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to the forumEmotion Regulation Deficits as Mediators Between Trauma Exposure and Borderline Symptoms
Raluca M. Gaher,
Nicole L. Hofman,
Jeffrey S. Simons,
Ryan Hunsaker
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.
Traumatic Experiences and Borderline Symptoms
Trauma exposure (i.e., the experience of a threatening
event that produced intense fear, helplessness or horror) is
associated with a wide range of negative sequelae,
including internalizing problems such as depression and
anxiety (Dulin and Passmore 2010), and externalizing
problems such as substance use (Suarez et al. 2012). The
experience of traumatic events is elevated among individuals
with borderline personality disorder (BPD). Estimates
indicate that 75–90 %of individuals who have borderline
personality disorder also report experiencing potentially
traumatic events (Afifi et al. 2011; Bandelow et al. 2002;
Brune et al. 2010; Igarashi et al. 2010). Individuals diagnosed
with BPD report experiencing more potentially
traumatic events than healthy controls (Bandelow et al.
2002; Jovev and Jackson 2006; Horesh et al. 2008), those
diagnosed with other personality disorders.
Individuals with BPD report higher frequency of sexual
and physical abuse, as well as exposure to domestic
violence, verbal abuse, and neglect (Brune et al. 2010;
Igarashi et al. 2010; Martins et al. 2011; Johnson et al.
2005; Sansone et al. 2011; Yen et al. 2002; Zanarini et al.
2000; Zweig-Frank et al. 1994). Interpersonal trauma,
relative to other forms of trauma, is most closely associated
with the development of borderline symptoms
(Battle et al. 2004; Sansone et al. 2005; Helgeland and
Torgersen 2004).
Trauma and Emotional and Behavioral Dysregulation
Emotional dysregulation is a central component of borderline
personality disorder. Linehan’s biosocial model
posits that the emotional dysregulation among individuals
with borderline personality disorder manifests as high
emotional sensitivity, intense emotions that individuals
cannot regulate, and a slow return to baseline (Linehan
1993). Developing effective abilities to regulate emotions
and tolerate distress is impaired by trauma exposure (Briere
and Rickards 2007; Kim and Cicchetti 2010; Cloitre et al.
2005, 2008; Ford et al. 2006; van der Kolk et al. 2005).
One possible explanation for the emotional dysregulation
associated with traumatic experiences is that trauma
hinders the development of recognizing and labeling
emotional states. The ability to identify and describe
emotions is essential to the processing and integration of
emotional experiences into daily life. Alexithymia is a term
describing deficits in the ability to identify and describe
feelings. Alexithymia may interfere with effective regulation
of emotion (Taylor et al. 1997), contributing to poor
tolerance for distress and disinhibition when emotionally
aroused. Identifying and understanding emotion is essential
for a variety of emotional regulation skills. For example,
one emotional regulation technique, cognitive reappraisal,
involves identifying the feeling state, the situational
determinant, and then changing one’s interpretation of the
situation in order to alter the emotional reaction (Gross and
Thompson 2007). This process of identifying feelings,
describing them, and analyzing their cause allows the
individual to reflect on the situation and respond appropriately,
rather than act solely based on the immediate
emotional response.
Alexithymia is also associated with impulsivity (Suarez
et al. 2012; van Strien and Ouwens 2007) and generally
poor mental health and well-being (Taylor et al. 1997).
Negative urgency refers to the tendency to engage in
impulsive behaviors when negatively aroused (Whiteside
and Lynam 2001) and is a factor in many risk behaviors
(Cyders and Smith 2008), including deliberate self-harm
(Arens et al. 2012), eating disorders (Anestis et al. 2009),
and substance use (Verdejo-Garcı´a et al. 2007). Both
alexithymia and negative urgency have been linked to
traumatic experiences (Kooiman et al. 2004; Arens et al.
2012). Metcalfe and Mischel (1999) proposed a twosystem
model of self-regulation in which a ‘‘hot’’ system is
characterized as emotional, impulsive, reflexive, and is
stimulated by stressful experiences. Negative urgency, the
tendency to act rashly when emotionally aroused, may be
considered a trait reflecting dominance in this hot system.
