Socioemotional functioning in youth with borderline personality disorder

This thesis makes an original contribution to our understanding of socioemotional functioning in borderline personality disorder (BPD) by critically examining social cognition and emotion regulation BPD research from a developmental perspective. It also extends on previous research, making a novel and important contribution to our understanding of sociocognitive functioning and emotion regulation ability in youth with first presentation BPD. This was achieved via two critical narrative reviews of the existing literature and two empirical studies, which examined aspects of social cognition and emotion regulation considered key to interpersonal functioning in BPD. The empirical studies assessed, 1) unconscious simulation processes, a key aspect of affective empathy, and 2) the application of two emotion regulation strategies, expressive suppression and cognitive reappraisal, in the regulation of negative and positive affect, in a standard laboratory context, as well as in the context of social rejection. The reviews demonstrated that despite their shared diagnosis, important differences between young people and adults with BPD, in terms of their sociocognitive functioning and emotion regulation abilities, are evident. Future research and reviews should avoid conflating developmental age and stage of disorder. Instead, these processes, which are central to interpersonal functioning, need to be better understood over the course of BPD, especially early in its course. The empirical studies demonstrated that socioemotional functioning in youth with first presentation BPD is not uniformly affected. Specifically, rapid facial mimicry was unimpaired, contradicting predictions that heightened unconscious motor mimicry leads to heightened emotional contagion, and associated emotion regulation difficulties. Future research is needed to determine whether this finding also holds true for adults and young people later in the course of the disorder. Future research should also explore other factors that might lead to heightened emotional contagion and associated emotion regulation difficulties in BPD. Emotion regulation ability was largely preserved in youth with first presentation BPD, and functioning was mostly similar to that of typically developing young people. Specifically, for the most part, they could apply expressive suppression and cognitive reappraisal, to regulate both positive and negative affect (felt subjectively and expressed behaviourally), in a standard laboratory context and in the context of social rejection, with similar effectiveness to that of healthy youth. However, youth with first presentation BPD were not only unable to apply cognitive reappraisal to regulate the behavioural expression of negative emotions in the context of social rejection, but its application in this context intensified their facial expression of negative affect. They also demonstrated a pattern of pervasively blunted positive affect, relative to healthy youth, across indices and contexts. Further research is needed to better understand whether the effectiveness of cognitive reappraisal can be improved in this context, or whether it is contraindicated. Given that social rejection is commonly experienced by this group, and given the common application of cognitive strategies in therapy, future research is clearly needed to better understand the effectiveness and consequences of this, and alternative strategies, for use in the context of social rejection by youth with first presentation BPD. Finally, while positive affect has often been neglected in BPD research, the evident pervasive blunting clearly needs greater research and clinical attention in this group

The role peer responses to adolescent expression of emotions plays in their emotion regulation : A systematic literature review

Introduction Peer responses to adolescents’ emotional expressions (PREE), are thought to influence the continued development of emotion regulation (ER). Unsupportive (e.g., dismissive) PREE, for example, are expected to be associated with greater maladaptive ER. Poor ER is known to place adolescents at risk of psychopathology. The aim of this systematic review was to collate and synthesize the emerging evidence exploring the role that peer emotion socialization, specifically PREE, plays in adolescent ER and identify future directions. Methods In adherence with PRISMA guidelines, PsychINFO, Medline Complete, CINAHL Complete, Scopus and Web of Science were searched on April 20th, 2021, May 28th, 2022, and April 12th, 2023 for English language reports published after 1998. To be included, studies needed to report on PREE and its relation to adolescent ER. Results A total of eight studies, one qualitative and seven quantitative, met inclusion criteria and had a combined N of 785 participants (aged 10–18 years). Studies were primarily undertaken in the US and mostly included males and females, with one study only including female participants. Conclusions Although only eight studies were identified, the review identified preliminary evidence for an association between PREE and ER in adolescents. This association appeared to vary depending on adolescent gender, age, the closeness of the friendship and the PREE. Several limitations were identified, and suggestions are made for future research in this emerging area

Early maladaptive schemas, emotion regulation difficulties, and alexithymia : A systematic review and meta-analysis

