A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder

Abstract

Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross’s extended process model of ER and Linehan’s updated theoretical account on the development of emotion dysregulation.

A network analysis of borderline personality disorder symptoms and disordered eating

“…Overall, the current findings may be seen as a transdiagnostic risk model for the development of ED and/or BPD symptoms, where the shared underlying factors of emotion dysregulation and abandonment, may predispose individuals to develop symptoms for either disorder. These findings are in line with previous research that has shown emotion dysregulation (e.g., Daros & Williams, 2019; Selby et al, 2010) and abandonment (e.g., Al‐Salom & Boylan, 2019; De Paoli, Fuller‐Tyszkiewicz, & Krug, 2017) to be key predisposing and maintaining factors for ED and BPD symptoms. Interestingly, a new study by Al‐Salom and Boylan (2019) found abandonment to fully mediate the relationship between BPD traits and eating pathology, highlighting its importance in explaining the relationship of both problem sets.…”

“…In terms of emotion dysregulation, it has been suggested that a function of disordered eating may be to regulate emotions by focusing on eating, weight, and body shape, when more effective coping strategies are unavailable (Ambwani & Morey, 2015). Conversely, in BPD, emotion dysregulation, often considered a core feature of the illness, has generally been observed in the areas of interpersonal relationships, behavior, identity, and cognition (Daros & Williams, 2019). Research has also shown that BPD individuals are emotionally sensitive from birth (Carpenter & Trull, 2013).…”

“…However, given the complexity of emotion regulation, it is not surprising to see that there has been considerable variation as regards how this umbrella term has been studied (Carpenter & Trull, 2013). While some researchers have focused on emotion sensitivity, others have looked at affective intensity, and yet others have assessed emotional vulnerability (Daros & Williams, 2019). One way to comprehend these different approaches better is to regard emotion dysregulation not as a final product, but more of a progression of various interactive and reinforcing factors (Werner & Gross, 2010).…”

“…Difficulties in regulating emotions are considered a core feature of BPD (Daros & Williams, 2019), and are also frequently observed in clinical ED populations (Prefit, Cândea, & Szentagotai‐Tătar, 2019), with patients with ED reporting more emotion regulation difficulties including higher levels of emotion intensity, lower acceptance of emotions, less emotional awareness and clarity, and increased use of dysfunctional emotion regulation strategies when compared to healthy controls (Lavender et al, 2015).…”

“…Identification of potential bridging variables (or transdiagnostic features) that serve to connect the two conditions may enable targeting of these in treatment contexts to reduce comorbidity and, in turn, symptom severity for each condition. The limited available evidence suggests that insecure attachment and socio‐emotional processing constructs, such as RS (Selby et al, 2010; Staebler et al, 2011), emotion dysregulation (e.g., Daros & Williams, 2019; Prefit et al, 2019), ToM, and emotion recognition (e.g., Caglar‐Nazali et al, 2014; Mitchell et al, 2014), may act in this capacity, explaining co‐occurrence of BPD and ED symptoms.…”