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" Borderline personality traits and emotion regulation strategies in adolescents : "
McLachlan, Jane
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Latin Dissertation
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| Record Number
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1103573
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TLets803749
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McLachlan, Jane
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| Title & Author
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Borderline personality traits and emotion regulation strategies in adolescents :\ McLachlan, Jane
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| College
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University of Liverpool
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| Date
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2019
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2019
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| Degree
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D.Clin.Psy.
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| Abstract
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The Research of Borderline Personality Disorder: Within the United Kingdom (UK) many clinical psychologists are detached from the traditional medical model, which imposed diagnostic categories for mental health (Kinderman, Read, Moncrieff, & Bentall, 2013). Clinical psychologists have often advocated for a holistic formulation-based approach, which can incorporate the psychological, biological and social aspects of the individual (Johnstone & Dallos, 2014). The recently published Power Threat Meaning Framework (Johnstone et al., 2018) outlines a conceptual alternative to traditional models to combine psychological, sociological and biological aspects of the person. Despite this, the predominant models in many mental health services within the National health Service (NHS) rely on a medical diagnostic-based model. Many of these diagnoses can be stigmatising for the individual but personality disorder arguably remains the most controversial of all mental health diagnoses. Borderline Personality Disorder (BPD) has been defined in the most recent version of the Diagnostic and Statistical Manual for Mental Disorders (DSM5) as a pervasive pattern of instability in affect, interpersonal relationships and impulsivity (American Psychiatric Association, 2013). To get a diagnosis based on the DSM5 criteria, people must meet at least five of the nine defined indicators for BPD. The wide range of subsequent combinations that form a diagnosis of BPD means that two people meeting criteria for a diagnosis may only have one symptom in common (Biskin & Paris, 2012). The most recent version of the International Classification of Diseases (ICD-11; World Health Organisation, 2018) has moved from a categorical approach to diagnosis to a continuum-based approach for personality disorder. The term BPD, however, is still consistently used in healthcare and even in reference to adolescents. The diagnosis is even more controversial in adolescents due to uncertainty around the development of identity at this age (Shapiro, 1990) and the impact that this stigmatising label may have on a person going forward (Rusch et al., 2006). Research suggests however, that BPD traits are present in adolescents (Johnson, Cohen, Kasen, Skodol, & Oldham, 2008) and may predict lifetime chronicity and outcome (McGorry, 2013). Whilst some people may find a diagnosis to be helpful because it explains their difficulties and provides a direction for treatment, others find labels to be a barrier to recovery (British Psycholgoical Society, 2015). The author has reservations about accepting use of this medicalised language but is aware that we cannot ignore that difficulties may exist in young people that can have long term costs to their development and wellbeing. To understand these difficulties and provide early interventions that are effective for young people, it is difficult to not use categories associated with the difficulties. We acknowledge however, the need for the use of this language to be challenged in practice. Thesis Overview: There are two separate papers contained within this thesis. The first is a systematic review, which aimed to assess the association of rumination with dysregulated behaviours that are often present in people with a diagnosis of BPD. These associations were specifically assessed in children and adolescents under the age of 19 years. A systematic search of three databases resulted in 30 studies being found which met all of the inclusion and exclusion criteria. These studies measured numerous types of rumination and dysregulated behaviours. The studies were assessed against a quality framework, which revealed varying levels of quality across the studies. As there were limited studies of high quality and a paucity of evidence for the different types of rumination and behaviours assessed, it was difficult to draw conclusive results from the review. Methodological issues and suggestions for future research were discussed. The second paper in this thesis is an empirical study which sought to understand how adolescents' beliefs about emotions' malleability is associated with Borderline Personality traits and cognitive emotion regulation strategies. This study tested whether adolescents in a mental health inpatient setting would increasingly use cognitive emotion regulation strategies that are generally accepted as more helpful (i.e. cognitive reappraisal) versus those viewed as unhelpful (i.e. rumination). Whilst rumination can at times be helpful, for example dwelling on past mistakes may help a person adapt and improve for similar scenarios in future, higher levels of rumination is generally considered to be more unhelpful for emotion regulation (Kring & Werner, 2004). Higher use of cognitive reappraisal on the other hand, is generally considered to be a more helpful strategy and associated with better wellbeing (Haga, Kraft & Corby, 2009). The importance of beliefs about emotions in mental health was highlighted through the results of this study. The use of virtual reality for psychoeducational purposes was shown to be beneficial for this population. Relevant literature is highlighted throughout the discussion and the limitations of the research are discussed. The information in the two chapters is supplemented by material in the appendices for purpose of examination, which includes publication guidance and documents provided to participants.
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University of Liverpool
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