Top

Cognitive Therapy and Research

Tip

Swipe om te navigeren naar een ander artikel

Gepubliceerd in:

01-06-2013 | Original Article

Emotion Regulation Deficits as Mediators Between Trauma Exposure and Borderline Symptoms

Auteurs: Raluca M. Gaher, Nicole L. Hofman, Jeffrey S. Simons, Ryan Hunsaker

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2013

Abstract

We tested a model of mechanisms linking the experience of trauma exposure with borderline personality symptoms via deficits in core aspects of emotion regulation. Participants were college students (N = 579). History of traumatic exposure and negative affectivity were positively and emotional intelligence inversely associated with borderline symptoms. These effects were mediated via alexithymia. Deficits in identifying and describing emotions, in turn, were associated with poor tolerance for emotional distress and an increase in acting rashly when negatively aroused. Finally, distress tolerance exhibited both direct, and indirect (via urgency), associations with borderline personality symptoms. Deficits in the ability to identify, describe, and understand emotion are related to intolerance for distress and impulsive behavior when negatively aroused. The effects of distress tolerance are consistent with theoretical models that posit that intolerance for distress contributes to deficits in behavioral regulation. Borderline personality symptoms reflect deficits in behavioral control when negatively aroused as well as a pattern of negative evaluations, poor self-efficacy, and emotional absorption contributing to marked interference with adaptive goal directed activity when distressed.

vorige artikel Rumination Mediates the Relationship Between Distress Tolerance and Depressive Symptoms Among Substance Users

volgende artikel Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

We tested two alternative measurement models. In the first, we modeled a single affect dysregulation factor, loading the emotional intelligence, alexithymia, distress tolerance, and negative urgency indictors onto one factor. This model was a poor fit to the data χ²(149, N = 579) = 2674.26, p < .001; CFI = .68, RMSEA = 0.171, SRMR = 0.100. In the second, we combined the emotional intelligence and alexithymia factors, to see whether alexithymia could be modeled as indicators of a higher order emotional intelligence factor rather than a separate factor. This was a better fit to the data χ²(142, N = 579) = 916.69 p < .001; CFI = .90, RMSEA = 0.097, SRMR = 0.105. However, the hypothesized measurement model was a better fit ∆ χ²(5, N = 579) = 425.98, p < .001.

Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., et al. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45, 814–822. PubMedCrossRef

Anestis, M. D., Smith, A. R., Fink, E. L., & Joiner, T. E. (2009). Dysregulated eating and distress: Examining the specific role of negative urgency in a clinical sample. Cognitive Therapy and Research, 33, 390–397. CrossRef

Arens, A. M., Gaher, R. M., & Simons, J. S. (2012). Child maltreatment and deliberate self-harm among college students: Testing mediation and moderation models for impulsivity. American Journal of Orthopsychiatry, 82, 328–337. PubMedCrossRef

Austin, E., Saklofske, D. H., & Egan, V. (2005). Personality, well-being and health correlates of trait emotional intelligence. Personality and Individual Differences, 38, 547–558. CrossRef

Austin, E. J., Saklofske, D. H., Huang, S. S., & McKenney, D. (2004). Measurement of trait emotional intelligence: Testing and cross-validating a modified version of Schutte et al.'s (1998) measure. Personality and Individual Differences, 36, 555–562. CrossRef

Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The Twenty-Item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32. PubMedCrossRef

Bandelow, B., Spath, C., Tichauer, G. Á., Broocks, A., Hajak, G., & Rüther, E. (2002). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Comprehensive Psychiatry, 43, 269–278. PubMedCrossRef

Battle, C. L., Shea, M., Johnson, D. M., Yen, S., Zlotnick, C., Zanarini, M. C., et al. (2004). Childhood maltreatment associated with adult personality disorders: Findings from the collaborative longitudinal personality disorders study. Journal of Personality Disorders, 18, 193–211. PubMedCrossRef

Bernstein, A., Zvolensky, M. J., Vujanovic, A. A., & Moos, R. (2009). Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: A hierarchical model of affect sensitivity and tolerance. Behavior Therapy, 40, 291–301. PubMedCrossRef

