1. Borderline Personality Disorder
Cadet Andrew Crane
12/8/2015

2. Borderline Personality Overview
According to a survey conducted by the National Institute of Mental Health 1.6% of United States citizens have BPD in a given year. 42% of those diagnosed with disorder are receiving treatment
The onset of BPD usually occurs during adolescents
BPD is categorized by instability, impulsivity, and emptiness.

3. The Influence of Emotional Dysregulation
Buckholdt et. al. (2015) examined the resolving effect of emotion dysregulation in the relation between exposure to violence and both Post Traumatic Stress Syndrome and Borderline Personality pathology.
144 adolescent participants (50.7% male) admitted into a residential treatment center in Missouri were assessed.
Participants were between the ages of 10 and 17 with the mean age being 14.5 years old and a standard deviation of 1.5.
48.9% percent were in middle school, 46.8 percent were in high school, and 4.3% were still in grade school.
The Life Events Scale (LES) was used to asses participants for exposure to a wide range of violent events.
The Difficulties in Emotional Regulation Scale (DERS) measured the participants levels of emotional dysregulation across six different domains: nonacceptance of negative emotions, difficulties engaging in goal-directed behaviors when distressed, difficulties controlling impulsive behaviors when distressed, limited access to emotion regulation strategies perceived as effective, lack of emotional awareness, and lack of emotional clarity.
The Child PTSS Symptom Scale (CPSS) and the Borderline Personality Features Scale for Children (BPFSC) were used to asses for Post Traumatic Stress Symptoms and Borderline Personality features in the participants.

4. Correlations Among Variables Being Studied
Measure 1 2 3 4 5 6 7
Gender
Age
-.09
Race
.01
.19*
Violence Exposure
-.07
.03
.24***
Emotional Dysregulation
-.16
-.04
.32***
PTSS
-.36***
-.03
.44***
.56***
BP Pathology
-.31
.02
-.11
.38***
.65***
.62***
Mean
.51
14.26
.64
32.34
94.34
16.44
43.40 SD
.50
1.50
.48
25.95
23.04
11.85
15.95
Range
0-1
10-17
0-126
38-158
0-46
4-92
N= ***p<.001 **p<.01 *p< Race: White=0 Other=1

5. Conceptual Model .85 .79 .83 56% .43*** .35*** 14% .60*** .79 61% .79
Violence Exposure
Emotinal Dysregulation
Post Truamatic Stress Symptoms
Arousal
Re-experience
Avoidance
Borderline Personality Features
Identity Dist.
Affective Instability
Self-Harm
Negative Relations
.85
.79
.83
56%
.43***
.35***
14%
.60***
.79
61%
.79
.77
.71

6. Theory of Mind and Borderline Personality Disorder
Baez et. al. assessed the performance of adult individuals with BPD on Theory of the Mind, emotion regulation, and emotional functioning in an attempt to test the idea that ToM deficits and their variability in BPD would depend on more basic skills, such as executive functions and emotion recognition.
15 participants were selected from the outpatient populations of the Institute of Cognitive Neurology who met the requirements for BPD diagnosed by a psychiatrist. 15 control participants were selected to match the BPD counterparts based on age, sex, and years of education.
They had to complete psychiatric and behavior questionnaires. The Beck Depression Inventory ll to rate depression, the state-trait anxiety inventory to assess anxiety, and the Barratt impulsiveness scale to evaluate impulsivity. These tests were used to evaluate emotional functioning.
They were also evaluated on their emotion recognition using Emotional Morphing and The Awareness of Social Inference Test. Emotional Morphing is a facial recognition test that measures the ability of the participant to recognize an emotion. The Awareness of Social Inference Test assessed recognition of spontaneous emotional expression using videotaped vignettes of everyday social interactions.
Finally the Theory of Mind of each participants was evaluated using Faux pas test, an assessment of the emotional and cognitive aspects of the ToM. The Reading the Mind In the Eyes test was also used to assess the emotional inference aspect of the ToM.