Chronic or severe stress is thought to affect the relationship
between the ‘‘hot’’ and ‘‘cold’’ system, contributing to
dominance of the ‘‘hot’’ system and reactionary behaviors,
thoughts, and emotions (Metcalfe and Mischel 1999;
Metcalfe and Jacobs 1996, 1998).
Finally, poor tolerance for distress is also associated
with post-traumatic stress symptoms (Danielson et al.
2010; Marshall-Berenz et al. 2010; Vujanovic et al. 2011)
and is one of the core features of borderline personality
disorder (Linehan 1993). Distress tolerance refers to the
extent to which a person can experience and withstand
negative emotional states (Simons and Gaher 2005). We
believe identifying and describing feelings may be important
for tolerating negative emotion. For example, the
inability to understand emotional experience may make
such experiences more threatening. Likewise, the inability
to reflect about the state may contribute to the sense of
being consumed by the immediate emotional reactions.
Finally, to the extent that lack of understanding of emotional
experience interferes with the ability to modulate the
emotional experience (e.g., via cognitive reappraisal or
other approaches), individuals may be predisposed towards
intolerance for the feeling state. Poor distress tolerance, in
turn, may contribute to disinhibited behavior when negatively
aroused. In support of this, Wray et al. (2012) found
that negative urgency mediated associations between distress
tolerance and alcohol related risk behaviors. Associations
between distress tolerance and borderline symptoms
may also be partially mediated by negative urgency. Individuals
who experience a traumatic event and endorse
lower levels of distress tolerance are more likely to experience
negative emotional experiences which manifest in
various mood, eating, substance use, and personality disorders
(Zvolensky et al. 2011). Thus, distress tolerance
may act to mediate associations between trauma and borderline
personality disorder.
Emotional Intelligence as a Resiliency Variable
in Trauma and Borderline Personality Disorder
Emotional intelligence refers to the ability to know and
regulate one’s and others’ emotion, as well as utilizing
emotion through flexible planning, creative thinking, redirected
attention and motivation (Salovey and Mayer 1990).
Alexithymia has been found to be inversely correlated with
emotional intelligence (Parker et al. 2001). However, the
strength of association is moderate and suggests they are
distinct constructs.
High emotional intelligence has been related to good
social skills, self-monitoring, cooperative responses, closer
relationships, and higher marital/partner satisfaction
(Schutte et al. 2001). In contrast, low emotional intelligence
has been associated with more intensive smoking, alcohol
use, and illicit drug use (Kun and Demetrovics 2010; Austin
et al. 2005). Thus, emotional intelligence may play an
important role in interpersonal relationships, substance use,
and overall emotional regulation, all prominent features
among individuals with borderline personality disorder.
Individuals with borderline traits are deficient in multiple
facets of trait emotional intelligence, especially those related
to managing emotions (Gardner and Qualter 2009). High
emotional intelligence has emerged as a significant predictor
of decreased psychological symptoms related to traumatic
experiences (Hunt and Evans 2004). Emotional intelligence
is positively associated with affect regulation skills and
highly adaptive interpersonal functioning (Hunt and Evans
2004) and inversely associated with risky behaviors such as
alcohol consumption and problems (Austin et al. 2005; Riley
and Schutte 2003; Brackett et al. 2004). In a recent experiential
sampling protocol with underage drinkers, individuals
who had intense negative emotions were more likely to drink
if they could not describe their emotional experiences very
specifically (Kashdan et al. 2010). Emotional intelligence
may be considered an individual characteristic that may act
as a resilience factor for a variety of outcomes including
borderline symptoms, by possibly influencing the development
of more proximal variables such as alexithymia, negative
urgency, and distress tolerance.
