Comprehensive Psychiatry
Volume 51, Issue 3 , Pages 275-285 , May 2010

An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: the role of shame

  • Kim L. Gratz

      Affiliations

    • Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 601 815 6450.
  • ,
  • M. Zachary Rosenthal

      Affiliations

    • Duke University Medical Center, Durham, NC 27710, USA
  • ,
  • Matthew T. Tull

      Affiliations

    • Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
  • ,
  • C.W. Lejuez

      Affiliations

    • Center for Addictions, Personality, and Emotion Research and the Department of Psychology, University of Maryland, College Park, MD 20742, USA
  • ,
  • John G. Gunderson

      Affiliations

    • Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA

References 

  1. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press; 1993;
  2. Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever JJ, et al. The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biol Psychiatry. 2002;51:936–950
  3. Livesley WJ, Jang KL, Vernon PA. Phenotypic and genetic structure of traits delineating personality disorder. Arch Gen Psychiatry. 1998;55:941–948
  4. Gratz KL, Tull MT, Gunderson JG. Preliminary data on the relationship between anxiety sensitivity and borderline personality disorder: the role of experiential avoidance. J Psychiatr Res. 2008;42:550–559
  5. Siever LJ, Davis KL. A psychobiological perspective on the personality disorders. Am J Psychiatry. 1991;148:1647–1658
  6. Siever LJ, Torgersen S, Gunderson JG, Livesley WJ, Kendler KS. The borderline diagnosis III: Identifying endophenotypes for genetic studies. Biol Psychiatry. 2002;51:964–968
  7. Gunderson JG, Zanarini MC, Kisiel C. Borderline personality disorder. In:  Widiger TA editors. DSM-IV sourcebook. Vol. 2:Washington (DC): American Psychiatric Association Press; 1996;p. 717–733
  8. Rothbart MK, Derryberry D. Development of individual differences in temperament. In:  Lamb ME,  Brown AL editor. Advances in developmental psychology. Vol. 1:Hillsdale (NJ): Erlbaum; 1981;p. 37–86
  9. Larsen RJ, Diener E. Affect intensity as an individual difference characteristic: a review. J Res Pers. 1987;21:1–39
  10. Henry C, Mitropoulou V, New AS, Koenigsberg HW, Silverman J, Siever LJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res. 2001;35:307–312
  11. Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, et al. Characterizing affective instability in borderline personality disorder. Am J Psychiatry. 2002;159:784–788
  12. Cheavens JS, Rosenthal MZ, Daughters SB, Nowak J, Kosson D, Lynch TR, et al. An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression. Behav Res Ther. 2005;43:257–268
  13. Ebner-Priemer UW, Badeck S, Beckmann C, Wagner A, Feige B, Weiss I, et al. Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. J Psychiatr Res. 2005;39:85–92
  14. Herpertz SC, Kunert HJ, Schwenger UB, Sass H. Affective responsiveness in borderline personality disorder: a psychophysiological approach. Am J Psychiatry. 1999;156:1550–1556
  15. Herpertz SC, Schwenger UB, Kunert HJ, Lukas G, Gretzer U, Nutzmann K, et al. Emotional responses in patients with borderline as compared with avoidant personality disorder. J Personal Disord. 2000;14:339–351
  16. Herpertz SC, Werth U, Lucas G, Qunaibi M, Schuerkens A, Kunert H, et al. Emotion in criminal offenders with psychopathy and borderline personality disorders. Arch Gen Psychiatry. 2001;58:737–745
  17. Herpertz SC, Koetting K. Startle response in inpatients with borderline personality disorder vs. healthy controls. J Neural Transm. 2005;112:1435–1463
  18. Schmahl CG, Elzinga BM, Ebner UW, Simms T, Sanislow C, Vermetten E, et al. Psychophysiological reactivity to traumatic and abandonment scripts in borderline personality and posttraumatic stress disorders: a preliminary report. Psychiatry Res. 2004;126:33–42
  19. Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M. Aversive tension in patients with borderline personality disorder: a computer-based controlled field study. Acta Psychiatr Scand. 2005;111:372–379
  20. Levine D, Marziali E, Hood J. Emotion processing in borderline personality disorders. J Nerv Ment Dis. 1997;185:240–246
  21. Lenzenweger MF, Clarkin JF, Fertuck EA, Kernberg OF. Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. J Personal Disord. 2004;18:421–438
  22. Renneberg B, Heyn K, Gebhard R, Bachmann S. Facial expression of emotions in borderline personality disorder and depression. J Behav Ther Exp Psychiatry. 2005;36:183–196
  23. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 4th ed.. Washington (DC): American Psychiatric Association; 1994;
  24. Gunderson JG, Singer MT. Defining borderline patients: an overview. Am J Psychiatry. 1975;132:1–10
  25. Kernberg OF. Borderline personality organization. J Am Psychoanal Assoc. 1967;15:641–685
  26. Snyder S, Pitts WM. Characterizing anxiety in the DSM-III borderline personality disorder. J Personal Disord. 1988;2:93–101
  27. Rüsch N, Lieb K, Gottler I, Hermann C, Schramm E, Richter H, et al. Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry. 2007;164:500–508
  28. Rizvi SL, Linehan MM. The treatment of maladaptive shame in borderline personality disorder: A pilot study of “opposite action.”. Cogn Behav Pract. 2005;12:437–447
