Emotion dysregulation and negative affect: Association with psychiatric symptoms

Journal of Clinical Psychiatry

Volumn 72, Issue 5, 2011, Pages 685-691

  Bradley, Bekh ^a,c   DeFife, Jared A ^a   Guarnaccia, Clifford ^a   Phifer, Justine ^a   Fani, Negar ^a   Ressler, Kerry J ^a,b,d   Westen, Drew ^a  

^a EMORY UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b EMORY UNIVERSITY   (United States)

^c ATLANTA VA MEDICAL CENTER   (United States)

^d HOWARD HUGHES MEDICAL INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADAPTATION; ADULT; AFFECT; AGE; AGED; ALCOHOL ABUSE; ALCOHOL USE DISORDERS IDENTIFICATION TEST; ARTICLE; BECK DEPRESSION INVENTORY; CHILDHOOD; CHILDHOOD TRAUMA QUESTIONNAIRE; CLINICIAN ADMINISTERED PTSD SCALE; CONSTRUCT VALIDITY; DEPRESSION; DISTRESS SYNDROME; DRUG ABUSE; EMOTION DYSREGULATION; EMOTION DYSREGULATION SCALE; EMOTIONAL DISORDER; FEMALE; GENDER; GLOBAL ADAPTIVE FUNCTIONING SCALE; HUMAN; MAJOR CLINICAL STUDY; MALE; MENTAL DISEASE; NEGATIVE AFFECT; POSTTRAUMATIC STRESS DISORDER; PRIORITY JOURNAL; PSYCHOLOGICAL RATING SCALE; PSYCHOTRAUMA; QUESTIONNAIRE; SELF REPORT; SHORT DRUG ABUSE SCREENING TEST; STRUCTURED INTERVIEW; SUICIDE; UNITED STATES;

ADOLESCENT; ADULT; AFFECT; AGED; DEPRESSIVE DISORDER; EMOTIONAL INTELLIGENCE; FEMALE; HUMANS; MALE; MENTAL DISORDERS; MIDDLE AGED; PSYCHIATRIC STATUS RATING SCALES; PSYCHOLOGICAL TESTS; REGRESSION ANALYSIS; STRESS DISORDERS, POST-TRAUMATIC; SUBSTANCE-RELATED DISORDERS; SUICIDE, ATTEMPTED; YOUNG ADULT;

EID: 79959206916     PISSN: 01606689     EISSN: None     Source Type: Journal    
DOI: 10.4088/JCP.10m06409blu     Document Type: Article

References (88)

