Emotion processing in borderline personality disorders

BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model

This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.

Entwicklung und Validierung eines Fragebogens zur standardisierten Selbsteinschätzung emotionaler Kompetenzen (SEK-27)

Theoretischer Hintergrund: Defizite und Ressourcen im Bereich der allgemeinen Emotionsregulation spielen eine wichtige Rolle bei Entstehung, Aufrechterhaltung und Behandlung psychischer Störungen. Fragestellung: Um möglichst viele Bereiche des konstruktiven Umgangs mit negativen Emotionen ökonomisch erfassen zu können, wurde der Fragebogen zur Selbsteinschätzung Emotionaler Kompetenzen (SEK-27) entwickelt und validiert. Methode: Anhand von zwei nicht-klinischen (N = 952) und drei klinischen Stichproben (N = 238) wurden verschiedene Indikatoren der Testgüte bestimmt. Ergebnisse: Die Befunde sprechen für die ausreichende bis sehr gute Reliabilität, Validität und Veränderungssensitivität des Fragebogens. Schlussfolgerungen: Mit dem SEK-27 steht ein ökonomischer Fragebogen mit angemessenen psychometrischen Eigenschaften zur Selbsteinschätzung des konstruktiven Umgangs mit negativen Emotionen zur Verfügung.

Borderline personality disorder and emotional responding: A review of the research literature

Although problems with emotional functioning are considered central to borderline personality disorder (BPD), it is only recently that studies have begun utilizing laboratory biobehavioral measures (including neuroimaging and psychophysiological measures) to examine emotional responding in BPD. The application of basic science methodologies used in a systematic program of research to investigate clinically relevant phenomena, often called translational research, holds much promise in advancing the assessment and treatment of BPD. In this paper, we begin with an overview of the research on self-reported emotional responding in BPD. Next, we outline the advantages that translational research has over traditional self-report methodology in furthering an understanding of emotional responding in BPD, and review the extant laboratory studies of emotional responding in BPD. Finally, problems commonly encountered when conducting translational research on emotion in BPD are outlined, and solutions to these problems are offered.

Wahrnehmung und Bewertung von emotionalen Gesichtsausdrücken bei weiblichen Jugendlichen mit einer Borderline-Persönlichkeitsstörung

Zusammenfassung: Fragestellung: Untersuchung der Wahrnehmung von emotionalen und neutralen Gesichtsausdrücken bei weiblichen Jugendlichen mit einer Borderline-Persönlichkeitsstörung (BPS). Methodik: Bei 30 Jugendlichen mit der Diagnose einer BPS, 29 Jugendlichen mit anderen psychischen Störungen sowie 30 psychisch gesunden Jugendlichen wurden emotionale und neutrale Gesichtsausdrücke aus dem Bildersatz von Ekman und Friesen (1976) vorgelegt. Sämtliche Studienteilnehmer waren weiblichen Geschlechts. Mit Hilfe eines selbst konstruierten Fragebogens zur Wahrnehmung von Emotionen in Gesichtsausdrücken sollten die Jugendlichen die Art der dargestellten Emotion benennen sowie Einschätzungen über die wahrgenommene Intensität, Bedrohlichkeit und Positivität vornehmen. Ergebnisse: Jugendliche Patientinnen mit der Diagnose einer BPS zeigten keine Schwierigkeiten bei der Benennung der dargestellten Emotionen sowie bei der subjektiven Einschätzung negativ emotionaler und neutraler Gesichtsausdrücke. In der Wahrnehmung positiv emotionaler Gesichtsausdrücke zeigte sich allerdings, dass Jugendliche mit der Diagnose einer BPS die Positivität und Intensität positiver Gesichtsausdrücke geringer und die Bedrohlichkeit höher einschätzten als die beiden Kontrollgruppen. Schlussfolgerungen: Die Verarbeitung positiver Reize und deren Rolle bei der Emotionsregulation bei Jugendlichen mit einer BPS sollte Gegenstand weiterer Forschung sein. Aufgrund der dysfunktionalen Interpretation positiv emotionaler Stimuli könnte es gewinnbringend sein, differenziert auf die möglichen Wahrnehmungsverzerrungen der Patienten im Therapieprozess einzugehen.

