Arousal Temporally Precedes Dissociation in Patients with Borderline Personality Disorder: An Experience Sampling Approach

Affective dysregulation is a core feature of borderline personality disorder, and some patients also report dissociative symptoms. The present study investigated the temporal relations between arousal and valence dimensions of affect and dissociative states using micro-assessments in daily life. Patients with borderline personality disorder (n = 42) or depressive disorders (n = 40), and non-clinical controls (n = 39) reported affective and dissociative states every 15 min for 13 hours (52 times). Dynamic structural equation modeling showed the highest levels of average daily arousal, negative affect, and dissociative states in patients with borderline personality disorder, as expected. In addition, increased arousal linearly predicted stronger dissociative states in the next measurement, especially for negative affective valence, in patients with borderline personality disorder. Finally, descriptive results indicated that negative affective valence decreased following increased dissociative states in patients with borderline personality disorder. These findings suggest that changes in affect play an important role at the onset of dissociations and may explain why dissociations are maintained. Clinicians should provide patients with adaptive means to regulate high levels of arousal when helping them to deal with dissociative symptoms.