1. Watson D, Clark LA. Affects separable and inseparable: on the hierarchical arrangement of the negative affects. J Pers Soc Psychol. 1992;62(3):489-505. doi:10.1037/02-3514.62.3.489
2. Krueger RF. The structure of common mental disorders. Arch Gen Psychiatry. 1999;56(10):921-926. doi:10.101/archpsyc.56.10.921 PubMed (Pubitemid 29480128)
3. Gross JJ, ed. Handbook of Emotion Regulation. New York, NY: Guilford Press; 2007.
4. Linehan MM, Heard HL. Dialectical behavior therapy for borderline personality disorder. In: Clarkin JF, Marziali E, Munroe-Blum H, eds. Borderline Personality Disorder: Clinical and Empirical Perspectives. New York, NY: Guilford Press; 1992:248-267.
5. Shedler J, Westen D. Dimensions of personality pathology: an alternative to the five-factor model. Am J Psychiatry. 2004;161(10):1743-1754. doi:10.176/api.ajp.161.10.1743 PubMed (Pubitemid 39314662)
6. Westen D. Cultural, emotional, and unconscious aspects of self. In: Curtis RC, ed. The Relational Self. New York, NY: Guilford Press; 1991:181-210.
7. Westen D. Affect regulation and psychopathology: applications to depression and borderline personality disorder. In: Flack W, Laird J, eds. Affect and Psychopathology. New York, NY: Oxford University Press; 1998.
8. Cole PM, Michel MK, Teti LO. The development of emotion regulation and dysregulation: a clinical perspective. Monogr Soc Res Child Dev. 1994;59(2-3):73-100. doi:10.1/j.1540-5834.194.tb01278.x PubMed
9. Calkins SD, Hill A. Caregiver influences on emerging emotion regulation: biological and environmental transactions in early development. In: Gross JJ, ed. Handbook of Emotion Regulation. New York, NY: Guilford Press; 2007:229-248.
10. De Pauw SS, Mervielde I. Temperament, personality and developmental psychopathology: a review based on the conceptual dimensions underlying childhood traits. Child Psychiatry Hum Dev. 2010;41(3):313-329. doi:10.107/s10578-09-0171-8 PubMed
11. Krueger RF, Hicks BM, Patrick CJ, et al. Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. J Abnorm Psychol. 2002;111(3):411-424. doi:10.1037/021-843X.1.3.41 PubMed (Pubitemid 34791142)
12. Krueger RF, Tackett JL. Personality and psychopathology: working toward the bigger picture. J Pers Disord. 2003;17(2):109-128. doi:10.1521/pedi.17.2. 109.23986 PubMed (Pubitemid 36535095)
13. Nigg JT. On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychol Bull. 2000;126(2):220-246. doi:10.1037/03-2909.126.2.20 PubMed
14. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256(3):174-186. doi:10.107/s0406-05-0624-4 PubMed
15. Zittel Conklin C, Westen D. Borderline personality disorder in clinical practice. Am J Psychiatry. 2005;162(5):867-875. doi:10.176/api.ajp.162.5.867 PubMed (Pubitemid 40676198)
16. Bradley R, Jenei J, Westen D. Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents. J Nerv Ment Dis. 2005;193(1):24-31. doi:10.1097/01.nmd.0149215.8020.7c PubMed (Pubitemid 40096908)
17. Skodol AE, Siever LJ, Livesley WJ, et al. The borderline diagnosis II: biology, genetics, and clinical course. Biol Psychiatry. 2002;51(12):951-963. doi:10.1016/S06-323(02)01325-2 PubMed (Pubitemid 34607711)
18. Trull TJ, Widiger TA, Lynam DR, et al. Borderline personality disorder from the perspective of general personality functioning. J Abnorm Psychol. 2003;112(2):193-202. doi:10.1037/021-843X.12.2.193 PubMed (Pubitemid 36583173)
19. Westen D, Heim AK, Morrison K, et al. Classifying and diagnosing psychopathology: a prototype matching approach. In: Beutler L, Malik M, eds. Rethinking the DSM: A Psychological Perspective. Washington, DC: American Psychological Association Press; 2002:221-250.
20. Zanarini MC, Frankenburg FR, DeLuca CJ, et al. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harv Rev Psychiatry. 1998;6(4):201-207. doi:10.3109/1067329809030 PubMed (Pubitemid 28507381)
21. Zanarini MC, Frankenburg FR, Hennen J, et al. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry. 2003;160(2):274-283. doi:10.176/api.ajp.160.2.274 PubMed (Pubitemid 41110452)
