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Vol. 46, No. 3, 2013
Issue release date: April 2013
Psychopathology 2013;46:153-162

Cognitive and Affective Dimensions of Difficulties in Emotional Functioning in Somatoform Disorders and Borderline Personality Disorder

van Dijke A. · van der Hart O. · van Son M. · Bühring M. · van der Heijden P. · Ford J.D.
aDelta Psychiatric Hospital, Poortugaal, bUtrecht University, Utrecht, and cAltrecht, Zeist, The Netherlands; dDepartment of Psychiatry, University of Connecticut School of Medicine, Farmington, Conn., USA

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Background: To study difficulties in emotional functioning in two mental disorders that have been associated with difficulties in identifying and modulating emotions: borderline personality disorder (BPD) and somatoform disorder (SoD). Sampling and Methods: In 472 psychiatric inpatients, difficulties in emotional functioning were measured using the Bermond-Vorst Alexithymia Questionnaire. Results: Profiles of difficulties in emotional functioning were identified, suggesting that patients diagnosed with BPD with or without SoD were more likely to report difficulty identifying emotions and less likely to report reduced ability to fantasize or ‘pensée opératoire' (externally oriented thinking) than patients diagnosed with SoD only and patients with mixed anxiety and affective disorders. SoD patients were more likely to report reduced ability to phantasize or pensée opératoire than difficulty identifying emotions. Patients with mixed anxiety and affective disorders were more likely to report reduced ability to experience emotions than patients diagnosed with BPD and/or SoD. Conclusions: By using a finer-grained perspective on difficulties in emotional functioning some evidence was found for the existence of cognitive-emotional profiles that may provide more clinically relevant information than alexithymia as just a unitary construct. Further research on cognitive-emotional profiles of difficulties in emotional functioning is needed to advance the understanding, diagnosis and treatment of mental disorders.

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  1. Nyklíček I, Temoshok L, Vingerhoets A (eds): Emotional Expression and Health: Advances in Theory, Assessment and Clinical Applications. New York, Brunner-Routledge, 2004.
  2. Bradley SJ: Affect Dysregulation and the Development of Psychopathology. New York, Guilford Press, 2000.
  3. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Washington, American Psychiatric Association, 2004.
  4. Ford JD, Kidd P: Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder. J Trauma Stress 1998;11:743-761.
  5. Linehan MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford Press, 1993.
  6. Ebner-Priemer UW, Badeck S, Beckmann C, Wagner A, Feige B, Weiss I, Lieb K, Bohus M: Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. J Psychiatr Res 2005;39:85-92.
  7. Waller E, Scheidt CE: Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry 2006;18:13-24.
  8. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N: Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63:757-766.
  9. Bateman A, Fonagy P: Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford, University Press, 2004.
  10. Allen JG, Fonagy P (eds): Handbook of Mentalization-Based Treatment. Chichester, Wiley, 2006.
  11. Mayou R, Kirmayer L, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 2008;162:847-855.
  12. Lumley MA, Burger N: The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess 2007;89:230-246.
  13. Taylor GJ: Recent developments with in alexithymia theory and research. Can J Psychiatry 2000;45:61-74.

    External Resources

  14. Taylor GJ: Alexithymia: 25 years of theory and research; in Nyklicek I, Vingerhoets A, Temoshok T (eds): Emotional Expression and Health. Advances in Theory, Assessment, and Clinical Applications. Hove, Brunner Routledge, 2004, pp 137-153.
  15. Deborde AS, Berthoz S, Wallier JM, Fermanian J, Falisaard B, Jeammet P, Corcos M: The Bermond-Vorst Alexithymia Questionnaire cut-off scores: a study in eating-disordered and control subjects. Psychopathology 2008;41:43-49.
  16. Van't Wout M, Van Dijke A, Aleman A, Kessels RPC, Pijpers W, Kahn RS: Fearful faces in schizophrenia: the relationship between patient characteristics and facial affect recognition. J Nerv Ment Dis 2007;195:758-764.
  17. Bermond B, Moormann PP, Albach F, Van Dijke A: Impact of severe childhood sexual abuse on the development of alexithymia in adulthood. Psychother Psychosom 2008;77:260-262.
  18. Sifneos PE: Alexithymia: past and present. Am J Psychiatry 1996;153:137-142.

    External Resources

  19. Lumley MA, Beyer J, Radcliff A: Alexithymia and physical health problems: a critique of potential pathways and a research agenda; in Vingerhoets A, Nyklicek I, Denollet J (eds): Emotion Regulation, Conceptual and Clinical Issues. New York, Springer, 2008, pp 43-68.

    External Resources

  20. Nemiah JC, Sifneos PE: Affect and fantasy in patients with psychosomatic disorders; in Hill OW (ed): Modern Trends in Psychosomatic Medicine. London, Butterworths, 1970, vol 2, pp 26-34.
  21. Bagby RM, Parker JDA, Taylor GJ: The Twenty-Item Toronto Alexithymia Scale - I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23-32.
  22. Vorst HC, Bermond B: Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire. Pers Individ Dif 2001;30:413-434.

