Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls.

Abstract

Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.

The specificity of emotional switching in borderline personality disorder in comparison to other clinical groups.

“…These findings are in line with the conclusion formulated by Houben, Van Den Noortgate et al (2015), in which was shown that several indicators of emotional change were not specifically linked to BPD, as other clinical groups or other indicators of psychological ill-being were characterized by similar patterns. Moreover, the results show that next to limited specificity for indicators of changes in the overall intensity of emotions as concluded in Santangelo, Reinhard et al (2014), also indicators of emotional switching between positive and negative emotions are not very specific to BPD after comparison with other clinical groups.…”

“…We used two datasets in which previously it was shown that BPD patients tend to show large changes in overall emotional intensity over time in daily life (Santangelo, Reinhard et al, 2014 and Scheiderer et al, 2015). However, these emotional intensity results were not always specific to BPD after comparison with other clinical groups.…”

“…In a meta-analysis linking BPD to more variable emotions and emotions that showed larger changes from one point to the next (Houben, Van Den Noortgate et al, 2015), results revealed that several indicators of psychological ill-being, such as major depressive disorder or mere neuroticism were linked to the same emotion dynamical patterns. Moreover, a recent study by Santangelo, Reinhard et al (2014) has shown that in comparison to persons with a diagnosis of bulimia nervosa or posttraumatic stress disorder, no difference was found for BPD patients concerning various indicators of overall changes in emotional intensity, such as the MSSD, probability of acute change, and aggregated point-by-point changes. On the other hand, a study by Trull et al (2008) found that BPD patients showed higher variability in average negative affect and fear over time, but also larger changes from one point to the next (as measured by MSSD) in hostility, fear, and sadness specifically when compared to patients with a depressive disorder.…”

“…Using data from persons with BPD, bulimia nervosa or posttraumatic stress disorder and healthy controls as reported in Santangelo, Reinhard et al (2014) and data of persons with BPD and with a depressive disorder (major depressive disorder or dysthymic disorder) as reported in Scheiderer et al (2015) and Trull et al (2008), we compared the different groups in terms of their propensity to switch (i.e. the probability that someone switches between positive and negative emotions states, irrespective of the size of such changes), and their average switch distance from a positive to a negative emotional state or vice versa (i.e.…”

Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa

“…These momentary ratings were used to derive the Mean Squared Successive Difference (MSSD) statistic, calculated as the squared difference across successive time points in relation to the distance between the measured time points. Consistent with prior research in samples with various forms of psychopathology, including eating disorders, (e.g., Santangelo et al, 2014; Woyshville et al, 1999), this statistic was used as an EMA-based measure affect lability, as it represents the extent to which consecutive negative affect ratings vary across time points. Finally, participants were instructed to report the occurrence of each episode of binge eating and self-induced vomiting, and were also given the opportunity at each random signal to report recent behaviors (i.e., those that had occurred since their last recording) that they had not previously reported.…”