Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli
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This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups.
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Individuals with AUD and only one comorbid disorder (AUD-1) had a mean DERS total score (M = 87.8), above the normal range and corresponding to levels found among clinical samples of self-harming college students, individuals diagnosed with social anxiety disorder, and treatment-seeking individuals with cocaine use disorder.
“individuals with an AUD and only one comorbid disorder (AUD-1) had a mean DERS total score (M = 87.8), above the “normal” range and corresponding to levels found among clinical samples of self-harming college students (Gratz & Chapman, 2007; Gratz & Roemer, 2008), individuals diagnosed with social anxiety disorder (Kuo & Linehan, 2009) and treatment-seeking individuals with cocaine use disorder (”
From Difficulties in emotion regulation in treatment-seeking alcoholics with and without co-occurring mood and anxiety disorders. (2018) · cites this paper as Kuo & Linehan, 2009
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Experimental — accuracy not yet measuredIndividuals with BPD report higher baseline negative emotion than controls, but no heightened reactivity to emotional stimuli was found.
“Newer evidence suggests that people with a BPD diagnosis indeed report experiencing high levels of baseline negative emotion relative to controls although heightened reactivity in the presence of emotional stimuli was not found”
From Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (2014) · cites this paper as Kuo & Linehan, 2009
The Results (Baseline Negative Emotional Intensity) report significantly higher self-reported baseline negative emotion in the BPD group than in nonclinical controls, but no significant difference from the social-anxiety-disorder control group. The Discussion (Emotional Reactivity) reports no greater self-reported or physiological reactivity in BPD. Thus, the baseline comparison is supported for one control group, not controls generally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAmong non-clinical samples or samples of normal controls, the DERS total score ranges from the mid 50s on the low end to the mid 70s on the high end.
“our review of the literature indicates that among non-clinical samples or samples of normal controls, the total score ranges from the mid 50’s on the low end to the mid 70’s on the high end (Gratz & Tull, 2015; Kuo & Linehan, 2009; Fox et al, 2007).”
From Difficulties in emotion regulation in treatment-seeking alcoholics with and without co-occurring mood and anxiety disorders. (2018) · cites this paper as Kuo & Linehan, 2009
The Results section (Self-Report Measures; page unavailable) says the study measured total DERS scores in normal controls and refers to Table 3, but the passages from our copy do not give their scores. Searches for the control-group DERS total and values in the mid 50s or mid 70s did not locate the claimed range. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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Battaglia, M., Ferini‐Strambi, L., Bertella, S., Bajo, S., & Bellodi, L. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00213-3 · Cited by 43 · see citing works
Williams, L. M., Sidis, A., Gordon, E., & Meares, R. A. (2006) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0622 · Cited by 38 · see citing works
Electrophysiological Aberrations in Borderline Personality Disorder: State of the Evidence
Boutros, N. N., Torello, M. W., & McGlashan, T. H. (2003) · Journal of Neuropsychiatry · doi:10.1176/jnp.15.2.145 · Cited by 35 · see citing works
Porges (1996) · doi:10.1002/(sici)1098-2302(199612)29:8
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Emotion regulation and mental health: recent findings, current challenges, and future directions
Berking, M., & Wupperman, P. (2012) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3283503669 · Cited by 836 · see citing works
“Persons with BPD tend to display lower parasympathetic activity in response to emotional stressors than do controls [11]; and emotion dysregulation predicts subsequent BPD features, even when controlling for impulsivity [12].”
BackgroundComponents of Emotion Dysregulation in Borderline Personality Disorder: A Review
Carpenter, R. W., & Trull, T. J. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0335-2 · Cited by 446 · see citing works
Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications.
Haynos, A. F., & Fruzzetti, A. E. (2011) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2011.01250.x · Cited by 315 · see citing works
Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2010.535582 · Cited by 254 · see citing works
Kuo, J. R., Khoury, J. E., Metcalfe, R., Fitzpatrick, S., & Goodwill, A. M. (2014) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2014.08.008 · Cited by 177 · see citing works
Self-citationDaros, A. R., & Williams, G. E. (2019) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000212 · Cited by 169 · see citing works
Lavender, J. M., Tull, M. T., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2017) · Assessment · doi:10.1177/1073191115601218 · Cited by 164 · see citing works
“…and consistent with past research examining emotional responding in the laboratory (e.g., Ehring, Tuschen-Caffier, Schnülle, Fischer, & Gross, 2010; Kuo & Linehan, 2009), participants viewed three brief (4-5 minutes) film clips that have been shown in previous research to elicit amusement (“The…”
ResultAssessing and Managing Risk With Suicidal Individuals
Linehan, M. M., Comtois, K. A., & Ward‐Ciesielski, E. F. (2011) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2010.11.008 · Cited by 153 · see citing works
“We have also conducted or supervised five experimental or epidemiological studies with suicidal clients (e.g., Brown, 2003; Kuo & Linehan, 2009; Welch, 2005).”
