Affective arousal temporally precedes dissociation in patients with borderline personality disorder: A preliminary experience sampling study.

Abstract

Objective: Affective dysregulation is a core feature of borderline personality disorder (BPD), and some patients report dissociative symptoms. The present study investigated temporal dynamic relations between affective states and current experiences of depersonalization and derealization in daily life to test key theoretical premises of trauma models of dissociation. Method: Patients with BPD (n = 42) or depressive disorders (n = 40), and nonclinical controls (n = 39) were assessed every 15 min for 13 hr within a single day using smartphone-based diaries. Results: As expected, dynamic structural equation modeling results show the highest levels of average daily affective arousal, negative affective valence, and dissociation in the BPD group. As hypothesized, arousal and subsequent dissociation were significantly linked only in the BPD group, implying that momentary arousal above a person's daily average is followed by higher dissociation in the next measurement ( 15 min later). In addition, some patients with BPD reported less negative affective valence following dissociation. Conclusions: Our findings suggest that changes in affective states play an important role at the onset of dissociation in patients with BPD. Subsequent relief from distress may explain maintenance. We recommend that clinicians provide means to regulate affect when dealing with dissociation. Clinical Impact StatementPatients with borderline personality disorder (BPD) often feel strongly tense and unwell, and some patients with BPD report transient feelings of being detached from one's self and/or one's surroundings (dissociation). In this study, we asked individuals to indicate how they feel 52 times prompting them every 15 min. We found that patients with BPD feel particularly tense before reporting increased dissociation. Shortly after increased dissociation, some patients with BPD report feeling less unwell. These relationships were not found in individuals with depressive disorders or nonclinical controls. Our findings suggest that one function of dissociation may be to regulate negative emotions.

The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample

“…Medication type and dose will be assessed and controlled for in statistical analyses. We do not plan to include a non-clinical sample because the forms of dissociation investigated in this project rarely occur in such samples and floor effects seem likely that would complicate group comparisons [ 30 ].…”

“…Studies using multiple assessments per day report positive within-person associations between dissociation and self-reported unpleasant, inner tension (indicating distress) in patients with BPD or PTSD (but not non-clinical controls), suggesting that dissociation is strongest when distress is increased [ 67 , 75 ]. One study shows that increased self-reported arousal (feeling tense as opposed to calm; one operationalization of distress) precedes dissociation in patients with BPD (but not patients with depression), and that self-reported valence (feeling unpleasant as opposed to pleasant; another operationalization of distress) improves for some patients shortly after a dissociation [ 30 ]. However, the study has several methodological limitations and current evidence is insufficient to conclude that distress increases prior to and decreases during dissociation across diagnostic categories.…”

The Temporal Dynamics of Dissociation: Protocol for an Ecological Momentary Assessment and Laboratory Study in a Transdiagnostic Sample

“…Medication type and dose will be assessed and controlled for in statistical analyses. We do not plan to include a non-clinical sample because the forms of dissociation investigated in this project rarely occur in such samples and floor effects seem likely that would complicate group comparisons (Heekerens et al, 2023).…”

“…80% compliance). For hypothesis 1, we assume that the fixed effect of the temporal relation between arousal (t-1) and subsequent dissociative states (t) is 0.15 in our dynamic SEM, which is a conservative estimate based on earlier results (effect in pilot study: 0.25; Heekerens et al, 2023).…”

“…For hypothesis 1, we assume that the fixed effect between arousal after the first part of the TSST (preparing the speech, t-1) and dissociative states after the second part of the TSST (delivering the speech, t) will be 0.30. The estimate is based on an earlier study that reports an effect of 0.25 across everyday life situations (Heekerens et al, 2023), and can be considered conservative as the association between arousal and dissociative states is expected to be higher under stress (Graumann et al, 2023). In a sample of N = 85, we estimate the power of our model to detect the effect of 0.30 to be 0.88.…”