Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review

Is PTSD symptomatology a mechanism of emotional regulation? Insights from an interdisciplinary point of view

Post-traumatic stress disorder (PTSD) symptomatology has historically been considered a psychic ailment that is part of a mental disorder. However, it has often been proposed that it could play an adaptive role, in that it would prevent individuals from being exposed to content or situations that they would not be prepared to process. Within the literature on emotional regulation (ER), PTSD symptomatology has commonly been linked to the concept of emotional dysregulation (ED). However, some definitions open the possibility that traumatic symptomatology could be considered ER, from which delicate conclusions would follow. To resolve this dilemma, we turn to interdisciplinary dialogue, specifically with the aid of Thomistic anthropology, whose concepts allow us to understand precisely the relationship between voluntary and involuntary processes and the close relationship between the concepts of reason and regulation. Even though part of the PTSD symptomatology involves psychic mechanisms aimed at modifying emotional states, it is concluded that it is necessary to continue conceptualizing it as ED. The theoretical and practical implications of this discussion are reviewed.

Pilot cluster randomised controlled trial of Stepping Stones and Creating Futures Plus to reduce emotional dysregulation among young men in rural areas and urban informal settlements in KwaZulu-Natal Province, South Africa

AIM

Emotional dysregulation (ED) - the difficulty to control emotional responses to stressors - is a potential driver of intimate partner violence (IPV) perpetration among young men in HIV endemic resource-limited settings. This two-armed pilot cluster randomised controlled trial investigated the effectiveness of Stepping Stones and Creating Futures Plus (SSCF+), a participatory gender transformative and livelihood strengthening intervention, on the emotional dysregulation (ED) among young men in South Africa (SA).

METHODS

A total of 163 young men ages 18 to 30 years were recruited in 30 clusters (friendship groups) in urban informal settlements and rural areas in KwaZulu-Natal, SA. Clusters were randomly allocated (1:1) to either the experimental SSCF+ or control arm, stratified urban/rural and participants were followed-up at 5 months. Intention-to-treat analysis based on generalised estimating equations (GEE) were fitted to quantify the impact of SSCF+ on the men's ED using the culturally tested short version of the Difficulties in Emotion Regulation Scale with 16 items (DERS-16).

RESULTS

At 5 months SSCF+ did not significantly reduce ED in the overall sample. However, SSCF+ had a significant impact on ED among the men at risk of depression at baseline (adjusted odds ratio = 0.12, 95% CI [0.03, 0.46], p = .002).

CONCLUSION

SSCF+, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges, reduced ED among youth with depression challenges in KwaZulu-Natal Province, South Africa.

Mindful eating and orthorexia nervosa: How do they interact?

The present study explored the associations between orthorexia nervosa, social media addiction, emotion regulation difficulties, perfectionism and BMI with four facets of mindful eating, using path analysis to assess these relationships. A sample of 551 students (127 males, 424 females, mean age = 22.6 years) completed an online self-report questionnaire evaluating these constructs. Analyses revealed that mindful eating contributed to emotion dysregulation and orthorexia nervosa and was related to social media addiction. Significant indirect paths were identified from mindful eating, social media addiction and adaptive perfectionism through emotion dysregulation to maladaptive perfectionism. While no direct paths were observed between mindful eating and perfectionism, a direct path was found between adaptive perfectionism and orthorexia nervosa. These findings suggest a more nuanced understanding of eating behaviours is required. Individuals susceptible to eating disorders should approach mindful eating with caution and seek support from healthcare providers to ensure it is used in a way that supports overall wellbeing. Future research should aim to replicate and further clarify these associations to reveal the long-term effects of mindful eating.

Self-Compassion and Emotion Dysregulation Mediate the Effect of Stress Appraisals on Elder Abuse and Neglect Behaviors in Dementia Family Caregiving

OBJECTIVES

The purpose of this paper is to evaluate the mechanistic process by which family caregivers' situational stress appraisals of behavioral symptoms of dementia (BSD) increase the likelihood of a caregiver engaging in abusive and neglectful behaviors toward their care recipient with dementia. We test the hypotheses that (1) the effect of daily BSD stress appraisals on elder abuse and neglect (EAN) is mediated by the caregivers' emotion dysregulation (2) and the mediation path is moderated by self-compassion.

METHODS

This study employed a multitime series design in which participants (N = 453) completed traditional longitudinal surveys at enrollment followed by 21 sequential days of diary surveys (n = 9,513). The hypothesized moderated mediation path was evaluated through a multilevel structural equation model.

