Linking Daily-Life Interpersonal Stressors and Health Problems Via Affective Reactivity in Borderline Personality and Depressive Disorders

Overview

Journal Psychosom Med

Specialty Psychiatry

Date 2019 Oct 9

PMID 31592936

Citations 6

Authors

Johanna Hepp

Sean P Lane

Ryan W Carpenter

Timothy J Trull

Affiliations

Soon will be listed here.

Abstract

Objective: Borderline personality disorder (BPD) is associated with unstable interpersonal relationships, affective instability, and physical health problems. In individuals with BPD, intense affective reactions to interpersonal stressors may contribute to the increased prevalence of health problems.

Methods: BPD (n = 81) and depressed participants (DD; n = 50) completed six daily ambulatory assessment prompts for 28 days. At each prompt, participants reported interpersonal stressors (disagreements, rejections, feeling let down), negative affect, and health problems in four domains (gastrointestinal, respiratory, aches, depressive symptoms). In multilevel moderated mediation models, we examined the indirect effects of interpersonal stressors on health problems via negative affect, by group.

Results: Interpersonal stressors were positively associated with negative affect in both groups (β values > 0.12, p values < .001), but more so for participants with BPD (βDay = 0.05, p < .001). Negative affect was positively associated with health problems across all domains (βMoment/Day values > 0.01, p values < .046), but associations were larger at the day level for respiratory symptoms in BPD (β = 0.02, p = .025) and for depressive symptoms in DD (β = 0.04, p < .001). Negative affect mediated the association of interpersonal stressors and health problems in both groups, with larger effects for the DD group for depressive problems (β = 0.02, p = .092) and for the BPD group for the other three domains (β values > 0.02, p values < .090).

Conclusions: Interpersonal stressors may contribute to increased physical health problems via an inability to regulate affective responses to such events. This pathway may be stronger in several health domains for those with BPD and may contribute to an elevated risk of morbidity and mortality in this disorder, suggesting a target for intervention to reduce these risks.

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References

Reynolds C, Carpenter R, Tragesser S . Accounting for the association between BPD features and chronic pain complaints in a pain patient sample: The role of emotion dysregulation factors. Personal Disord. 2017; 9(3):284-289. DOI: 10.1037/per0000237. View

Chesney E, Goodwin G, Fazel S . Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014; 13(2):153-60. PMC: 4102288. DOI: 10.1002/wps.20128. View

Berenson K, Downey G, Rafaeli E, Coifman K, Paquin N . The rejection-rage contingency in borderline personality disorder. J Abnorm Psychol. 2011; 120(3):681-90. PMC: 4990070. DOI: 10.1037/a0023335. View

Tragesser S, Bruns D, Disorbio J . Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample. Clin J Pain. 2010; 26(4):348-53. DOI: 10.1097/AJP.0b013e3181cd1710. View

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B . Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007; 370(9590):851-8. DOI: 10.1016/S0140-6736(07)61415-9. View

Cruitt P, Boudreaux M, Jackson J, Oltmanns T . Borderline personality pathology and physical health: The role of employment. Personal Disord. 2016; 9(1):73-80. PMC: 5311027. DOI: 10.1037/per0000211. View

Suls J, Bunde J . Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005; 131(2):260-300. DOI: 10.1037/0033-2909.131.2.260. View

Gratz K, Weiss N, McDermott M, DiLillo D, Messman-Moore T, Tull M . Emotion Dysregulation Mediates the Relation Between Borderline Personality Disorder Symptoms and Later Physical Health Symptoms. J Pers Disord. 2016; 31(4):433-448. PMC: 5472518. DOI: 10.1521/pedi_2016_30_252. View

Fok M, Hotopf M, Stewart R, Hatch S, Hayes R, Moran P . Personality disorder and self-rated health: a population-based cross-sectional survey. J Pers Disord. 2013; 28(3):319-33. DOI: 10.1521/pedi_2013_27_119. View

10.

Uchino B, Cacioppo J, Kiecolt-Glaser J . The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996; 119(3):488-531. DOI: 10.1037/0033-2909.119.3.488. View

11.

Aan Het Rot M, Hogenelst K, Schoevers R . Mood disorders in everyday life: a systematic review of experience sampling and ecological momentary assessment studies. Clin Psychol Rev. 2012; 32(6):510-23. DOI: 10.1016/j.cpr.2012.05.007. View

12.

Larsen R, Kasimatis M . Day-to-day physical symptoms: individual differences in the occurrence, duration, and emotional concomitants of minor daily illnesses. J Pers. 1991; 59(3):387-423. DOI: 10.1111/j.1467-6494.1991.tb00254.x. View

13.

Bauer D, Preacher K, Gil K . Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations. Psychol Methods. 2006; 11(2):142-63. DOI: 10.1037/1082-989X.11.2.142. View

14.

Trull T, Solhan M, Tragesser S, Jahng S, Wood P, Piasecki T . Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. J Abnorm Psychol. 2008; 117(3):647-61. DOI: 10.1037/a0012532. View

15.

Lakey B, Orehek E . Relational regulation theory: a new approach to explain the link between perceived social support and mental health. Psychol Rev. 2011; 118(3):482-95. DOI: 10.1037/a0023477. View

16.

El-Gabalawy R, Katz L, Sareen J . Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med. 2010; 72(7):641-7. DOI: 10.1097/PSY.0b013e3181e10c7b. View

17.

Sansone R, Sansone L . Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 2012; 9(1):10-4. PMC: 3280073. View

18.

Frankenburg F, Zanarini M . The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. J Clin Psychiatry. 2005; 65(12):1660-5. DOI: 10.4088/jcp.v65n1211. View

19.

Grant B, Chou S, Goldstein R, Huang B, Stinson F, Saha T . Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008; 69(4):533-45. PMC: 2676679. DOI: 10.4088/jcp.v69n0404. View

20.

Hepp J, Lane S, Wycoff A, Carpenter R, Trull T . Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension. J Abnorm Psychol. 2018; 127(2):183-189. PMC: 5851290. DOI: 10.1037/abn0000318. View