BackgroundSelf-citationBeauchaine, T. P., Bell, Z., Knapton, E., McDonough‐Caplan, H., Shader, T., & Zisner, A. (2019) · Psychophysiology · doi:10.1111/psyp.13329 · Cited by 144 · see citing works
Resting state vagal tone in borderline personality disorder: A meta-analysis
Koenig, J., Kemp, A. H., Feeling, N. R., Thayer, J. F., & Kaess, M. (2016) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2015.07.002 · Cited by 145 · see citing works
“Of the included studies, only two initially reported statistically significant differences between BPD patients and controls (Kuo and Linehan, 2009; Weinberg et al., 2009), highlighting the utility of meta-analysis over individual studies which often lack statistical power.”
BackgroundMethodResultInfluentialAffective Instability in Daily Life Is Predicted by Resting Heart Rate Variability
Koval, P., Ogrinz, B., Kuppens, P., den Bergh, O. V., Tuerlinckx, F., & Sütterlin, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0081536 · Cited by 144 · see citing works
“Similarly, patients suffering from bipolar or borderline personality disorder, both characterized by affective instability, are also marked by low vagally mediated HRV [48-50].”
BackgroundReconsidering Emotion Dysregulation
D’Agostino, A., Covanti, S., Monti, M. R., & Starčević, V. (2017) · Psychiatric Quarterly · doi:10.1007/s11126-017-9499-6 · Cited by 151 · see citing works
Ebner‐Priemer, U., Houben, M., Santangelo, P., Kleindienst, N., Tuerlinckx, F., Oravecz, Z., Verleysen, G., Deun, K. V., Bohus, M., & Kuppens, P. (2015) · Journal of Abnormal Psychology · doi:10.1037/abn0000021 · Cited by 144 · see citing works
Suicidal behavior and problems with emotion regulation
Neacsiu, A. D., Fang, C. M., Rodriguez, M., & Rosenthal, M. Z. (2018) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12335 · Cited by 139 · see citing works
“No assessment was proposed for these constructs although research examining Linehan’s theory employed physiological measurement such as skin conductance and heart rate (HR) to examine emotional vulnerability, reactivity, and return to baseline (e.g., Ebner-Priemer et al., 2008; Kuo & Linehan, 2009).”
Limberg, A., Barnow, S., Freyberger, H. J., & Hamm, A. O. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.10.024 · Cited by 136 · see citing works
Influence of emotional distraction on working memory performance in borderline personality disorder
Krause-Utz, A., Oei, N. Y. L., Niedtfeld, I., Bohus, M., Spinhoven, P., Schmahl, C., & Elzinga, B. M. (2012) · Psychological Medicine · doi:10.1017/s0033291712000153 · Cited by 131 · see citing works
“Emotion dysregulation in BPD patients involves high emotional reactivity (Rosenthal et al. 2008), high emotional arousal (Kuo & Linehan, 2009), and impaired inhibition of emotional processing, which suggests an increased emotional distractibility (Domes et al. 2006 ; Fertuck et al. 2006 ;…”
Hughes, A., Crowell, S. E., Uyeji, L. L., & Coan, J. (2011) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-011-9555-x · Cited by 119 · see citing works
“To date, research on BPD has largely examined single areas of dysfunction, with studies of emotion dysregulation dominating the empirical literature (see Kuo and Linehan 2009).”