22. Coccaro EF, Bergeman CS, McClearn GE. Heritability of irritable impulsiveness: a study of twins reared together and apart. Psychiatry Res. 1993;48(3):229-242. doi:10.1016/0165-1781(93)9074-Q PubMed (Pubitemid 23290594)
23. Sanislow CA, Grilo CM, McGlashan TH. Factor analysis of the DSM-III-R borderline personality disorder criteria in psychiatric inpatients. Am J Psychiatry. 2000;157(10):1629-1633. doi:10.176/api.ajp.157.10.1629 PubMed
24. Sanislow CA, Grilo CM, Morey LC, et al. Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study. Am J Psychiatry. 2002;159(2):284-290. doi:10.176/api.ajp.159.2.284 PubMed (Pubitemid 34126907)
25. Zanarini MC, Frankenburg FR, Yong L, et al. Borderline psychopathology in the first-degree relatives of borderline and Axis II comparison probands. J Pers Disord. 2004;18(5):439-447. doi:10.1521/pedi.18.5.439.51327 PubMed (Pubitemid 39518505)
26. Yen S, Zlotnick C, Costello E. Affect regulation in women with borderline personality disorder traits. J Nerv Ment Dis. 2002;190(10):693-696. doi:10.1097/05053-20210-06 PubMed (Pubitemid 35191505)
27. Westen D, Muderrisoglu S, Fowler C, et al. Affect regulation and affective experience: individual differences, group differences, and measurement using a Q-sort procedure. J Consult Clin Psychol. 1997;65(3):429-439. doi:10.1037/02-06X.65.3.429 PubMed (Pubitemid 27246784)
28. Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press; 1993.
29. Kellogg SH, Young JE. Schema therapy for borderline personality disorder. J Clin Psychol. 2006;62(4):445-458. doi:10.102/jclp.20240 PubMed
30. Young J, Klosko J, Weishaar M. Schema Therapy: A Practitioner's Guide. New York, NY: Guilford Press; 2003.
31. Clarkin JF, Levy KN, Lenzenweger MF, et al. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164(6):922-928. doi:10.176/api.ajp.164.6.92 PubMed (Pubitemid 46972908)
32. Miller JD, Pilkonis PA. Neuroticism and affective instability: the same or different? Am J Psychiatry. 2006;163(5):839-845. doi:10.176/api.ajp.163.5.839 PubMed
33. McDermott MJ, Tull MT, Gratz KL, et al. The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment. J Anxiety Disord. 2009;23(5):591-599. doi:10.1016/j.janxdis.209.01.06 PubMed
34. Gillespie CF, Bradley B, Mercer K, et al. Trauma exposure and stress-related disorders in inner city primary care patients. Gen Hosp Psychiatry. 2009;31(6):505-514. doi:10.1016/j.genhospsych.209.05.03 PubMed
35. Alim TN, Graves E, Mellman TA, et al. Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. J Natl Med Assoc. 2006;98(10):1630-1636. PubMed
36. Chapman DP, Whitfield CL, Felitti VJ, et al. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004;82(2):217-225. doi:10.1016/j.jad.203.12.013 PubMed (Pubitemid 39370823)
37. Binder EB, Bradley RG, Liu W, et al. Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA. 2008;299(11):1291-1305. doi:10.101/jama.29.1.1291 PubMed (Pubitemid 351439075)
38. Bradley RG, Binder EB, Epstein MP, et al. Influence of child abuse on adult depression: moderation by the corticotropin-releasing hormone receptor gene. Arch Gen Psychiatry. 2008;65(2):190-200. doi:10.101/archgenpsychiatry.207. 26 PubMed (Pubitemid 351214318)
39. Bernstein D, Fink L. Childhood Trauma Questionnaire Manual. San Antonio, TX: Psychological Corporation; 1998.
40. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169-190. doi:10.1016/S0145-2134(02)0541-0 PubMed (Pubitemid 36293325)
41. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-1070. doi:10.1037/02-3514.54.6.1063 PubMed
42. Westen D, Shedler J. Revising and assessing Axis II, part 1: developing a clinically and empirically valid assessment method. Am J Psychiatry. 1999;156(2):258-272. PubMed
43. Westen D, Shedler J. Revising and assessing Axis II, part 2: toward an empirically based and clinically useful classification of personality disorders. Am J Psychiatry. 1999;156(2):273-285. PubMed
