Reward and Punishment Sensitivity in Borderline and Avoidant Personality Disorders.

The authors compared self-reported and behavioral responses to reward and punishment in individuals diagnosed with borderline personality disorder (BPD) or avoidant personality disorder (APD) relative to a healthy comparison (HC) group. As predicted, self-reported sensitivity to reward was significantly higher in the BPD group than in the APD and HC groups. Also as predicted, self-reported sensitivity to punishment was significantly elevated in both disordered groups but significantly higher in APD than in BPD. These hypothesized patterns were also evident in responses to behavioral tasks: Participants with BPD made more errors of commission and fewer errors of omission than HC participants on a passive avoidance learning task, and participants with APD showed greater reactivity to losses than other participants on a probabilistic reversal learning task. Results help characterize differences between these two disorders.

Borderline personality features and integration of positive and negative thoughts about significant others.

Taking the bad with the good is a necessity of life, and people who readily integrate thoughts of their loved one's flaws with thoughts of their more positive attributes maintain more stable, satisfying relationships. Borderline personality disorder, however, is often characterized by interpersonal perceptions that fluctuate between extremes of good and bad. We used a timed judgment task to examine information processing about significant others in individuals high in borderline personality features relative to healthy individuals and those high in avoidant personality features. In Study 1, when judging traits of a liked significant other, same-valence facilitation by negative primes (judging negative traits faster than positive traits after a negative prime) was significantly stronger in the borderline features group than the other two groups, and was inversely associated with self-reports of integrated thoughts about significant others. In contrast, same-valence facilitation by positive primes (judging positive traits faster than negative traits after a positive prime) was significantly stronger in the avoidant features group than the other two groups, and inversely associated with self-esteem. No between-group differences in same-valence facilitation were statistically significant when participants judged traits of disliked significant others, liked foods, and disliked foods. In Study 2, same-valence facilitation by negative primes when judging traits of a liked significant other was significantly associated with less integrated positive/negative thoughts about that person in a 12-day diary. These results identify an implicit information-processing pattern relevant to interpersonal difficulties in borderline personality disorder. (PsycINFO Database Record

Identification of mental states and interpersonal functioning in borderline personality disorder.

Atypical identification of mental states in the self and others has been proposed to underlie interpersonal difficulties in borderline personality disorder (BPD), yet no previous empirical research has directly examined associations between these constructs. We examine 3 mental state identification measures and their associations with experience-sampling measures of interpersonal functioning in participants with BPD relative to a healthy comparison (HC) group. We also included a clinical comparison group diagnosed with avoidant personality disorder (APD) to test the specificity of this constellation of difficulties to BPD. When categorizing blended emotional expressions, the BPD group identified anger at a lower threshold than did the HC and APD groups, but no group differences emerged in the threshold for identifying happiness. These results are consistent with enhanced social threat identification and not general negativity biases in BPD. The Reading the Mind in the Eyes Test (RMET) showed no group differences in general mental state identification abilities. Alexithymia scores were higher in both BPD and APD relative to the HC group, and difficulty identifying one's own emotions was higher in BPD compared to APD and HC. Within the BPD group, lower RMET scores were associated with lower anger identification thresholds and higher alexithymia scores. Moreover, lower anger identification thresholds, lower RMET scores, and higher alexithymia scores were all associated with greater levels of interpersonal difficulties in daily life. Research linking measures of mental state identification with experience-sampling measures of interpersonal functioning can help clarify the role of mental state identification in BPD symptoms. (PsycINFO Database Record

Affective instability as a clinical feature of avoidant personality disorder.

The current study's main goal was to examine whether affective instability is elevated among individuals suffering from avoidant personality disorder (APD) by comparing it to the affective instability found among individuals suffering from borderline personality disorder (BPD) as well that found among healthy controls. Adults (N = 152, aged 18-65 years) with BPD, APD, or no psychopathology participated in a 3-week computerized diary study. We examined temporal instability in negative affect using experience-sampling methods. Both within and between days, individuals with APD showed greater affective instability compared to the healthy control individuals, although less affective instability compared to individuals with BPD. The findings are in line with affective instability (or emotional lability) as a key dimension relevant across personality disorders. Additionally, they emphasize the need for research and clinical attention to affective characteristics (alongside the more readily recognized interpersonal characteristics) of APD. (PsycINFO Database Record

Impulsivity, Rejection Sensitivity, and Reactions to Stressors in Borderline Personality Disorder.