Exaggerated affect-modulated startle during unpleasant stimuli in borderline personality disorder

BACKGROUND

Excessive emotional responding is considered to be a hallmark of borderline personality disorder (BPD). The affect-modulated startle response is a reliable indicator of emotional processing of stimuli. The aim of this study was to examine emotional processing in BPD patients (n = 27) and healthy control subjects (n = 21).

METHODS

Participants viewed an intermixed series of unpleasant, borderline-salient (e.g., "hate"), and neutral (e.g., "view") words and were instructed to think about the meaning of the word for them personally while eyeblink responses were assessed.

RESULTS

The BPD patients exhibited larger startle eyeblink during unpleasant but not neutral words, indicating exaggerated physiological affect. This finding remained significant when we controlled for comorbid diagnoses, including generalized anxiety disorder and post-traumatic stress disorder. Greater symptom severity was associated with greater affective-startle difference scores (unpleasant-neutral).

CONCLUSIONS

Consistent with the symptom of affective dysregulation, these results suggest an abnormality in the processing of unpleasant emotional stimuli by BPD patients.

Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder

Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.

Advances in crisis management of the suicidal patient: perspectives from patients

This paper discusses crisis intervention with the suicidal client from the perspective of two clients who discuss both the strengths and challenges they have encountered while in crisis. The paper then discusses a model for understanding a suicidal crisis and a template for intervention.

Social-emotion recognition in borderline personality disorder

Borderline personality disorder (BPD) is characterized by interpersonal disturbances, but the neurocognitive aspects of these symptoms are poorly understood. We hypothesized that patients with BPD have impaired perception of emotional expressions, which are related to symptoms of interpersonal dysfunction. To control potential confounding factors, this study excluded subjects with comorbid diagnoses known to be associated with impaired affect perception. We tested 43 outpatients with BPD and 26 healthy controls on emotion recognition tasks (facial, prosodic, and integrated facial/prosodic), nonemotional facial feature recognition, and interpersonal antagonism (Buss-Durkee Hostility Index). Patients with BPD showed normal ability to recognize isolated facial or prosodic emotions but had impaired recognition of emotions in integrated facial/prosodic stimuli, as well as impaired discrimination of nonemotional facial features. In patients with BPD, impaired recognition of integrated emotional stimuli was associated with interpersonal antagonism, particularly suspiciousness and assaultiveness. These results suggest that patients with BPD have deficits in higher order integration of social information, which may be related to some of the more serious symptoms of the disorder.

Affect intensity: association with anxious and fearful responding to bodily sensations

The present investigation evaluated affect intensity in regard to anxious and fearful responding to a voluntary hyperventilation paradigm. Participants were 90 young adults without a history of Axis I psychopathology or nonclinical panic attacks. The incremental validity of affect intensity was examined relative to gender, negative affectivity, anxiety sensitivity, and anticipatory anxiety. As hypothesized, affect intensity significantly and incrementally predicted the perceived intensity of post-challenge panic-relevant physical and cognitive symptoms but not physiological arousal. Findings are discussed in relation to better understanding the role of affect intensity as a potential risk factor for panic-related problems.

Emotion dysregulation and the development of borderline personality disorder

We review the role of emotion regulation in borderline personality disorder (BPD). We briefly discuss the historical development of BPD as a disorder where emotional regulation plays a key role. We review the concept of emotion regulation in general and explore both one-factor and two-factor models of emotion regulation. We discuss cognitive and attentional aspects of emotion regulation, and explore these regulatory controls as operating as both voluntary as well as automatic processes. We then turn to other neurophysiological models of emotion regulation in general and examine how those models, both neurophysiologically and neuroanatomically, are expressed in individuals with BPD. We examine how neuroimaging, both anatomical and functional, reveals the roles that various neuroanatomical structures play in the regulation of emotion in BPD. We conclude by creating a neurodevelopmental model that describes how a complex matrix involving the interplay of constitutional/biological predispositions with environmental stressors as well as with parental effectiveness in response to the child's emotion expression can impact key aspects of adult cognitive, affective, interpersonal, and behavioral functioning that culminate in a diagnosis of BPD.