44. Blake D, Weathers FW, Nagy LM, et al. A clinician rating scale for assessing current lifetime PTSD: the CAPS-1. Behav Ther (N Y N Y). 1990;13:187-188.
45. Weathers FW, Keane TM, Davidson JR. Clinician-Administered PTSD Scale: a review of the first ten years of research. Depress Anxiety. 2001;13(3):132-156. doi:10.102/da.1029 PubMed
46. Blake DD, Weathers FW, Nagy LM, et al. The development of a clinician administered PTSD scale. J Trauma Stress. 1995;8(1):75-90. doi:10.102/jts. 249080106 PubMed
47. Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791-804. doi:10.1/j.1360-043.193.tb02093.x PubMed
48. Skinner HA. The Drug Abuse Screening Test. Addict Behav. 1982;7(4): 363-371. doi:10.1016/0306-4603(82)905-3 PubMed (Pubitemid 13162181)
49. Cocco KM, Carey KB. Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychol Assess. 1998;10(4): 408-414. doi:10.1037/1040-3590.10.4.408 (Pubitemid 29031511)
50. Maisto SA, Carey MP, Carey KB, et al. Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess. 2000;12(2):186-192. doi:10.1037/1040-3590.12.2.186 PubMed
51. French MT, Roebuck MC, McGeary KA, et al. Using the Drug Abuse Screening Test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting. Subst Use Misuse. 2001;36(6-7):927-946. doi:10.1081/JA-10104096 PubMed (Pubitemid 32660809)
52. Beck AT, Steer RA, Ball R, et al. Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588-597. doi:10.1207/s1532752jpa6703-13 PubMed (Pubitemid 26382973)
53. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory- II. San Antonio, TX: Psychological Corporation; 1996.
54. Keller MB, Lavori PW, Friedman B, et al. The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry. 1987;44(6):540-548. PubMed
55. O'Brien R. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673-690. doi:10.107/s135-06-9018-6
56. Riggs S. Childhood emotional abuse and the attachment system across the life cycle: what theory and research tell us. J Aggress Maltreat Trauma. 2010;19(1):5-51. doi:10.1080/1092670903475968
57. Kochanska G, Philibert RA, Barry RA. Interplay of genes and early mother-child relationship in the development of self-regulation from toddler to preschool age. J Child Psychol Psychiatry. 2009;50(11):1331-1338. doi:10.1/j.1469-7610.208.02050.x PubMed
58. Alink LR, Cicchetti D, Kim J, et al. Mediating and moderating processes in the relation between maltreatment and psychopathology: mother-child relationship quality and emotion regulation. J Abnorm Child Psychol. 2009;37(6):831-843. doi:10.107/s10802-09-9314-4 PubMed
59. Cicchetti D, Ackerman B, Izard C. Emotions and emotion regulation in developmental psychopathology. Dev Psychopathol. 1995;7(1):1-10. doi:10.1017/S0954579406301
60. Kim J, Cicchetti D. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. J Child Psychol Psychiatry. 2010;51(6):706-716. doi:10.1/j.1469-7610.209.0202.x PubMed
61. Brotman MA, Schmajuk M, Rich BA, et al. Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry. 2006;60(9):991-997. doi:10.1016/j.biopsych.206.08.042 PubMed (Pubitemid 44739929)
62. Hatzenbuehler ML, McLaughlin KA, Nolen-Hoeksema S. Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. J Child Psychol Psychiatry. 2008;49(12):1270-1278. doi:10.1/j.1469-7610.208.01924.x PubMed
63. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217-237. doi:10.1016/j.cpr.209.1.04 PubMed
64. Taylor SF, Liberzon I. Neural correlates of emotion regulation in psychopathology. Trends Cogn Sci. 2007;11(10):413-418. doi:10.1016/j.tics.207. 08.06 PubMed (Pubitemid 47588995)
65. Jones M, Westen D. Diagnosis and subtypes of adolescent antisocial personality disorder. J Pers Disord. 2010;24(2):217-243. doi:10.1521/pedi.2010. 24.2.217 PubMed
66. Thompson-Brenner H, Eddy KT, Satir DA, et al. Personality subtypes in adolescents with eating disorders: validation of a classification approach. J Child Psychol Psychiatry. 2008;49(2):170-180. doi:10.1/j.1469-7610.207.01825.x PubMed