This research investigated baseline impulsivity, rejection sensitivity, and reactions to stressors in individuals with borderline personality disorder compared to healthy individuals and those with avoidant personality disorder. The borderline group showed greater impulsivity than the avoidant and healthy groups both in a delay-discounting task with real monetary rewards and in self-reported reactions to stressors; moreover, these findings could not be explained by co-occurring substance use disorders. Distress reactions to stressors were equally elevated in both personality disorder groups (relative to the healthy group). The borderline and avoidant groups also reported more maladaptive reactions to a stressor of an interpersonal vs. non-interpersonal nature, whereas the healthy group did not. Finally, self-reported impulsive reactions to stressors were associated with baseline impulsivity in the delay-discounting task, and greater self-reported reactivity to interpersonal than non-interpersonal stressors was associated with rejection sensitivity. This research highlights distinct vulnerabilities contributing to impulsive behavior in borderline personality disorder.

Seeing things differently: An experimental investigation of social cognition and interpersonal behavior in anorexia nervosa.

OBJECTIVE: Interpersonal difficulties among individuals with anorexia nervosa (AN) may stem in part due to misperceiving social cues. The current study investigated social functioning by comparing interpersonal self-efficacy, perceptions of dominance/submission (i.e., agency) and coldness/warmth (i.e., communion), and hypothetical behavioral reactions among individuals with and without AN. METHOD: Seventy-seven women (AN/Other Specified Feeding or Eating Disorder OSFED-AN n = 41, nonclinical comparison group n = 36) completed questionnaires assessing mood symptoms and interpersonal self-efficacy, followed by an experimental video-rating task in which they received critical feedback from job supervisors varying in degrees of agency and communion. RESULTS: AN respondents perceived more coldness overall, even after adjusting for differences in depression and anxiety symptoms, and tended to respond with coldness even to videos that they perceived as being warm. However, perceptual accuracies for agency were similar across groups. Interpersonal self-efficacy moderated the relationship between diagnostic status and behavioral responses: among those who felt competent being cold-submissive, AN respondents selected cold-submissive responses more frequently than did the nonclinical comparison group. DISCUSSION: Among those with AN symptoms, there may be a tendency toward social perceptual inaccuracies regarding communion and non-complementary cold behavioral responses. Results suggest that improving social perceptions may be a fruitful intervention target for enhancing interpersonal functioning among individuals with AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:499-506).

Rejection Sensitivity, Perceived Power, and HIV Risk in the Relationships of Low-Income Urban Women.

The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and, therefore, may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women's sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001-2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and, in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention.

Explicit and inferred motives for nonsuicidal self-injurious acts and urges in borderline and avoidant personality disorders.

Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18-65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.

Out of the frying pan, into the fire: mixed affective reactions to social proximity in borderline and avoidant personality disorders in daily life.

Social proximity typically helps individuals meet their belongingness needs, but several forms of psychopathology, including borderline and avoidant personality disorders (BPD and APD, respectively) are characterized by social difficulties. This experience-sampling study is one of the first to directly investigate the affective reactions of individuals with BPD and APD (compared with healthy controls [HC]) to social proximity in daily life. We examined both person-level and day-level reactions. At the person level, the rate of social proximity across the diary period was associated with diminished feelings of rejection, isolation, shame, and dissociation in the HC group. In contrast, it was not associated with any affective reaction in the BPD group, and was associated with decreased rejection and isolation on the one hand, but also with increased anxiety in the APD group. At the day level, we used multilevel regression to examine affective reactions when in social proximity. The HC group showed a consistent benefit when in social proximity. In contrast, both PD groups exhibited mixed affective reactions to social proximity; specifically, benefits (increased positive affect, decreased rejection, isolation, and dissociation) were interspersed with costs (increased shame for both PD groups; increased anger for BPD; increased anxiety for APD). The mixed reactions found in both PDs may contribute to the disturbed relationships of individuals with these disorders.

Emotion differentiation as a protective factor against nonsuicidal self-injury in borderline personality disorder.

Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.

From negative to positive and back again: polarized affective and relational experience in borderline personality disorder.