BackgroundBecerra, R., Preece, D. A., Campitelli, G., & Scott-Pillow, G. (2017) · Assessment · doi:10.1177/1073191117694455 · Cited by 110 · see citing works
Aldao, A., & Mennin, D. S. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.12.004 · Cited by 105 · see citing works
Revising the Borderline Diagnosis for DSM-V: An Alternative Proposal
Gunderson, J. G. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.6.694 · Cited by 102 · see citing works
“…2006)] (3) chronic feeling of emptiness (Klonsky, 2008) (no change) Affective/Emotional Dysregulation (4) negative emotionality (chronic dysphoria) (Kuo & Linehan, 2009; Livesley, 2008; Nica & Links, 2009; Shedler & Westen, 2004; Zanarini et al, 2007), with sudden shifts from irritability or…”
Coifman, K. G., Berenson, K. R., Rafaeli, E., & Downey, G. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0028502 · Cited by 102 · see citing works
Dixon–Gordon, K. L., Chapman, A. L., Lovasz, N., & Walters, K. N. (2011) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0021799 · Cited by 99 · see citing works
Trauma and Dissociation: Implications for Borderline Personality Disorder
Vermetten, E. H. G. J. M., & Spiegel, D. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-013-0434-8 · Cited by 101 · see citing works
Stasiewicz, P. R., Bradizza, C. M., Schlauch, R. C., Coffey, S. F., Gulliver, S. B., Gudleski, G. D., & Bole, C. W. (2013) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2013.05.012 · Cited by 94 · see citing works
“The mean score on the Dysfunctional Emotional Regulation Scale was 87.5 and is comparable to other clinical samples (i.e., social anxiety disorder, Kuo & Linehan, 2009; generalized anxiety disorder, Roemer et al., 2009; cocaine dependence, Fox, Axelrod, Paliwal, Sleeper, & Sinha, 2007).”
MethodInfluentialMatzke, B., Herpertz, S. C., Berger, C., Fleischer, M., & Domes, G. (2013) · Psychopathology · doi:10.1159/000351122 · Cited by 93 · see citing works
Dissociation and emotion regulation in borderline personality disorder
Barnow, S., Limberg, A., Stopsack, M., Spitzer, C., Grabe, H. J., Freyberger, H. J., & Hamm, A. O. (2011) · Psychological Medicine · doi:10.1017/s0033291711001917 · Cited by 93 · see citing works
“In another study, Kuo & Linehan (2009) found no differences in emotional reactivity in an imagery task for electrodermal activity controlling for dissociation.”
BackgroundCrowell, S. E., Beauchaine, T. P., Hsiao, R. C.-J., Vasilev, C. A., Yaptangco, M., Linehan, M. M., & McCauley, E. (2011) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-011-9578-3 · Cited by 90 · see citing works
“Furthermore, in the one study in which higher baseline EDR was found, EDR decreases in response to sad mood induction were reported among those with BPD, but not among those with social anxiety disorder (Kuo and Linehan 2009).”
BackgroundResultSelf-citationNeural responses to monetary incentives among self-injuring adolescent girls
Sauder, C. L., Derbidge, C. M., & Beauchaine, T. P. (2016) · Development and Psychopathology · doi:10.1017/s0954579415000449 · Cited by 89 · see citing works
“…Klonsky & Muehlenkamp, 2007), based on self-report (e.g., Nock, 2008, 2009, 2010), peripheral psychophysiological (e.g., Crowell, Baucom, et al., 2014; Crowell et al., 2005, 2008; Kuo & Linehan, 2009), and neuroimaging data (Hazlett et al., 2012; Lis, Greenfield, Henry, Guile, & Dougherty, 2007).”
Crowell, S. E., Baucom, B., McCauley, E., Potapova, N. V., Fitelson, M., Barth, H., Smith, C. J., & Beauchaine, T. P. (2013) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.785360 · Cited by 85 · see citing works
“This is defined as high baseline sensitivity to emotional stimuli, an intense response to emotion evocation, and a slow return to emotional baseline (see, e.g., Kuo & Linehan, 2009).”
Musser, N., Zalewski, M., Stepp, S. D., & Lewis, J. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.06.003 · Cited by 85 · see citing works
Kamphausen, S., Schröder, P., Maier, S., Bader, K., Feige, B., Kaller, C., Glauche, V., Ohlendorf, S., van Elst, L. T., Klöppel, S., et al. (2013) · World Journal of Biological Psychiatry · doi:10.3109/15622975.2012.665174 · Cited by 80 · see citing works
“This is in line with cumulating evidence suggesting a lack of a previously proposed generalized peripheral physiological hyperreactivity to emotional/aversive stimuli in BPD (Herpertz et al. 1999; Herpertz et al. 2000; Ebner-Priemer et al. 2009; Kuo and Linehan 2009).”
ResultNeacsiu, A. D., Lungu, A., Harned, M. S., Rizvi, S. L., & Linehan, M. M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.12.004 · Cited by 80 · see citing works
“…front matter Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.brat.2013.12.004 with a BPD diagnosis indeed report experiencing high levels of baseline negative emotion relative to controls although heightened reactivity in the presence of emotional stimuli was not found (Kuo & Linehan, 2009).”
