Borderline personality disorder features in nonclinical young adults: 2. Two-year outcome

Countering emotional behaviors in the treatment of borderline personality disorder

The purpose of the current study was to investigate the unique effects of a commonly used skill incorporated into treatment packages for borderline personality disorder (BPD), countering emotion-driven behavioral urges. Individuals with BPD (N = 8) participated in a single-case experimental design, specifically a multiple baseline, in which they were randomly assigned to complete a baseline assessment-only phase of 2 or 4 weeks. Participants then received four sessions of the countering emotional behaviors module from the unified protocol, followed by a 4-week follow-up phase. Throughout the duration of the study, daily data capture was used to assess real-time changes in the frequency of emotionally avoidant behaviors in response to emotional experiences. Symptoms of BPD, depression, and anxiety were also assessed. By follow-up, the majority of patients demonstrated a meaningful reduction (per single-case experimental design guidelines for evaluating improvements) in their use of avoidant behaviors. There was also preliminary evidence that encouraging participants to act counter to avoidant urges is associated with decreases in BPD, depression, and anxiety symptoms, as well as negative affectivity. The countering emotional behaviors skill from the unified protocol indeed engages its putative target of emotionally avoidant behavioral coping, indicating it is an active ingredient in multicomponent treatment packages for BPD, with implications for downstream clinical endpoints such as BPD and depressive and anxiety symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The paradoxical decline and growth of trust as a function of borderline personality disorder trait count: Using discontinuous growth modelling to examine trust dynamics in response to violation and repair

Borderline personality disorder (BPD) is associated with paradoxical trust cognitions and behaviours. While BPD is associated with difficulty forming trust and maintaining cooperation in trust-based exchanges, design and analytical methodology best suited to reveal the temporal ebb and flow of trust have been underutilized. We used an economic game to examine the trajectories of trust as it forms, dissolves, and restores in response to trust violation and repair, and to explain how these vary as a function of borderline pathology. Young adults (N = 234) played a 15-round trust game in which partner trustworthiness was varied to create three phases: trust formation, trust violation, and trust restoration. Discontinuous growth modelling was employed to capture the trends in trust over time and their relationship with BPD trait count. BPD trait count was associated with an incongruous pattern of trust behaviour in the form of declining trust when interacting with a new and cooperative partner, and paradoxically, increasing trust following multiple instances of trust violation by that partner. BPD trait count was also associated with trust restoring at a faster rate than it was originally formed. By adopting a methodology that recognizes the dynamic nature of trust, this study illustrated at a micro level how relational disturbances may be produced and maintained in those with a moderate to high BPD trait count. Further investigation of the factors and processes that underlie these incongruous trust dynamics is recommended.

Isolating the effect of opposite action in borderline personality disorder: A laboratory-based alternating treatment design

Evaluating the unique effects of each component included in treatment protocols for borderline personality disorder (BPD) is a necessary step in refining these interventions so that they only include skills that drive therapeutic change. One strategy, included in several prominent treatments for BPD, is acting opposite to emotion-driven behavioral urges; engaging in behaviors that are inconsistent with an experienced emotion is thought to lead to reductions in its intensity, though this has not been empirically-tested. The present study was a single-case experiment, specifically an alternating treatment design, that explored the effects of a laboratory-based adaptation of opposite action (versus acting consistent) on emotional intensity. Sixteen individuals with BPD attended six laboratory sessions in which they were instructed to act consistent with an induced emotion in half the sessions and opposite in the other half. Participants were randomly assigned to the specific emotion (i.e., anxiety, sadness, anger, and shame/guilt) that was induced across all study sessions. Findings from visual inspection and percentage of non-overlapping data suggest that acting opposite (versus consistent) leads to significantly greater decreases in emotional intensity for those in the sadness and guilt/shame conditions, but not those in the anxiety or anger conditions. Possible interpretations of these findings are presented. Replication outside of the laboratory context is necessary to draw further conclusions of the clinical implications of these findings.

The rewarding nature of provocation-focused rumination in women with borderline personality disorder: a preliminary fMRI investigation

BACKGROUND

Understanding why individuals with borderline personality disorder (BPD) ruminate on prior provocations, despite its negative outcomes, is crucial to improving interventions. Provocation-focused rumination may be rewarding in the short term by amplifying anger and producing feelings of justification, validation, and increased energy, while reducing self-directed negative affect. If provocation-focused rumination is utilized regularly as a rewarding emotion regulation strategy, it could result in increased activation in reward-related neural regions. The present pilot study examined neural correlates of provocation-focused rumination, relative to other forms of thought, in BPD.

