Borderline personality disorder (BPD) is a persistent pattern characterized by marked emotional instability and lack of impulse control that significantly affects interpersonal relationships. The age of onset of symptoms is usually at the beginning of adulthood, at which time the subjects manifest behaviors such as: repeated efforts to avoid situations of abandonment (real or imagined), unstable behavior in social relationships, alterations self-identity (both in terms of self-image and sense of self), impulsive behaviors (which can become reckless), affective instability with sudden mood swings, chronic thoughts and feelings of emptiness, difficulties to control emotions, and even paranoid ideation associated with states of stress and / or severe dissociative symptoms (American Psychiatric Association, APA, 2013).
In relation to the prevalence and incidence data, epidemiology places frequency rates within the range 0.2–1.8% in the general population of developed countries (APA, 2013). It is also known that BPD is the cause of hospital admission in a high percentage of patients, and that in psychiatric care units this disorder can be identified in almost 50% of admitted patients. Available data also indicate that this disorder occurs more frequently in women, with a ratio that can reach 3: 1 (APA, 2013; Skodol & Bender, 2003). This differentiation by sex should, however, be taken with caution, since some professionals indicate that the real incidence in men may be underestimated due to their greater resistance to receiving psychological care (Briscoe, 1987; Labrador, Estupiñá & Vera, 2010).
Different studies have observed a close association of BPD with various psychological manifestations, such as alterations in emotional regulation [evidenced by various cognitive biases and difficulties in emotional expression (Carvalho Fernando et al., 2014; Gratz & Gunderson, 2006)], and dysfunctional emotional states [disturbances in both positive and negative affect (Coifman et al., 2012; Sadikaj et al., 2010)]. In fact, the available empirical evidence indicates that emotional (de) regulation constitutes a fundamental characteristic in the phenotype of the disorder (Chapman, 2019; Daros et al., 2018; Van Zutphen et al., 2015).
Emotional regulation is a complex construct that includes internal and external mechanisms responsible for identifying, analyzing, and modifying emotional reactions according to contextual demands, in order to provide optimal responses and satisfactorily meet the proposed goals (Thompson 1994). It involves cognitive, physiological and behavioral aspects (Gross & Jazaieri, 2014; Scherer, Schorr & Johnstone, 2001). Gross's model of emotional regulation maintains that regulation strategies can be explained based on two basic mechanisms: cognitive reappraisal referring to the mental construction of the situation, focused on the “antecedent” of the emotion) and Expressive suppression (referred to the modulation of the response, focused on the inhibition of the expressive behavior of the current emotion) (Gross, 2002; Gross & John, 2003).
It has been found that, in comparison with healthy controls, patients with BPD tend to show differences in the degree of cognitive reappraisal they perform of situations. Specifically, the presence of this disorder causes a poorer expression of cognitive elaboration, which would be the basis for the subsequent expression of more dysfunctional responses in emotional regulation (Koenigsberg et al., 2019). But these results may not be specific, since relevant differences have not always been observed when BPD is compared with other psychiatric disorders (attention deficit disorder; major depressive disorder; post-traumatic stress disorder and bipolar disorder) (Cavelti et al., 2019; Daros et al., 2018; Schulze et al., 2019).
Regarding the emotional states of BPD, there is a large number of studies in this area that relate the disorder with affectation in two dominant dimensions: positive affect and negative affect (Conklin, Bradley & Westen, 2006; Jacob et al., 2011; Sadikaj et al., 2010). Positive affect refers to the experience of characteristics related to satisfaction, good humor, security, or enthusiasm (generators of pleasant states). Negative affect refers to aversive emotional characteristics, such as nervousness, fear, disgust, guilt or anger (generators of emotional distress). In global terms, it is known that people with BPD tend to present instability in affect (Trull et al., 2008; Zittel-Conklin & Westen, 2005), probably as a consequence of difficulties in recognizing, differentiating and processing their own emotions. Ultimately, the consequences of this instability are usually impulsive actions that can become self-injurious and / or heterolesive (Berlin, Rolls & Iversen, 2005; Westen, 1991).
In healthy people, aspects of emotional regulation, cognitive reappraisal and expressive suppression have been related to positive and negative affects (Gross & John, 2003). On the other hand, in patients with LPD, the psychological aspects of negative affect and expressive suppression have been investigated (Salsman & Linehan, 2012), highlighting important interrelations between the characteristics of BPD, emotional regulation and negative affective intensity. Specifically, considering that, in healthy people, the regular use of cognitive reappraisal strategies has been related to greater positive affect, better interpersonal functioning and greater well-being in general, and that, on the contrary, expressive suppression is It has been associated with a greater presence of negative affect, that is, a greater number of depressive symptoms and less success in recovering mood (Gross & John, 2003; Haga, Kraft & Corby, 2009). It is unknown if this relationship is stable in the clinical population due to BPD, because it maintains a variant model in both affects and different personality disorders (Pérez-Nieto, González-Ordi & Redondo, 2007).
The present study arises from the need to have empirical evidence on the psychological manifestations and characteristic symptoms of BPD. The knowledge about the development of these psychological characteristics attached to the emotional and affective determinant, will make it possible to support the direct and predictive effects, as well as the interrelationships that involve the discernment of BPD. Previous studies in this area have been limited by their inability to use comprehensive measures among these psychological manifestations. Therefore, the main objective of this study is to compare measures of cognitive (re) evaluation, expressive suppression, positive affect and negative affect between patients with a diagnosis of BPD and controls. Based on the data published in the available literature, it is hypothesized that: H1) BPD symptoms moderate the relationship between (re) evaluation and negative affect; and H2) cognitive reappraisal has less relationship on the symptoms of BPD, when positive affect is controlled.
The results obtained in the study have an implication in the field of evaluation and intervention in patients with BPD. Knowing better what the interrelationships are between these aspects will help to design measuring instruments with greater discriminatory capacity and more precise treatment programs between these dimensions.