Investigation of underlying mechanisms contributing to the maintenance, development, and exacerbation of features associated with Borderline Personality Disorder: the role of metacognition, emotion regulation suppression, and the lack of emotion regulation reappraisal

Abstract

Background Borderline Personality Disorder (BPD) is considered to be one of the most debilitating and difficult to treat mental disorders. Traditionally, studies investigating the aetiology and mechanisms associated with the development and exacerbation of BPD have relied on the use of clinical populations. As a consequence, the opportunities to understand vulnerabilities and fundamental processes that may contribute to the development and maintenance of the disorder have been limited. Objectives The aim of this study was to examine the potential interactions and mediating effects of metacognition and emotion regulation on the relationships among different forms of childhood abuse, attachment, and parental bonding with a composite of core BPD features designed to encompass major areas of personality functioning and pathological personality traits (per DSM-5 section III). Method: A non-clinical sample of 695 students in the city of Edinburgh, Scotland took part in an internet survey composed of a battery of self-report measures. This was geared to identify features associated with BPD, emotion regulation difficulties, characteristics of metacognition, adult insecure attachment, fundamental parental bonding styles and signs of childhood maltreatment. Structural Equation Modelling (SEM) was used to analyse the data. Results All variables of interest had a direct effect on the development of features associated with BPD. Metacognition was found to mediate the effects of all three forms of childhood abuse used in the study as well as the effects of adult insecure attachment on the development BPD related traits. Emotion regulation suppression was found to mediate the effects of sexual and physical childhood abuse (but not emotional abuse, adult insecure attachment, parental bonding indifference, or parental bonding overprotection) on the development of borderline features. In addition, the lack of emotion regulation reappraisal was found to mediate the effects of sexual abuse and adult insecure attachment (but not emotional or physical abuse, parental bonding indifference, or parental bonding overprotection) on the development of BPD related traits. Discussion These findings have important clinical and theoretical implications. The results provide support and understanding of the role of mediating mechanisms in the exacerbation and in the development of features associated with BPD. This is important because metacognition and emotion regulation may be more amenable to change than traumatic past experiences and/or deep seeded patterns of attachment. In addition, further development in this area of research has the potential to lead to better and more effective psychotherapeutic treatments for BPD.