BackgroundInfluentialSelf-citationBeauchaine, T. P., Hinshaw, S. P., & Bridge, J. A. (2019) · Clinical Psychological Science · doi:10.1177/2167702618818474 · Cited by 80 · see citing works
“…excessive PNS withdrawal during negative emotion inductions among those who engage in NSSI and SBs (Crowell et al., 2005, 2008, 2013, 2014, 2017; Kuo & Linehan, 2009), autonomic hyper-reactivity is not as consistent when using (1) other markers, such as sympathetic nervous system (SNS)…”
BackgroundKuhlmann, A., Bertsch, K., Schmidinger, I., Thomann, P. A., & Herpertz, S. C. (2013) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.120039 · Cited by 78 · see citing works
Rausch, J., Gäbel, A., Nagy, K., Kleindienst, N., Herpertz, S. C., & Bertsch, K. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.02.002 · Cited by 75 · see citing works
“Patients with BPD also report more frequent and intense daily hassles (Jovev and Jackson, 2006) and elevated levels of stress-associated inner tension (Kuo and Linehan, 2009), which often precede self-injury and impulsive aggression (Kleindienst et al., 2008).”
BackgroundKuo, J. R., Fitzpatrick, S., Metcalfe, R. K., & McMain, S. F. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.05.002 · Cited by 73 · see citing works
“…reactivity using a range of methodologies including laboratory paradigms with negative images (Herpertz, Kunert, Schwenger, & Sass, 1999; 2000), scripts (Kuo & Linehan, 2009; Schmahl et al., 2004), and film clips (Austin, Riniolo, & Porges, 2007; Kuo & Linehan, 2009; Lobbestael & Arntz, 2010).”
MethodSelf-citationHerr, N. R., Rosenthal, M. Z., Geiger, P. J., & Erikson, K. M. (2012) · Personality and Mental Health · doi:10.1002/pmh.1204 · Cited by 73 · see citing works
Emotion in psychogenic nonepileptic seizures: Responses to affective pictures
Roberts, N. A., Burleson, M. H., Weber, D. J., Larson, A., Sergeant, K., Devine, M. J., Vincelette, T. M., & Wang, N. C. (2012) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2012.03.018 · Cited by 67 · see citing works
“, [21]) than PTS-low, but did not differ from PTS-high.”
Reitz, S. C., Krause-Utz, A., Pogatzki-Zahn, E. M., Ebner‐Priemer, U., Bohus, M., & Schmahl, C. G. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.4.605 · Cited by 65 · see citing works
A Biosocial Model of BPD: Theory and Empirical Evidence
Crowell, S. E., Kaufman, E. A., & Beauchaine, T. P. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0591-1_11 · Cited by 64 · see citing works
Emotion Regulation and Perceptions of Hostile and Constructive Criticism in Romantic Relationships
Klein, S. R., Renshaw, K. D., & Curby, T. W. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.10.007 · Cited by 63 · see citing works
“…emotion regulation and suppression are associatedwith greater physiological arousal (e.g., Gross & Levenson, 1993, 1997; Gottman & Levenson, 1992; Kuo & Linehan, 2009) and more negative and less positive emotion (e.g., Bloch, Haase, & Levenson, 2014; Butler et al., 2003; Gross & John, 2003), the…”
BackgroundThe case for borderline personality disorder as an emotional disorder: Implications for treatment.
Sauer-Zavala, S. E., & Barlow, D. H. (2014) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12063 · Cited by 62 · see citing works
“Linehan (1993) described individuals with BPD as emotionally vulnerable or, in other words, characterized by high baseline levels of negative affect (intensity), coupled with substantial changes in the intensity of this affect when faced with an emotionally evocative cue (reactivity).”
BackgroundGratz, K. L., Moore, K. E., & Tull, M. T. (2016) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000198 · Cited by 62 · see citing works
Identity disturbance and problems with emotion regulation are related constructs across diagnoses.
Neacsiu, A., Herr, N. R., Fang, C. M., Rodriguez, M., & Rosenthal, M. Z. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22141 · Cited by 71 · see citing works
Biobehavioral reactivity to social evaluative stress in women with borderline personality disorder.