Developmental precipitants of borderline personality disorder

Traditional theories regarding the etiology of borderline personality disorder have focused on poor attachment figures and/or traumatic experience. The present review posits an additional pathogenic course for this disorder. Specifically, the proposed mechanism involves a basic disruption of the neural hardware that supports the formation and maintenance of unconscious emotional memory, hardware essential for the formation of early attachments. It is further theorized that this early disruption has ongoing effects on both behavioral and concomitant neural development. Within this model, adolescence is described as a period of intense change that serves as the tipping point for the onset of borderline personality disorder.

Level of emotional awareness as a differentiating variable between individuals with and without generalized anxiety disorder

Using Mennin, Heimberg, Turk, and Fresco's [Emotion regulation deficits as a key feature of generalized anxiety disorder: Testing a theoretical model, submitted for publication] conceptualization of generalized anxiety disorder (GAD) as a syndrome involving emotion dysregulation and an overuse of cognitive control strategies, this study sought to differentiate individuals with GAD from controls by offering differences in emotional awareness as one of the central distinctions between these groups. This study employs the Levels of Emotional Awareness Scale (LEAS) [Lane et al., 1990Lane, R. D., Quinlan, D. M., Schwartz, G. E., Walker, P. A., & Zeitlin, S. B. (1990). The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion. Journal of Personality Assessment, 55, 124-134] a rater-coded measure, to assess level of emotional awareness, a methodological improvement over previous tests of the model, which relied upon self-report. Individuals with GAD scored significantly higher than controls on emotional awareness. These findings are discussed in light of the theoretical implications for GAD.

Facial expression of emotions in borderline personality disorder and depression

Borderline personality disorder (BPD) is characterized by marked problems in interpersonal relationships and emotion regulation. The assumption of emotional hyper-reactivity in BPD is tested regarding the facial expression of emotions, an aspect highly relevant for communication processes and a central feature of emotion regulation. Facial expressions of emotions are examined in a group of 30 female inpatients with BPD, 27 women with major depression and 30 non-patient female controls. Participants were videotaped while watching two short movie sequences, inducing either positive or negative emotions. Frequency of emotional facial expressions and intensity of happiness expressions were examined, using the Emotional Facial Action Coding System (EMFACS-7, Friesen & Ekman, EMFACS-7: Emotional Facial Action Coding System, Version 7. Unpublished manual, 1984). Group differences were analyzed for the negative and the positive mood-induction procedure separately. Results indicate that BPD patients reacted similar to depressed patients with reduced facial expressiveness to both films. The highest emotional facial activity to both films and most intense happiness expressions were displayed by the non-clinical control group. Current findings contradict the assumption of a general hyper-reactivity to emotional stimuli in patients with BPD.

Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms

The purpose of this study was to examine the relationships among negative affect, childhood sexual abuse (CSA), thought suppression, and diagnostic symptoms of borderline personality disorder (BPD) in a community sample (n=127). Findings suggest that the temperamental variable negative affect intensity/reactivity was a stronger predictor of BPD symptoms than CSA. In addition, results indicated that higher thought suppression mediated the relationship between negative affective intensity/reactivity and BPD symptoms, after controlling for a history of CSA. Overall, findings suggest that (a) negative affectivity may be a better predictor of BPD symptoms than CSA, and (b) chronic efforts to suppress unpleasant thoughts may be a regulation strategy underlying the relationship between intense negative emotions and BPD symptoms.

Interpersonal relationships and sex differences in the development of conduct problems

This article investigates the role of interpersonal relationships in shaping sex differences in the manifestation, etiology, and developmental course of conduct problems and their treatment needs. The review examines whether: (1) Girls' conduct problems are more likely than boys' to manifest as a function of disrupted relationships with caretakers and peers; (2) For girls more than for boys, the outcomes of conduct problems in adolescence and adulthood, and related treatment needs, are more likely to be a consequence of the quality of interpersonal relationships with others, particularly opposite-sex peers and partners. Evidence reviewed suggests that boys and girls share many similarities in their expression of conduct problems, but that a relational perspective does unify important differences. There is fair evidence that girls with conduct problems are more likely to come to the attention of authorities because of chaotic, unstable family relationships, and to express antisocial behavior in the context of close relationships; there is stronger evidence that the course and outcomes of conduct problems in females versus males pertain to interpersonal relationship impairments. Those sex differences map onto specific differences in treatment needs. Further empirical testing of the proposed relational model is indicated.

