Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T05:15:25.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm

Published online by Cambridge University Press:  17 November 2020

Skye Fitzpatrick Open the ORCID record for Skye Fitzpatrick [Opens in a new window] ,
Sonya Varma  and
Janice R. Kuo
Skye Fitzpatrick*
Affiliation:
Department of Psychology, York University, Canada
Sonya Varma
Affiliation:
Department of Psychology, York University, Canada
Janice R. Kuo
Affiliation:
Department of Psychology, Palo Alto University, USA
*
Author for correspondence: Skye Fitzpatrick, E-mail: skyefitz@yorku.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups.

Methods

Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits.

Results

Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group.

Conclusions

There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

Keywords

Borderline personality disorderemotion dysregulationemotion regulationvagal tone
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 12 , September 2022 , pp. 2319 - 2331
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atkins, D. C., & Gallop, R. J. (2007). Rethinking how family researchers model infrequent outcomes: A tutorial on count regression and zero-inflated models. Journal of Family Psychology, 21, 726–735. doi:10.1037/0893-3200.21.4.726.CrossRefGoogle ScholarPubMed
Austin, M. A., Riniolo, T. C., & Porges, S. W. (2007). Borderline personality disorder and emotion regulation: Insights from the polyvagal theory. Brain and Cognition, 65, 69–76. doi:10.1016/j.bandc.2006.05.007CrossRefGoogle ScholarPubMed
Baczkowski, B. M., van Zutphen, L., Siep, N., Jacob, G. A., Domes, G., Maier, S., … van de Ven, V. (2017). Deficient amygdala-prefrontal intrinsic connectivity after effortful emotion regulation in borderline personality disorder. European archives of psychiatry and clinical neuroscience, 267, 551–565. doi:10.1007/s00406-016-0760-zCrossRefGoogle ScholarPubMed
Baschnagel, J. S., Coffey, S. F., Hawk, L. W. Jr., Schumacher, J. A., & Holloman, G. (2013). Psychophysiological assessment of emotional processing in patients with borderline personality disorder with and without comorbid substance use. Personality Disorders: Theory, Research, and Treatment, 4, 203–213. doi:10.1037/a0029777.CrossRefGoogle ScholarPubMed
Baskin-Sommers, A., Vitale, J. E., MacCoon, D., & Newman, J. P. (2012). Assessing emotion sensitivity in female offenders with borderline personality symptoms: Results from a fear-potentiated startle paradigm. Journal of Abnormal Psychology, 121, 477–483. doi:10.1037/a0026753.CrossRefGoogle ScholarPubMed
Beauchaine, T. P. (2001). Vagal tone, development, and gray's motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and Psychopathology, 13, 183–214. doi:10.1017/S0954579401002012.CrossRefGoogle ScholarPubMed
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011–1023. doi:10.1016/j.janxdis.2009.07.006.CrossRefGoogle ScholarPubMed
Bohus, M., Limberger, M. F., Frank, U., Chapman, A. L., Kühler, T., & Stieglitze, R. (2007). Psychometric properties of the borderline symptom list (BSL). Psychopathology, 40, 126–132. doi:10.1159/000098493.CrossRefGoogle Scholar
Burton, P., Gurrin, L., & Sly, P. (1998). Extending the simple linear regression model to account for correlated responses: An introduction to generalized estimating equations and multi-level mixed modelling. Statistics in Medicine, 17, 1261–1291. doi:10.1002/(SICI)1097-0258(19980615)17:11<1261::AID-SIM846>3.0.CO;2-Z.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence, and kappa. Journal of Clinical Epidemiology, 46, 423–429. doi:10.1016/0895-4356(93)90018-V.CrossRefGoogle ScholarPubMed
