Abstract
BackgroundBorderline personality disorder (BPD) and somatoform disorders (SoD) involve significant problems in relationships and emotion regulation, but the similarities and differences between these disorders in these areas is not well understood.MethodIn 472 psychotherapy inpatients BPD and/or SoD diagnoses were confirmed or ruled out using clinical interviews and standardized measures. Emotional under- and over-regulation and indices of adult attachment working models and fears were assessed with validated self-report measures. Bivariate and multivariate analyses were conducted to examine relationships among the study variables and differences based on diagnostic status.ResultsUnder-regulation of emotion was moderately related to fear of abandonment but weakly related to fear of closeness. Over-regulation of emotion was moderately related to fear of closeness but not to fear of abandonment. BPD was associated with under-regulation of emotion and fear of abandonment, and, when comorbid with SoD, with fear of closeness. SoD was associated with inhibition or denial of fears of abandonment or closeness, and over-regulation of emotion.ConclusionsStudy results suggest that insecure attachment may play a role in both BPD and SoD, but in different ways, with hyperactivating emotion dysregulation prominent in BPD and deactivating emotion dysregulation evident in SoD. Also, combined hyper- and de-activating strategy components that may reflect a pattern of disorganized attachment were found, particularly in patients with comorbid BPD and SoD.
Highlights
Borderline personality disorder (BPD) and somatoform disorders (SoD) involve significant problems in relationships and emotion regulation, but the similarities and differences between these disorders in these areas is not well understood
Under-regulation of emotion was moderately related to fear of abandonment but weakly related to fear of closeness
Study results suggest that insecure attachment may play a role in both BPD and SoD, but in different ways, with hyperactivating emotion dysregulation prominent in BPD and deactivating emotion dysregulation evident in SoD
Summary
Borderline personality disorder (BPD) and somatoform disorders (SoD) involve significant problems in relationships and emotion regulation, but the similarities and differences between these disorders in these areas is not well understood. Bowlby ([1,2,3,4]) highlighted the anxiety-buffering and physical protection functions of close relationships and conceptualized proximityseeking as an emotionally regulated alternative to the instinctive and typically dysregulated fight-flight responses. He emphasized the importance of interpersonal experiences as sources of individual differences in emotion regulation over one’s lifetime. Secondary attachment strategies involve a defensive focus either on fear of abandonment (i.e., attempts to restore proximity and reduce anxiety; hyperactivation) or fear of closeness (i.e., attempts to inhibit proximity seeking and reduce awareness of distress; deactivation). And phenomenologically, the secondary attachment strategies appear to involve relatively distinct van Dijke and Ford Borderline Personality Disorder and Emotion Dysregulation (2015) 2:6 forms of emotion dysregulation, with under-regulation of emotion predominating in fear of abandonment and overregulation of emotion characterizing fear of closeness
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