Emotional Regulation: Depressive Disorder vs. Borderline Personality

In this article, I provide my bi-weekly research summary on a topic I think may help others in some way. This week I focused on depression, borderline personality, and different types of emotional regulation. I read the research so you don't have to 😌

Emotional Regulation: Depressive Disorder vs. Borderline Personality

What is Emotion Regulation?

Emotion regulation is the process of managing our emotional responses to events and situations. It is a complex process that involves a variety of cognitive, behavioral, and physiological mechanisms. Emotion regulation can be adaptive or maladaptive. Adaptive emotion regulation helps us to cope with stress and to maintain emotional balance. Maladaptive emotion regulation can lead to problems such as anxiety, depression, and aggression.

Today I'm going to summarize for you the following article: 

Title: Daily Emotion Regulation in Major Depression and Borderline Personality Disorder

Author/s: Ulrike Zetsche, Paul-Christian Bürkner, Julian Bohländer, Babette Renneberg, Stefan Roepke, and Lars Schulze

Publication and Year: Clinical Psychological Science, 2023

DOI: 10.1177/21677026231160709

This article is for anyone who has a Major Depressive Disorder or Borderline Personality Disorder diagnosis, depressive or borderline-like traits, or that cares for these individuals in some capacity. If you find this information helpful, please share this article with your community. 

Emotional Regulation and Mental Health

Emotional disturbances occur in many mental health disorders and present differently in each one. Major depressive disorder (MDD) and borderline personality disorder (BPD) are two mental disorders that are characterized by problems with emotion regulation. People with MDD often experience intense and prolonged negative emotions, such as sadness, hopelessness, and worthlessness. People with BPD also experience intense emotions, but their emotions are often more unstable and unpredictable. They may also have difficulty regulating their anger and impulsive behaviors.

Effective emotional regulation strategies can help with these symptoms. Here are four:

• Cognitive reappraisal of the emotion-eliciting situation: changing the way you think about an emotion-eliciting situation in order to change your emotional response.
• Acceptance of one’s emotional response: acknowledging and allowing oneself to experience their emotions without judgment.
• Distraction: focusing on something else when you are feeling overwhelmed by your emotions.
• Social sharing: talking to someone about how you are feeling.

Two potentially ineffective emotional regulation strategies?

• Rumination: repeatedly thinking about and analyzing your emotions, often in a negative or self-critical way.
• Suppression: consciously or unconsciously avoiding or denying your emotions.

Problems may arise when we start to use ineffective tools, underuse effective ones, and/or not use the effective ones in a helpful way. Let's learn more about emotional regulation in MDD and BPD so we can try and prevent these problems!

What We Know About Emotion Regulation in Depression and Borderline

1.  People with Major Depressive Disorder and Borderline Personality Disorder may use rumination and suppression more often than what studies call "healthy individuals" (not the best term, I agree).
2. People with MDD and BPD have been shown to employ certain effective strategies as successfully as healthy individuals.
3. Some strategies are less ineffective in certain mental disorders at times (e.g. Suppression may show some benefit for depressed and borderline personality individuals). 

What The Study Was

The study by Zetsche et al. examined daily emotion regulation in people with MDD and BPD. The participants included 52 females with BPD, 55 females with current MDD, and 55 healthy females. The study took place in Berlin, Germany, and between January 2017 and June 2019.

The study participants used electronic diaries (smartphones with an app downloaded on them) for two weeks and recorded their emotions, thoughts, and behaviors multiple times a day. 

What The Results Showed

• People with MDD and BPD reported distraction, rumination and suppression more often than those deemed healthy
• Those with MDD reported rumination more than those with BPD.
• People with BPD reported more impulsive behaviors, such as self-harm and substance abuse.
• Acceptance and social sharing were reported less in people with MDD and BPD than in the healthy group
• People with MDD and BPD may tend to ruminate and suppress their emotions more often than cognitively appraising them.
• People with BPD showed an equal amount of rumination and acceptance.
• Surprisingly, healthy people did not report the use of cognitive appraisal more than rumination or suppression either. But, they did use acceptance much more than either ineffective strategy.

Quick Subjective Analysis of The Results

In this study, people with BPD and MDD used one seemingly effective emotion regulation strategy more often than healthy individuals: distraction. A common factor in each of the most used strategies for the BPD and MDD groups (distraction, suppression, rumination) is an ability to not directly share, accept, or address one's emotions.

When we experience mental health disorders and difficult mental health symptoms, 

How To Apply What You Learned

This study suggests that problems with emotion regulation are a core feature of Major Depressive Disorder and Borderline Personality Disorder. These problems can lead to a variety of other symptoms, such as rumination, impulsive behaviors, and social isolation. Emotion regulation is an important target for treatment in MDD and BPD. Treatments that focus on emotion regulation can help people to manage their emotions more effectively and to improve their overall quality of life.

Here are some of those specific emotion regulation strategies that can be helpful for people with MDD and BPD:

• Cognitive reappraisal: This involves changing the way you think about a situation in order to change your emotional response. For example, if you are feeling anxious about a social event, you could try to reframe the event as an opportunity to meet new people and make friends or fellows.
• Acceptance: This involves accepting your emotions without judgment. This does not mean that you have to like your emotions, but it does mean that you allow yourself to experience them without trying to change them.
• Distraction: This involves focusing on something else when you are feeling overwhelmed by your emotions. For example, you could listen to music, read a book, or go for a walk.
• Social sharing: This involves discussing, or presenting in a non-verbal form, your emotions to another person. For example, if you are feeling angry because you are stuck in traffic, you could try to call a friend to help calm you down and support you in finding a different route to your destination.

If you are struggling with problems with emotion regulation, there are many resources available to help you. You can talk to your doctor or a mental health professional about treatment options. There are also many self-help books and websites that can provide information and support. You're not alone in this.

Thanks for reading and see you in a couple weeks! 

Remember: You're a human first, your unconscious is showing, and I'm so glad you exist.

Written by Dr. Courtney Tracy, LCSW, PsyD