However, it should be noted that Fossati and colleagues [ 37 ] relied on a theory-neutral measure of one dimension of impulsivity the Barratt Impulsiveness ScaleA; [ 38 , 39 ] , rather than a comprehensive measure of multiple dimensions of impulsivity. Thus, the goal of the current study was to extend extant research by a examining differences in emotion dysregulation and impulsivity both assessed as multi-faceted constructs across adolescents with high high-BPD , average average-BPD , and low low-BPD levels of BPD features, and b exploring the unique contributions of emotion dysregulation and impulsivity dimensions to BPD group status within this population.
We hypothesized that both the impulsivity and emotion dysregulation measures would significantly discriminate adolescents in the high-BPD group from those in the average- and low-BPD groups. Furthermore, we hypothesized that both emotion dysregulation and impulsivity dimensions would contribute unique variance to BPD group status, such that the observed between-group differences in these factors would remain significant when controlling for the variance associated with the other. The present study did not rely on DSM-IV [ 40 ] criteria in order to assess BPD features due to three major considerations: a researchers have suggested that the DSM-IV [ 40 ] emphasis on categorical diagnoses does not adequately represent the latent structure of BPD [ 41 ]; b consistent longitudinal data suggest that the DSM-IV criteria for BPD are not homogeneous, but should be reconceptualized as a hybrid of stable personality traits and intermittently expressed symptomatic behaviors which could increase the risk of diagnostic inconsistency in adolescents; e.
As part of a broader study on theory of mind and BPD features in adolescents, a total of 1, adolescents who were attending public high school were administered the Italian translation of the Borderline Personality Inventory BPI; [ 43 ] during school time; participants This sample was completely distinct from past studies examining emotion dysregulation and BPD features in adolescents conducted by this research team see [ 37 ].
Ethical principles laid down in the Declaration of Helsinki were followed in the conduct of the study. All participants gave their written consent to participate in the study after it had been explained to them; when participants were of minor age, parents also had to sign written informed consent to allow the participation of their children. All adolescents volunteered to participate in the study.
None of them received extra credit or money, the research project was originally presented by principal investigator to the school principle and to the school teacher counsel. Finally, the research team was formally presented by the teachers to the students during classroom meetings. The research was presented on personality and its influence on life style The BPI was administered and scored anonymously.
In the full sample, the mean BPI total score was Based on this criterion, 35 participants with a score of or greater were assigned to the high-BPD group. Likewise, 35 participants scoring 57 or lower i. Finally, a sample of 35 participants was randomly selected from the 90 participants who scored between 85 i. Of note, six adolescents in the high-BPD group and four adolescents from both the low- and average-BPD groups were absent from school and could not be administered the impulsivity and emotion dysregulation measures.
Thus, the final sample sizes were 29 participants, 31 participants, and 31 participants for the high-BPD group, the low-BPD group and the average-BPD groups, respectively. All measures were administered during school time. All measures were administered in random order. The BPI, the UPPS-P, and the DERS were translated into Italian by two of the authors; for all measures, the adequacy of the Italian translations to their respective original versions was controlled by English mother-tongue professional translators through back-translations.
In adult participants, the BPI has been found to be a reliable and valid measure of BPD, with sensitivity and specificity data showing that the BPI identifies independently diagnosed patients with sufficient hit rates [ 43 ]. Of particular relevance to this study, the BPI has also been found to be a reliable measure of BPD features in samples of adolescents [ 45 ].
In the present study, a subsample of 75 adolescents The DERS is item measure that provides a comprehensive assessment of overall emotion dysregulation as well as six specific dimensions: nonacceptance of negative emotions, difficulties engaging in goal-directed behaviors when distressed, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, lack of emotional awareness, and lack of emotional clarity.
Further, the DERS has been found to have good internal consistency and adequate construct and convergent validity among adolescents aged 11—17, as well as a similar factor structure to that found in adults [ 50 ]. Whiteside and Lynam [ 21 ] found that the UPPS demonstrates excellent internal consistency and convergent validity, and later studies have indicated that the subscales of the UPPS make unique contributions to different disorders suggesting that these subscales represent important aspects of impulsivity not assessed in other impulsivity measures; [ 51 ].
The presence of a significant difference between the high-BPD group and each of the control groups average- and low-BPD was tested using Bonferroni simultaneous contrasts; in the case of the UPPS-P scales, Bonferroni contrasts were performed only for those scales that showed significant F values. This measure indicates the proportion of the association between BPD features and both impulsivity and emotion dysregulation, respectively, that can be explained by the other.
After correcting the nominal significance level according to the Bonferroni procedure i. Effect size estimates for Dunn-Bonferroni contrasts: 1. The nominal significance level i.
Similar results were obtained when age-adjusted DERS scores were analyzed, with Bonferroni t values of 8. In contrast to the results for the DERS above, all between group differences in Negative and Positive Urgency remained significant when controlling for the variance associated with emotion dysregulation.
As a whole, our findings confirmed previous findings within adult samples suggesting that emotion dysregulation and some dimensions of impulsivity are robustly related to BPD features in a sample of nonclinical adolescents. Consistent with previous reports e.
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These findings provide further support for the relevance of emotion dysregulation to BPD and extend the research in this area to adolescents with heightened BPD features. Our results also extended past research highlighting the relevance of dimensions of impulsivity to BPD [ 61 ]. In this study, the tendency to act impulsively when experiencing heightened emotional arousal, both negative and positive, differentiated the high-BPD group of adolescents from both control groups of adolescents.