Carr, O., de Vos, M., & Saunders, K. E. A. (2018). Heart rate variability in bipolar disorder and borderline personality disorder: A clinical review. Evidence Based Mental Health, 21, 23–30. doi:10.1136/eb-2017-102760.CrossRefGoogle ScholarPubMed
Chapman, A. L., Dixon-Gordon, K., Butler, S. M., & Walters, K. N. (2015). Emotional reactivity to social rejection versus a frustration induction among persons with borderline personality features. Personality Disorders: Theory, Research, and Treatment, 6, 88–96. doi:10.1037/per0000101.CrossRefGoogle ScholarPubMed
Chapman, A. L., Rosenthal, M. Z., & Leung, D. W. (2009). Emotion suppression in borderline personality disorder: An experience sampling study. Journal of Personality Disorders, 23(1), 29–47. doi:10.1037/int0000044.CrossRefGoogle Scholar
Daros, A. R., Williams, G. E., Jung, S., Turabi, M., Uliaszek, A. A., & Ruocco, A. C. (2018). More is not always better: Strategies to regulate negative mood induction in women with borderline personality disorder and depressive and anxiety disorders. Personality Disorders: Theory, Research, and Treatment, 9, 530–542. doi:10.1037/per0000296CrossRefGoogle Scholar
Dixon-Gordon, K., Gratz, K. L., & Tull, M. T. (2013a). Multimodal assessment of emotional reactivity in borderline personality pathology: The moderating role of posttraumatic stress disorder symptoms. Comprehensive Psychiatry, 54, 639–648. doi:10.1016/j.comppsych.2012.12.019.CrossRefGoogle Scholar
Dixon-Gordon, K., Weiss, N. H., Tull, M. T., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2015). Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence. Comprehensive Psychiatry, 62, 187–203. doi:10.1016/j.comppsych.2015.07.014.CrossRefGoogle ScholarPubMed
Dixon-Gordon, K., Yiu, A., & Chapman, A. L. (2013b). Borderline personality features and emotional reactivity: The mediating role of interpersonal vulnerabilities. Journal of Behavior Therapy and Experimental Psychiatry, 44, 271–278. doi:10.1016/j.jbtep.2012.12.001.CrossRefGoogle Scholar
Ebner-Priemer, U., Badeck, S., Beckmann, C., Wagner, A., Feige, B., Weiss, I., … Bohus, M. (2005). Affective dysregulation and dissociative experience in female patients with borderline personality disorder: A startle response study. Journal of Psychiatric Research, 39, 85–92. doi:10.1016/j.jpsychires.2004.05.001.CrossRefGoogle ScholarPubMed
Ebner-Priemer, U. W., Houben, M., Santangelo, P., Kleindienst, N., Tuerlinckx, F., Oravecz, Z., … Kuppens, P. (2015). Unraveling affective dysregulation in borderline personality disorder: A theoretical model and empirical evidence. Journal of Abnormal Psychology, 124, 186–198. doi:10.1037/abn0000021.CrossRefGoogle ScholarPubMed
Ebner-Priemer, U., Welch, S. S., Grossman, P., Reisch, T., Linehan, M. M., & Bohus, M. (2007). Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder. Psychiatry Research, 150, 265–275. doi:10.1016/j.psychres.2006.04.014.CrossRefGoogle ScholarPubMed
Elices, M., Soler, J., Fernández, C., Martín-Blanco, A., Jesús Portella, M., Pérez, V., … Carlos Pascual, J. (2012). Physiological and self-assessed emotional responses to emotion-eliciting films in borderline personality disorder. Psychiatry Research, 200, 437–443. doi:10.1016/j.psychres.2012.07.020.CrossRefGoogle ScholarPubMed
Erisman, S. M., & Roemer, L. (2010). A preliminary investigation of the effects of experimentally induced mindfulness on emotional responding to film clips. Emotion (Washington, D.C.), 10, 72–82. doi:10.1037/a0017162CrossRefGoogle ScholarPubMed
