Two Potential Causes of Emotional Swings in Borderline Personality
A new study focuses on the emotional lives of those with borderline personality.
Posted Dec 14, 2019
People who are diagnosed with borderline personality disorder (BPD) go through daily ups and downs in their emotions that can seriously hamper their lives. Among the symptoms of this disorder are not only affective instability (those ups and downs) but also dependency on others, fear of rejection, insecure sense of self, problems with interpersonal boundaries, and attempts at self-harm. If you know people with this disorder, you see these symptoms in action, and you know how trying it can be to maintain a relationship with them. However, you’re also aware of how painful their lives can be, and in conversation, you tread lightly on topics that you fear may cause turmoil.
A new study on borderline personality disorder by KU Leuven (Belgium)’s Kristof Vansteelandt and colleagues (2019) used an experience sampling method to tap into the daily emotional experiences of people with BPD. The Belgian authors based their research on this concept of affective instability as “the tendency to experience emotions that fluctuate frequently and intensively over time” (p. 1). Although thought of as a unitary quality, the authors note that affective instability includes the components of “variability” (fluctuations over time) and “serial dependency,” also called “auto-correlation.” In other words, people with BPD may vacillate from anxiety to anger without much provocation (variability). However, a high level of anger can feed on itself, making those negative emotions even more negative over time.
Vansteelandt and his coauthors point out that research on BPD becomes complicated by the fact that there is “heterogeneity” in BPD, meaning that some individuals may have one set of the 5 (out of 7) symptoms necessary to receive the diagnosis, and others may have a different set of 5. The lack of overlap means that there may be two people with a BPD diagnosis who may have only one symptom in common, making it difficult to place them in the same group. The authors believe that underlying the heterogeneity in BPD are variations in two fundamental dimensions: the development of one's own identity or sense of self, and the development of relations with others. These two processes interact in a “dialectical synergistic” fashion, meaning that change in one relates to change in the other process.
An individual’s sense of identity, within this developmental framework, can be disrupted by a constant inner stream of self-criticism and blame. Individuals with BPD who are high on the self-criticism dimension would, according to the Belgian authors, be more likely to avoid interpersonal relationships because they fear receiving that same high level of criticism from others. This is one form of that dialectical synergism. For people with BPD high in the relatedness dimension, the problem becomes one of being overly dependent on others. They have “an exaggerated emphasis on interrelatedness… resulting in an overdependence on others and fear for abandonment and rejection” (p. 2).
Using these two dimensions, then, you can see how the development of people with BPD can go down different tracks. Rather than just list the symptoms of BPD, then, the approach recommended by Vansteelandt et al. involves understanding the heterogeneity of the disorder by examining whether an individual's deficiencies are in the self-criticism or dependency dimensions.
Returning now to the issue of affective variability, or what contributes to the individual’s daily experiences of emotions, the KU Leuven researchers predicted that those individuals high in self-criticism would differ in how much their emotions would rise and fall than would those high in the dependency dimension. To test this out, Vansteelandt et al. used a procedure referred to as an “ecological momentary assessment of affect (EMA).” In this method, you respond to a prompt to rate how much, on a scale of 1 to 100, you are currently feeling the negative emotions of anger, sadness, and fear and the positive emotions of cheerful and relaxed. These emotions, the authors note, differ not only in valence (positive to negative) but also activation (high or low). For example, you could feel cheerful, which is a positive emotion with high activation, or relaxed, which is also a positive emotion but with low activation. The research team collected EMA ratings via a handheld computer which sent a signal to respond 10 times a day for 8 days.
As you can imagine, the EMA procedure may be burdensome, and in fact, participants rated, on average, 50 of the possible 80 signals over the course of the study (63 percent compliance). However, this compliance rate was comparable to those obtained in other studies on people with BPD, so the authors considered this rate to be within an acceptable range. The 32 patients in the study (84 percent women) averaged 28 years of age (most were between 19 and 37), and all were diagnosed with BPD using the DSM-5. Participants also took a standard depression questionnaire to provide the research team with scores on the two dimensions of self-criticism and dependency.
The findings indicated that the emotional experiences of BPD participants did in fact differ according to the dimension on which they were higher. Those who scored higher on the self-criticism dimension showed more daily variations in anger, depression, anxiety, cheerfulness, and feeling relaxed. Individuals with higher dependency scores also showed high variation on a daily basis in anger, but less variation in anxiety and feelings of relaxation.
The authors believe that the findings with respect to self-criticism suggest that people with BPD who find fault in themselves are also more likely to perceive that others disapprove of them, leading to extreme variations in their feelings of anger, sadness, and fear. At the same time, their positive emotions are also more likely to show extreme shifts. People high on dependency may go into "freeze mode," leading their emotional experiences to be less variable when they are fearful or relaxed. For those individuals high in both self-criticism and dependence, the findings suggest, in the words of the authors, “equifinality,” in which "the same clinical feature of variability in anger” (p. 6) results from differing degrees of the two developmental processes.
To sum up, the Belgian study sheds light on the dynamics of emotions in people with BPD as they make their way through their daily lives. Anger seems to be a prominent feature of their experience, whether it follows from feeling that others are criticizing them or from feeling abandoned by those close to them. However, they differ in the nature of their emotional upheavals. Their fulfillment, and your relationships with them, can benefit from understanding the developmental pathways that can create havoc with their inner lives.
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Vansteelandt, K., Houben, M., Claes, L., Berens, A., Sleuwaegen, E., & Kuppens, P. (2019). Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study. Personality Disorders: Theory, Research, and Treatment. doi: 10.1037/per0000374