67. Lanius RA, Vermetten E, Loewenstein RJ, et al. Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010;167(6):640-647. doi:10.176/api.ajp.209.0908168 PubMed
68. Ortigo KM, Westen D, Bradley B. Personality subtypes of suicidal adults. J Nerv Ment Dis. 2009;197(9):687-694. doi:10.1097/NMD.0b013e3181b3b13f PubMed
69. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2008;98(suppl):S29-S37. PubMed
70. Himle JA, Baser RE, Taylor RJ, et al. Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. J Anxiety Disord. 2009;23(5):578-590. doi:10.1016/j.janxdis.209.01.02 PubMed
71. Ellis BH, MacDonald HZ, Lincoln AK, et al. Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol. 2008;76(2):184-193. doi:10.1037/02-06X.76.2.184 PubMed (Pubitemid 351522254)
72. Weems CF, Watts SE, Marsee MA, et al. The psychosocial impact of Hurricane Katrina: contextual differences in psychological symptoms, social support, and discrimination. Behav Res Ther. 2007;45(10):2295-2306. doi:10.1016/j.brat.207.04.013 PubMed (Pubitemid 47374086)
73. Daughters SB, Reynolds EK, MacPherson L, et al. Distress tolerance and early adolescent externalizing and internalizing symptoms: the moderating role of gender and ethnicity. Behav Res Ther. 2009;47(3):198-205. doi:10.1016/j.brat.208.12.01 PubMed
74. Bornovalova MA, Gratz KL, Daughters SB, et al. A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment. J Psychiatr Res. 2008;42(9):717-726. doi:10.1016/j.jpsychires.207.07.014 PubMed
75. Gratz KL, Tull MT, Baruch DE, et al. Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Compr Psychiatry. 2008;49(6):603-615. doi:10.1016/j.compsych.208. 04.05 PubMed
76. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85(2):348-362. doi:10.1037/02-3514.85.2.348 PubMed (Pubitemid 37394968)
77. Gratz K, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess. 2004;26(1):41-54. doi:10.1023/B:JOBA.0745.08539.94 (Pubitemid 38182213)
78. Conklin CZ, Bradley R, Westen D. Affect regulation in borderline personality disorder. J Nerv Ment Dis. 2006;194(2):69-77. doi:10.1097/01.nmd. 0198138.41709.4f PubMed (Pubitemid 43260184)
79. Bradley R, Westen D. The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Dev Psychopathol. 2005;17(4):927-957. doi:10.1017/S095457940505043 PubMed (Pubitemid 43362198)
80. Dozier M, Lee S. Discrepancies between self- and other-report of psychiatric symptomatology: effects of dismissing attachment strategies. Dev Psychopathol. 1995;7(1):217-226. doi:10.1017/S095457940643X
81. Bradley R, Hilsenroth M, Guarnaccia C, et al. Relationship between clinician assessment and self-assessment of personality disorders using the SWAP-200 and PAI. Psychol Assess. 2007;19(2):225-229. doi:10.1037/1040-3590.19. 2.25 PubMed (Pubitemid 47445227)
82. DeFife J, Drill R, Nakash O, et al. Agreement between clinician and patient ratings of adaptive functioning and developmental history [published online ahead of print July 15, 2010]. Am J Psychiatry. 2010;167(12):1472-1478. PubMed
83. Gross JJ, Thompson RA. Emotion regulation: conceptual foundations. In: Gross JJ, ed. Handbook of Emotion Regulation. New York, NY: Guilford Press; 2007:3-25.
84. Brown MZ, Comtois KA, Linehan MM. Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol. 2002;111(1):198-202. doi:10.1037/021-843X.1.1.198 PubMed (Pubitemid 34150837)
85. Kullgren G. Factors associated with completed suicide in borderline personality disorder. J Nerv Ment Dis. 1988;176(1):40-44. doi:10.1097/05053- 198010-05 PubMed (Pubitemid 18042984)
86. Montgomery SA, Montgomery D, Baldwin D, et al. Intermittent 3-day depressions and suicidal behaviour. Neuropsychobiology. 1989;22(3):128-134. doi:10.159/018606 PubMed (Pubitemid 20291710)
87. Markey MA, Vander Wal JS. The role of emotional intelligence and negative affect in bulimic symptomatology. Compr Psychiatry. 2007;48(5):458-464. doi:10.1016/j.compsych.207.05.06 PubMed (Pubitemid 47247441)
88. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205-230. (Pubitemid 38821731)