Arousal Temporally Precedes Dissociation in Patients with Borderline Personality Disorder: A Preliminary Experience Sampling Study

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, we found a positive relation between arousal and lag1 dissociative states, implying that momentary arousal above a person’s daily average is followed by higher dissociative ratings in the next measurement. This effect was not shown in the comparison groups. In some patients with borderline personality disorder negative affective valence decreased following increased dissociative states in patients with borderline personality disorder. Our findings suggest that changes in distress play an important role at the onset of dissociations and subsequent relief from distress may explain why dissociative reactions are maintained in some patients. Clinicians should provide patients with adaptive means to regulate high levels of arousal when helping them to deal with dissociative symptoms.