Temporal instability of affect is a defining characteristic of psychological disorders such as borderline personality disorder (BPD) and mood cycling disorders. Ecological momentary assessment (EMA) enables researchers to directly assess such frequent and extreme fluctuations over time. The authors examined 4 operationalizations of such temporal instability: the within-person variance (WPV), the first-order autocorrelation, the mean square successive difference (MSSD), and the probability of acute change (PAC). It is argued that the MSSD and PAC measures are preferred indices of affective instability because they capture both variability and temporal dependency in a time series. Additionally, the performance of these 2 measures in capturing within- and between-day instability is discussed. To illustrate, the authors present EMA data from a study of negative mood in BPD and major depressive disorder patients. In this study, MSSD and PAC captured affective instability better than did WPV. Given that MSSD and PAC are individual difference measures, the authors propose that group differences on these indices be explored using generalized multilevel models. Versions of MSSD and PAC that adjust for randomly elapsed time interval between assessments are also presented.

Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (>or=90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment.

We applied different diagnostic rules for diagnosing personality disorders to the NESARC epidemiological study of over 40,000 individuals. Specifically, unlike previous NESARC publications, we required that each personality disorder criterion be associated with significant distress or impairment in order to be counted toward a personality disorder (PD) diagnosis. Results demonstrated significant reductions in prevalence rates for PDs (9.1% versus 21.5% using original NESARC algorithms), and these revised prevalence rates were much more consistent with recent epidemiological studies in the U.S. and Great Britain. We also found gender differences in the prevalence rate for most PDs. Comorbidity analyses revealed strong associations between PDs and alcohol dependence, drug dependence, and tobacco dependence. PD diagnoses were also associated with scores on dysfunction and impairment, perceived stress and less social support, lifetime history of suicide attempts, interpersonal difficulties, and problems with legal authorities.

Traditional self-report measures of psychopathology may be influenced by a variety of recall biases. Ecological momentary assessment (EMA) reduces these biases by assessing individuals' experiences as they occur in their natural environments. This study examines the discrepancy between trait questionnaire, retrospective report, and EMA measures of affective instability in psychiatric outpatients either with a borderline personality diagnosis (BPD; n=58) or with a current major depressive episode or dysthymia (MDD/DYS; n=42). We examined the agreement of three trait measures of affective instability (Personality Assessment Inventory-Borderline Features scaleAffective Instability scale, Affect Intensity Measure, and the Affect Lability Scales) and one retrospective mood recall task with EMA indices of mood and mood instability. Results indicate only modest to moderate agreement between momentary and questionnaire assessments of trait affective instability; agreement between recalled mood changes and EMA indices was poor. Implications for clinical research and practice and possible applications of EMA methodology are discussed. KeywordsBorderline Personality Disorder; affective instability; Ecological Momentary Assessment; retrospective report Clinical researchers and practitioners primarily rely on retrospective self-reports of experiences such as emotions, symptoms, traits, and behaviors when evaluating an individual's functioning. Traditional questionnaire assessments have a variety of strengths, including ease of administration and cost-effectiveness. In addition, the clinical or diagnostic interview is a major tool used by clinical psychologists for evaluation and treatment planning. Both questionnaires and interviews, however, require the respondent to retrospect and integrate information from memory in order to rate items or answer questions. Unfortunately, retrospective reports are influenced by a variety of recall biases, which may introduce error and limit the usefulness of findings based on these reports .Alternate methodologies, such as Ecological Momentary Assessment (EMA; Stone & Shiffman, 1994), offer ways to circumvent (or at least minimize) many sources of recall bias and thereby provide the opportunity to assess the discrepancies between reports of recalled Correspondence concerning this article should be addressed to Timothy J. Trull, Department of Psychological Sciences, 210 McAlester Hall, University of Missouri-Columbia, Columbia, MO 65211. Electronic mail may be sent to trullt@missouri.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The publis...

Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the two substances may have profound health consequences. In order to characterize the motivationally relevant processes contributing to co-use, the current study used Ecological Momentary Assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N = 259) monitored their daily experiences for 21 days using electronic diaries. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion-and personlevel covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of "buzzed" and "dizzy" were synergistically affected by couse of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects. Keywordsalcohol; cigarettes; electronic diary; craving; reward; reinforcement Alcohol drinkers are more likely to smoke cigarettes than teetotalers and smokers are more likely to report drinking alcohol than nonsmokers (Falk, Yi & Hiller-Sturmhofel, 2006; Shiffman & Balabanis, 1995). Moreover, heavy drinkers are likely to be heavy smokers and vice versa (Shiffman & Balabanis, 1995). In psychiatric epidemiology, alcohol use disorders show substantial comorbidity with tobacco dependence (Falk, et al., 2006;Jackson, Sher, Wood, & Bucholz, 2003). The probability of smoking is strongly related to the number of alcohol dependence criteria endorsed (Madden, Bucholz, Martin & Heath, 2000). Indeed, this overlap is so robust that it could be argued alcoholism is most often a disorder involving problematic use of alcohol and tobacco. The covariation of the two substances is practically and clinically important. For instance, abuse of both alcohol and tobacco confers synergistic risk for some forms of cancer (e.g., Castellsague, et al., 1999). Even though alcoholism is associated with devastating medical consequences, a follow-up study of treated alcoholics found they were even more likely to die of tobacco-related disease (Hurt, et al., 1996).Alcohol and tobacco not only tend to be used by the same individuals, but also tend to be used at the same time. In the laboratory, alcohol administration spurs tobacco use (e.g., Mello, Mendelson, & Palmieri, 1987;Mintz, Boyd, Rose, Charuvastra, & Jarvik, 1985). Some evidence suggests nicotine administration i...

Impulsivity is a core feature of many psychiatric disorders. Traditionally, impulsivity has been assessed using retrospective questionnaires or laboratory tasks. Both approaches neglect intraindividual variability in impulsivity and do not capture impulsivity as it occurs in real-world settings. The goal of the current study was to provide a method for assessing impulsivity in daily life that provides both between-individual and within-individual information. Participants with borderline personality disorder (BPD; n = 67) or a depressive disorder (DD; n = 38) carried an electronic diary for 28 days and responded to 9 impulsivity items up to 6 times per day. Item distributions and iterative exploratory factor analysis (EFA) results were examined to select the items that best captured momentary impulsivity. A brief 4-item scale was created that can be used for the assessment of momentary impulsivity. Model fit was good for both within- and between-individual EFA. As expected, the BPD group showed significantly higher scores on our Momentary Impulsivity Scale than the DD group, and the resulting scale was moderately correlated with common trait impulsivity scales.

Parallel analysis (PA) is recommended as one of the best procedures to determine the number of factors but its theoretical justification has long been questioned. The current study discussed theoretical issues on the use of eigenvalues for dimensionality assessment and reviewed the development of PA and its recent variants proposed to address the issues. The performances of 13 different PAs including PA with minimum rank factor analysis, revised PA, and comparison data method were investigated through a Monte Carlo simulation under a wide range of factor structures that produce small factor-representing and nonrepresenting eigenvalues for different types of measurement scales. Results showed that the traditional PA using full correlation matrices performed best in most of the conditions, especially when population error was involved. However, the overall accuracy of PA was not satisfactory when factor-representing eigenvalues were small, that is, when factor loadings were low and factor correlations were high. From these results, we suggest that the original PA be used to determine the number of factors but the estimated number should not be taken as a fixed estimate. The number of factors within Ϯ1 range of the estimate can be considered as viable candidates and interpretational validity of the competing models should be consulted for the decision.

Alcohol use may be viewed as an attempt (albeit maladaptive) to regulate negative emotional states. We examined associations between both negative and positive affects and alcohol use in outpatient women diagnosed with borderline personality disorder (BPD; n = 74), a prototype of emotional dysregulation, as well as a psychiatric control group of women with current depressive disorder (major depressive disorder/dysthymic disorder [MDD\DYS]; n = 50). Participants completed randomly prompted reports of mood and alcohol use up to six times a day over a 28-day period using electronic diaries. Mean levels of either positive or negative affects did not distinguish between drinkers and nondrinkers in either diagnostic group. However, levels of both negative and positive affects were positively associated with alcohol use at the momentary level in BPD drinkers. More robust findings were obtained with respect to within-person affective variability, which was related to alcohol use in multiple ways. BPD drinkers showed higher within-person variability for most negative affects than BPD nondrinkers; MDD\DYS drinkers in general showed less within-person variability than MDD\DYS nondrinkers for negative affects. Multilevel lagged analyses for BPD drinkers indicated that alcohol use was positively related to variability in all affects, concurrently, but fewer significant effects of affect variability on the next day’s drinking or significant effects of alcohol use on the next day’s affect variability were observed. Among MDD\DYS drinkers, we observed more significant associations between affect variability on next day’s alcohol use and of alcohol use on next day’s affect variability. We discuss theoretical and methodological issues relevant to these findings as well as implications for future research.