  29. Grinker R, Werble B, Drye R. The borderline syndrome: a behavioral study of ego functions. New York (NY): Basic Books; 1968;
  30. Zetzel ER. A developmental approach to the borderline patient. Am J Psychiatry. 1971;127:867–871
  31. Gardner DL, Leibenluft E, O'Leary KM, Cowdry RW. Self-ratings of anger and hostility in borderline personality disorder. J Nerv Ment Dis. 1991;179:157–161
  32. Wilson ST, Stanley B, Oquendo MA, Goldberg P, Zalsman G, Mann JJ. Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. J Clin Psychiatry. 2007;68:1533–1539
  33. Houck JH. The intractable female patient. Am J Psychiatry. 1972;129:27–31
  34. Domes G, Czieschnek D, Weidler F, Berger C, Fast K, Herpertz SC. Recognition of facial affect in borderline personality disorder. J Personal Disord. 2008;22:135–147
  35. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, et al. The collaborative longitudinal personality disorders study: baseline axis I/II and II/II diagnostic co-occurrence. Acta Psychiatr Scand. 2000;102:256–264
  36. Skodol AE, Oldham JM, Hyler SE, Stein DJ, Hollander E, Gallagher PE, et al. Patterns of anxiety and personality disorder comorbidity. J Psychiatr Res. 1995;29:361–374
  37. Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–1739
  38. Livesley WJ, Jackson DN. Manual for the dimensional assessment of personality problems—basic questionnaire. Port Huron (MI): Sigma; 2009;
  39. Crowe M. Never good enough—part 1: shame or borderline personality disorder?. J Psychiatr Ment Health Nur. 2004;11:327–334
  40. Tangney JP, Dearing RL. Shame and guilt. New York (NY): The Guilford Press; 2002;
  41. Hastings ME, Northman LM, Tangney JP. Shame, guilt, and suicide. In:  Joiner T,  Rudd MD editor. Suicide science: expanding the boundaries. Norwell (Mass): Kluwer Academic Publishers; 2000;p. 67–80
  42. Lester D. The association of shame and guilt with suicidality. J Soc Psychol. 1998;138:535–536
  43. Brown RA, Lejuez CW, Kahler CW, Strong D. Distress tolerance and duration of past smoking cessation attempts. J Abnorm Psychol. 2002;111:180–185
  44. Lejuez CW, Kahler CW, Brown RA. A modified computer version of the Paced Auditory Serial Addition Task (PASAT) as a laboratory-based stressor. Behav Ther. 2003;26:290–293
  45. Daughters SB, Lejuez CW, Kahler CW, Strong DR, Brown RA. Psychological distress tolerance and duration of most recent abstinence attempt among residential treatment-seeking substance abusers. Psychol Addict Behav. 2005;19:208–211
  46. Zanarini MC, Frankenburg FR, Sickel AE, Young L. Diagnostic interview for DSM-IV personality disorders. Boston (Mass): McLean Hospital; 1996;
  47. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I disorders—patient edition (SCID-I/P, Version 2.0). New York (NY): New York State Psychiatric Institute; 1996;
  48. Zanarini MC, Skodol AE, Bender D, Dolan R, Sanislow C, Schaefer E, et al. The Collaborative Longitudinal Personality Disorders Study: II. reliability of Axis I and II diagnoses. J Personal Disord. 2000;14:291–299
  49. Larsen RJ, Diener E, Emmons RA. Affect intensity and reactions to daily life events. J Abnorm Soc Psychol. 1986;51:803–814
  50. Flett GL, Boase P, McAndrews MP, Pliner P, Blankstein KR. Affect intensity and the appraisal of emotion. J Res Pers. 1986;20:447–459
  51. Fujita F, Diener E, Sandvik E. Gender differences in negative affect and well-being: the case for emotional intensity. J Pers Soc Psychol. 1991;61:427–434
  52. Larsen RJ, Diener E. A multitrait-multimethod examination of affect structure: hedonic level and emotional intensity. Pers Individ Differ. 1985;6:631–636
  53. Flett GL, Hewitt PL. Criterion validity and psychometric properties of the Affect Intensity Measure in a psychiatric sample. Pers Individ Differ. 1995;19:585–591
  54. Bryant FB, Yarnold PR, Grimm LG. Toward a measurement model of the Affect Intensity Measure: a three-factor structure. J Res Pers. 1996;30:223–247
  55. Simonsson-Sarnecki M, Lundh L, Törestad B. Factor structure and validity of the Affect Intensity Measure in a Swedish sample. Pers Individ Differ. 2000;29:337–350
  56. Weinfurt KP, Bryant FP, Yarnold PR. The factor structure of the Affect Intensity Measure: in search of a measurement model. J Res Pers. 1994;28:314–331
  57. Williams DG. Neuroticism and extraversion in different factors of the Affect Intensity Measure. Pers Individ Differ. 1989;10:1095–1100
  58. Baumeister RF, Bratslavsky E, Muraven M, Tice DM. Ego depletion: is the active self a limited resource?. J Pers Soc Psychol. 1998;74:1252–1265
  59. Ronningstam EF. Identifying and understanding the narcissistic personality. New York (NY): Oxford University Press; 2005;
  60. Orsillo SM, Batten SV, Plumb JC, Luterek JA, Roessner BM. An experimental study of emotional responding in women with posttraumatic stress disorder related to interpersonal violence. J Trauma Stress. 2004;17:241–248
  61. Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther. 2005;43:1281–1310
  62. Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harv Rev Psychiatry. 1998;6:201–207
  63. Bijttebier P, Vertommen H. Coping strategies in relation to personality disorders. Pers Individ Differ. 1999;26:847–856
  64. Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Beh Res Ther. 2005;43:1173–1185

PII: S0010-440X(09)00091-1

doi: 10.1016/j.comppsych.2009.08.005

Comprehensive Psychiatry
Volume 51, Issue 3 , Pages 275-285 , May 2010