Brackett, M. A., Mayer, J. D., & Warner, R. M. (2004). Emotional intelligence and its relation to everyday behavior. Personality and Individual Differences, 36, 1387–1402. CrossRef

Briere, J., & Rickards, S. (2007). Self-awareness, affect regulation, and relatedness: Differential sequels of childhood versus adult victimization experiences. Journal of Nervous and Mental Disease, 195, 497–503. PubMedCrossRef

Brown, G. R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61. PubMed

Brune, M., Ghiassi, V., & Ribbert, H. (2010). Does borderline personality disorder reflect the pathological extreme of an adaptive reproductive strategy? Insights and hypotheses from evolutionary life-history theory. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 7, 3–9.

Cloitre, M., Miranda, R., Stovall-McClough, K., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36, 119–124. CrossRef

Cloitre, M., Stovall-McClough, C., Zorbas, P., & Charuvastra, A. (2008). Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories. Journal of Traumatic Stress, 21, 282–289. PubMedCrossRef

Cyders, M. A., & Smith, G. T. (2008). Emotion-based dispositions to rash action: The trait of urgency. Psychological Bulletin, 134, 807–828. PubMedCrossRef

Danielson, C., Ruggiero, K. J., Daughters, S. B., & Lejuez, C. W. (2010). Distress tolerance, risk-taking propensity, and PTSD symptoms in trauma-exposed youth: Pilot study. The Behavior Therapist, 33, 28–34.

De Moor, M., Distel, M., Trull, T., & Boomsma, D. (2009). Assessment of borderline personality features in population samples: Is the Personality Assessment Inventory–Borderline Features scale measurement invariant across sex and age? Psychological Assessment, 21, 125–130. PubMedCrossRef

Dulin, P. L., & Passmore, T. (2010). Avoidance of potentially traumatic stimuli mediates the relationship between accumulated lifetime trauma and late-life depression and anxiety. Journal of Traumatic Stress, 23, 296–299. PubMed

Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling: A Multidisciplinary Journal, 8, 430–457. CrossRef

Ford, J. D., Stockton, P., Kaltman, S., & Green, B. L. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence, 21, 1399–1416. PubMedCrossRef

Gardner, K., & Qualter, P. (2009). Emotional intelligence and borderline personality disorder. Personality and Individual Differences, 47, 94–98. CrossRef

Goodman, L. A., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress, 11, 521–542. PubMedCrossRef

Green, B. L. (1996). Psychometric review of Trauma History Questionnaire (self-report). In B. H. Stamm & E. M. Varra (Eds.), Measurement of stress, trauma and adaptation. Lutherville, MD: Sidran.

Green, B. L., Goodman, L. A., Krupnick, J. L., Corcoran, C. B., Petty, R. M., Stockton, P., et al. (2000). Outcomes of single versus multiple trauma exposure in a screening sample. Journal of Traumatic Stress, 13, 271–286. PubMedCrossRef

Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). New York: Guilford Press.

Helgeland, M. I., & Torgersen, S. (2004). Developmental antecedents of borderline personality disorder. Comprehensive Psychiatry, 45, 138–147. PubMedCrossRef

Hirsh, J. B., Guindon, A., Morisano, D., & Peterson, J. B. (2010). Positive mood effects on delay discounting. Emotion, 10, 717–721. PubMedCrossRef

Horesh, N., Ratner, S., Laor, N., & Toren, P. (2008). A comparison of life events in adolescents with major depression, borderline personality disorder and matched controls: A pilot study. Psychopathology, 41, 300–306. PubMedCrossRef

Howell, A. L., Teresa, M. H., Buckner, J., & Zvolensky, M. J. (2010). Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers. Addictive Behaviors, 35, 1144–1147. PubMedCrossRef

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. CrossRef

Hunt, N., & Evans, D. (2004). Predicting traumatic stress using emotional intelligence. Behavior Research and Therapy, 42, 791–798. CrossRef

