Mehmet Emin DEMİRKOL, Lut TAMAM, Soner ÇAKMAK, Kerim UĞUR, Caner YESİLOĞLU

The relationship between perceived stress, dissociative experiences, depressive symptoms, and anxiety sensitivity in borderline personality disorder

ABSTRACT Objective: Borderline personality disorder is characterized by impulsive behaviors, inconsistency in interpersonal relationships, and difficulty in regulating feelings and thoughts. In these patients, dissociative symptoms, defined as impaired consciousness, memory, and integrity of perception, are often observed and negatively affect the prognosis. This study aims to demonstrate the mediating effects of depressive symptoms and anxiety sensitivity between perceived stress and dissociative experiences in patients with borderline personality disorder. Method: Seventy-four patients with borderline personality disorder according to the DSM-5 criteria and 70 healthy controls with no psychiatric disorders were included in the study. A sociodemographic data form, the Beck Depression Inventory, Dissociative Experiences Scale, Perceived Stress Scale, and Anxiety Sensitivity Index were used for data collection. Results: The total score and physical, cognitive, and social subscores of the Anxiety Sensitivity Index and the total scores of Dissociative Experiences Scale, Beck Depression Inventory, and Perceived Stress Scale were higher in the patient group than the control group. There was a positive and statistically significant correlation between anxiety sensitivity, dissociative experiences, depressive symptoms, and perceived stress scores in the patient group. Depressive symptoms and anxiety sensitivity had partial mediating effects in the relationship between perceived stress and dissociative experiences. Conclusion: Dissociative symptoms lead to worsening of the course of borderline personality disorder. Our study revealed a significant relationship of perceived stress, depressive symptoms, and anxiety sensitivity with dissociative experiences. Therapeutic interventions for anxiety sensitivity and depressive symptoms would be beneficial regarding the prognosis of borderline personality disorder by preventing or reducing the severity of dissociative experiences.

PDF

___

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed., Washington, DC: American Psychiatric Association, 2013.

2. Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and Clinical Epidemiology of Borderline Personality Disorder. Psychiatr Clin North Am 2018; 41:561-573.

3. Sar V, Akyuz G, Kugu N, Ozturk E, Ertem-Vehid H. Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma. J Clin Psychiatry 2006; 67:1583-1590.

4. Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychol Bull 2009; 135:495-510.

5. Gratz KL, Tull MT, Gunderson JG. Preliminary data on the relationship between anxiety sensitivity and borderline personality disorder: the role of experiential avoidance. J Psychiatr Res 2008; 42:550-559.

6. Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am 2000; 23:89-101.

7. Sturrock, BA, Francis A, Carr S. Avoidance of affect mediates the effect of invalidating childhood environments on borderline personality symptomatology in a non-clinical sample. Clinical Psychologist 2009; 13:41-51.

8. Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry 2002; 51:936-950.

9. Atesci FC, Kuloglu M, Tezcan E, Yildiz M. Axis I and Axis II diagnoses in suicide attempters. Klinik Psikiyatri 2002; 5:22-27. (Turkish)

10. Tas HI, Altinbas K. Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Noro Psikiyatr Ars 2019; 57:27-32.

11. Sadock BJ, Sadock VA. Clinical Psychiatry. Aydin H, Bozkurt A (Translation Editor) Eleventh ed., Ankara: Gunes Kitabevi Ltd. Sti., 2005, 451-465. (Turkish)

12. Stiglmayr CE, Ebner-Priemer UW, Bretz J, Behm R, Mohse M, Lammers CH, et al. Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatr Scand 2008; 117:139-147.

13. Korzekwa MI, Dell PF, Pain C. Dissociation and borderline personality disorder: an update for clinicians. Curr Psychiatry Rep 2009; 11:82-88.

14. Beck AT, Steer RA. Internal consistencies of the original and revised Beck Depression Inventory. J Clin Psychol 1984; 40:1365- 1367.

15. Hisli N. A study on the validity of Beck Depression Inventory. Turkish Journal of Psychology 1988; 6:118-122.

16. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986; 24:1-8.

17. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess 2007; 19:176-188.

18. Mantar A, Yemez B, Alkın T. The validity and reliability of the Turkish version of the anxiety sensitivity index-3. Turk Psikiyatri Derg 2010;21:225-234. (Turkish)

19. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24:385-396.

20. Eskin M, Harlak H, Demirkiran F, Dereboy C. The adaptation of the Perceived Stress Scale into Turkish: a reliability and validity analysis. New Symposium 2013; 51:132-140. (Turkish)

21. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174:727-735.

22. Sar V, Kundakci T, Kiziltan E. Validity and reliability of the Dissociative Experiences Scale (DES-II). 33rd National Psychiatry Congress, Presentation Book, 1997, 55-64. (Turkish)

23. Thompson CG, Kim RS, Aloe AM, Becker BJ. Extracting the variance inflation factor and other multicollinearity diagnostics fron typical regression results. Basic Appl Soc Psych 2017; 39:81- 90.

24. Tekin M, Tekin A. Dissociative Symptoms in Anxiety Disorders. Current Approaches in Psychiatry 2014; 6:330-339. (Turkish)

25. Moritz S, Schilling L, Wingenfeld K, Köther U, Wittekind C, Terfehr K, et al. Psychotic-like cognitive biases in borderline personality disorder. J Behav Ther Exp Psychiat 2011; 42:349- 354.

26. Köhling J, Ehrenthal JC, Levy KN, Schauenburg H, Dinger U. Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015; 37:13-25.

27. Demirkol ME, Tamam L, Namli Z, Karaytuğ MO, Uğur K. Association of Psychache and Alexithymia With Suicide in Patients With Schizophrenia. J Nerv Ment Dis 2019; 207:668- 674.

28. Lilienfeld SO, Penna S. Anxiety sensitivity: relations to psychopathy, DSM-IV personality disorder features, and personality traits. J Anxiety Disord 2001; 15:367-393.

29. Bounoua N, Felton JF, Long K, Stadnik RD, Loya JM, MacPherson L, et al. Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents. Personal Ment Health 2015; 9:87-95.

30. Janke EA, Jones E, Hopkins CM, Ruggieri M, Hruska A. Catastrophizing and anxiety sensitivity mediate the relationship between persistent pain and emotional eating. Appetite 2016; 103:64-71.

31. Kleindienst N, Priebe K, Görg N, Dyer A, Steil R, Lyssenko L, et al. State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. Eur J Psychotraumatol 2016; 7:30375.

32. Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry 2017; 74:319-328.

33. Sahin M. The concept of integrative psychotherapy. Avrasya Sosyal ve Ekonomi Arastirmalari Dergisi 2019; 6:147-165. (Turkish)

34. Keough ME, Riccardi CJ, Timpano KR, Mitchell MA, Schmidt NB. Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity. Behav Ther 2010; 41:567-574.

35. Evren C, Cinar O, Evren B, Celik S. History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression. Psychiatry Res 2011; 190:126-131.

36. Semiz UB, Basoglu C, Ebrinc S, Ergun BM, Noyan CO, Cetin M. Body dysmorphic disorder, trauma, and dissociation in patients with borderline personality disorder: a preliminary study. Bulletin of Clinical Psychopharmacology 2005; 15:65-70.

37. Maxwell SE, Cole DA. Bias in cross-sectional analyses of longitudinal mediation. Psychol Methods 2007; 12:23-44. 38. Ross CA. Borderline personality disorder and dissociation. J Trauma Dissociation 2007; 8:71-80.