Scott, L. N., Levy, K. N., & Granger, D. A. (2012) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0030117 · Cited by 60 · see citing works
“The high NA in the BPD group compared with both control groups is consistent with a number of studies suggesting intense NA but not hyperreactivity of NA in those with BPD (e.g., Herpertz et al., 1999; Jacob et al., 2008, 2009; Kuo & Linehan, 2009).”
Elices, M., Soler, J., Fernández, C., Martín‐Blanco, A., Portella, M. J., Pérez, V., Álvarez, E., & Pascual, J. C. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.07.020 · Cited by 57 · see citing works
“Most studies have found that patients with BPD report greater intensity of negative emotions compared to healthy controls (HC) (Rosenthal et al., 2008; Kuo and Linehan, 2009).”
BackgroundResultInfluentialThomson, N. D., Aboutanos, M. B., Kiehl, K. A., Neumann, C. S., Galusha, C., & Fanti, K. A. (2018) · Psychophysiology · doi:10.1111/psyp.13276 · Cited by 55 · see citing works
Qiu, F., Kang, N., Tan, J., Yan, S., Lin, L., Cai, L., Goodman, J. M., & Gao, Q. (2023) · Microbiology Spectrum · doi:10.1128/spectrum.04625-22 · Cited by 56 · see citing works
Bracken, K. L., & McDevitt‐Murphy, M. E. (2013) · Archives of Suicide Research · doi:10.1080/13811118.2013.809040 · Cited by 53 · see citing works
“Difficulties with emotion regulation also have been associated with both BPD (Kuo & Linehan, 2009), and NSSI (Gratz & Roemer, 2008; Muehlenkamp, Kerr, Bradley et al., 2010).”
BackgroundGratz, K. L., Tull, M. T., Matusiewicz, A. M., Breetz, A., & Lejuez, C. W. (2013) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000020 · Cited by 53 · see citing works
“Consistent with both past research (e.g., Chapman, Dixon-Gordon, & Walters, in press; Kuo & Linehan, 2009) and recommendations in the literature (see Cacioppo, Tassinary, & Berntson, 2007), participants were instructed to abstain from alcohol, illicit substances, and PRN medications during the 24…”
BackgroundMethodResultInfluentialBorderline personality features moderate the effect of a fear induction on impulsivity.
Chapman, A. L., Dixon–Gordon, K. L., Layden, B. K., & Walters, K. N. (2010) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0019226 · Cited by 52 · see citing works
“…this particular film segment has been shown to elicit fear, interest, and tension among college students (Gross & Levenson, 1995) and increased fear among individuals with BPD (Kuo & Linehan, 2009), and we wanted to use a fear induction that induced fear among both the high- and low-BP groups.”
BackgroundDeborde, A.-S., Miljkovitch, R., Roy, C. S., Bigre, C. D.-L., Pham‐Scottez, A., Speranza, M., & Corcos, M. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.5.676 · Cited by 51 · see citing works
Bradizza, C. M., Brown, W. C., Ruszczyk, M. U., Dermen, K. H., Lucke, J. F., & Stasiewicz, P. R. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.12.033 · Cited by 48 · see citing works
Kuo, J. R., Neacsiu, A. D., Fitzpatrick, S., & MacDonald, D. E. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9378-x · Cited by 45 · see citing works
“In this study, we aimed to address this gap by conducting analyses on a dataset previously published by the first author (Kuo and Linehan 2009).”
BackgroundMethodInfluentialSelf-citationDixon–Gordon, K. L., Turner, B. J., Rosenthal, M. Z., & Chapman, A. L. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.03.001 · Cited by 49 · see citing works
Borderline personality disorder in adolescents.
Courtney‐Seidler, E. A., Klein, D. A., & Miller, A. L. (2013) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12051 · Cited by 48 · see citing works
Emotional processes in borderline personality disorder: An update for clinical practice.
Dixon–Gordon, K. L., Peters, J. R., Fertuck, E. A., & Yen, S. (2016) · Journal of Psychotherapy Integration · doi:10.1037/int0000044 · Cited by 50 · see citing works
Emotion Regulation: Definition and Relevance for Mental Health
Berking, M., & Whitley, B. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1022-9_2 · Cited by 48 · see citing works
Dixon-Gordon, K., Yiu, A., & Chapman, A. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2012.12.001 · Cited by 40 · see citing works
“In the laboratory, some studies have found greater physiological reactivity (Ebner-Priemer et al., 2005) and lower parasympathetic reactivity (Austin, Riniolo, & Porges, 2007; Kuo & Linehan, 2009) among personswith BPD, comparedwith both psychiatric and nonpsychiatric controls.”