A core feature of borderline personality disorder (BPD) is the tendency to evaluate one's experience with extreme polarity (i.e., feeling all good or all bad; Beck, Freeman, & Davis, 2004; Kernberg, 1975; Linehan, 1993). In this investigation, we examined the polarity of within-person reports of experience in individuals with BPD and healthy adults over the course of a 21-day, experience-sampling diary. We applied multilevel modeling techniques (Rafaeli, Rogers, & Ravelle, 2007) to capture the within-person covariance of momentary reports of negative and positive features of experience, either affective or relational. Our data indicated significantly greater polarity in reports of affective and relational experiences in BPD that increased during heightened interpersonal stress. We also examined the association of affective and relational polarity to reports of impulsive behaviors (e.g., self-injury, substance use, etc.) and found evidence that increased polarity in reports of affective (in low-stress contexts) and relational experiences (in high-stress contexts) predicted increased rate of reports of impulsive behaviors. Together, these data present strong evidence for the role of polarized experiences in BPD, and have implications for the treatment of individuals with this disorder.

The rejection-rage contingency in borderline personality disorder.

Though long-standing clinical observation reflected in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) suggests that the rage characteristic of borderline personality disorder (BPD) often appears in response to perceived rejection, the role of perceived rejection in triggering rage in BPD has never been empirically tested. Extending basic personality research on rejection sensitivity to a clinical sample, a priming-pronunciation experiment and a 21-day experience-sampling diary examined the contingent relationship between perceived rejection and rage in participants diagnosed with BPD compared with healthy controls. Despite the differences in these 2 assessment methods, the indices of rejection-contingent rage that they both produced were elevated in the BPD group and were strongly interrelated. They provide corroborating evidence that reactions to perceived rejection significantly explain the rage seen in BPD.

Rejection sensitivity and the rejection-hostility link in romantic relationships.

Rejection sensitivity is the disposition to anxiously expect, readily perceive, and intensely react to rejection. In response to perceived social exclusion, highly rejection sensitive people react with increased hostile feelings toward others and are more likely to show reactive aggression than less rejection sensitive people in the same situation. This paper summarizes work on rejection sensitivity that has provided evidence for the link between anxious expectations of rejection and hostility after rejection. We review evidence that rejection sensitivity functions as a defensive motivational system. Thus, we link rejection sensitivity to attentional and perceptual processes that underlie the processing of social information. A range of experimental and diary studies shows that perceiving rejection triggers hostility and aggressive behavior in rejection sensitive people. We review studies that show that this hostility and reactive aggression can perpetuate a vicious cycle by eliciting rejection from those who rejection sensitive people value most. Finally, we summarize recent work suggesting that this cycle can be interrupted with generalized self-regulatory skills and the experience of positive, supportive relationships.

Rejection sensitivity and disruption of attention by social threat cues.

Two studies tested the hypothesis that Rejection Sensitivity (RS) increases vulnerability to disruption of attention by social threat cues, as would be consistent with prior evidence that it motivates individuals to prioritize detecting and managing potential rejection at a cost to other personal and interpersonal goals. In Study 1, RS predicted disruption of ongoing goal-directed attention by social threat but not negative words in an Emotional Stroop task. In Study 2, RS predicted attentional avoidance of threatening but not pleasant faces in a Visual Probe task. Threat-avoidant attention was also associated with features of borderline personality disorder. This research extends understanding of processes by which RS contributes to a self-perpetuating cycle of interpersonal problems and distress.

Childhood physical and emotional abuse by a parent: transference effects in adult interpersonal relations.

Extending research on transference and the relational self (Andersen & Chen, 2002), female undergraduates with or without a history of physical and emotional abuse by a loved parent participated in an experiment manipulating parental resemblance and threat-relevant interpersonal context in a new person. Transference elicited differences not evident in the control condition between abused and nonabused participants' responses, with greater rejection expectancy, mistrust, dislike, and emotional indifference reported by abused participants. Immediate implicit affect was more positive in transference than in the control condition regardless of abuse history. Yet, abused participants in transference also reported increased dysphoria that was markedly attenuated when interpersonal threat was primed, and no such pattern occurred among nonabused participants. Evidence that interpersonally guarded and affectively complex responses are triggered in transference among previously abused individuals suggests that this social-cognitive process may underlie long-term interpersonal difficulties associated with parental abuse.

Relative impact of young adult personality disorders on subsequent quality of life: findings of a community-based longitudinal study.

Little is known about long-term prognostic implications of personality disorder (PD) for quality of life (QOL) in the young adult population not selected for psychiatric treatment. The purpose of this study was to determine the association of PDs with QOL assessed after an 11-year interval. PDs were assessed in 1991-1994 at mean age 22, and indicators of QOL were assessed in 2001-2004 at mean age 33 based on a community sample of 588 young adults. Findings indicated that any PD, or a cluster A, B, or C PD each were independently associated with elevated impairment in overall QOL after adjusting for demographic variables, co-occurring Axis I disorder, and physical illness, and PDs in other clusters. Cluster B PD had a greatest adverse impact on QOL. Symptoms of antisocial, borderline, and schizotypal PD symptoms were independently associated with significant reductions in QOL; avoidant, paranoid, and dependent PD symptoms were associated with smaller reductions, not reaching statistical significance. Symptoms of other individual PDs were not associated with reduced QOL. PDs in young adults in the community have an enduring and adverse impact on subsequent QOL that cannot be attributed to physical illness or Axis I psychiatric disorder.