Evans, D., Howard, M., Dudas, R., Denman, C., & Dunn, B. D. (2013). Emotion regulation in borderline personality disorder: Examining the consequences of spontaneous and instructed use of emotion suppression and emotion acceptance when viewing negative films. Journal of Experimental Psychopathology, 4, 546–565. doi:10.5127/jep.029512.CrossRefGoogle Scholar
Feliu-Soler, A., Pascual, J. C., Soler, J., Pérez, V., Armario, A., Carrasco, J., … Borràs, X. (2013). Emotional responses to a negative emotion induction procedure in borderline personality disorder. International Journal of Clinical and Health Psychology, 13, 9–17. doi:10.1016/S1697-2600(13)70002-4.CrossRefGoogle Scholar
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). Structured clinical interview for axis I DSM-IV disorders-patient edition (SCIDI/P). New York, NY: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Fitzpatrick, S., & Kuo, J. R. (2015). A comprehensive examination of delayed emotional recovery in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 47, 51–59. doi:10.1016/j.jbtep.2014.11.004.CrossRefGoogle ScholarPubMed
Fitzpatrick, S., Maich, K., Kuo, J. R., & Carney, C. (2020). Identifying specific insomnia components in borderline personality disorder and their influence on emotion dysregulation. Personality Disorders: Theory, Research, and Treatment. Advanced online publication. doi:10.1037/per0000395.CrossRefGoogle ScholarPubMed
Fitzpatrick, S., Wagner, A. C., & Monson, C. M. (2019). Optimizing borderline personality disorder treatment by incorporating significant others: A review and synthesis. Personality Disorders: Theory, Research and Treatment, 4, 297–308. doi: 10.1037/per0000328.CrossRefGoogle Scholar
Fowles, D. C., Christie, M. J., Edelberg, R., Grings, W. W., Lykken, D. T., & Venables, P. H. (1981). Publication recommendations for electrodermal measurements. Psychophysiology, 18, 232–239. doi:10.1111/j.1469-8986.1981.tb03024.xCrossRefGoogle ScholarPubMed
Glaser, J. P., Van Os, J., Mengelers, R., & Myin-Germeys, I. (2008). A momentary assessment study of the reputed emotional phenotype associated with borderline personality disorder. Psychological Medicine, 38, 1231–1239. doi:10.1017/S0033291707002322.CrossRefGoogle ScholarPubMed
Glaser, J. P., Van Os, J., Thewissen, V., & Myin-Germeys, I. (2010). Psychotic reactivity in borderline personality disorder. Acta Psychiatrica Scandinavica, 121, 125–134. doi:10.1111/j.1600-0447.2009.01427.x.CrossRefGoogle ScholarPubMed
Gratz, K. L., Richmond, J. R., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2019). Multimodal assessment of emotional reactivity and regulation in response to social rejection among self-harming adults with and without borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 10, 395–405. doi:10.1037/per0000334.CrossRefGoogle ScholarPubMed
Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2010). An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: The role of shame. Comprehensive Psychiatry, 51, 275–285. doi:10.1016/j.comppsych.2009.08.005.CrossRefGoogle ScholarPubMed
Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224–237. doi:10.1037/0022-3514.74.1.224CrossRefGoogle ScholarPubMed
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In Gross, J. J. (Ed.), Handbook of emotion regulation (pp. 3–26). New York, NY: Guilford Press.Google Scholar
Harpur, T. J., Hare, R. D., & Hakstian, A. R. (1989). Two-factor conceptualization of psychopathy: Construct validity and assessment implications. Psychological Assessment, 1, 6–17. doi: 10.1037/1040-3590.1.1.6.CrossRefGoogle Scholar