Background Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia. Method PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain. Results A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]). Conclusions The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy

Cognitive reappraisal impairs negative affect regulation in the context of social rejection for youth with early-stage borderline personality disorder

Application of emotion regulation strategies might be susceptible to the context of social rejection for individuals with borderline personality disorder (BPD). This study compared the ability of 27 outpatient youths (15-25 years old) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, with social rejection acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies because they might be contraindicated

The role of parent and peer emotion socialization and emotion regulation in the development of internalizing problems in adolescents

Adolescence is a dynamic period for the development of emotion regulation skills. Difficulties in emotion regulation are an important predictor of risk for internalizing problems. Parents and peers play an important role in both emotion regulation (ER) skills and the development of internalizing problems, however, few studies have examined their influence concurrently using longitudinal data. This study investigated the impact of parent and peer emotion socialization and adolescent ER on adolescent (N = 213; aged 13 to 14 years old) internalizing problems 11 months later, as reported by adolescents. Results indicated peer but not parent emotion socialization predicted adolescent internalizing problems. Moreover, adolescent difficulties in ER at baseline moderated the impact of peer emotion socialization on adolescent internalizing problems. The findings highlight peer emotion dismissing responses impact internalizing problems, especially if adolescents also report difficulties in ER, underscoring the importance of prevention during earlier developmental periods

Rapid facial mimicry responses are preserved in youth with first presentation borderline personality disorder

Background: Empathy is a complex and multifaceted construct comprising cognitive and affective components. Abnormal empathic responses are implicated in borderline personality disorder (BPD). Specifically, unconscious motor mimicry (a primitive component of affective empathy evident from infancy) is theorized to be heightened and to contribute to the heightened emotional contagion often seen in people with BPD. Yet, no study has directly tested whether abnormally heightened unconscious motor mimicry is associated with BPD features or whether this is present early in the course of BPD. Methods: In the present study, facial electromyography was used to assess the rapid facial mimicry responses (a form of unconscious motor mimetic responding) of 32 outpatient youths (aged 15–25 years) with early stage BPD features and 47 demographically matched healthy control participants (HC). Results: The results showed no group differences in rapid facial mimetic responses to either positive (happy) or negative (angry) facial emotions. Limitations: Co-occurring psychopathology and the potential impact of state affect on rapid facial mimicry were considered and discussed. Conclusions: These data indicate that there is no evidence for abnormally heightened rapid motor mimicry in youth early in the course of BPD, suggesting that rapid facial mimicry is preserved in this group. It is thus unlikely that abnormally heightened unconscious simulation contributes to heightened emotional contagion in youth with first presentation BPD. Future research should explore alternative mechanisms for this phenomenon and also whether abnormalities in motor mimetic responses are evident in later stages of the disorder

Social cognition impairments in long-term opiate users in treatment

Background: Long-term opiate users experience pervasive social difficulties, but there has been surprisingly limited research focused on social-cognitive functioning in this population. Aim: The aim of this study was to investigate whether three important aspects of social cognition (facial emotion recognition, theory of mind (ToM) and rapid facial mimicry) differ between long-term opiate users and healthy controls. Methods: The participants were 25 long-term opiate users who were enrolled in opiate substitution programmes, and 25 healthy controls. Facial emotion recognition accuracy was indexed by responses to 60 photographs of faces depicting the six basic emotions (happiness, sadness, anger, fear, surprise and disgust). ToM was assessed using the Reading the Mind in the Eyes task, which requires participants to infer mental states of others from partial facial cues. Rapid facial mimicry was assessed by recording activity in the zygomaticus major and corrugator supercilii muscle regions while participants passively viewed images of happy and angry facial expressions. Results: Relative to the control group, the opiate user group exhibited deficits in both facial emotion recognition and ToM. Moreover, only control participants exhibited typical rapid facial mimicry responses to happy facial expressions. Conclusions: These data indicate that long-term opiate users exhibit abnormalities in three distinct areas of social-cognitive processing, pointing to the need for additional work to establish how social-cognitive functioning relates to functional outcomes in this group. Such work may ultimately inform the development of interventions aimed at improving treatment outcomes for long-term opiate users