Clinical supervision of nurses working with patients with borderline personality disorder

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (Pesut & Herman, 1999). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.

An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression

The current study examined the relationships among biological predisposition, social environment, emotion regulation, and features characteristic of Borderline Personality Disorder (BPD). Using an analogue sample, we examined whether thought suppression mediated the relationship of negative affective intensity/reactivity and perceived parental criticism with a composite of BPD features including impulsivity, interpersonal sensitivity, and aggression. Results indicated that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD features and partially mediated the relationship between BPD features and perceived parental criticism. Clinical implications, directions for further research, and limitations of the present study are discussed.

Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study

Affective dysregulation and dissociation are currently discussed as core features of borderline personality disorder (BPD). Affective dysregulation is hypothesized to be correlated with increased amygdala functioning and dissociation is linked to inhibited processing on the amygdala and dampened autonomic output, according to the corticolimbic disconnection model of dissociation from Sierra and Berrios [Biological Psychiatry 44 (1998) 898]. We assessed startle response, which is mainly mediated by the amygdala, to investigate the relationship between affective dysregulation and dissociation. We hypothesized that patients with BPD would reveal enhanced responses to startling tones, but that these would be lessened by the presence of state dissociative experiences. 21 unmedicated female patients with BPD and 21 healthy female controls listened to 15 startling tones (95-dB, 500-ms, 1000-Hz) while heart rate, skin conductance and orbicularis oculi electromyogram responses were measured. Covariance analysis showed that the BPD group had a significantly higher startle response in the electromyogram as compared to controls. Furthermore, present-state dissociative experiences significantly influenced the startle response. Patients with low dissociative experiences revealed enhanced startle responses whereas patients with high dissociative experiences showed reduced responses. Our data support affective dysregulation in BPD as well as the corticolimbic disconnection model of dissociation, at least for EMG. Furthermore, it highlights the importance of assessing present-state dissociation in basic research as well as psychotherapy.

A model predicting suicidal ideation and hopelessness in depressed older adults: the impact of emotion inhibition and affect intensity

The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.

[The phenomenology and psychodynamics of affects in borderline patients]

This paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed.

Emotion processing in borderline personality disorders

This study examined relationships between the ability to recognize facial affect and affective intensity in women with Borderline Personality Disorder. Women hospitalized with borderline personality disorder and community women without psychiatric disorder (n s = 35/group) were recruited via convenience sampling. The Pictures of Facial Affect and the Affect Intensity Measure were administered to consenting women. Hypotheses related to differences in recognizing facial affect were supported, but further exploration indicated that selected negative emotions accounted for the statistical significance. Implications for practice and research are explored.

Mood patterns and variations associated with personality disorder pathology

This study examined mood and mood variation in relation to varying forms and degrees of personality disorder (PD) pathology. Mood experiences of 98 psychotropic medication-free individuals were repeatedly assessed over a 4-day period. Persons with PDs (n = 57) generally displayed neutral to moderately positive moods; however, overall mood valence was less positive when compared to those without PDs (n = 41). Mood ratings demonstrated moderate covariations with anxious-fearful (A-F) PD traits but little or no association with erratic-emotional-dramatic (E-D) and odd-eccentric (O-E) PD traits once common variance among PD dimensions was removed. For PD diagnostic categories, the presence of avoidant and/or depressive PDs was most strongly associated with negative mood. When dimensional scores based on specific PD trait features were considered, avoidant, depressive, borderline, passive-aggressive, obsessive-compulsive, dependent, paranoid, and schizoid PD traits demonstrated the most reliable associations with negative mood. Apart from borderline PD features, traits associated with other E-D cluster PDs displayed little or no associations with mood quality. Consistent with previous research, mood variability emerged as an internally consistent and stable individual difference variable. Mood variability, however, was not generally associated with PD diagnostic categories or traits. Implications of this study's findings are considered in relation to the conceptual modeling of PDs.

