Affective 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 (BPD), and some patients report dissociative symptoms. The present study investigated the temporal dynamic relations between affective states and current dissociative experiences of depersonalization and derealization in daily life to test key theoretical premises of trauma models of dissociation. Patients with BPD (n = 42) or depressive disorders (n = 40), and non-clinical controls (n = 39) were assessed every 15 min for 13 hours within a single day using smartphone-based diaries. As expected, dynamic structural equation modeling results suggest the highest levels of average daily affective arousal, negative affective valence, and dissociation in the BPD group. As hypothesized, arousal and lag1 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 (ca. 15 min later). In addition, some patients with BPD reported less negative affective valence following dissociation. Our findings suggest that changes in affective state play an important role at the onset of dissociations in patients with BPD and subsequent relief from distress may explain maintenance in some individuals. We recommend that clinicians provide means to regulate affect when dealing with dissociative symptoms.