Dysfunctional affect regulation

Background: Although affect dysregulation is considered a core component of borderline personality disorder  (BPD) and somatoform disorders (SoD), remarkably little research has focused on the prevalence and nature  of   affect   dysregulation   in   these   disorders.   Also,   despite   apparent   similarities,   little   is   known   about   how  dysfunctional under- and overregulation of affect and positive and negative somatoform and  psychoform  dissociative experiences inter-relate. Prior studies suggest a clear relationship between early childhood psycho-  logical trauma and affect dysregulation, especially when the caretaker is emotionally, sexually, or physically  abusing the child, but how these relate to under- and overregulation while differentiating for developmental  epochs is not clear. Although an elevated risk of childhood trauma exposure or complex posttraumatic stress  disorder   (CPTSD)   symptoms   has   been   reported   in   BPD   and   SoD,   trauma   histories,   dysfunctional   affect  regulation, dissociation, PTSD, and CPTSD were never assessed in unison in BPD and/or SoD.  Method: BPD and/or SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical  interviews. Dysfunctional under- and overregulation of affect and somatoform and psychoform dissociation,  childhood trauma-by-primary-caretaker (TPC), PTSD, and CPTSD were all measured using self reports.  Results: No disorder-specific form of dysfunctional affect regulation was found. Although both BPD and SoD  can involve affect dysregulation and dissociation, there is a wide range of intensity of dysfunctional regulation  phenomena   in   patients   with   these   diagnoses.   Evidence   was   found   for   the   existence   of   three   qualitatively  different forms of experiencing states: inhibitory experiencing states (overregulation of affect and negative  psychoform dissociation) most commonly found in SoD, excitatory experiencing states (underregulation of  affect and positive psychoform dissociation) most commonly found in BPD, and combination of inhibitory  and   excitatory   experiencing   states   commonly   occurring   in   comorbid   BPD’SoD.   Almost   two-thirds   of  participants   reported   having   experienced   childhood   TPC.   Underregulation   of   affect   was   associated   with  emotional TPC and TPC occurring in developmental epoch, 0Á6 years of age. Overregulation of affect was  associated with physical TPC. Almost a quarter of all participants met the criteria for CPTSD. BPD’SoD  patients had the most extensive childhood trauma histories and were most likely to meet CPTSD criteria,  followed by BPD, psychiatric comparison (PC), and SoD. The BPD’SoD and BPD reported significantly  higher levels of CPTSD than the SoD or PC groups but did not differ from each other except for greater  severity of CPTSD somatic symptoms by the BPD’SoD group.  Conclusion:   Three   qualitatively   different   forms   of   dysfunctional   regulation   were   identified:   inhibitory,  excitatory, and combined inhibitory and excitatory states. Distinguishing inhibitory versus excitatory states  of experiencing may help to clarify differences in dissociation and affect dysregulation between and within BPD and SoD patients. Specific interventions addressing overregulation in BPD, or underregulation in SoD,  should be added to disorder-specific evidence-based treatments. CPT is particularly prevalent in BPD and  BPD’SoD and is differentially associated with under- and overregulation of affect depending on the type of  traumatic   exposure.   CPTSD   warrants   further   investigation   as   a  potential   independent   syndrome   or   as   a  marker   identifying   a   sub-group   of   affectively,   or   both   affectively   and   somatically,   dysregulated   patients  diagnosed with BPD who have childhood trauma histories.