Quality of depressive experiences in borderline personality disorders: Differences between patients with borderline personality disorder and patients with higher levels of personality organization

Clinical observations suggest that depressive experiences in patients with borderline personality disorder have a specific quality. These experiences are characterized by emptiness and anger ("angry depression") and are associated with primitive forms of object relations. In this study, this observation was tested empirically. A sample of borderline inpatients (N=30) was compared with a sample of inpatients with higher levels of personality organization suffering from neurotic disorders (N=30). Depression and other affects were assessed by the Affective Dictionary Ulm (Dahl, Hölzer, & Berry, 1992). The quality of object relations was assessed by a scale developed by Urist (1977), which was applied to responses in the Holtzman Inkblot Technique (Holtzman, Thorpe, Swartz, & Herron, 1961). Correlations were assessed between depression, on the one hand, and anger, anxiety, and the quality of object relations, on the other hand. The clinical observations were confirmed: In the patients with borderline personality disorder, depression showed significant correlations with the affects of anger, anxiety, and fear, and with primitive forms of object relations. In the patients with higher levels of personality organization, no such correlations were found. The results are discussed with regard to the understanding of borderline disorders, diagnosis, and therapy.

The role of childhood trauma in differences in affective instability in those with personality disorders

BACKGROUND

This study examined the relationship of self-reported histories of childhood trauma to measures of affective instability in a sample of unmedicated outpatients with various personality disorders (n=174).

METHODS

Childhood trauma was measured by the Childhood Trauma Questionnaire. Affective instability comprises at least two dimensions: affective lability, assessed using the Affective Lability Scale, and affective intensity, assessed using the Affective Intensity Measure.

RESULTS

A history of emotional abuse was the only trauma variable that significantly correlated with the affect measures in the total sample (r=.21-.30). More fine-grained analyses revealed that the relationship of emotional abuse and affective instability measures varied as a function of both gender and personality disorder type. In subjects with borderline personality disorder, the correlation for emotional abuse was greatly attenuated for both Affective Lability Scale (r=.10) and Affective Intensity Measure (r=.15) total scores.

CONCLUSION

This suggests that nontrauma-related factors may be more predominant in affective dyscontrol in individuals with borderline personality disorder.

Emotional processing in personality disorder

In the field of personality disorders, borderline and antisocial types are associated with emotional dysfunctioning. In borderline personality disorder (BPD), the hypothesis of emotional hyperresponsiveness can be supported by several experimental studies that suggest highly intensive and slowly subsiding emotions to primed and non-primed stimuli, as well as by data showing biased information, which processes in the context of emotions. In addition, the first neuroimaging data suggest that limbic hypersensitivity is a neurofunctional correlate of emotional vulnerability in BPD. In antisocial psychopathic personality disorder, data confirm the theory of emotional detachment, subsuming fearlessness, and, beyond that, emotional indifference to appetitive stimuli. Because of a fundamental dysfunction in the amygdala, psychopathic individuals appear to use alternative cognitive operations of processing affective material to compensate for the absence of appropriate limbic input, which normally provides prompt information about the affective characteristics of stimuli.

Affect regulation in women with borderline personality disorder traits

Affect dysregulation is considered a defining feature of borderline personality disorder (BPD). In spite of this, there is a dearth of empirical research that examines affect regulation among persons with BPD. The present study examined the relationship between specific dimensions of affect regulation and borderline traits in a sample of 39 patients. Participants were administered the Personality Diagnostic Questionnaire-Revised to assess the degree of borderline traits and the Affect Intensity Measure and Affect Control Scale to assess dimensions of affect regulation, selected based on the biosocial theory of BPD. Results from hierarchical regression analyses indicated that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses.

A Description of a Psychosocial/Psychoeducational Intervention for Persons with Recurrent Suicide Attempts

Summary: This paper gives a description of a psychosocial/psychoeducational group intervention for individuals with a history of recurrent suicide attempts. The intervention was conceived to reduce the risk of future suicidal behavior and to modify the client's psychopathology. Three features are felt to make the intervention unique from others described in the literature. First, the intervention is targeted at both men and women from an inner-city population who are often underhoused, underemployed, and undereducated. 24 of 48 clients (50%) lived alone, and 24 of those (92%) were living in subsidized housing; 33% lived in supportive housing, and one lived on the street at the time of assessment. 48% had a high-school education or less. Second, the principles of our approach stressed client validation and participation in the development and delivery of the therapy. Our frame of reference was to name ourselves as professionals with a set of skills and access to some kinds of information and clients as the experts on the experience in their lives. Third, the group content incorporated a multimodal approach to meet the varied needs of the clients. Future reports will discuss the empirical evaluation of this intervention; however, the development of specific, targeted approaches for unique individuals with recurrent suicide attempts is clearly needed.

Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study

BACKGROUND

Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD); however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates of abnormal emotional processing have been identified so far.

METHODS

Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (fMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order.

RESULTS

Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects.

CONCLUSIONS

Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects' perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.

Modeling the relationship between affective lability, impulsivity, and suicidal behavior in patients with borderline personality disorder

This article reviews the concept of affective lability and suggests that new models are needed to characterize the relationship between affective states such as affective lability, impulsivity, and suicidal behavior. The association of affective lability, impulsivity, and suicidal behavior is most relevant to understanding the risk of suicide in individuals with borderline personality disorder. The relationship between affective lability and suicide might be explained as 1) a form of bipolarity, 2) a form of impulse dyscontrol, 3) a quantitative disorder of affect, or 4) an environmental reactivity. Our opinion of the relevant literature suggests that a quantitative disorder of affect accompanied by the inability to control these affects are the essential components leading to the risk of suicidal behavior. Characterizing the dyscontrol and high intensity of affect leads to a reconceptualization of depression in patients with borderline personality disorder and to a re-examination of the causal chain of events leading to suicidal behavior. The implications for clinical practice resulting from the proposed model are discussed.

The effects of exogenous analgesia in a patient with borderline personality disorder (BPD) and severe self-injurious behaviour

In order to analyse the effects of potent exogenous analgesia with opioids in borderline personality disorder (BPD), we present a case report in which the application of morphine abolished the perception of pain during self-injury and intensified self-injurious activities. On the basis of our observations, we concluded that the use of potent analgesics might aggravate psychopathology in BPD.

Pervasive emotion recognition deficit common to alexithymia and the repressive coping style

OBJECTIVE

Previous research has demonstrated a deficit in the ability to recognize emotions in alexithymic individuals. The repressive coping style is thought to preferentially impair the detection of unpleasant compared with pleasant emotions, and the degree of deficit is typically thought to be less severe than in alexithymia. We compared emotion recognition ability in both individuals with alexithymia and those with the repressive coping style.

METHODS

Three hundred seventy-nine subjects completed the 20-item Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Marlowe-Crowne Scale (a measure of repressive defensiveness), the Bendig Short Form of the Taylor Manifest Anxiety Scale, and the Perception of Affect Task. The Perception of Affect Task consists of four 35-item emotion recognition subtasks: matching sentences and words, faces and words, sentences and faces, and faces and photographs of scenes. The stimuli in each subtask consist of seven emotions (happiness, sadness, anger, fear, disgust, surprise, and neutral) depicted five times each. Recognition accuracy results were collapsed across subtasks within each emotion category.

RESULTS

Highly alexithymic subjects (for all, p<.01) and those with low emotional awareness (for all, p<.001) were consistently less accurate in emotion recognition in all seven categories. Highly defensive subjects (including repressors) were less accurate in the detection of anger, sadness, fear, and happiness (for all, p<.05). Furthermore, scores on the Levels of Emotional Awareness Scale accounted for significantly more variance in performance on the Perception of Affect Task than scores on the Marlowe-Crowne Scale (p<.01).

CONCLUSIONS

The results indicate that alexithymia and the repressive coping style are each associated with impairments in the recognition of both pleasant and unpleasant emotions and that the two styles of emotional self-regulation differ more in the magnitude than in the quality of these impairments.

Borderline personality disorder. Neuropsychological testing results

Earlier clinical hypotheses regarding borderline personality disorder, based on projective psychological testing and intelligence tests, are examined. Recent findings of comparative deficits in this population in the domains of verbal and visual memory as well as visual perception are reviewed, together with clinical relevance. Efforts to examine the way individuals with this disorder process emotion-laden material are discussed, with suggestions for further research.