Hazlett, E. A., Zhang, J., New, A. S., Zelmanova, Y., Goldstein, K. E., Haznedar, M. M., … Chu, K. (2012). Potentiated amygdala response to repeated emotional pictures in borderline personality disorder. Biological Psychiatri, 72, 1550–1556. http://dx.doi.org.ezproxy.library.yorku.ca/10.1016/j.biopsych.2012.03.027Google ScholarPubMed
Herpertz, S. C., Kunert, H. J., Schwenger, U. B., & Sass, H. (1999). Affected responsiveness in borderline personality disorder: A psycho-physiological approach. The American Journal of Psychiatry, 156, 1550–1556. doi:10.1176/ajp.156.10.1550CrossRefGoogle Scholar
Herpertz, S. C., Schwenger, U. B., Kunert, H. J., Lukas, G., Gretzer, U., Nutzmann, J., … Sass, H. (2000). Emotional responses in patients with borderline as compared with avoidant personality disorder. Journal of Personality Disorders, 14, 339–351. doi:10.1521/pedi.2000.14.4.339.CrossRefGoogle ScholarPubMed
Hörz, S., Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). Ten-year use of mental health services by patients with borderline personality disorder and with other axis II disorders. Psychiatric Services, 61, 612–616. doi:10.1176/ps.2010.61.6.612.CrossRefGoogle ScholarPubMed
Hubbard, A. E., Ahern, J., Fleischer, N. L., Van, D. L., Lippman, A. A., Jewell, N., … Satariano, W. A. (2010). To GEE or not to GEE: Comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology (Cambridge, Mass.), 21, 467–474. doi:10.1097/EDE.0b013e3181caeb90CrossRefGoogle ScholarPubMed
Jacob, G. A., Kathrin, H., Ower, N., Pillmann, M., Scheel, C. N., Rüsch, N., & Lieb, K. (2009). Emotional reactions to standardized stimuli in women with borderline personality disorder: Stronger negative affect, but no differences in reactivity. Journal of Nervous and Mental Disease, 197, 808–815. doi:10.1097/NMD.0b013e3181bea44d.CrossRefGoogle ScholarPubMed
Jennings, J. R., Kamarck, T. W., Stewart, C., & Eddy, M. J. (1992). Alternate cardiovascular baseline assessment techniques: Vanilla or resting baseline. Psychophysiology, 29, 742–750. doi: 10.1111/j.1469-8986.1992.tb02052.xCrossRefGoogle ScholarPubMed
Koenig, J., Kemp, A. H., Feeling, N. R., Thayer, J. F., & Kaess, M. (2016). Resting state vagal tone in borderline personality disorder: A meta-analysis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 64, 18–26. doi:10.1016/j.pnpbp.2015.07.002.CrossRefGoogle ScholarPubMed
Köhling, J., Moessner, M., Ehrenthal, J. C., Bauer, S., Cierpka, M., Kämmerer, A., … Dinger, U. (2016). Affective instability and reactivity in depressed patients with and without borderline pathology. Journal of Personality Disorders, 30, 776–795. doi:10.1521/pedi_2015_29_230.CrossRefGoogle ScholarPubMed
Krause-Utz, A., Walther, J., Lis, S., Schmahl, C., & Bohus, M. (2019). Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: The role of comorbid posttraumatic stress disorder and dissociation. Psychological Medicine, 49, 1810–1821. doi:10.1017/S0033291718002489CrossRefGoogle ScholarPubMed
Kröger, C., Harbeck, S., Armbrust, M., & Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51, 411–416. doi:10.1016/j.brat.2013.04.008.CrossRefGoogle Scholar
Kuo, J. R., Fitzpatrick, S., Metcalfe, R. K., & McMain, S. (2016). A multi-method laboratory investigation of emotional reactivity and emotion regulation abilities in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 50, 52–60. doi: 10.1016/j.jbtep.2015.05.002.CrossRefGoogle ScholarPubMed
Kuo, J. R., & Linehan, M. M. (2009). Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology, 118, 531–544. doi:10.1037/a0016392.CrossRefGoogle ScholarPubMed
Lang, S., Kotchoubey, B., Frick, C., Spitzer, C., Grabe, H. J., & Barnow, S. (2012). Cognitive reappraisal in trauma-exposed women with borderline personality disorder. NeuroImage, 59, 1727–1734. doi:10.1016/j.neuroimage.2011.08.061CrossRefGoogle ScholarPubMed