Current Study
Although it has been demonstrated that environments characterized
by abuse, neglect, and other potentially traumatic
experiences are risk factors for psychopathology including
borderline personality disorder (Brune et al. 2010; Klonsky
and Moyer 2008; Martins et al. 2011), the joint contribution
of potentially traumatic experiences and emotional dysregulation
to the development of borderline symptoms are not
well understood. In addition, the role of resilience factors
such as emotional intelligence in the development of borderline
symptoms has been understudied.
We posit that traumatic experience, in conjunction with
negative affectivity and poor emotional intelligence, contributes
to deficits in the ability to identify and describe
emotional states. Deficits in the cognitive processing of
emotion, the understanding of emotional experience,
reduce the ability to tolerate aversive emotional experience
and increase the likelihood of impulsive behavior when
negatively aroused. This combination of negative affect,
intolerance of negative affect, and negative affectively
driven impulsive behavior manifest in observed symptoms
of borderline personality.
Specifically, we test the following hypotheses: (1) There
will be a significant indirect association between trauma
and borderline symptoms via distress tolerance, alexithymia,
and negative urgency. (2) There will be a significant
indirect association between emotional intelligence and
borderline symptoms via alexithymia, distress tolerance,
and negative urgency. (3) The association between distress
tolerance and borderline symptoms will be partially mediated
by negative urgency. These effects will be significant
above and beyond the effects of gender and negative affect.
[...]
Discussion
The purpose of this study was to clarify the relationships
between trauma, aspects of emotional regulation, and borderline
personality disorder symptoms. Results supported
the theoretical model of borderline personality symptoms.
History of trauma is positively, and emotional intelligence,
inversely, associated with borderline personality symptoms.
These effects are mediated via impairments in the ability to
recognize and describe emotions. Deficits in identifying and
describing emotions, in turn, are 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 negative urgency), associations
with borderline personality symptoms. The model
thus identifies mechanisms linking the experience of
potentially traumatic events with borderline personality
symptoms via deficits in core aspects of emotion regulation.
We discuss the findings below, organizing them around the
three mediating variables; alexithymia, distress tolerance,
and negative urgency.
Alexithymia fully mediated the effects of trauma history
and emotional intelligence on distress tolerance, negative
urgency, and borderline personality symptoms. The experience
of trauma may be associated with a wide range of
negative sequelae, including problems in interpersonal
functioning (Lamoureux et al. 2011), internalizing problems
(e.g., depression and anxiety; Dulin and Passmore
2010), and externalizing problems (e.g., substance use;
Suarez et al. 2012). Emotional intelligence is also associated
with a similarly broad range of positive outcomes
including decreased substance use (Kun and Demetrovics
2010; Austin et al. 2005), greater marital satisfaction, more
close relationships, and stronger social networks (Schutte
et al. 2001). The diverse benefits of high emotional intelligence
may stem, in part, from the strength of individuals’
meta-cognitive/meta-emotion abilities such as increased
awareness and understanding of their emotional experience.
In contrast, the results of the current study suggest
that trauma may interfere with basic abilities in the cognitive
processing of emotion. Individuals who are then
unable to identify and describe feeling states are vulnerable
to diverse maladaptive outcomes. In the current study,
deficits in the ability to identify and describe feeling states
are related to both poor tolerance for negative emotion and
an increased tendency for impulsive action when negatively
aroused, two constructs associated with a range of
maladaptive behaviors.
Distress Tolerance. The results indicate that emotional
intelligence and history of trauma are indirectly associated
with distress tolerance via alexithymia. The association
between perceived distress tolerance and trauma is consistent
with previous research (Marshall-Berenz et al. 2010,
2011; Vujanovic et al. 2011). In addition, previous research
has indicated significant associations between distress tolerance
and meta-emotion constructs of mood acceptance
and mood typicality (Simons and Gaher 2005). The current
findings highlight the potential importance of being able to
identify and understand feeling states in supporting adaptive
tolerance of negative emotion. In addition to tolerance,
the DTS assesses being consumed, or absorbed, by negative
emotion. Thus, the process of identifying and labeling
feeling states may act to decrease the intensity and create
some distance between the self and the state of arousal. The
DTS also assesses shame, non-acceptance, and fear of
emotional experience. Thus, measuring perceived intolerance
of a variety of emotional distressing states via a selfreport
scale (i.e., DTS) is important for capturing one’s
internal experiences beyond just frustration tolerance in
response to task difficulty. The results of the current study
suggest that poor clarity regarding emotional experience
may contribute to heightened negative appraisal of aversive
emotional experience.