METHOD

Functional magnetic resonance imaging (fMRI) was utilized to examine this theory in a pilot study of women diagnosed with BPD (n = 13) and healthy controls (n = 16). All participants received highly critical feedback on a previously written essay in the scanner, followed by prompts to engage in provocation-focused, self-focused, and neutral thought.

RESULTS

Whole-brain analyses showed that in response to the provocation, participants with BPD (compared to controls) demonstrated increased activation in the ventrolateral prefrontal cortex (PFC). BPD participants also showed greater activation in the dorsomedial PFC during provocation-focused rumination (relative to neutral-focus). Subsequent ROI analyses revealed that provocation-focused rumination (compared to neutral-focus) increased activation in the nucleus accumbens for the BPD group only.

CONCLUSIONS

These findings, while preliminary due to the small sample size and limitations of the protocol, provide initial data consistent with the proposed neurobiological mechanism promoting provocation-focused rumination in BPD. Directions for further research are discussed.

Characteristics of Repetitive Thought Associated with Borderline Personality Features: A Multimodal Investigation of Ruminative Content and Style

Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of self-focused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.

Pupillary and affective responses to maternal feedback and the development of borderline personality disorder symptoms

Etiological models propose that a biological vulnerability to emotional reactivity plays an important role in the development of borderline personality disorder (BPD). However, the physiological and phenomenological components of emotional reactivity that predict the course of BPD symptoms in adolescence are poorly understood. This prospective study examines pupillary and affective responses to maternal feedback as predictors of BPD symptom development in adolescent girls over 18 months. Fifty-seven 16-year-old girls completed a laboratory task in which they heard recorded clips of their own mothers making critical or praising statements about them, as well as neutral statements that did not pertain to them. Changes in girls' pupil dilation and subjective affect were assessed throughout the task. The results demonstrated that greater pupillary response to maternal criticism predicted increases in BPD symptoms over time. In addition, greater pupillary and positive affective responses to maternal praise were associated with higher BPD symptoms at age 16 and faster decreases in BPD symptoms over time, but only among girls who heard clips that were rated by independent observers as less praising. The results suggest that emotional reactivity can serve as either a risk or a protective factor depending on context, with differential effects of reactivity to criticism versus praise.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study

OBJECTIVE

Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study.

METHOD

Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study.

RESULTS

Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management.

CONCLUSION

Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.

Borderline personality disorder and self-conscious affect: Too much shame but not enough guilt?

Shame has emerged as a particularly relevant emotion to the maintenance and exacerbation of borderline personality disorder (BPD) features; however, little attention has been paid to the potentially differing effects of other forms of self-conscious affect. While guilt has been demonstrated to have adaptive functions in the social psychology literature, it has not been previously explored whether a lack of socially adaptive guilt might also contribute to BPD-related dysfunction. The present study examined the relationship between BPD features and self-conscious emotions in a sample of undergraduate students (n = 839). Increased shame and decreased guilt independently accounted for significant variance in the association between BPD features and anger, hostility, and externalization of blame. Only increased shame significantly mediated the association between BPD features and anger rumination, and only decreased guilt significantly mediated the relationship between BPD features and aggression. These findings suggest BPD and its associated problems with anger and externalizing may be characterized not only by high levels of shame, but also by lower levels of guilt. Clinical implications include the need to differentiate between self-conscious emotions and teach adaptive responses to warranted guilt. (PsycINFO Database Record

Exploration of emotion regulation experiences associated with borderline personality features in a non-clinical sample

BACKGROUND

Emotion dysregulation is a core feature associated with borderline personality features (BPF). Little research has explored how individuals with high levels of BPF regulate their emotions. This study aimed to explore how individuals with high versus low levels of BPF compare on the strategies they use to regulate emotions and in their experiences of emotion regulation.

METHODS

Twenty-nine university students were recruited and assessed for the presence of BPF using self-report questionnaires. Each participant took part in a semi-structured interview about their experiences of emotion regulation. All interview transcripts then underwent thematic analysis. In addition chi square analyses were conducted to explore the association between level of BPF (High vs Low) and each qualitative theme identified.

