Dysfunctional Affect Regulation: in borderline personality disorder and somatoform disorder

Abstract

The aim of this dissertation was to provide a systematic exploration of the nature and distribution of dysfunctional affect regulation, its associated phenomena, and retrospectively reported potentially traumatizing events in 475 patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), comorbid BPD+SoD, and a psychiatric comparison group (PC) to provide a baseline against which to compare the hypothesized elevations in dysfunctional self and affect regulation. Whereas some patients react to adversities with inhibited experiencing and social withdrawal, others react hyper-emotionally and tend to cling to a significant other to alleviate stress and regulate to base-line. Van Dijke described dysfunctional self and affect regulation as operating in vicious cycles that approach the long-term sequelae of trauma-by-primary-caretaker from a developmental perspective. Activation of dysfunctional regulation seems to follow trauma-by-primary-caretaker associated negatively biased cognitive-emotional information processing. However, when potentially neutral situations are processed and evaluated as threatening or potentially harmful, dysfunctional regulation is activated false positively. Consequently, this may result in interpersonal misunderstanding and disappointments, which in turn condition and uphold the insecure attachment representation/ working models eventually turning into dysfunctional regulation vicious circles. The present studies demonstrated that dysfunctional regulation presents in patients in three qualitatively different forms: Inhibitory-, Excitatory-, and combined Inhibitory & Excitatory (IE)-regulation. Symptoms include disturbances in self-regulation across several domains of functioning including affective, cognitive, somatic, relational, reflective, executive, behavioral, and psycho-physiological functioning. However, no disorder-specific form of dysfunctional affect regulation or dissociation was found. Adults who were exposed to potentially traumatizing events by primary caretaker during childhood often demonstrate complex psychological disturbances that are not fully captured by the Posttraumatic Stress Disorder (PTSD) diagnosis. In an attempt to capture the complex symptom presentation that includes not only posttraumatic stress symptoms, but also other symptoms reflecting disturbances predominantly in affective and interpersonal self-regulatory capacities, dissociation, somatization, and shattered or altered basic beliefs, Complex PTSD (CPTSD) was introduced as a clinical syndrome for adults. This disorder fundamentally involves the focus of this study: Dysfunctional affect regulation and dissociation. Childhood trauma-primary-caretaker plays a role in both over- and under-regulation of affect depending on the type and developmental epoch of the traumatization in psychiatrically-impaired adults, specifically in BPD. Also, CPTSD can be distinguished from BPD and/or SoD. By including patients of both genders and other diagnoses as well as BPD, the present study demonstrated that CPTSD is not exclusively or always found with (and therefore not synonymous with) BPD. The combined results of this dissertation suggest that further clinical and research studies are needed in order to further the development of empirically-based clinical assessment and treatment protocols for trauma-related self and affect dysregulation in adults with a range of Axis I and II psychiatric disorders. Also, disorder-specific assessment and treatment methods and guidelines for BPD, SoD and severe affective, and anxiety, may be enhanced by the addition of approaches focused on the types of dysfunctional affect- and self regulation that were identified and examined in the present studies.