Personality Disorders
Borderline personality disorder symptom interaction with poor sleep quality to predict higher levels of negative emotion: A daily diary study
Kelly V. Klein, B.S.
PhD Student in Clinical Psychology
American University
Arlington, Virginia
Alexandra D. Long, M.A.
PhD Student in Clinical Psychology
American University
Ashburn, Virginia
Haley Hunt, B.A.
Graduate Student
American University
Walton, Kentucky
Nathaniel R. Herr, Ph.D.
Associate Professor
American University
Washington, District of Columbia
Alanna Covington, Ph.D.
Clinical Psychologist
Arlington Behavior Therapy Institute
Arlington, Virginia
Kathleen C. C. Gunthert, Ph.D.
Associate Professor
American University
Washington, District of Columbia
Borderline Personality Disorder (BPD) is characterized by emotion dysregulation, in particular difficulties controlling negative emotions (i.e., anger, sadness, anxiety, and fatigue). While emotion dysregulation is intensified by physiological vulnerabilities such as poor sleep quality, the impact of poor sleep on daily levels of negative emotions among individuals with BPD has received little attention in the literature. The present study sought to evaluate whether BPD symptoms impact the relation between daily sleep quality and self-reported negative emotions.
A sample of 84 cohabitating couples (n=168) from the Washington, DC area were recruited for a three-week daily-diary study. Participants completed an overall BPD symptom measure (PAIBOR) and measures specific to identity disturbance (Borderline Identity Disturbance Self-Report; BIDS) and emotion dysregulation (Difficulties with Emotion Regulation Scale; DERS) at baseline, daily sleep quality assessment in the morning, and daily emotion assessments in the evening.
Mixed-model regression analyses, which accounted for the multi-level nature of the data (i.e., days within participants within couples) and controlled for baseline depression, revealed a significant interaction between sleep quality and overall BPD symptoms in predicting daily levels of anger, anxiety, and fatigue. For each interaction, lower sleep quality was associated with higher daily levels of negative emotions. However, this relationship was stronger for those higher in BPD symptoms as compared to those lower in BPD symptoms. Thus, participants with higher BPD symptoms showed higher increases in negative emotions on days when they reported poorer sleep quality, as compared to the increases shown by participants with fewer BPD symptoms. No significant interaction was found when examining this relationship with the sadness subscale. The same pattern of results was found when examining the DERS as the interacting variable. For the BIDS, however, the interaction with sleep quality predicted all negative emotions, including sadness.
These results further research into the relationship between physiological vulnerabilities and emotional reactivity in BPD by strengthening our understanding of the interplay between sleep quality and BPD symptoms and their impact on daily emotional functioning of those with BPD. Results provide empirical support for therapeutic efforts to improve sleep quality as a strategy for reducing high levels of negative emotions among individuals with many BPD symptoms. Specifically, this finding provides support for Dialectical Behavior Therapy’s ABC Please Skill for emotion regulation and furthers research into the relation between physiological vulnerabilities and emotional reactivity.