Multimodal examination of emotion regulation difficulties as a function of co-occurring avoidant personality disorder among women with borderline personality disorder.

Abstract

Despite a robust association between borderline personality disorder (BPD) and emotion dysregulation, evidence of within-BPD group differences in emotion regulation (ER) difficulties highlights the need to examine factors that increase the risk for ER difficulties within BPD. One factor that warrants consideration is co-occurring avoidant personality disorder (AVPD), the presence of which is associated with worse outcomes in and outside of BPD and theorized to interfere with adaptive ER. Thus, this study examined if co-occurring AVPD among women with BPD is associated with heightened ER difficulties (assessed across self-report, behavioral, and physiological domains). Participants included 39 women with BPD (13 with co-occurring AVPD) and 18 women without BPD. Although results revealed no significant differences in overall self-reported ER difficulties (or the specific dimensions involving emotional clarity and the control of behaviors when distressed) between BPD participants with and without AVPD (with both groups reporting greater ER difficulties than non-BPD participants), other ER difficulties were found to be heightened among BPD participants with AVPD. Specifically, BPD participants with (vs. without) AVPD reported greater difficulties accessing effective ER strategies, evidenced less willingness to experience distress on a laboratory stressor, and exhibited a greater decrease in high frequency heart rate variability in response to this stressor (indicative of poor ER capacity). Findings add to the literature on ER difficulties in BPD, suggesting that co-occurring AVPD within BPD may be associated with a lower capacity for regulating distress and greater difficulties accessing effective ER strategies, potentially leading to greater efforts to avoid emotional distress.

Resting state vagal tone in borderline personality disorder: A meta-analysis

“…Women with BPD were divided into two groups: those with comorbid avoidant personality disorder (AVPD), and those without comorbid AVPD. The authors found no significant group differences comparing BPD with AVPD, BPD without AVPD, and controls on HF HRV at baseline and HRV during the low-stress section of the distress tolerance taskcausing them to conclude that without emotional distress, BPD participants respond similarly to normal controls (Gratz et al, 2013), based on a significant difference during a stress task. The authors reported that while BPD patients without AVPD and controls displayed a slight increase in HF-HRV, BPD patients with AVPD displayed a decrease in HF-HRV reactivity (Gratz et al, 2013).…”

“…Another study was excluded because it didn't report a measure of vmHRV (Battaglia et al, 1995). Following exclusions, a total of 5 studies (Austin et al, 2007;Dixon-Gordon et al, 2011;Gratz et al, 2013;Kuo and Linehan, 2009;Weinberg et al, 2009) were eligible for inclusion in the meta-analysis. These studies are summarized in Table 1.…”

“…For studies reporting multiple comparisons (Gratz et al, 2013;Kuo and Linehan, 2009) data were first combined across sub-groups to yield a summary effect (Borenstein et al, 2009) (sub-group values reported in Fig. 2).…”

“…The study by Gratz et al (2013) was conducted in 57 women (39 with BPD, 18 controls) measuring resting baseline and phasic HF-HRV during a distress-tolerance task. While controls showed high rates of lifetime psychiatric disorders, participants in both groups with current (past two weeks) manic, hypomanic, or depressive mood episodes, current (past-month) substance dependence, and/or primary psychosis were excluded from the study.…”

Identifying Mental Disorder from the Faces of Women with Borderline Personality Disorder

“…Here, independent samples of perceivers rated the targets on one of several behaviorallyand clinically-relevant characteristics found to typically associate with BPD in previous research: depression, anxiety, emotional instability, social avoidance (tested as ''introversion''), and impulsivity (Glenn and Klonsky 2009;Gratz et al 2013;Gunderson 2010;Koenigsberg et al 2002;Trull et al 2008;Zimmerman and Mattia 1999).…”