical number of pills (in 1 day), dependence features, and use both on weekdays and on weekends; this motive had a negative association with maximum number of pills taken in 1 day. Pain motives were largely related to frequency of use (in past 3 months), consequencess, and dependence features. The present study is the first to present an empirical measure of prescription opioid motives and demonstrates how these motives have important implications for understanding patterns of prescription opioid use and related problems.

Differences in illicit drug-use rates among Oklahoma and non-Oklahoma Indian youth.

Demographic factors may serve as risk or protective factors for drug use in American Indian communities. The purpose of the present study was to compare drug-use rates among Oklahoma and Non-Oklahoma Indian youth, and test corresponding rates of preventative and protective community, family, and social–demographic factors. Participants’ data included 1,928 Indian 7th–12th graders from non-Oklahoma schools and 1,938 Indian students from schools in Oklahoma, aggregated across 2–3 years from an ongoing survey study of substance use and prevention among Indian youth. As predicted, one-way analysis of variance tests indicated that Oklahoma youth showed lower rates of drug use, later ages of initiation of drug use, and greater levels of perceived harm from using drugs. These differences were reflected in the predicted protective factor differences, including higher levels of exposure to anti-drug campaigns in the community and schools, greater family involvement in drug-use prevention, and lower levels of peer drug associations. The strength of these protective factors is illustrated by the fact that drug-use rates were lower among Oklahoma youth despite the perception among Oklahoma youth that drugs were more available, compared with non-Oklahoma youth. Limitations and suggestions for future research are noted.