Patients with Borderline Personality Disorder (BPD) show evidence of disturbed emotion regulation. In particular, patients may try to suppress their emotions with possibly negative effects on mental health. We investigated the suppression of both negative and positive emotions in BPD patients and healthy participants. Thirty BPD patients and 30 matched healthy controls were assessed for emotion suppression using the Emotion Acceptance Questionnaire (EAQ). In addition, we administered additional questionnaires to validate emotion suppression findings. BPD patients reported increased attempts to suppress both negative and positive emotions. These findings indicate that BPD patients are not simply acting out negative emotions. Therapeutic approaches that focus on emotion acceptance of emotions are supported by our study data. Apart from negative emotions, treatment programs should consider positive emotions as well.
Emotional dysfunction is a main symptom of patients with Borderline Personality Disorder (BPD; Gratz et al., 2006). Compared with healthy subjects, BPD patients report more affective instability, increased affective intensity and reactivity related to negative emotional stimuli, and negative affectivity overall (Rosenthal et al., 2008). With respect to positive emotions, BPD patients suffer from anhedonia (Marissen et al., 2012) and experience less affective and cognitive positive states than healthy people (Reed and Zanarini, 2011). Several authors consider disturbed emotion regulation to be the primary emotional dysfunction in BPD patients and the main cause of further emotional symptoms in BPD (Glenn and Klonsky, 2009, Gratz et al., 2006 and Putnam and Silk, 2005). Emotion regulation is defined as a set of actions aimed at influencing which emotions we have and how we experience and express those emotions (Gross, 2002).
The attempt to suppress emotions has been shown to be a maladaptive emotion regulation strategy and is related to psychopathology (Beblo et al., 2012, Aldao et al., 2010 and Chawla and Ostafin, 2007). While Gross (2002) focuses primarily on suppression of emotional expression, other authors relate the attempt to suppress emotions to the entire emotional response including psychological and physiological features (Liverant et al., 2008). There is some evidence that BPD patients show increased efforts to suppress emotions. In BPD patients (Conklin et al., 2006), outpatients with BPD symptoms (Iverson et al., 2011) and in female inmate participants (Chapman et al., 2005), BPD symptoms were related to experiential avoidance (Hayes et al., 1996). Experiential avoidance refers to attempts to suppress unwanted emotions and other internal experiences, e.g., thoughts. Sauer and Baer (2009) reported that thought suppression fully mediated the relationship between negative social conditions and BPD symptoms in a student sample with a wide range of BPD features. Rosenthal et al. (2005) found a mediating effect of thought suppression on the association between negative affect and BPD symptoms in a community sample. In addition, neuroimaging studies support the hypothesis that BPD is associated with increased attempts to control emotions. In a recent fMRI study, we asked BPD patients to recall unresolved negative life events. In contrast to resolved negative life events and compared to healthy subjects, BPD patients demonstrated increased activation of the amygdala and PFC areas, including the orbitofrontal cortex (Beblo et al., 2006). We interpreted the results to represent an effortful but insufficient attempt to control intense emotions in patients with BPD.
BPD symptoms have also been found to be associated with a decreased acceptance of current experiences in a psychiatric sample (Wupperman et al., 2009), and an acceptance-based emotion regulation group intervention decreased symptoms in BPD patients (Gratz and Gunderson, 2006). Emotion acceptance is often contrasted to emotion suppression (Hofmann and Asmundson, 2008, Stein et al., 2008 and Williams et al., 2007), i.e., decreased emotion acceptance corresponds to increased emotion suppression efforts in BPD. Because there is some overlap between BPD and major depression symptomatology (MDD; Beblo et al., 2010 and Goodman et al., 2010), findings of decreased acceptance of negative and positive emotions in MDD patients (Beblo et al., 2012) support the assumption that BPD patients may show a similar pattern of emotion dysregulation.
However, studies that focus on attempts to suppress or accept emotions are primarily based on sub-clinical samples or other patient groups, and studies that investigate the regulation of positive emotions in BPD are missing. Therefore, definite conclusion about emotion suppression and emotion acceptance in BPD patients cannot be drawn. The present study aims to investigate attempts to suppress or accept negative and positive emotions in BPD patients and healthy participants. We hypothesized that BPD patients would show increased suppression and decreased acceptance of both negative and positive emotions.