RESULTS

Findings indicated similarities in the types of emotion regulation strategies used by the high and low-BPF groups. However, the groups differed in their experiences and thought processes surrounding emotion regulation. High-BPF participants were found to describe a need to communicate negative emotions with others and demonstrated difficulty maintaining attention on positive experiences. In addition there was a trend towards High-BPF participants demonstrating less forward-planning in emotion regulation.

CONCLUSIONS

This study provides insights into some of the unique aspects of emotion regulation in individuals with high BPF that may make emotion regulation attempts less successful.

Does hostile rumination mediate the associations between reported child abuse, parenting characteristics and borderline features in adulthood?

This cross-sectional study investigated whether hostile rumination mediated the association between several indicators of a negative childhood environment (retrospectively reported child abuse and perceived parental care and overprotection) and borderline features. Community participants (N = 524) completed self-report measures in the laboratory. Results showed that adults exhibiting borderline features reported less parental care and more parental overprotection, as well as greater abuse. Additionally, hostile rumination statistically mediated the associations between all childhood environmental variables and borderline features, even controlling for depressive symptoms, alcohol use and impulsivity. Although cross-sectional data cannot test causal mediation, this pattern of results provides preliminary evidence that hostile rumination may partially account for the well-established connection between negative environments and borderline features. Future directions, including a discussion of longitudinal and experimental work that might help build on and strengthen the current findings, are explored.

Dispositional mindfulness and rejection sensitivity: The critical role of nonjudgment

The pain of rejection is a crucial component of normal social functioning; however, heightened sensitivity to rejection can be impairing in numerous ways. Mindfulness-based interventions have been effective with several populations characterized by elevated sensitivity to rejection; however, the relationship between mindfulness and rejection sensitivity has been largely unstudied. The present study examines associations between rejection sensitivity and multiple dimensions of dispositional mindfulness, with the hypothesis that a nonjudgmental orientation to inner experiences would be both associated with decreased rejection sensitivity and attenuate the impact of sensitivity to rejection on general negative affect. A cross-sectional sample of undergraduates (n = 451) completed self-report measures of rejection sensitivity, dispositional mindfulness, and trait-level negative affect. Significant zero-order correlations and independent effects were observed between most facets of dispositional mindfulness and rejection sensitivity, with nonjudging demonstrating the largest effects. As predicted, rejection sensitivity was associated with negative affectivity for people low in nonjudging (β = .27, t = 5.12, p < .001) but not for people high in nonjudging (β = .06, t = .99, p = .324). These findings provide preliminary support for mindfulness, specifically the nonjudging dimension, as a protective factor against rejection sensitivity and its effects on affect.

Investigating the role of executive attentional control to self-harm in a non-clinical cohort with borderline personality features

Self-injurious behavior (or self-harm) is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD). Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.

Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls

Theories of borderline personality disorder (BPD) postulate that high-risk transactions between caregiver and child are important for the development and maintenance of the disorder. Little empirical evidence exists regarding the reciprocal effects of parenting on the development of BPD symptoms in adolescence. The impact of child and caregiver characteristics on this reciprocal relationship is also unknown. Thus, the current study examines bidirectional effects of parenting, specifically harsh punishment practices and caregiver low warmth, and BPD symptoms in girls aged 14-17 years based on annual, longitudinal data from the Pittsburgh Girls Study (N = 2,451) in the context of child and caregiver characteristics. We examined these associations through the use of autoregressive latent trajectory models to differentiate time-specific variations in BPD symptoms and parenting from the stable processes that steadily influence repeated measures within an individual. The developmental trajectories of BPD symptoms and parenting were moderately associated, suggesting a reciprocal relationship. There was some support for time-specific elevations in BPD symptoms predicting subsequent increases in harsh punishment and caregiver low warmth. There was little support for increases in harsh punishment and caregiver low warmth predicting subsequent elevations in BPD symptoms. Child impulsivity and negative affectivity, and caregiver psychopathology were related to parenting trajectories, while only child characteristics predicted BPD trajectories. The results highlight the stability of the reciprocal associations between parenting and BPD trajectories in adolescent girls and add to our understanding of the longitudinal course of BPD in youth.