Furthermore, the differences in Negative and Positive Urgency between high-BPD adolescents and both control groups remained significant even when partialing out the variance associated with the DERS. These findings suggest that emotion dysregulation does not fully account for the association between negative and positive urgency and BPD features in adolescents. Interestingly, despite strong inter-correlations between the Negative and Positive Urgency subscales consistent with past research, see [ 62 ] , these dimensions of impulsivity were differentially associated with BPD features in our sample.
Specifically, when controlling for the influence of Positive Urgency, results revealed no significant differences in Negative Urgency between adolescents in the high—BPD group and those in the control groups. Conversely, Positive Urgency significantly discriminated the high-BPD group of adolescents from both control groups even when its overlap with Negative Urgency was taken into account.
These findings highlight the relevance of Positive Urgency in particular to BPD features in adolescence, and suggest that Positive Urgency may represent the component of impulsivity that is uniquely altered in adolescents with prominent BPD features. This interpretation is consistent with recent literature suggesting that the decisional and motivational components of impulse control may be more strongly affected in BPD than the cognitive component of impulse control [ 64 ].
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The particular relevance of positive vs. These findings suggest that positive emotional arousal may also increase the likelihood of impulsive behaviors among adolescents with heightened BPD features. As such, these findings have potential clinical implications, highlighting the need for clinicians to assess the frequency and severity of impulsive behaviors that occur during times when adolescents experience a sense of well-being — behaviors that may be less likely to be spontaneously reported as disturbing or problematic by adolescent clients with BPD features e.
Interestingly, despite providing evidence for the relevance of Positive and Negative Urgency to BPD features in adolescents, results did not provide support for the relevance of other dimensions of impulsivity to BPD pathology within this population.
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These findings differ from past research indicating heightened levels of others forms of impulsivity among adults with BPD [ 65 , 66 , 67 , 68 ], and fail to provide support for theories highlighting the relevance of lack of premeditation to BPD see [ 11 , 69 ]. Conversely, these results highlight the importance of emotional arousal to impulsivity within this population, suggesting that the impulsivity most relevant to BPD features in adolescents may be emotion-driven impulsivity that occurs predominantly in the context of emotional arousal vs.
Findings that both emotion dysregulation and Positive and Negative Urgency emerged as uniquely associated with BPD features in adolescents, above and beyond the variance associated with the other, provide support for the role of both emotion dysregulation and emotion-driven impulsivity in BPD pathology consistent with theories suggesting that it may be the combination of emotional dysregulation and impulsivity that leads to BPD; e. Nonetheless, within our sample, the unique contributions of emotion dysregulation and Positive and Negative Urgency to BPD features were not equivalent.
These data suggest that among adolescents with heightened BPD features, the propensity to act impulsively when experiencing either negative i. Future research is needed to explore other mechanisms through which emotional arousal influences impulsive behaviors within this population. One possibility is that individuals with BPD pathology may have deficits in the mental representation of emotional states, which in turn may lead to a propensity to act impulsively see, for instance, [ 70 ].
Our results should be considered in the light of several limitations. The sample was composed of nonclinical adolescents attending high school who volunteered to participate in the study; this strongly limits the generalizability of our findings, particularly with respect to clinical populations of adolescents. In addition, this study relied only on self-reports of BPD features. Indeed, concerns have been raised about the current categorical diagnostic system for the classification of personality disorders e. Thus, our use of the BPI was considered a more appropriate choice for this sample.
Nonetheless, given that emotion dysregulation and impulsivity were also assessed using self-report questionnaires, the potential influence of shared method variance on our findings needs to be considered. Specifically, it is possible that the use of self-report measures to assess all constructs of interest may have spuriously increased inter-correlations between measures. However, given our interest in examining the unique associations between BPD features and both emotion dysregulation and impulsivity dimensions, shared method variance is less of a concern, and the use of self-report measures for all constructs of interest ensures that method variance did not differentially influence certain findings versus others.
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Moreover, given the conceptual overlap between Negative Urgency and one dimension of emotion dysregulation as assessed with the DERS i. Specifically, findings of unique relations between BPD features and both overall emotion dysregulation and negative urgency when controlling for the variance associated with the other suggest that: a the relation between emotion dysregulation and BPD features is not fully accounted for by the dimension of emotion dysregulation that overlaps with negative urgency, and b the relation between negative urgency and BPD features is robust and only partially explained by the conceptual overlap between negative urgency and one dimension of emotion dysregulation.
For instance, Jacob and colleagues [ 61 ] found that patients with BPD scored significantly higher than controls on self-report measures of impulsivity, but not behavioral measures of the same constructs. In particular, given the somewhat mixed findings with regard to impulsivity in BPD [ 61 ], research examining the precise dimensions of impulsivity assessed multi-modally most relevant to BPD pathology in both adolescents and adults is needed. These attitudes are much less frequently seen from clinicians working with people suffering from complex PTSD or other trauma-spectrum disorders.
Intra-Psychic Pain Is the Root
Explicitly linking BPD to trauma could alleviate some of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement, and better outcomes. When people with BPD sense that people are distancing themselves or treating them with disdain, they may respond by self-harming or refusing treatment. Clinicians may in turn react by further distancing themselves or becoming frustrated, which perpetuates these same negative behaviours.
Read more: Biology is partly to blame for high rates of mental illness in women — the rest is social. Thinking about BPD in terms of its underlying cause would help us treat its cause rather than its symptoms and would reinforce the importance of preventing child abuse and neglect in the first place.
If we started thinking about it as a trauma-spectrum condition, patients might start being viewed as victims of past injustice, rather than perpetrators of their own misfortune. BPD is a difficult condition to treat, and the last thing we need to do is to make it harder for patients and their families.
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