Current affairs and the public psyche: American anxiety in the post 9/11 world.

BACKGROUND: The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended "natural experiment" allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied. METHODS: Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined. RESULTS: In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher's exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms. CONCLUSIONS: Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods.

Impact of adolescent mental disorders and physical illnesses on quality of life 17 years later.

OBJECTIVE: To investigate associations of mental disorders and physical illnesses during adolescence with quality of life (QOL) 17 years later. DESIGN: The Children in the Community Study, a prospective longitudinal investigation. SETTING: Upstate New York. PARTICIPANTS: A community-based sample of mothers and their offspring were interviewed. MAIN OUTCOME MEASURES: Axis I disorders and Axis II personality disorders and physical illnesses were assessed by self-report and mother report in 1985-1986. Outcome indicators of QOL were assessed in 2001-2004. RESULTS: Compared with participants without adolescent illness or disorder, those with a history of physical illness reported poorer physical health (mean difference [MD], -4.8); those with a history of an Axis I disorder reported poorer physical health (MD, -8.0) and more problematic social relationships (MD, -4.5); and those with a history of personality disorder reported poorer physical health (MD, -8.2), more problematic social relationships (MD, -5.0), lower psychological well-being (MD, -3.6), and more adversity within their environmental context (MD, -4.6) in adulthood. Comorbid physical illness and mental disorder were associated with all 5 QOL domains (MD, -3.1 to -11.9). After adjusting for all demographic variables and comorbidity, associations remained between physical illness and poor physical health (effect size [ES], -0.33); an Axis I disorder and problematic social relationships (ES, -0.37); and personality disorder and problematic social relationships (ES, -0.36), low psychological well-being (ES, -0.23), impaired role function (ES, -0.24), and an adverse environmental context (ES, -0.50). CONCLUSIONS: Mental disorders may have more adverse long-term associations with QOL than do physical illnesses. Adolescent personality disorders may have a more adverse impact on adult QOL than do adolescent Axis I disorders.

Documented and self-reported child abuse and adult pain in a community sample.

OBJECTIVES: To examine the association of chronic pain in young adults with childhood exposure to maltreatment and to determine whether depressive symptoms mediate such an association. DESIGN: A total of 649 members of a randomly selected cohort of young adults from a multiwave, multi-informant epidemiological study were interviewed with regard to chronic pain and symptoms of major depressive disorder. Maltreatment was measured both by retrospective self-report and by official records of substantiated child maltreatment. OUTCOME MEASURES: Current complaints of frequent pain and functionally impairing chronic pain were assessed in young adult interviews at mean age 22. RESULTS: Net of demographic factors, adult chronic pain was associated with self-reported sexual abuse. This association persisted after the contribution of concurrent depression was statistically controlled. Elevations of pain attributable to documented maltreatment were comparatively modest and below the threshold of statistical significance. Pain complaints in participants who self-reported physical abuse were not significantly elevated. CONCLUSIONS: Overall, results show an association between self-reported sexual abuse history and adult pain complaints in this general population sample, which was not attributable to symptoms of depression at the time of such reports.

Dual work and family roles and depressive symptoms in two birth cohorts of women.

BACKGROUND: Rising depression rates in more recent cohorts of women have been attributed in part to their increased participation in dual family and work roles. METHOD: This study examined associations among depressive symptoms, age, and work and marital status in two cohorts of women, all mothers, born between 1931 and 1944 (preboomers) or between 1945 and 1958 (baby boomers), assessed at comparable ages. RESULTS: Being married (vs. divorced) was related to less depression within and across cohorts, whereas working was related to more depression in preboomers only. Moreover, divorced working preboomers were significantly more depressed than women in most other role status groups within and across cohorts. Depression scores declined across age among working women in the combined cohorts; however, that association held only for baby boomers when cohorts were analyzed separately. Among divorced working women, that decline was significantly greater in baby boomers than preboomers. CONCLUSIONS: These cohort differences support a call for new social policies that address the mental health needs of women and their children.