Borderline features are associated with inaccurate trait self-estimations

BACKGROUND

Many treatments for Borderline Personality Disorder (BPD) are based upon the hypothesis that gross distortion in perceptions and attributions related to self and others represent a core mechanism for the enduring difficulties displayed by such patients. However, available experimental evidence of such distortions provides equivocal results, with some studies suggesting that BPD is related to inaccuracy in such perceptions and others indicative of enhanced accuracy in some judgments. The current study uses a novel methodology to explore whether individuals with BPD features are less accurate in estimating their levels of universal personality characteristics as compared to community norms.

METHOD

One hundred and four students received course instruction on the Five Factor Model of personality, and then were asked to estimate their levels of these five traits relative to community norms. They then completed the NEO-Five Factor Inventory and the Personality Assessment Inventory-Borderline Features scale (PAI-BOR). Accuracy of estimates was calculated by computing squared differences between self-estimated trait levels and norm-referenced standardized scores in the NEO-FFI.

RESULTS

There was a moderately strong relationship between PAI-BOR score and inaccuracy of trait level estimates. In particular, high BOR individuals dramatically overestimated their levels of Agreeableness and Conscientiousness, estimating themselves to be slightly above average on each of these characteristics but actually scoring well below average on both. The accuracy of estimates of levels of Neuroticism were unrelated to BOR scores, despite the fact that BOR scores were highly correlated with Neuroticism.

CONCLUSIONS

These findings support the hypothesis that a key feature of BPD involves marked perceptual distortions of various aspects of self in relationship to others. However, the results also indicate that this is not a global perceptual deficit, as high BOR scorers accurately estimated that their emotional responsiveness was well above average. However, such individuals appear to have limited insight into their relative disadvantages in the capacity for cooperative relationships, or their limited ability to approach life in a planful and non-impulsive manner. Such results suggest important targets for treatments addressing problems in self-other representations.

[Psychosocial integration of inpatients with borderline personality disorder: reflection of a health care system focused on symptom remission]

BACKGROUND

Borderline personality disorder (BPD) is characterized by a profound instability of identity, by stress and affect dysregulation and impulsivity, and by cognitive-perceptual disturbances. These deficits seriously impair interpersonal experiences and social interaction. The typical impulsive style and psychosocial malfunctioning of these patients lead to grave disturbances in their everyday areas of life with numerous break-ups in all relevant areas of life and entail inadequate vocational placement. Despite vast demands on the health care system, BPD attracts little attention of care process research and reintegration measures as, for instance, exist for schizophrenia. At the LVR-Klinikum Düsseldorf as representative of a large clinic in North Rhein-Westphalia, we analysed socio-demographic characteristics of BPD inpatients. The aims of the study were to substantiate the high impact of the disease on patient's social and vocational integration and to sensitize for significant aspects of disease-specific therapy and care.

METHODS

A retrospective analysis of DGPPN-BADO of all patients (n = 9,425) who were admitted between January 2004 and December 2009 to the LVR-Klinikum Düsseldorf, department of psychiatry and psychotherapy, Heinrich Heine University Hospital, Germany. Data analysis involved the divisions general psychiatry and addictive disorders and covered 999 patients with BPD (ICD-10: F60.3) and 1,937 patients with schizophrenia (ICD-10: F20). The defined characteristics of DGPPN-BADO that depict psychosocial integration were "living situation at admission", "highest academic/professional degree achieved", "working situation" und "livelihood". Besides descriptive statistics of the elected variables, comparative analysis of the diagnoses BPD and schizophrenia involved calculating group differences after adjusting the groups for sex and age. Statistical analysis was performed by the χ2-test.

RESULTS

The comparative analysis of psychosocially relevant BADO characteristics reveals a significantly stronger impairment of patients with BPD concerning their academic and professional qualification than patients with schizophrenia. Nevertheless they more often hold a job or cover their living expenses without subsidy, respectively.

CONCLUSION

The data suggest a lack of general awareness in the significance of social and vocational disturbances in BPD. The interactional deficits of patients with BPD affect all areas of life but their illness-related nature seems to be disregarded in relevant life areas, such as educational processes and the vocational situation. Furthermore, the impact of BPD on earning capacity is not given adequate consideration in the assessment of pensions or subsidies. Consistent with the recent literature, our socio-demographic data indicate significant deficits of the present health system in handling BPD.