BackgroundSauer, C., Arens, E. A., Stopsack, M., Spitzer, C., & Barnow, S. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.06.041 · Cited by 46 · see citing works
“…any self-reported or psychophysiological differences between individuals with BPD and healthy controls (HC) in response to negative picture stimuli (Herpertz et al., 1999; Feliu-Soler et al., 2013), negative film clips (Kuo and Linehan, 2009) or emotion eliciting stories (Jacob et al., 2008, 2009).”
BackgroundDixon–Gordon, K. L., Weiss, N. H., Tull, M. T., DiLillo, D., Messman‐Moore, T. L., & Gratz, K. L. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.07.014 · Cited by 47 · see citing works
“Moreover, laboratory-based studies provide further support for heightened subjective emotional reactivity in BPD (for exceptions, see references [23,24]), finding greater self-reported emotional reactivity in response to laboratory stressors among patients with (vs.”
BackgroundKaufman, E. A., Puzia, M., Godfrey, D. A., & Crowell, S. E. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22902 · Cited by 43 · see citing works
Adapting Dialectical Behavior Therapy (DBT) for the Treatment of Psychopathy
Galietta, M., & Rosenfeld, B. D. (2012) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2012.746762 · Cited by 45 · see citing works
“Emotion dysregulation and impulsivity have increasingly been recognized as central elements of several highly problematic personality disorders (Fairholme et al., 2010; Kuo & Linehan, 2009).”
BackgroundThe Complexity of Complex PTSD
Bryant, R. A. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10040606 · Cited by 45 · see citing works
Quigley, K. M., & Moore, G. A. (2018) · Developmental Review · doi:10.1016/j.dr.2018.06.004 · Cited by 39 · see citing works
Krause-Utz, A., Walther, J.-C., Lis, S., Schmahl, C., & Bohus, M. (2019) · Psychological Medicine · doi:10.1017/s0033291718002489 · Cited by 38 · see citing works
“In contrast, Kuo and Linehan (2009) observed reduced baseline RSA and increased RSA during sad film clips in BPD.”
BackgroundDaros, A. R., Guevara, M. A., Uliaszek, A. A., McMain, S. F., & Ruocco, A. C. (2018) · Psychopathology · doi:10.1159/000487008 · Cited by 37 · see citing works
Southward, M. W., & Cheavens, J. S. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000357 · Cited by 37 · see citing works
“…greater difficulties in emotion regulation than healthy controls (HCs) and people with anxiety and mood disorders (Fletcher et al., 2014; Kuo & Linehan, 2009; Neacsiu et al., 2015), Obsessive-Compulsive Personality Disorder (Steenkamp et al., 2015), and people who engage in non-suicidal…”
BackgroundFitzpatrick, S., Liebman, R. E., & Monson, C. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.101983 · Cited by 32 · see citing works
Effects of Shame Induction in Borderline Personality Disorder
Scheel, C. N., Schneid, E., Tüscher, O., Lieb, K., Tuschen‐Caffier, B., & Jacob, G. A. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-013-9567-7 · Cited by 37 · see citing works
“…altered emotional responses compared to healthy and/or patient control groups in reaction to: emotional pictures (Herpertz et al. 2000, 2001), abandonment scripts (Schmahl et al. 2004), emotional short stories (Jacob et al. 2009), or individual and general emotion inductions (Kuo and Linehan 2009).”
BackgroundKrantz, L. H., McMain, S., & Kuo, J. R. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.02.006 · Cited by 45 · see citing works
Self-citationEmotion Dysregulation in Personality Disorders
Fitzpatrick, S., Dixon–Gordon, K. L., Turner, C. J., Chen, S. X., & Chapman, A. L. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-023-01418-8 · Cited by 41 · see citing works
Reichenberger, J., Eibl, J. J., Pfaltz, M., Wilhelm, F., Voderholzer, U., Hillert, A., & Blechert, J. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2016_30_238 · Cited by 29 · see citing works
Naoum, J., Reitz, S. C., Krause-Utz, A., Kleindienst, N., Willis, F. M., Kuniss, S., Baumgärtner, U., Mancke, F., Treede, R., & Schmahl, C. G. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.10.066 · Cited by 33 · see citing works
Bortolla, R., Cavicchioli, M., Fossati, A., & Maffei, C. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_382 · Cited by 33 · see citing works
Baschnagel, J. S., Coffey, S. F., Hawk, L. W., Schumacher, J. A., & Holloman, G. (2012) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0029777 · Cited by 32 · see citing works
“A few studies even suggest that patients with BPD may show hyporeactivity to emotional stimuli, as evidenced by lower SCRs to emotional stimuli in BPD participants than in control participants (Herpertz et al., 1999; Kuo & Linehan, 2009; Schmahl et al., 2004).”
