New study of emotion regulation in Borderline Personality
Sep 29, 2012
Continuing the examination of a central topic in victims of childhood complex traumatization -- emotion dysregulation -- is a new study, which will soon be reviewed, looking at "Dysfunctional affect regulation in Borderline Personality Disorder and Somatoform Disorder" by van Dijke et al (2012) -- [LINK]
In this study, diagnoses of Borderline Personality (BPD) and Somatoform Disorder (SoD) were arrived at by means of clinical interviews; and dysfunctional under- and overregulation of affect and somatoform and psychoform dissociation, childhood trauma-by-primary-caretaker (TPC), PostTraumatic Stress Disorder (PTSD), and Comlex PTSD (CPTSD) were all measured using self reports. While no disorder-specific form of dysfunctional affect regulation was found, inhibitory experiencing states (overregulation of affect and negative psychoform dissociation) were most commonly found in SoD, excitatory experiencing states (underregulation of affect and positive psychoform dissociation) were most commonly found in BPD, and the combination of inhibitory and excitatory experiencing states was found most commonly occurring in comorbid BPD+SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch, 0-6 years of age. Overregulation of affect was associated with physical TPC. Comorbid BPD+SoD was associated with the most extensive childhood trauma histories and were most likely to meet criteria for CPTSD, followed by BPD, psychiatric comparison (PC), and SoD. The BPD+SoD and BPD reported significantly higher levels of CPTSD than the SoD or PC groups but did not differ from each other except for greater severity of CPTSD somatic symptoms by the BPD+SoD group. The authors conclude distinguishing inhibitory versus excitatory states of experiencing may help to clarify differences in dissociation and affect dysregulation between and within BPD and SoD patients. Further, these authors state that specific interventions "addressing overregulation in BPD, or underregulation in SoD", should be added to disorder-specific evidence-based treatments.
COMMENT These authors conclusions and recommendations, as included in their abstract seem in contradiction to their actual results: Whilst in their results section they state that over-regulation of affect was most commonly found in those with Somatoform disorder, and under-regulation of affect was most commonly found in Borderline Personality Disorder -- the obtained results are consistent with a decades old distinction between "cognitisers" and "somatisers" -- some people express their distress through cognitve phenomena, others through somatic phenomena; and the longstanding heightened emotional lability in those with BPD. What is important, however, apart from clarifying this distinction, is that the results argue for disorder-specific evidence-based treatments. I would argue that rather than going to the step of using disorder-type language, people's actually difficulties with over- or under-regulation of affect be targeted directly. These conclusions are in agreement with the findings of Dorrepaal et al (2012) I reviewed earlier today but take the treatment guidelines further in the direction suggested in my review of treatment recommendations on my website [LINK]. Complex PTSD is particularly prevalent in BPD and comorbid BPD+SoD and is differentially associated with both under- and overregulation of affect depending on the type of traumatic exposure. van Dijke argue that CPTSD warrants further investigation as a potential independent syndrome or as a marker identifying a sub-group of affectively, or both affectively and somatically, dysregulated patients diagnosed with BPD who have childhood trauma histories. In essence, this is merely a re-statement that Complex PTSD is a more "severe" disorder, with a greater mix of symptoms, warranting an independent diagnosis -- something not yet envisioned for DSM5, but clearly something to be expected from van der Kolk's early (2005) description of Developmental Trauma Disorder, in children, and Complex Trauma in adults.