State affective instability in borderline personality disorder assessed by ambulatory monitoring.
BACKGROUND
Although affective instability is an essential criterion for borderline personality disorder (BPD), it has rarely been reported as an outcome criterion. To date, most of the studies assessing state affective instability in BPD using paper-pencil diaries did not find indications of this characteristic, whereas in others studies, the findings were conflicting. Furthermore, the pattern of instability that characterizes BPD has not yet been identified.


METHODS
We assessed the affective states of 50 female patients with BPD and 50 female healthy controls (HC) during 24 hours of their everyday life using electronic diaries.


RESULTS
In contrast to previous paper-and-pencil diary studies, heightened affective instability for both emotional valence and distress was clearly exhibited in the BPD group but not in the HC group. Inconsistencies in previous papers can be explained by the methods used to calculate instability (see Appendix). In additional, we were able to identify a group-specific pattern of instability in the BPD group characterized by sudden large decreases from positive mood states. Furthermore, 48% of the declines from a very positive mood state in BPD were so large that they reached a negative mood state. This was the case in only 9% of the HC group, suggesting that BPD patients, on average, take less time to fluctuate from a very positive mood state to a negative mood state.


CONCLUSIONS
Future ambulatory monitoring studies will be useful in clarifying which events lead to the reported, sudden decrease in positive mood in BPD patients.
Ebner-Priemer
Ulrich W
UW
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Germany. ulrich.ebner-priemer@zi-mannheim.de
Kuo
Janice
J
Kleindienst
Nikolaus
N
Welch
Stacy S
SS
Reisch
Thomas
T
Reinhard
Iris
I
Lieb
Klaus
K
Linehan
Marsha M
MM
Bohus
Martin
M
D000328:Adult; D000339:Affect; D001883:Borderline Personality Disorder / Q000503:physiopathology / Q000523:psychology*; D016022:Case-Control Studies; D004644:Emotions; D005260:Female; D006801:Humans; D018670:Monitoring, Ambulatory; D013312:Stress, Physiological; D013997:Time Factors