Ego‐resiliency in borderline personality disorder and the mediating role of positive and negative affect on its associations with symptom severity and quality of life in daily life

Abstract

Borderline personality disorder (BPD) is a serious mental health condition associated with severe symptoms of distress and poor quality of life (QoL). Research outside the field of BPD suggests that ego‐resiliency is negatively associated with psychopathology and positively associated with a range of positive life outcomes. Thus, ego‐resiliency may be a valuable construct for furthering our understanding and treatment of BPD. However, the mechanisms linking ego‐resiliency to psychopathology and QoL in relation to BPD have not been examined and explored by research. This study has addressed this gap in the collective knowledge by evaluating whether within‐person associations between daily reports of positive affect (PA) and negative affect (NA) mediated the relationship between ego‐resiliency, BPD symptom severity, and QoL. For 21 consecutive days, 72 women diagnosed with BPD completed end‐of‐day electronic assessments regarding ego‐resiliency, PA and NA, symptom severity, and QoL. Multilevel structural equation modelling established that PA and NA were parallel mediators linking ego‐resiliency with BPD symptom severity and QoL. As hypothesized, the path to QoL was stronger through PA than through NA. The mediation paths through NA and PA to BPD symptom severity were both significant, but their strength did not differ. Our findings align with the assertions of theories on emotion, thus suggesting a two‐factor approach to PA and NA. Future research can build on these findings by developing psychotherapeutic interventions designed not only to reduce symptom severity but also to enhance PA in individuals with BPD and determine whether an increase in PA is associated with improved QoL.

Psychopathological Determinants of Quality of Life in People with Borderline Personality Disorder

“…Our cross-sectional data may be sensitive to reverse causality, i.e., poor SQOL may also negatively affect dimensions of mental health in BPD patients. Our findings, however, will be interpreted in terms of the predictive variables as potential determinants of global and domain-specific SQOL, as was the case in all previous crosssectional studies in the field [19,23,38,46,48], since the emerging relationships may provide crucial insights into the putative effects of BPD psychopathological dimensions on SQOL, the causality and direction of which could be tested in future longitudinal studies.…”

“…Notably, other important non-clinical factors such as resilience and shame-proneness have been found to influence SQOL in BPD patients in parallel with psychopathological factors. Specifically, resilience has been indicated as a predictor of global SQOL in BPD patients before and after treatment [23], while poor ego-resiliency has been reported to negatively affect global SQOL in a BPD female population, with this relationship being mediated by both positive and negative affect [48]. Additionally, higher levels of shame were associated with lower global SQOL in women with BPD [82].…”

“…This is likely attributable to a variety of limitations in earlier research. First, only a few studies seeking determinants of SQOL have focused on an adult clinical population with a primary or single BPD diagnosis [19,23,46,48]. Second, most of the prior research studied just a subset of the main BPD traits and co-existing symptoms, making it hard to identify those that have the greatest influence on SQOL.…”

“…Second, most of the prior research studied just a subset of the main BPD traits and co-existing symptoms, making it hard to identify those that have the greatest influence on SQOL. Third, the majority of studies on patients with a primary BPD diagnosis assessed global SQOL predictors rather than domainspecific elements [23,48]. In the study of Frías et al [46], which examined domain-specific SQOL, only the effects of age on psychopathology and SQOL were tested.…”

Affecting OCD

“…Positive affect has previously been linked to resilience in other mental disorders (Harpøth et al, 2021;Hoorelbeeke et al, 2019;Robinson et al, 2014). More research on positive affect and its possible effect on obsessive-compulsive symptoms may open the way to interventions, which can have a role in the treatment or prevention of OCD by increasing aspects as happiness, contentment or savoring.…”