InfluentialParet, C., Hoesterey, S., Kleindienst, N., & Schmahl, C. G. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.07.054 · Cited by 31 · see citing works
“Increased emotional reactivity (Ebner-Priemer et al., 2007, 2005; Kuo and Linehan, 2009; Reitz et al., 2012) and deficits in emotion and behavior regulation (Schmahl et al., 2014) are core features of borderline personality disorder (BPD).”
BackgroundSchnell, K., & Herpertz, S. (2018) · Journal of Personality Disorders · doi:10.1521/pedi.2018.32.supp.12 · Cited by 32 · see citing works
Gratz, K. L., Richmond, J. R., Dixon–Gordon, K. L., Chapman, A. L., & Tull, M. T. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000334 · Cited by 31 · see citing works
Stressors and drinking in sexual minority women: The mediating role of emotion dysregulation.
Fitzpatrick, S., Dworkin, E. R., Zimmerman, L. E., Javorka, M., & Kaysen, D. L. (2019) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000351 · Cited by 31 · see citing works
“…my behavior”) apply from 1 (almost never/0-10% of the time) to 5 (almost always/91-100% of the time) (sum score range: 32-166) The DERS has good psychometric properties and can, for example, distinguish between populations characterized by emotion dysregulation and those not (Kuo & Linehan, 2009).”
BackgroundAutonomic Changes in Psychogenic Nonepileptic Seizures
Reinsberger, C., Sarkis, R. A., Papadelis, C. L., Doshi, C., Perez, D. L., Baslet, G. C., Loddenkemper, T., & Dworetzky, B. A. (2015) · Clinical EEG and Neuroscience · doi:10.1177/1550059414567739 · Cited by 31 · see citing works
“These findings were replicated using EDA: Higher EDA (measured as skin conductance response) was discovered in patients with BPD.(57) In contrast, HF-HRV at baseline (measured over 24 hours) was found to be higher in patients with BPD.”
MethodInscoe, A. B., Tseng, W., Murray-Close, D. K., Pitula, C. E., & Crick, N. R. (2014) · Development and Psychopathology · doi:10.1017/s095457941400039x · Cited by 31 · see citing works
“Thus, the second goal of the present study was to examine longitudinal associations between BPFs and both physical and relational forms of aggression.”
BackgroundResultInfluentialArens, E. A., Grabe, H.-J., Spitzer, C., & Barnow, S. (2010) · Personality and Mental Health · doi:10.1002/pmh.143 · Cited by 30 · see citing works
Differential Susceptibility to the Environment and Borderline Personality Disorder
Rioux, C., Séguin, J. R., & Paris, J. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000182 · Cited by 29 · see citing works
A comprehensive examination of delayed emotional recovery in borderline personality disorder
Fitzpatrick, S., & Kuo, J. R. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.11.004 · Cited by 29 · see citing works
“…Trull, & Barrett, 2008) and others indicating no differences in sensitivity to emotional stimuli and magnitudes of emotional responding between BPD or high BPD feature youth compared to other groups (e.g., Jovev et al., 2011; Kuo & Linehan, 2009; Staebler, Gebhard, Barnett, & Renneberg, 2009).”
BackgroundMethodResultInfluentialSelf-citationToward a Definition of Affective Instability
Renaud, S., & Zacchia, C. (2012) · Harvard Review of Psychiatry · doi:10.3109/10673229.2012.747798 · Cited by 31 · see citing works
Past, present, and future of genetic research in borderline personality disorder
Nia, A. B., Eveleth, M. C., Gabbay, J. M., Hassan, Y., Bosi, Z., & Pérez-Rodríguez, M. M. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.09.002 · Cited by 30 · see citing works
Rosenthal, M. Z., Neacsiu, A. D., Geiger, P. J., Fang, C. M., Ahn, R. R., & Larrauri, J. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9736-y · Cited by 28 · see citing works
“…Durham, NC, USA 3 University of Kentucky, Lexington, KY, USA 4 Star Center, Greenwood Village, CO, USA (e.g., Herpertz et al. 1999, 2000, 2001; Kuo and Linehan 2009; Baschnagel et al. 2013; Suvak et al. 2012; Scott et al. 2013; for a review, see Rosenthal et al. 2008; Weinberg et al. 2009).”
