Emotional instability, poor emotional awareness, and the development of borderline personality

Abstract

Emotional instability and poor emotional awareness are cardinal features of the emotional dysregulation associated with borderline personality disorder (BPD). Most models of the development of BPD include child negative emotional reactivity and grossly inadequate caregiving (e.g., abuse, emotional invalidation) as major contributing factors. However, early childhood emotional reactivity and exposure to adverse family situations are associated with a diverse range of long-term outcomes. We examine the known effects of these risk factors on early childhood emotional functioning and their potential links to the emergence of chronic emotional instability and poor emotional awareness. This examination leads us to advocate new research directions. First, we advocate for enriching the developmental assessment of children's emotional functioning to more closely capture clinically relevant aspects. Second, we advocate for conceptualizing children's early family experiences in terms of the proximal emotional environment to which young children may be or become sensitive. Such approaches should contribute to our ability to identify risk for BPD and guide preventive intervention.

Childhood maltreatment profile in a clinical population in China: A further analysis with existing data of an epidemiologic survey

“…Data from the current study indicates that patients with narcissistic PD actually experienced more EN in childhood. Like prior studies, early traumatic experience has the most significant impact on personality pathology, which is characterized by high levels of impulsivity [62, 63]. Furthermore, early experience of neglect may has more impact on cluster A PDs (schizoid and paranoid PD), which reveals that the characteristics of unwarranted mistrust or indifferent to society is formed probably by being neglected by family and society in early life.…”

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

“…However, a ubiquitous observation among papers on the subject is the paucity of evidence from longitudinal studies of BPD, particularly those relying on prospective data, that might help to elucidate developmental pathways from childhood to adulthood (see e.g. Carlson, Egeland & Sroufe, 2009; Cole, Llera & Pemberton, 2009; Gratz et al, 2009). When considering the amount of evidence of the developmental relationships between child psychopathology and other personality disorders, particularly APD (e.g.…”

Relação terapêutica com pacientes borderlines na terapia comportamental dialética

“…Frequentemente mudam rapidamente de uma reação emocional a outra, podendo vivenciar diversos estados emocionais negativos e períodos de eutimia em apenas um dia (Lieb et al, 2004). As mudanças emocionais parecem exageradas e imprevisíveis (Cole, Llera & Pemberton, 2009). A teoria biossocial, que fundamenta a TCD, pressupõe que tais características são oriundas da interação do ambiente com predisposições biológicas, tais como hiperatividade do sistema límbico, bem como um pobre controle de impulsos associados a áreas específicas do córtex pré-frontal, que, em contato com um ambiente de profunda invalidação, levam à desregulação emocional presente no TPB.3 1 Além disso, estudos apontam que familiares de pacientes Borderlines apresentam cerca de cinco vezes mais chances de desenvolverem o transtorno, o que indica uma influência genética provavelmente associada à gênese do quadro clínico (APA, 2014).…”

“…No caso de pacientes borderlines, a perturbação nos relacionamentos interpessoais, constitui-se em uma das principais dificuldades. Esses sujeitos costumam envolver-se em relacionamentos instáveis e intensos (Lieb et al, 2004) e apresentam comportamentos que dificultam o estabelecimento e a manutenção dessas relações (Cole et al, 2009), inclusive a relação terapêutica.…”

“…Ambos devem estar comprometidos e engajados no tratamento, para que este possa ser viabilizado (Howard et al, 2006). Indivíduos borderlines costumam apresentar intensa impulsividade que pode manifestar-se por meio de comportamentos de risco (Cole et al, 2009), como comportamentos suicidas ou parassuicidas, abuso de substâncias, distúrbios alimentares, entre outros (McMain et al, 2001). Dessa forma, na TCD, terapeuta e paciente devem comprometer-se com uma das prioridades iniciais do tratamento, que é eliminar os comportamentos de risco (Lynch et al, 2007), os que atrapalham a terapia e aqueles que interferem na qualidade de vida, ao mesmo tempo em que estimula habilidades de resolução de problemas (Melo, 2014).…”