Linehan’s biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Abstract

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan’s biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan’s model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan’s biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan’s model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

Transdiagnostic skills training group of dialectical behavior therapy: a long-term naturalistic study

“…The acquisition of DBT skills is readily adaptable to various diagnostic contexts, particularly considering that Linehan’s biosocial model can account for the development of ED in the case of developmental peculiarities [ 3 ]. Furthermore, DBT skills are now widely disseminated and have become a dominant model.…”

“…Emotion dysregulation (ED) is defined as an inability to use effective strategies to reduce intense emotional oscillations. ED is a core processus of borderline personality disorder (BPD) but it is also observed in other disorders such as bipolar disorder (BD) [ 1 ], ADHD [ 2 ], or autism [ 3 ]. Importantly, ED is associated with suicidal behaviors, poorer social and interpersonal functioning, and psychological distress [ 4 , 5 ].…”

“…Mechanisms that explain emotional dysregulation may differ to some extent across disorders and ED has been reported to be heightened in BPD compared to BD [ 1 ] and ADHD [ 2 ]. However, several recent findings suggest that ED is a transdiagnostic mechanism of psychopathology [ 10 – 12 ] and, beyond its clinical relevance, Linehan’s biosocial model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric and neurodevelopmental disorders [ 3 , 13 ].…”