7. Results
Findings
The Clinical Assessment revealed that BPD participants showed more depressive symptoms that the control group. The mean BDI-II of participants with BDP was 18.6 and the mean of the control participants was 6.8. BPD participants also exhibited higher anxiety levels than the controls revealed by the STAI-state test. Similar to the BDI-II tests the mean of the BPD participants was higher than the mean of the control group on the STAI-state testing.
The Executive Functioning assessments showed the BPD patients scored particularly worse than the control group on the IFS total score, lower scores in motor inhibitory control, and spatial working memory.
The Emotion Recognition tests revealed little to no difference between the two groups on the emotion morphing testing. However, BPD participants scored lower overall than the control group on the TASIT test.
The FTP test which analyises patients ToM presented that BPD patients showed lower intentionality and emotional attribution scores. However, the two groups did not much a difference on the RMET testing p=.51
By completing regression testing they were able to find that IFS total score was a predictor of the FPT performance. In contrast with this the IFS score was not an effective predictor of the RMET scores.

8. Conclusion
The participants with BPD showed impaired emotional functioning, and impaired and preserved ToM and emotion recognition.
They found that ToM and emotion recognition tasks that involved real world social clue integration were more sensitive to the impairment of the individuals with BPD.
This study also presented that basic functions emotional functioning and emotion recognition predicted ToM in certain situations.
After analyzing these two findings they make the claim that ToM deficits of BPD patients has to do with emotional functioning and the ability to recognize social ques to identify emotions.

9. Poor Self Control and Harsh Punishment
Hallquist et. al. (2015) used longitudinal data from the Pittsburg Girls Study to examine the influences that harsh parenting, self-control, and negative emotionality among girls ages 5-14 had on predicting BPD symptoms in girls ages
The Pittsburg Girls Study consists of 2,450 girls initially assessed at ages 5-8 and followed annually.
The analyses reported in this publication examines symptoms of BPD assessed between ages 14 and 17 form the data of 2,228 girls due to the attrition rate of the longitudinal study.
In home interviews were conducted annually for each participant by trained interviewers assessing parenting styles, parent psychopathology, and the girl’s characteristics. At age 14 the interviewer began assessing for self reported BPD symptoms.

10. Methods
Harsh punishment was assessed in this study using child and caregiver reports on the Conflict Tactics Scale: Parent-Child version.
Child negative emotionality was studied by caregiver reports early on then at age 11 the Emotionality, Activity, and Sociability Temperament Survey was given to the participants.
Poor Self control was reported by caregivers at early ages between 5-8, and between age it was measured using caregiver and child reports on the self-control subscale of the Social Skills Rating Scale.
At the beginning of this study poverty was evaluated by whether or not the caregiver was receiving public assistance.
Borderline Personality symptoms were evaluated using the International Personality Disorder Examination–Screen.

11. Results and Conclusion
Using a structural equation model Hallquist et. al. the effects of harsh punishment, negative emotionality, and poor self-control on the level and rate of change in BPD symptoms in adolescence.
There was a significant association between BPD at age 14 and harsh punishment at age 10. There was also an association between the rate of growth in harsh punishment between the ages of and BPD symptoms in participants age 14.
The level and rate of growth in poor self-control between the ages of 10 and 12 significantly predicted increased BPD symptom severity.
An increase in negative emotionality at age 11 was predictive of BPD symptoms in participants age 14.

12. References
Baez, et. al. (2015). Theory of Mind and Its Relationship With Executive Functions and Emotion Recognition in Borderline Personality Disorder. Journal of Neuropsychology, 9, Borderline Personality Disorder. (2007). Retrieved December 9, 2015, from disorder.shtml Buckholdt, et. al. (2015). Exposure to Violence, Posttraumatic Stress Symptoms, and Borderline Personality Pathology Among Adolescents in Residential Psychiatric Treatment: The Influence of Emotion Dysregulation. Child Psychiatry and Human Development, 46, Hallquist, M. N., Hipwell, A. E., Stepp, S. D. (2015). Poor Self-Control and Harsh Punishment in Childhood Prospectively Predict Borderline Personality Symptoms in Adolescent Girls. Journal of Abnormal Psychology, 124,