Distress tolerance exhibited a direct association with
borderline personality symptoms as well as an indirect
effect via negative urgency. Poor tolerance for distress is
considered to be a central aspect of borderline personality
disorder (Linehan 1993). Perhaps this finding ties into
previous research that denotes experiential avoidance may
be a key process in BPD (Iverson et al. 2012). Allowing
oneself to experience negative emotion might be necessary
for deliberative non-impulsive type behavior. Individuals
with borderline personality disorder are characterized by
heightened affective lability, unstable self-concept, deficits
in interpersonal functioning, and marked impulsivity.
Negative emotion is an integral part of human life and
although unpleasant, it has important functions and the
ability to tolerate and adaptively experience negative
emotion is important for affective and behavioral regulation
and adaptive interpersonal functioning. The findings
indicate that perceived distress tolerance acts as a proximal
variable, mediating the effects of several etiologically relevant
variables including trauma history, emotional intelligence,
negative affectivity, and alexithymia. The DTS
was significantly associated with borderline symptoms over
and above the effects of both negative affectivity and
negative urgency. The findings thus provide additional
support for the construct validity of the DTS.
Negative Urgency. Considering the status of impulsivity
and emotional volatility as major dimensions of borderline
personality disorder (New and Siever 2002), the observed
associations between negative urgency and borderline
symptomatology are not surprising. We suggest that the
ability to engage in deliberative action or engage in mood
regulation strategies that may be adaptive, yet not immediate,
when experiencing negative emotion requires tolerance
for the feeling state. In this regard, we hypothesized
inverse effects from distress tolerance to negative urgency.
The results of this study are consistent with Wray et al.
(2012) indicating good tolerance for distress may reduce
the tendency to act rashly when negatively aroused. Negative
urgency, in turn, acts to partially mediate the effects
of distress tolerance on health outcomes (e.g., borderline
symptoms or substance-related risk behavior (cf. Wray
et al. 2012).
Like distress tolerance, negative urgency was significantly
predicted by alexithymia (and indirectly associated
with emotional intelligence and trauma history). Previous
research has identified associations between alexithymia
and other impulsivity measures (Larsen et al. 2006;
Ouwens et al. 2009; Strein and Ouwens 2007; Zimmerman
et al. 2005). The current study extends this to the negative
urgency facet of impulsivity. Some models of impulsive
action emphasize the role of emotion-based action tendencies
(Hirsh et al. 2010; Metcalfe and Mischel 1999;
Shen and Bigsby 2010; Yan and Dillard 2010). In addition,
neurocognitive systems underlying reflexive action are
facilitated by heightened arousal (Lieberman 2007). In
contrast, reflective processing is thought to facilitate
behavioral inhibition in part because engaging the ‘‘cool’’
system and utilizing cognitive representation of semantic
symbols provides a buffer or delay in which alternative
responses can be evaluated and selected (Metcalfe and
Mischel 1999). The results suggest that the inability to
cognitively represent feeling states (i.e., alexithymia) may
increase the tendency to act rashly when negatively
aroused.
to the forum.
For the last couple of batches of broth I oven roasted the bones first. The flavor was fantastic! I think I will be continuing to roast the bones for a while. Did not even miss the onions in the last batch.
I also have a copper colored coating that has developed in my stainless steel distiller. I can't get it all out even with boiling a mild acid solution, because it goes to the top and it's hard to fill it to the brim; so there's an inch and a half. And the top part of the distiller where it goes up through the coils I can't really get the copper color off. I tried laying vinegar soaked paper towels on it with no success. I think I should get a new one, because I just looked and I've had it for 3.5 years now! And I know I pretty much boil a gallon a day.
