A new paper appearing in the journal Personality Disorders attempts to catalog the nuanced emotional experiences associated with borderline personality disorder (BPD) and offers insight on how to treat one of the more “treatment-resistant” personality disorders.
“Some of borderline personality disorder’s reputation of being difficult to treat comes from the antiquated idea that BPD is intractable and that people with BPD have a character problem that makes them attention-seeking and help-rejecting,” says Nicole Cardona of Boston Univerity’s Center for Anxiety and Related Disorders and the lead author of the research. “That said, advancements in BPD research over the last 30 years have begun changing this reputation. There are currently several evidence-based treatments for BPD that have been shown to reduce symptoms and greatly improve quality of life.”
To add to the current understanding of borderline personality disorder, Cardona and her research team recruited eight people with BPD to participate in a diary study over a 12-week period. The goal of the study was to track the types of intense emotions participants experienced on a daily basis (for example, anger, sadness, anxiety, or guilt/shame), what triggered those emotions, and how participants responded to those emotions, which fell into one or more of the categories listed below:
- Purposefully tried to push the feeling away (e.g., distracted myself, used substances/alcohol, engaged in self-injury)
- “Dug in” to the feeling (e.g., listened to angry music, vented, paced);
- Engaged in impulsive behavior (e.g., shopped, ate, used substances/alcohol, lashed out, engaged in self-injury)
- Engaged in problem-solving (e.g., assertive behavior, set a limit, asked for something you needed)
- Allowed the feeling to be there and waited to react (e.g., focused on present tasks that need to get done, collected all the facts about the situation before responding)
They found that anxiety was the most frequent emotion felt by borderline participants in the study, followed by sadness, anger, and guilt/shame.
They also found that interpersonal events were most likely to trigger emotional experiences, often in the form of conflict, rejection sensitivity, and/or disconnection. Self-evaluation, such as a getting a bad grade or performance review, was also responsible for triggering some of the emotional states, as was short-term routine disruptions (“I left my keys at home”), physical/material vulnerabilities (“I was hungover”), and acute physiological triggers (e.g., “I had a panic attack”).
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The most common responses reported by participants were problem-solving and intentional avoidance, followed by mindful acceptance and amplification. Impulsivity was reported least frequently.
“There were some interesting findings regarding factors that predicted participants’ use of specific emotion regulation strategies,” says Cardona. “For example, when participants reported the specific emotion of anxiety, they were more likely to try to problem-solve, but when they reported sadness, they were less likely to problem-solve and more likely to push it away.”
The researchers also reported that participants with more severe BPD symptoms showed a tendency to amplify their emotions. They also found that impulsive regulation strategies were most commonly observed when the emotion was brought on by a physical vulnerability, like feeling sick or tired.
The researchers are careful to point out that no two individuals share the same emotional experience — and that learning one’s own signals is a critical part of effective emotion regulation.
“Emotions are signals, and specific signals can lead to specific courses of action,” says Cardona. “Especially if you struggle with BPD, understanding your own patterns of emotions and responses is the first step toward learning how to use strategies that are more adaptive in the long term.”
A full interview with Nicole Cardona discussing her new research on borderline personality disorder can be found here: A new way to understand borderline personality disorder