Licht, C. M. M., de Geus, E. J. C., van Dyck, R., & Penninx, B. W. J. H. (2010). Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biological Psychiatry, 68, 861–868. doi:10.1016/j.biopsych.2010.06.032CrossRefGoogle ScholarPubMed
Limberg, A., Barnow, S., Freyberger, H. J., & Hamm, A. O. (2011). Emotional vulnerability in borderline personality disorder is cue specific and modulated by traumatization. Biological Psychiatry, 69, 574–582. doi:10.1016/j.biopsych.2010.10.024CrossRefGoogle ScholarPubMed
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press.Google Scholar
Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). New York, NY: Guilford Press.Google Scholar
Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., … Regier, D. A. (1994). The international personality disorder examination: The world health organization/alcohol, drug abuse, and mental health administration international pilot study of personality disorders. Archives of General Psychiatry, 51, 215–224. doi:10.1001/archpsyc.1994.03950030051005CrossRefGoogle ScholarPubMed
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd. Ed.). Sydney, AUS: Psychology Foundation.Google Scholar
Manikandan, S., & Soman, K. P. (2012). A novel method for detecting R-peaks in electrocardiogram signal. Biomedical Signal Processing and Control, 7, 118–128. doi:10.1016/j.bspc.2011.03.004.CrossRefGoogle Scholar
Marissen, M. A. E., Meuleman, L., & Franken, I. H. A. (2010). Altered emotional information processing in borderline personality disorder: An electrophysiological study. Psychiatry Research: Neuroimaging, 181, 226–232. doi:10.1016/j.pscychresns.2009.10.006CrossRefGoogle ScholarPubMed
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281–1310. doi:10.1016/j.brat.2004.08.008CrossRefGoogle ScholarPubMed
O'Keefe, D. J. (2003). Colloquy: Should familywise alpha be adjusted? Against familywise alpha adjustment. Human Communication Research, 29, 431–447. doi:10.1093/hcr/29.3.431Google Scholar
Pfaltz, M. C., Schumacher, S., Wilhelm, F. H., Dammann, G., Seifritz, E., & Martin-Soelch, C. (2015). Acoustic emotional processing in patients with borderline personality disorder: Hyper- or hyporeactivity? Journal of Personality Disorders, 29, 809–827. doi: 10.1521/pedi_2015_29_176.CrossRefGoogle ScholarPubMed
Porges, S. W., Doussard-Roosevelt, J. A., & Maita, A. K. (1994). Vagal tone and the physiological regulation of emotion. Monographs of the Society for Research in Child Development, 59, 167–186, 250–283. doi:10.2307/1166144.CrossRefGoogle ScholarPubMed
Rosenthal, M. Z., Gratz, K. L., Kosson, D. S., Cheavens, J. S., Lejuez, C. W., & Lynch, T. R. (2008). Borderline personality disorder and emotional responding: A review of the research literature. Clinical Psychology Review, 28, 75–91. doi:10.1016/j.cpr.2007.04.001CrossRefGoogle ScholarPubMed
Rosenthal, M. Z., Neacsiu, A. D., Geiger, P. J., Fang, C., Ahn, R., & Larrauri, J. (2016). Emotional reactivity to personally-relevant and standardized sounds in borderline personality disorder. Cognitive Therapy and Research, 40, 314–327. doi:10.1007/s10608-015-9736-y.CrossRefGoogle Scholar
Ross, C. A. (2007). Borderline personality disorder and dissociation. Journal of Trauma & Dissociation, 8, 71–80. doi:10.1300/J229v08n01_05CrossRefGoogle ScholarPubMed
Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology (Cambridge, Mass.), 1, 43–46. Retrieved from https://journals.lww.com/epidem/pages/articleviewer.aspx?year=1990&issue=01000&article=00010&type=abstract#pdf-link.CrossRefGoogle ScholarPubMed