Igarashi, H., Hasui, C., Uji, M., Shono, M., Nagata, T., & Kitamura, T. (2010). Effects of child abuse history on borderline personality traits, negative life events, and depression: A study among a university student population in Japan. Psychiatry Research, 180, 120–125. PubMedCrossRef

Iverson, K. M., Follette, V. M., Pistorello, J., & Fruzzetti, A. E. (2012). An investigation of experiential avoidance, emotion dysregulation, and distress tolerance in young adult outpatients with borderline personality disorder symptoms. Personality Disorders: Theory, Research, and Treatment, 3, 415–422. CrossRef

Johnson, J. G., Bromley, E., & McGeoch, P. G. (2005). Role of childhood experiences in the development of maladaptive and adaptive personality traits. In J. M. Oldham, A. E. Skodol, & D. S. Bender (Eds.), The American Psychiatric Publishing textbook of personality disorders (pp. 209–221). Arlington, VA: American Psychiatric Publishing, Inc.

Jovev, M., & Jackson, H. J. (2006). The relationship of borderline personality disorder, life events, and functioning in an Australian psychiatric sample. Journal of Personality Disorders, 20, 205–217. PubMedCrossRef

Kashdan, T., Ferssizidis, P., Collins, R., & Muraven, M. (2010). Emotion differentiation as resilience against excessive alcohol use: An ecological momentary assessment in underage social drinkers. Psychological Science: A Journal of The American Psychological Society/APS, 21, 1341–1347. CrossRef

Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51, 706–716. PubMedCrossRef

Klonsky, E. D., & Moyer, A. (2008). Childhood sexual abuse and non-suicidal self-injury: Meta analysis. British Journal of Psychiatry, 192, 166–170. PubMedCrossRef

Kooiman, C. G., van Rees Vellinga, S., Spinhoven, P., Draijer, N., Trijsburg, R. W., & Rooijmans, H. G. M. (2004). Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood. Psychotherapy and Psychosomatics, 73, 107–116. PubMedCrossRef

Kun, B., & Demetrovics, Z. (2010). Emotional intelligence and addiction: A systematic review. Substance Use and Misuse, 45, 1131–1160. PubMedCrossRef

Lamoureux, B. E., Palmieri, P. A., Jackson, A. P., & Hobfoll, S. E. (2011). Child sexual abuse and adulthood-interpersonal outcomes: Examining pathways for intervention. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 605–613. CrossRef

Larsen, J. K., van Strien, T., Eisinga, R., & Engels, R. (2006). Gender differences in the association between alexithymia and emotional eating in obese individuals. Journal of Psychosomatic Research, 60, 237–243. PubMedCrossRef

Lieberman, M. D. (2007). Social cognitive neuroscience: A review of core processes. Annual Review of Psychology, 58, 259–289. PubMedCrossRef

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford Press.

Ludolph, P. S., Westen, D., Misle, B., Jackson, A., Wixom, J., & Wiss, F. C. (1990). The borderline diagnosis in adolescents: Symptoms and developmental history. American Journal of Psychiatry, 147, 470–476. PubMed

MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128. PubMedCrossRef

Marshall-Berenz, E. C., Vujanovic, A. A., Bonn-Miller, M. O., Bernstein, A., & Zvolensky, M. J. (2010). Multi-method study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample. Journal of Traumatic Stress, 23, 623–630. PubMedCrossRef

Marshall-Berenz, E. C., Vujanovic, A. A., & Zvolensky, M. J. (2011). Main and interactive effects of a non-clinical panic attack history and distress tolerance in relation to PTSD symptom severity. Journal of Anxiety Disorders, 25, 185–191. PubMedCrossRef

Martins, C., de Carvalho Tofoli, S., Von Werne Baes, C., & Juruena, M. (2011). Analysis of the occurrence of early life stress in adult psychiatric patients: A systematic review. Psychology and Neuroscience, 4, 219–227. CrossRef

Metcalfe, J., & Jacobs, W. J. (1996). A “hot-system/cool-system” view of memory under stress. PTSD Research Quarterly, 7, 1–6.