An evaluation of the parents under pressure programme: a study protocol for an RCT into its clinical and cost effectiveness

BACKGROUND

Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant's physical and emotional needs. The poor outcomes that are associated with such drug dependency appear to be linked to the multiple difficulties experienced by such parents.An increase in understanding about the crucial importance of early relationships for infant well-being has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent-infant interactions. The Parents under Pressure (PuP) programme is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby's development. An evaluation of the PuP programme in Australia with parents on methadone maintenance of children aged 3 to 8 years found significant reductions in child abuse potential, rigid parenting attitudes and child behaviour problems.

METHODS/DESIGN

The study comprises a multicentre randomised controlled trial using a mixed-methods approach to data collection and analysis in order to identify which families are most able to benefit from this intervention.The study is being conducted in six family centres across the UK, and targets primary caregivers of children less than 2.5 years of age who are substance dependent. Consenting participants are randomly allocated to either the 20-week PuP programme or to standard care.The primary outcome is child abuse potential, and secondary outcomes include substance use, parental mental health and emotional regulation, parenting stress, and infant/toddler socio-emotional adjustment scale.

DISCUSSION

This is one the first UK studies to examine the effectiveness of a programme targeting the parenting of substance-dependent parents of infants and toddlers, in terms of its effectiveness in improving the parent-infant relationship and reducing the potential for child abuse.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number Register: ISRCTN47282925.

Heterogeneity of interpersonal problems among depressed young adults: associations with substance abuse and pathological personality traits

This study extended previous theory and research on interpersonal heterogeneity in depression by identifying groups of depressed young adults who differ in their type and degree of interpersonal problems, and by examining patterns of pathological personality traits and alcohol abuse among these groups. We examined the interpersonal problems, personality traits, and alcohol-related problems of 172 college students with at least moderate levels of self-reported depression on the Patient Health Questionnaire (Spitzer, Kroenke, & Williams, 1999). Scores from the Inventory of Interpersonal Problems-Short Circumplex (Soldz, Budman, Demby, & Merry, 1995) were subjected to latent profile analysis, which classified individuals into 5 distinct groups defined by the types of interpersonal problems they experience (dominant, warm, submissive, cold, and undifferentiated). As hypothesized, groups did not differ in depression severity, but did show predicted patterns of differences on normative and maladaptive personality traits, as well as alcohol-related problems. The presence of clinically meaningful interpersonal heterogeneity in depression could have important implications for designing more individualized treatments and prevention efforts for depression that target diverse associated interpersonal problems.

Development of borderline personality disorder in adolescence and young adulthood: introduction to the special section

Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little information regarding the development of and risk factors for BPD in youth. The goal of this special section is to examine the development of BPD in adolescence and young adulthood using a broad collection of approaches, including a theoretical review paper, two prospective studies, and a multi-method cross-sectional study. This body of work provides new insights into vulnerabilities that may transact with early attachment relationships and experiences to predict the emergence of BPD in adolescence and young adulthood. These papers also point to future research that is needed to better understand the etiology, development, and course of BPD.

Personality disorders in later life: questions about the measurement, course, and impact of disorders

Lifespan perspectives have played a crucial role in shaping our understanding of many forms of psychopathology. Unfortunately, little attention has been given to personality disorders in middle adulthood and later life. Several issues are responsible for this deficiency, including difficulty applying the diagnostic criteria for personality disorders to older people and challenges in identifying appropriate samples of older participants. The goal of this review is to explore the benefits of considering older adults in the study of personality disorders. Later life offers a unique opportunity for investigators to consider links between personality pathology and consequential outcomes in people's lives. Many domains are relevant, including health, longevity, social adjustment, marital relationships, and the experience of major life events. We review each domain and consider ways in which the study of middle-aged and older adults challenges researchers to evaluate how personality disorders in general are defined and measured.

Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features

Two studies tested the hypothesis that rejection sensitivity (RS) and executive control (EC) jointly predict borderline personality (BP) features. We expected high RS to be related to increased vulnerability for BP features specifically in people who also had difficulties in executive control (EC). Study 1 tested this hypothesis using a sample of college students (N = 379) whereas Study 2 (N = 104) was conducted using a community sample of adults. Both studies operationalized EC by a self-report measure. For a subsample in Study 2 (N = 80), ability to delay gratification at age 4 was also used as an early behavioral precursor of EC in adulthood. In both studies, high RS was associated with increased BP features among people low in self-reported EC. Among those high in self-reported EC, the relationship between RS and BP features was attenuated. Study 2 found parallel findings using preschool delay ability as a behavioral index of EC. These findings suggest that EC may protect high RS people against BP features.