    External Resources

  23. Bagby RM, Taylor GJ, Parker JD: The Twenty-Item Toronto Alexithymia Scale - II. Convergent, discriminant, and concurrent validity. J Psychosom Res1994;38:33-40.
  24. Taylor GJ, Bagby RM: An overview of the alexithymia construct; in Baron R, Parker JD (eds): Handbook of Emotional Intelligence. San Francisco, Jossey-Bass, 2000, pp 40-67.
  25. Luminet O, Bagby RM, Taylo GJ: An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom 2001;70:254-260.
  26. Bermond B, Vorst HC, Moormann PP: Cognitive neuropsychology of alexithymia: implications for personality typology. Cogn Neuropsychiatry 2006;11:332-360.
  27. Larsen JK, Brand N, Bermond B, Hijman R: Cognitive and emotional characteristics of alexithymia: a review of neurobioloical studies. J Psychosom Res 2003;54:533-541.
  28. Waller E, Scheidt CE: Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia. J Psychosom Res 2004;57:239-247.
  29. Van Dijke A: The clinical assessment and treatment of trauma-related self-and-affect dysregulation; in Vingerhoets A, Nyklicek I, Denollet J (eds): Emotion Regulation: Conceptual and Clinical Issues. New York, Springer, 2008, pp 150-169.

    External Resources

  30. WHO: Composite International Diagnostic Interview. Mental Health Division. Geneva, WHO, 1997.
  31. Ter Smitten MH, Smeets RM, Van den Brink W: Composite International Diagnostic Interview (CIDI), version 2.1, 12 months (in Dutch). Amsterdam, World Health Organization, 1998.
  32. Andrews G, Peters L: The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 1998;33:80-88.
  33. Arntz A: BPDSI Borderline Personality Disorder Severity Index, Dutch version IV. Maastricht, Department of Medical, Clinical and Experimental Psychology, Maastricht University, 1999.
  34. Arntz A, Van der Hoorn M, Cornelis J, Verheul R, Van den Bosch W, De Bie A: Reliability and validity of the borderline personality disorder severity index. J Pers Disord 2003;17:45-49.
  35. Van Dijke A, Ford JD, Van der Hart O, Van Son MJ, Van der Heijden PG, Bühring M: Affect dysregulation in borderline personality disorder and somatoform disorder: differentiating under- and over-regulation. J Pers Disord 2010;24:296-311.
  36. Van Dijke A, Van der Hart O, Ford JD, Van Son M, Van der Heijden P, Bühring M: Affect dysregulation and dissociation in borderline personality disorder and somatoform disorder: differentiating inhibitory and excitatory experiencing states. J Trauma Dissociation 2010;11:424-443.
  37. Taylor GK, Bagby RM, Parker JD: Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.

    External Resources

  38. Zittel Conklin C, Bradley R, Westen D: Affect regulation in borderline personality disorder. J Nerv Ment Dis 2006;194:69-77.
  39. Fonagy P, Gergely G, Jurist E, Target M: Affect Regulation, Mentalization and the Development of the Self. New York, Other Press, 2002.
  40. Van der Hart O, Nijenhuis ER, Steele K: The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York, Norton, 2006.
  41. Paivio SC, Laurent C: Empathy and emotion regulation: reprocessing memories of childhood abuse. J Clin Psychol 2001;57:213-226.
  42. Ogden P, Minton K, Pain C: Trauma and the Body: A Sensimotor Approach to Psychotherapy. New York, Norton, 2006.
  43. Van Dijke A, Ford JD, Van der Hart O, Van Son MJ, Van der Heijden PG, Bühring M: Childhood traumatization by primary caretaker and affect dysregulation in patients with borderline personality disorder and/or somatoform disorder. Eur J Psychotraumatol 2011;2:5628.
  44. Van Dijke A, Ford JD, Van der Hart O, Van Son MJ, Van der Heijden PG, Bühring M: Complex posttraumatic stress disorder in patients with borderline personality disorder and somatoform disorders. Psychol Trauma, accepted.
  45. Moormann PP, Bermond B, Albach F, Van Dorp I: The etiology of alexithymia from the perspective of childhood sexual abuse; in Vingerhoets A, Van Bussel F, Boelhouwer A (eds): The Non-Expression of Emotions in Health and Disease. Tilburg, Tilburg University Press, 1997, pp 139-153.
  46. De Gucht V, Heiser W: Alexithymia and somatization: a quantitative review of the literature. J Psychosom Res 2003;54:425-434.
  47. Ekman P: Emotions Revealed. Recognizing Face and Feelings to Improve Communication and Emotional Life. New York, Times Books Henry Holt, 2003.
  48. Van Dijke: Dysfunctional Affect Regulation in Borderline Personality Disorder and Somatoform Disorders. Utrecht, Utrecht University, 2011.
  49. Lane RD, Schwartz GE: Levels of emotional awareness: a cognitive developmental theory and its application to psychopathology. Am J Psychiatry 1987;144:133-143.

    External Resources

  50. Clayton K: The interrelatedness of disconnection: the relationship between dissociative tendencies and alexithymia. J Trauma Dissociation 2004;5:77-101.

    External Resources

  51. Van der Hart O, Nijenhuis E, Steele K, Brown D: Trauma-related dissociation: conceptual clarity lost and found. Aust NZ J Psychiatry 2004;38:906-914.
  52. Domes G, Czieschnek D, Weidler F, Berger C, Fast K, Herpertz SC: Recognition of facial affect in borderline personality disorder. J Pers Disord 2008;22:135-147.
  53. Solomon MF, Siegel DJ: Healing Trauma: Attachment, Mind, Body, and the Brain. New York, Basic Books, 2003.
  54. Greenberg L, Borger L: An emotion-focused approach to the over-regulation of emotion and emotional pain. J Clin Psychol 2001;57:197-211.
  55. McCullough L, Kuhn N, Andrews S, Kaplan A, Wolf J, Hurley CL: Treating Affect Phobia: A Manual for Short-Term Dynamic Psychotherapy. New York, Guilford Press, 2003.

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