Metcalfe, J., & Jacobs, W. J. (1998). Emotional memory: The effects of stress on “cool” and “hot” memory systems. In D. L. Medin (Ed.), The psychology of learning and motivation (Vol. 38, pp. 187–222)., Advances in research and theory San Diego, CA: Academic Press.

Metcalfe, J., & Mischel, W. (1999). A hot/cool-system analysis of delay of gratification: Dynamics of willpower. Psychological Review, 106, 3–19. PubMedCrossRef

Meuser, T., Pietruck, C., Radbruch, L., Stute, P., Lehmann, K. A., & Grond, S. (2001). Symptoms during cancer pain treatment following WHO-guidelines: A longitudinal follow-up study of symptom prevalence, severity and etiology. Pain, 93, 247–257. PubMedCrossRef

Morey, L. C. (1991). The Personality Assessment Inventory: Professional manual. Lutz, FL: Psychological Assessment Resources.

Morey, L. (1996). An interpretative guide to the Personality Assessment Inventory (PAI). Odessa, FL: Psychological Assessment Resources.

Muthén, L. K., & Muthén, B. O. (2008). Mplus user’s guide. Los Angeles: Author.

New, A. S., & Siever, L. J. (2002). Neurobiology and genetics of borderline personality disorder. Psychiatric Annals, 32, 329–336.

Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M. (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder. American Journal of Psychiatry, 147, 1008–1013. PubMed

Ouwens, M. A., van Strien, T., & van Leeuwe, J. J. (2009). Possible pathways between depression, emotional, and external eating: A structural equation model. Appetite, 53, 245–248. PubMedCrossRef

Paris, J., Zweig-Frank, H., & Guzder, J. (1994). Risk factors for borderline personality in male outpatients. Journal of Nervous and Mental Disease, 182, 375–380. PubMedCrossRef

Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (2001). The relationship between emotional intelligence and alexithymia. Personality and Individual Differences, 30, 107–115. CrossRef

Riley, H., & Schutte, N. S. (2003). Low emotional intelligence as a predictor of substance-use problems. Journal of Drug Education, 33, 391–398. PubMedCrossRef

Saklofske, D. H., Austin, E. J., & Minski, P. S. (2003). Factor structure and validity of a trait emotional intelligence measure. Personality and Individual Differences, 34, 707–721. CrossRef

Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9, 185–211. CrossRef

Sansone, R. A., Songer, D. A., & Miller, K. A. (2005). Childhood abuse, mental healthcare utilization, self-harm behavior, and multiple psychiatric diagnoses among inpatients with and without a borderline diagnosis. Comprehensive Psychiatry, 46, 117–120. PubMedCrossRef

Sansone, R. A., Hahn, H. S., Dittoe, N., & Wiederman, M. W. (2011). The relationship between childhood trauma and borderline personality symptomatology in a consecutive sample of cardiac stress test patients. International Journal of Psychiatry in Clinical Practice, 15, 275–279. PubMedCrossRef

Schutte, N. S., Malouff, J. M., Bobik, C., Coston, T., Greeson, C., Jedlicka, C., et al. (2001). Emotional intelligence and interpersonal relations. Journal of Social Psychology, 141, 523–536. PubMedCrossRef

Schutte, N. S., Malouff, J. M., Hall, L. E., Haggerty, D. J., Cooper, J. T., Golden, C. J., et al. (1998). Development and validation of a measure of emotional intelligence. Personality and Individual Differences, 25, 167–177. CrossRef

Shen, L., & Bigsby, E. (2010). Behavioral activation/inhibition systems and emotions: A test of valence vs. action tendency hypotheses. Communication Monographs, 77, 1–26. CrossRef

Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83–102. CrossRef

Spitzer, C., Effler, K., & Freyberger, H. J. (2000). Posttraumatic stress disorder, dissociation and self-destructive behavior in borderline patients. Zeitschrift fuer Psychosomatische Medizin und Psychotherapie, 46, 273–285.