Ruef, A. M., & Levenson, R. W. (2007). Continuous measurement of emotion: The affect rating dial. In Coan, J. A., & Allen, J. J. B. (Eds.), Series in affective science. Handbook of emotion elicitation and assessment (pp. 286–297). New York, NY: Oxford University Press.Google Scholar
Ruocco, A. C., Medaglia, J. D., Ayaz, H., & Chute, D. L. (2010). Abnormal prefrontal cortical response during affective processing in borderline personality disorder. Psychiatry Research: Neuroimaging, 182, 117–122. doi:10.1016/j.pscychresns.2010.01.011CrossRefGoogle ScholarPubMed
Sansone, R. A., Wiederman, M. W., Hatic, A., & Flath, L. (2010). Borderline personality and emotional reactivity to theoretical media events: A pilot study. International Journal of Psychiatry in Clinical Practice, 14, 127–131. doi:10.3109/13651500903532314.CrossRefGoogle ScholarPubMed
Scheel, C. N., Schneid, E., Tuescher, O., Lieb, K., Tuschen-Caffier, B., & Jacob, G. A. (2013). Effects of shame induction in borderline personality disorder. Cognitive Therapy and Research, 37, 1160–1168. doi:10.1007/s10608-013-9567-7.CrossRefGoogle Scholar
Schulze, L., Domes, G., Kruüger, A., Berger, C., Fleischer, M., Prehn, K., … Herpertz, S. C. (2011). Neuronal correlates of cognitive reappraisal in borderline patients with affective instability. Biological Psychiatry, 69, 564–573. doi:10.1016/j.biopsych.2010.10.025CrossRefGoogle ScholarPubMed
Scott, L. N., Levy, K. N., & Granger, D. A. (2013). Biobehavioral reactivity to social evaluative stress in women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 4, 91–100. doi:10.1037/a0030117.CrossRefGoogle ScholarPubMed
Selby, E. A., & Joiner, T. E. Jr. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13, 219–229. doi:10.1037/a0015687.CrossRefGoogle ScholarPubMed
Sheppes, G., & Meiran, N. (2008). Divergent cognitive costs for online forms of reappraisal and distraction. Emotion (Washington, D.C.), 8, 870–874. doi:10.1037/a0013711CrossRefGoogle ScholarPubMed
Smoski, M. J., Salsman, N., Wang, L., Smith, V., Lynch, T. R., Dager, S. R., … Linehan, M. M. (2011). Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 2, 230–241. doi:10.1037/a0022228.CrossRefGoogle ScholarPubMed
Southward, M. W., & Cheavens, J. S. (2020). Quality or quantity? A multi-study analysis of emotion regulation skills deficits associated with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 11, 24–35. doi:10.1037/per0000357.CrossRefGoogle ScholarPubMed
Sprague, J., Javdani, S., Sadeh, N., Newman, J. P., & Verona, E. (2012). Borderline personality disorder as a female phenotypic expression of psychopathy? Personality Disorders, 3, 127–139. doi: 10.1037/a0024134.CrossRefGoogle ScholarPubMed
Stiglmayr, C. E., Shapiro, D. A., Stieglitz, R. D., Limberger, M. F., & Bohus, M. (2001). Experience of aversive tension and dissociation in female patients with borderline personality disorder: A controlled study. Journal of Psychiatric Research, 35, 111–118. doi:10.1016/S0022-3956(01)00012-7.CrossRefGoogle ScholarPubMed
Weinberg, A., Klonsky, E. D., & Hajcak, G. (2009). Autonomic impairment in borderline personality disorder: A laboratory investigation. Brain and Cognition, 71, 279–286. doi: 10.1016/j.bandc.2009.07.014CrossRefGoogle ScholarPubMed
Winter, D. (2016). Attention to emotional stimuli in borderline personality disorder – a review of the influence of dissociation, self-reference, and psychotherapeutic interventions. Borderline Personality Disorder and Emotion Dysregulation, 3, 11. doi:10.1186/s40479-016-0047-z.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998). Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry, 39, 296–302. doi:10.1016/S0010-440X(98)90038-4.CrossRefGoogle ScholarPubMed