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Personality

How Emotions Go Downhill in People with Personality Disorders

The ability to turn off negative thoughts contributes to mental health.

Key points

  • Research on borderline personality disorder has shown that rumination plays a role in leading to an emotional cascade.
  • A new study shows that personality disorders in general, not only borderline, are marked by downhill emotions.
  • Controlling ruminative thoughts and maladaptive ideas about worry can help people gain greater control over their emotions.
Johan Larson/Shutterstock
Source: Johan Larson/Shutterstock

When something bothers you, do you find that it runs through your mind on an endless loop? Do you replay situations in which you said or did something foolish, like making a bad joke at someone's expense? Perhaps you were on an online video chat in which you made what you meant as a humorous remark to someone else, a person you know relatively well, but instead managed to say something that the person clearly found belittling. In person, you could probably have handled this mild teasing incident by saying something privately afterward, but in the online environment, there’s no such opportunity. Instead, you think over and over again about how you inadvertently offended this person and how much it’s hurt your future relationship.

It’s natural to think back on situations like this and wish they’d gone differently, but another to let them preoccupy you to the point that you can hardly think of anything else. According to a new study by Marcantonio M. Spada and colleagues (2021) of London South Bank University, the process of “repetitive negative thinking (RNT),” or rumination, occurs when you think “attentively, repetitively, or frequently about the self and one’s world.”

The two forms of RNT are rumination and worry, and the fact that they take up space in your mind means that you have less room for such other thought processes as concentration, memory, problem-solving, and even the desire to engage in purposeful behavior. In other words, the more you allow RNT to take over, the less you’re able to go about your daily life unencumbered by these drains of your mental energy. Distinguishing rumination from worry, the British authors note that rumination involves thinking negatively about the past, and worry involves negative thoughts and expectations for the future.

When Emotions Go Downhill in Personality Disorders

As you can see, then, RNT is highly maladaptive. Previous research that Spada et al. cite was based on people with Borderline Personality Disorder (BPD), establishing that they are prone to engaging in various forms of RNT such as brooding and rumination involving anger, interpersonal situations, anxiety, and stress. Indeed, some studies suggest that these counterproductive thought processes predict the severity of BPD symptoms above and beyond sadness, anger, and generally negative mood.

The evidence regarding rumination and BPD forms the basis for what’s known as the “Emotional Cascade Model,” in which the individual experiences an event that triggers a negative emotion (such as an argument with a partner) and then replays the event through rumination in an attempt to understand what just went on. Unfortunately, this rethinking of the situation “will backfire and lead to the intensification of distress,” which in turn will lead to such impulsive behavior as self-harm or substance abuse “in order to escape or obtain relief from distress.” The escalation from a negative encounter to risky behavior can also involve other dysregulated behavior such as binge eating.

Above and beyond rumination, people with borderline personality disorder are also known to have certain thoughts about thinking, or what’s called “metacognition.” If you believe it’s a good idea to ruminate because it will help you “make sense” of your thoughts, you’ll clearly be inclined to engage in this mental activity. Furthermore, if you think you can’t control your mind so that you can turn off those thoughts when they prove to be counterproductive, you’ll also suffer ill effects above and beyond the thoughts themselves.

In reviewing the previous literature, the research team observed that most of this work was based not on samples of individuals with diagnosed BPD, but on college students. Additionally, prior studies didn’t include people with other personality disorders nor did they go beyond a correlational approach. Spada et al. believe that people with narcissistic and antisocial personality disorder could also engage in this type of nonproductive thinking pattern and impulsive behavior after experiencing a negative interpersonal situation.

Testing the Emotional Cascade Model

Comparing a sample of 186 outpatients with diagnosed personality disorders (PD) and the 372 with patients having no personality disorders (non-PD), averaging 37 years old, Spada and his fellow collaborators sought to establish whether there would be group differences in the key measures of rumination, worry, metacognitions, and distress. The three largest categories of personality disorders represented in the PD sample were borderline (26 percent), avoidant (23 percent), and obsessive compulsive (18 percent).

You can test yourself on the measures that Spada and his team administered to their PD and non-PD groups with these sample items:

  • Worry: “As soon as I finish one task, I start to worry about everything else I have to do.”
  • Rumination: (rate as almost never to almost always): “Think about how alone you feel;” “Think about how angry you are with yourself.”
  • Metacognitions: “Worrying helps me avoid problems in the future,” “I cannot ignore my worrying thoughts.”

The standard measures of anxiety and depression the authors used included self-ratings on items such as feeling “dizzy and lightheaded” (anxiety) and “I am so sad or unhappy that I can’t stand it” (depression).

As the authors predicted, the PD group scored higher on rumination and worry, as well as anxiety and depression than did the non-PD group. Furthermore, the rumination scores were correlated with the severity of PD symptoms, meaning that the greater number of symptoms an individual had, the higher that person’s rumination scores. Looking further at the role of metacognition, Spada et al. reported support for their role in “activation and maintenance of maladaptive coping strategies (e.g. ruminations and worry) that bring an escalation of psychological distress.”

It's important to keep in mind that, as is true for other studies in this field, there was no follow-up component to the design so that it wasn't possible to tease out cause and effect. However, regardless of what starts the emotional cascade, its impact is to lead people with PD’s to suffer from a continuous and escalating cycle of distress as they focus on their negative thoughts which they believe they cannot control.

How to Turn Off Your Own Emotional Cascade

Even if you do not have a personality disorder, the research team’s results have clear implications for why and how to stop your own ruminative cycles. You can begin by noticing the times that you replay an incident such as that unfortunate joke over and over again. Next, ask yourself whether continuing to reimagine the situation is actually doing you any good. Is it making you feel better or worse?

Turn now to your ability to carry out your daily activities, particularly those involving planning and concentration. Do you find yourself staring at your desk, wondering what it was you were supposed to be working on? Do you try to pour out the coffee from your coffee maker only to find that you turned it on but never filled the tank with water? Do you tend to spill things because you don't really look at what you're doing? Assuming that your memory and attention are just fine when you sit down to complete a task, it’s possible that your thought processes have been waylaid by some ruminative tendencies.

If you know someone with a personality disorder, or if you yourself have been diagnosed with one, the Spada et al. results can have an even more direct benefit for your life. The authors note that there is a specific type of therapy that targets metacognitions in which individuals learn to detect and stem their constant ruminations and fear of not being able to control their thoughts. Part of this process can involve what they call “detached mindfulness” in which you notice these mental experiences but let them float away without causing undue distress.

To sum up, this study of rumination and personality disorders provides intriguing suggestions about how thoughts and emotions can reverberate among themselves to increase your anxiety and depression. Rather than give in to this cycle, you can gain control and find ways to steer your thinking into a more productive and fulfilling direction.

Facebook/LinkedIn image: Johan Larson/Shutterstock

References

Spada, M. M., Nikčević, A. V., Kolubinski, D. C., Offredi, A., Giuri, S., Gemelli, A., Brugnoni, A., Ferrari, A., & Caselli, G. (2021). Metacognitions, rumination, and worry in personality disorder. Journal of Affective Disorders, 293, 117–123. https://doi-org /10.1016/j.jad.2021.06.024

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