Strein, T. V., & Ouwens, M. A. (2007). Effects of distress, alexithymia, and impulsivity on eating. Eating Behaviors, 8, 251–257. CrossRef

Suarez, L., Belcher, H., Briggs, E., & Titus, J. (2012). Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems. American Journal of Community Psychology, 49, 430–440. PubMedCrossRef

Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press. CrossRef

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389–399. PubMedCrossRef

van Strien, T., & Ouwens, M. A. (2007). Effects of distress, alexithymia and impulsivity on eating. Eating Behaviors, 8, 251–257. PubMedCrossRef

Verdejo-García, A., Bechara, A., Recknor, E. C., & Pérez-García, M. (2007). Negative emotion-driven impulsivity predicts substance dependence problems. Drug and Alcohol Dependence, 91, 213–219. PubMedCrossRef

Vujanovic, A. A., Bonn-Miller, M. O., Potter, C. M., Marshall, E. C., & Zvolensky, M. J. (2011). An evaluation of the relation between distress tolerance and posttraumatic stress within a trauma-exposed sample. Journal of Psychopathology and Behavioral Assessment, 33, 129–135. PubMedCrossRef

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070. PubMedCrossRef

Weaver, T. L., & Clum, G. A. (1993). Early family environments and traumatic experiences associated with borderline personality disorder. Journal of Consulting and Clinical Psychology, 61, 1068–1075. PubMedCrossRef

Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689. CrossRef

Wray, T. B., Simons, J. S., Dvorak, R. D., & Gaher, R. M. (2012). Trait-based affective processes in alcohol-involved “risk behaviors”. Addictive Behaviors, 37, 1230–1239. PubMedCrossRef

Yan, C., & Dillard, J. (2010). Emotion inductions cause changes in activation levels of the behavioral inhibition and approach systems. Personality and Individual Differences, 48, 676–680. CrossRef

Yen, S., Shea, M. T., Battle, C. L., Johnson, D. M., Zlotnick, C., Dolan-Sewell, R., et al. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive–compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. Journal of Nervous and Mental Disease, 190, 510–518. PubMedCrossRef

Zanarini, M. C., Ruser, T. F., Frankenburg, F. R., Hennen, J., & Gunderson, J. G. (2000). Risk factors associated with the dissociative experiences of borderline patients. Journal of Nervous and Mental Disease, 188, 26–30. PubMedCrossRef

Zimmerman, G., Rosssier, J., Meyer de Stadelhofen, F., & Gaillard, F. (2005). Alexithymia assessment and relations with dimensions of personality. European Journal of Psychological Assessment, 21, 23–33. CrossRef

Zvolensky, M. J., Leyro, T., Bernstein, A., & Vujanovic, A. A. (2011). Distress tolerance: Historical perspectives, theory, and measurement. In M. J. Zvolensky, A. Bernstein, & A. A. Vujanovic (Eds.), Distress tolerance. New York: Guilford.

Zweig-Frank, H., Paris, J., & Guzder, J. (1994). Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder. Canadian Journal of Psychiatry, 39, 259–264.

Titel: Emotion Regulation Deficits as Mediators Between Trauma Exposure and Borderline Symptoms
Auteurs: Raluca M. Gaher
Nicole L. Hofman
Jeffrey S. Simons
Ryan Hunsaker
Publicatiedatum: 01-06-2013
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2013
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-012-9515-y

Mijn bibliotheek

Shop

Tips voor Mijn BSL

Bohn Stafleu van Loghum

Tip

Swipe om te navigeren naar een ander artikel

Emotion Regulation Deficits as Mediators Between Trauma Exposure and Borderline Symptoms

Abstract

Mijn bibliotheek

Shop

Tips voor Mijn BSL

Bohn Stafleu van Loghum

Tip

Swipe om te navigeren naar een ander artikel

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 3/2013

The Effects of Attention Training on the Perception of Bodily Sensations in Patients with Hypochondriasis: A Randomized Controlled Pilot Trial

Differentiating Worry and Rumination: Evidence from Heart Rate Variability During Spontaneous Regulation

Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

Alcohol Expectancies and Alcohol Use Frequency: Does Drinking Context Matter?

Automatic Evaluative Processes in Health Anxiety and Their Relations to Emotion Regulation

Keep Your Eye on the Target: Safety Behavior Reduces Targeted Threat Beliefs Following a Behavioral Experiment