Emotion Regulation in Borderline Personality Disorder

This study examined affective instability in Borderline Personality Disorder using the as a direct physiological index of emotional reactivity and regulation. Based upon Marsha Linehan's (1993) theory regarding fundamental deficits in emotion regulation in BPD, we hypothesized that borderline participants would show aberrant patterns of startle potentiation while viewing both pleasant and unpleasant pictorial stimuli. Participants included 19 undergraduate college students who met criteria for Borderline Personality Disorder and 16 non-borderline students. Each participant viewed a series of 126 color slides (42 pleasant, 42 neutral, and 42 unpleasant) that were normed on ratings of valence and arousal. On 64 trials, a 50 ms burst of white noise was presented at differing time frames following onset of the 6-sec slide-viewing period. Slide valence categories were employed to assess the startle valence effects as measures of emotional intensity. Later probes were presented at 6.5, 7.5, 8.5, and 13 sec to assess emotion regulation. Startle blink responses to the probes were recorded via the EMG. Borderline participants showed significantly higher overall magnitudes of startle reflex response to pleasant, neutral, and unpleasant pictorial slides. While comparisons produced a linear valence effect, borderlines showed no significant valence trends. With respect to emotion regulation, comparison participants produced a positive linear trend across probe times reflecting a general increase in emotional intensity over time. Borderlines produced no such trend and demonstrated sustained magnitudes of startle across the 13-second epoch. Post hoc analyses revealed greater startle reactivity among borderline participants and a higher probability of startle response on any trial. Neither mood state nor affective disposition was found to be associated with the magnitude of startle response, suggesting that the effects observed are relatively unique to Axis II psychopathology. The results support Linehan's (1993) hypotheses regarding heightened emotional reactivity and delayed recovery of emotional responding in BPD. The results of the present study are interpreted in terms of fundamental deficits in emotion regulation in BPD. Increased "startleability" among borderlines might reflect increased reactivity of neural circuitry associated with defensive responding. Sustained increase in startle magnitude and probability across probe times might reflect delayed emotional recovery in BPD. Possible scenarios regarding cortical and subcortical deficits in emotion regulation are offered. The contribution of contextual factors, i.e., aversiveness of the experimental procedure and interpersonal context, are discussed.