A Contingency-Oriented Approach to Understanding Borderline Personality Disorder: Situational Triggers and Symptoms

Abstract

This article tested a contingency-oriented perspective to examine the dynamic relationships between in-the-moment borderline personality disorder (BPD) symptom events and in-the-moment triggers. An experience sampling study with 282 adults, including 77 participants with BPD, obtained reports of situational triggers and BPD symptom events five times daily for two weeks. Triggers included being rejected, betrayed, abandoned, offended, disappointed, having one’s self-concept threatened, being in a boring situation, and being alone. BPD was associated with increased situational triggers. Multilevel models revealed significant within-person associations between situational triggers and BPD symptoms for the average participant in the study, with significant individual variance in the strength and direction of trigger-symptom contingencies. Most trigger-symptom contingencies were stronger for individuals with higher borderline symptomatology, suggesting that triggers are meaningfully related to BPD. These findings highlight possible proximal mechanisms that maintain BPD and help explain the course of a disorder often described as chaotic and unpredictable.

Stability and fluctuation of personality disorder features in daily life.

“…With this evidence now in hand, we can now ask more sophisticated questions about the conditions under which PD is exacerbated, maintained, and, hopefully, diminished or even extinguished. Recent research has begun to examine this very question in BPD, seeking to uncover and clarify the contingencies of symptom expression (Miskewicz et al, 2015). Our results suggest that not only is this an important avenue for research, but that it should be extended beyond BPD to include other forms of personality pathology.…”

“…A portion of this work has focused on studying daily variability and instability in PD relevant behavior (e.g., Ebner-Priemer et al, 2007; Ebner-Primer et al, 2015; Miskiewicz et al, 2015; Russell et al, 2007; Sadikaj et al, 2010; 2013; Trull et al, 2008). However, this work has almost exclusively focused on borderline personality disorder (BPD), comparing samples diagnosed with BPD with various controls (See Santangelo et al, 2014 for a review).…”

The effect of pathological narcissism on interpersonal and affective processes in social interactions.

“…For example, Miskewicz and colleagues (2015) adopted a contingency-oriented approach to studying momentary borderline PD symptoms, finding that (a) stressors were strong predictors of momentary fluctuations in symptoms, and (b) this link was potentiated by borderline diagnostic status. This approach has also been applied to study patterns in the interpersonal situation.…”

Using Negative Emotions to Trace the Experience of Borderline Personality Pathology: Interconnected Relationships Revealed in an Experience Sampling Study

“…Viewed this way, individuals engage in destructive behavior in an attempt to escape intense and unpleasant emotional states. There is also evidence that individuals with BPD engage in destructive behavior when they experience stressful environmental triggers (Miskewicz, Furr, Fleeson, & Law, 2013). The causal direction of negative emotions triggering BPD symptoms was implied in Gratz, Levy, and Tull’s (2012) study, where they showed that improvement in emotion regulation mediated the relationship between Emotion Regulation Group Therapy (ERGT) and engaging in fewer deliberate self-harm behaviors.…”