RESULTS

Hypotheses were supported. At the within-person level, daily BSD stress appraisal has a significant direct effect on daily EAN. At the between-person level, the path was no longer significant implying a full mediation of emotion dysregulation. The main effect of self-compassion and the interaction term (emotion dysregulation × self-compassion) were also statistically significant indicating the path between emotion dysregulation and EAN is moderated by self-compassion.

DISCUSSION

This study significantly advances the field by empirically showing a mechanistic pathway for a theoretical explanation of EAN. These findings represent a breakthrough for the field and identify modifiable intervention targets for future behavioral interventions to prevent EAN. Emotion (dys)regulation and self-compassion are modifiable traits and skills that can be learned, with robust evidence bases of efficacious interventions that can be adapted for context to dementia family caregiving.

Emotion regulation profiles in Syrian refugees and migrants in Germany: self-efficacy, resilience and well-being comparisons

BACKGROUND

Emotion regulation (ER) plays a central role in psychopathology. Understanding person-centred patterns of ER strategies is crucial for prevention and intervention strategies. However, there is a paucity of research on ER profiles and their psychological correlates in forcibly displaced people (FDP).

OBJECTIVE

This study aimed to identify habitual ER profiles and to examine the predictive role of different psychological variables on these profiles in Syrian FDP in Germany.

METHOD

In a sample of 991 individuals, we conducted a latent profile analysis (LPA) to assess habitual reappraisal and suppression of emotion as ER strategies, as well as self-efficacy, resilience, well-being comparisons, trauma exposure and International Classification of Diseases 11th Revision post-traumatic stress disorder (PTSD) symptoms as potential predictors of ER profile membership.

RESULTS

LPA identified four distinct ER profiles: high regulators (12.8%), low regulators (20.6%), reappraisal regulators (25.1%) and suppressive regulators (41.5%). In multinomial regression analysis, self-efficacy, resilience, appetitive well-being comparisons and trauma exposure were significantly associated with profile membership, while PTSD and aversive well-being comparisons showed no significant association. High regulators exhibited the highest levels of self-efficacy, resilience and appetitive well-being comparisons, followed by reappraisal, suppressive and low regulators. Additionally, high regulators reported the highest number of traumatic events, followed by suppressive and low regulators.

CONCLUSIONS

Our results indicate a higher adaptiveness in high regulation ER profiles as opposed to low regulation ER profiles.

CLINICAL IMPLICATIONS

Given that most FDP in our sample relied predominantly on one ER strategy, developing interventions that focus on cultivating a broad repertoire of ER strategies may be beneficial.

Association between pathological narcissism and emotion regulation: The role of self-mentalizing?

Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.

The role of sexual communication in the relationship between emotion regulation and sexual functioning in women: The impact of age and relationship status

Objective

The aim of this study was to investigate sexual communication as a mechanism involved in the link between emotion regulation and sexual functioning in a sample of adult women, also testing the moderating role of relationship status and age in this association.

Method

1344 sexually active cisgender women (aged 18-57, M = 27.34; SD= 6.484) were recruited from March 30, 2021, to April 12, 2021, through an online survey. From the initial sample, 1280 women were retained and included in the analysis. Participants were asked to respond to three self-report questionnaires: the Difficulties in Emotion Regulation Scale (DERS), the Communication subscale of the Sexual Satisfaction Scale for Women (SSS-W), and the Female Sexual Function Index (FSFI).

Results

We found that sexual communication mediated the link between emotion regulation abilities and female sexual functioning. Moreover, we found that age, but not relationship status, moderated the association between emotion regulation and sexual communication, so that older women with difficulties in emotion regulation processes showed worse sexual communication abilities as compared to younger women.

Conclusions

According to this study's results, clinicians and sexual therapists should carefully consider emotion regulation abilities and sexual communication as crucial factors in promoting women's sexual well-being.

Childhood sexual abuse and suicide attempts in patients with substance use disorders: The mediating role of emotion dysregulation

BACKGROUND

Suicide attempts (SA) are a public health concern because of increasing prevalence and clinical implications. Childhood trauma (CT) and emotion dysregulation (ED) have been proposed as predictors of SA, but few data are available in patients with Substance Use Disorder (SUD).

OBJECTIVE

Our study aims to investigate the association of sociodemographic/clinical variables, CT typologies, and ED features with SA in SUD patients.

PARTICIPANTS AND SETTING

Subjects with SUD were screened in an outpatient setting. The final sample consisted of 226 patients, subdivided according to the presence of lifetime SA (SUD, n = 163 vs. SUD-SA, n = 63).

METHODS

Participants were compared for sociodemographic and clinical information. CT and ED were assessed through the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Difficulties in Emotion Regulation Scale (DERS), respectively. We performed a mediation analysis to test the effect of CT and ED on SA.

