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

Objective: Affective dysregulation is a core feature of borderline personality disorder (BPD), and some patients report dissociative symptoms. The present study investigated temporal dynamic relations between affective states and current experiences of depersonalization and derealization in daily life to test key theoretical premises of trauma models of dissociation. Method: Patients with BPD (n = 42) or depressive disorders (n = 40), and nonclinical controls (n = 39) were assessed every 15 min for 13 hr within a single day using smartphone-based diaries. Results: As expected, dynamic structural equation modeling results show the highest levels of average daily affective arousal, negative affective valence, and dissociation in the BPD group. As hypothesized, arousal and subsequent dissociation were significantly linked only in the BPD group, implying that momentary arousal above a person's daily average is followed by higher dissociation in the next measurement (similar to 15 min later). In addition, some patients with BPD reported less negative affective valence following dissociation. Conclusions: Our findings suggest that changes in affective states play an important role at the onset of dissociation in patients with BPD. Subsequent relief from distress may explain maintenance. We recommend that clinicians provide means to regulate affect when dealing with dissociation.