Sociodemographic correlates of alexithymia

The association between alexithymia and sociodemographic variables is not well understood. Previous studies using the current 20-item and previous 26-item versions of the Toronto Alexithymia Scale (TAS) have shown inconsistent associations with age, sex, socioeconomic status, and years of education. We tested 380 subjects from the community stratified equally across sex, five age groups, and three socioeconomic classes. In addition to the TAS-20, we also administered the Levels of Emotional Awareness Scale (LEAS), a behavioral measure of the ability to be aware of and represent emotions in words, a core component of alexithymia. The TAS-20 and LEAS were each correlated with age, sex, socioeconomic status (SES), and years of education (P < .01) in the same direction and to approximately the same degree. Alexithymia (or low emotional awareness) is associated with older age, male sex, lower SES, and fewer years of education. The TAS-20 and LEAS are only slightly correlated (r = -.19, n = 380, P < .001), but their correlation is largely accounted for by their shared variance with these demographic variables. The convergence of findings with these two quite different measures and the nature of their overlap support the validity of these associations between alexithymia and sociodemographic variables.

Emotion, Social Function, and Psychopathology

The studies of emotion function and emotional disorders complement one another. In this article, the authors outline relations between the social functions of emotion and four psychological disorders. The authors first present a social-functional account of emotion and argue that emotions help coordinate social interactions through their informative, evocative, and incentive functions. They then review evidence concerning the emotional and social problems related to depression, schizophrenia, social anxiety, and borderline personality disorder and consider how the emotional disturbances related to these disorders disrupt interactions and relationships, thus contributing further to the maintenance of the disorder. They conclude by discussing research strategies relevant to the study of emotion, social interaction, and psychopathology.

Neural correlates of levels of emotional awareness. Evidence of an interaction between emotion and attention in the anterior cingulate cortex

Recent functional imaging studies have begun to identify the neural correlates of emotion in healthy volunteers. However, studies to date have not differentially addressed the brain areas associated with the perception, experience, or expression of emotion during emotional arousal. To explore the neural correlates of emotional experience, we used positron emission tomography (PET) and 15-water to measure cerebral blood flow (CBF) in 12 healthy women during film- and recall-induced emotion and correlated CBF changes attributable to emotion with subjects' scores on the Levels of Emotional Awareness Scale (LEAS), a measure of individual differences in the capacity to experience emotion in a differentiated and complex way. A conjunction analysis revealed that the correlations between LEAS and CBF during film- and recall-induced emotion overlapped significantly (z = 3.74, p < 0. 001) in Brodmann's area 24 of the anterior cingulate cortex (ACC). This finding suggests that individual differences in the ability to accurately detect emotional signals interoceptively or exteroceptively may at least in part be a function of the degree to which the ACC participates in the experiential processing and response to emotion cues. To the extent that this finding is consistent with the functions of the ACC involving attention and response selection, it suggests that this neural correlate of conscious emotional experience is not exclusive to emotion.

Alexithymia: relationship with ego defense and coping styles

There is controversy in the literature as to whether alexithymia reflects a deficit in the cognitive processing of emotions or a defensive coping style. Previous studies with clinical populations reported a strong association between alexithymia and a maladaptive (immature) ego defense style. The present study was designed to examine this relationship in nonclinical populations, and also to explore the relationships between alexithymia and three general styles for coping with stressful situations. Sample 1, 287 nonclinical adults, completed the Twenty-Item Toronto Alexithymia Scale (TAS-20) and the Defense Style Questionnaire (DSQ). Sample 2, 83 undergraduate students who had been categorized previously into alexithymic and nonalexithymic subgroups, completed the DSQ and the Coping Inventory for Stressful Situations (CISS). In sample 1, the TAS-20 and its three factors were associated most strongly with an immature defense style, weakly with a neurotic defense style, and negatively with a mature defense style. In sample 2, alexithymic students scored significantly higher than nonalexithymic students on the immature and neurotic defense factors of the DSQ and significantly lower on the mature defense factor. Alexithymic students also scored significantly higher on the emotion-oriented coping scale and the distraction component of the avoidance-oriented coping scale of the CISS and significantly lower on the task-oriented coping scale. The results fail to support the view that alexithymia is an adaptive defense or coping style.