BackgroundResultInfluentialChu, C., Victor, S. E., & Klonsky, E. D. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22299 · Cited by 28 · see citing works
“…(2003) and are in line with previous research indicating that BPD is associated with higher mean levels of negative emotion overall, and negative emotional intensity and frequency, and not notably related to positive emotion (Ebner-Priemer et al., 2007; Kuo & Linehan, 2009; Russell et al., 2007).”
ResultRobins, C. J., & Rosenthal, M. Z. (2011) · doi:10.1002/9781118001851.ch7 · Cited by 28 · see citing works
Neacsiu, A. D., Rompogren, J., Eberle, J. W., & McMahon, K. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.10.004 · Cited by 28 · see citing works
Characteristics of female homicide offenders found not guilty by reason of insanity.
Ferranti, J., McDermott, B. E., & Scott, C. L. (2013) · PubMed · Cited by 27 · see citing works
Bemmouna, D., Lagzouli, A., & Weiner, L. (2023) · Molecular Autism · doi:10.1186/s13229-023-00580-3 · Cited by 26 · see citing works
Examining the Effectiveness of Fear Appeals in Prompting Help-Seeking: The Case of At-Risk Gamblers
Vos, S. D., Crouch, R. C., Quester, P. G., & Ilicic, J. (2017) · Psychology and Marketing · doi:10.1002/mar.21012 · Cited by 26 · see citing works
Fitzpatrick, S., Wagner, A. C., & Monson, C. M. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000328 · Cited by 26 · see citing works
The Application of an Etiological Model of Personality Disorders to Problem Gambling
Brown, M., Allen, J. S., & Dowling, N. A. (2014) · Journal of Gambling Studies · doi:10.1007/s10899-014-9504-z · Cited by 26 · see citing works
Willis, F. M., Kuniss, S., Kleindienst, N., Naoum, J., Reitz, S. C., Boll, S., Bohus, M., Treede, R., Baumgärtner, U., & Schmahl, C. G. (2016) · Pain · doi:10.1097/j.pain.0000000000000787 · Cited by 26 · see citing works
Houben, M., Claes, L., Sleuwaegen, E., Berens, A., & Vansteelandt, K. (2018) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-018-0095-7 · Cited by 28 · see citing works
“In another lab study [19], however, no heightened reactivity was found in response to audio recordings of negative or neutral personally relevant stories in the lab.”
BackgroundInoue, A., Oshita, H., Maruyama, Y., Tanaka, Y., Ishitobi, Y., Kawano, A., Ikeda, R., Ando, T., Aizawa, S., Masuda, K., et al. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.04.008 · Cited by 30 · see citing works
“Research has variably suggested both increased and decreased ANS activity in BPD patients (Austin et al., 2007; Kuo and Linehan, 2009).”
BackgroundNeece, C. L., Berk, M. S., & Combs-Ronto, L. A. (2013) · Professional Psychology Research and Practice · doi:10.1037/a0033396 · Cited by 25 · see citing works
- Authors
- Kuo, J. R., & Linehan, M. M.
- Affiliations
- Stanford University (US)
- University of Washington (US)
- Venue
- Journal of Abnormal Psychology
- Published
- 2009-08
- Volume
- 118
- Issue
- 3
- Pages
- 531-544
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC4277483
- OpenAlex
- W2033553478
- Cited by
- 288
- References
- 97
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 8 · 2023: 16 · 2022: 9 · 2021: 26 · 2020: 12 · 2019: 26 · 2018: 29 · 2017: 21 · 2016: 20 · 2015: 19 · 2014: 17 · 2013: 23 · 2012: 18
- FWCI
- 15.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Abnormal Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F31MH068887)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- borderline personality disorder, emotional dysregulation, biological vulnerability, emotional reactivity, emotion induction, respiratory sinus arrhythmia, skin conductance response, social anxiety disorder
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Arousal, Borderline Personality Disorder, Electrocardiography, Emotions, Female, Fourier Analysis, Galvanic Skin Response, Humans, Male, Phobic Disorders, Psychophysiology, Risk Factors, Self-Assessment, Signal Processing, Computer-Assisted, Social Environment, Sympathetic Nervous System, Young Adult
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