RESULTS

Patients with a history of SA (27.9 %) displayed more psychiatric comorbidities (p = 0.002) and hospitalizations (p < 0.001), higher scores at CTQ-SF sexual abuse (p < 0.001) and DERS 'impulse' (p = 0.002), 'goals', 'non-acceptance', 'strategies' (p < 0.001) subscales. The relationship between CTQ-SF sexual abuse and SA was significantly mediated by DERS 'strategies' (p = 0.04; bootstrapped 95 % LLCI-ULCI = 0.004-0.024).

CONCLUSIONS

CT and different dimensions of ED were associated with SA in SUD patients. In our sample, the effects of childhood sexual abuse on SA were mediated by limited access to emotion regulation strategies. SUD patients are burdened with higher all-cause mortality, and CT and lifetime SA can worsen clinical outcomes. Clarifying the reciprocal interactions of psychopathological dimensions may help deliver targeted interventions and reduce suicide risk in specific populations.

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles

Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.

Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review

Emotional dysregulation (ED) has recently been conceptualized as a transnosographic entity in major mental disorders, and increasing evidence has suggested association between ED and post-traumatic stress symptoms (PTSS), though the nature of this association is unclear. The aim of the present review was to examine the possible interplay between ED and trauma exposure in the literature, as well as a possible role for the comorbidity of PTSD or PTSS in adolescents and young adults. In particular, we explored whether ED may represent a risk factor for PTSD or, conversely, a consequence of traumatic exposure. This systematic review was conducted according to PRISMA 2020 guidelines in three databases (PubMed, Scopus, and Embase). The 34 studies included showed a wide heterogeneity in terms of the populations selected and outcomes examined. Most studies used the Difficulties in Emotion Regulation Scale (DERS) and examined the relationship between ED, trauma, and psychopathological manifestations after the occurrence of trauma, with a focus on child abuse. Although current data in the literature are heterogeneous and inconclusive, this research highlights the role of ED as a mechanism that may mediate vulnerability to PTSD, but also as a predictor of severity and maintenance of typical, atypical, or associated PTSD symptoms, suggesting prevention programs for PTSD and other mental disorders should support the development of emotion regulation strategies.

Comorbidity and Overlaps between Autism Spectrum and Borderline Personality Disorder: State of the Art

Despite the relationship between Autism spectrum disorder (ASD) and personality disorders (PD) still being scarcely understood, recent investigations increased awareness about significant overlaps between some PD and autism spectrum conditions. In this framework, several studies suggested the presence of similarities between BPD and ASD symptoms and traits, based on the recent literature that increasingly reported increased comorbidity rates and significant symptomatologic overlaps between the two conditions. The aim of this review is to describe the available studies about the prevalence of the association between different forms of autism spectrum (full-fledged clinical conditions as well as subthreshold autistic traits) and BPD. Despite some controversial results and lack of homogeneity in the methods used for the diagnostic assessment, the reviewed literature highlighted how subjects with BPD reported higher scores on tests evaluating the presence of AT compared to a non-clinical population and hypothesized the presence of unrecognized ASD in some BPD patients or vice versa, while also describing a shared vulnerability towards traumatic events, and a greater risk of suicidality in BPD subjects with high autistic traits. However, the specific measure and nature of this association remain to be explored in more depth.

Investigating suicidality across the autistic-catatonic continuum in a clinical sample of subjects with major depressive disorder and borderline personality disorder

Background

Recent literature has highlighted that catatonia may be more prevalent among psychiatric patients than previously thought, beginning from autism spectrum disorders (ASD), for which it has been suggested to represent a severe late consequence, but also among individuals with mood disorders and borderline personality disorder (BPD). Interestingly, one critical point shared by these conditions is the increased risk of suicidality. The aim of this study was to evaluate how the presence and the prevalence of catatonic symptoms may shape and correlate with suicidal risk in a sample of individuals with major depressive disorder (MDD) or BPD.

Methods

We recruited two clinical samples of subjects (BPD and MDD) and a control group without a diagnosis according to DSM-5 (CTL). Subjects were assessed with the catatonia spectrum (CS) and the MOODS-SR for evaluating suicidality.

Results

In the total sample, suicidality score was significantly and positively correlated with all CS domains and CS total score. Correlation and regression analyses highlighted specific patterns of association among Catatonia spectrum domains and suicidality in the MDD and BPD group and in the total sample.

Conclusion

In both disorders, higher catatonic traits are linked to higher suicidal tendencies, confirming the high risk of suicide for this population. However, different patterns of association between catatonic symptoms and suicidality were highlighted in the two disorders.