© Williams & Wilkins 1997. All Rights Reserved. Volume 185(4), April 1997, pp 240-246
Emotion Processing in Borderline Personality
University of Toronto Psychiatric Service and Department of Psychiatry,
University of Toronto.
Faculty of Social Work and Department of Psychiatry, University of
The Hospital for Sick Children and Clarke Institute of Psychiatry, Toronto.
Send reprint requests to Dr. Deborah Levine, University of Toronto
Psychiatric Service, 214 College Street, Toronto, Ontario, M5T 2Z9, Canada.
The first author acknowledges the support and encouragement of Dr.
David Dixon and Dr. Faye Mishna in the preparation of this article.
The aim of this study was to examine the ways in which adults with borderline personality
disorder (BPD) experience and manage their feelings. Responses of 30 subjects who met the
criteria for BPD on the Structured Clinical Interview for DSM-III-R were compared with 40 non-BPD
controls on the following measures of emotion processing and affect regulation: 1) level of
emotional awareness, 2) capacity to coordinate mixed valence feelings, 3) accuracy at identifying
facial expressions of emotion, and 4) intensity of response to negative emotions. The results
showed significant differences between the two groups on all measures. The borderlines showed
significantly lower levels of emotional awareness, less capacity to coordinate mixed valence
feelings, lower accuracy at recognizing facial expressions of emotion, and more intense responses
to negative emotions than the nonborderline controls. The findings corroborate clinical observations
of borderline patients' difficulties in regulating emotions. The implications of the results for the
therapeutic management of BPD patients are discussed.
Patients with borderline personality disorder (BPD) experience significant problems in managing
their emotions, especially anxiety and anger. They also exhibit problems identifying their own and
others' emotions. It is believed that BPD patients' propensity for impulsive self-destructive behavior
is associated with the failure to adequately process information about experienced emotions
and Heard, 1992; Westen, 1991)
Patients with borderline personality disorder demonstrate little “affect tolerance,” which is
thought to be associated with an impaired capacity to absorb the information that emotions
provide. They have particular difficulty in differentiating mixed valenced feelings. Clinical
observation indicates that BPD patients frequently experience affects as “doomsday signals” that
are overwhelming and provoke a sense of impending disaster
(Krystal, 1974). These problems in
emotion processing precipitate a state of heightened anxiety that appears out of control and
(Hartocollis, 1977). Projection and splitting, the defensive responses typical of BPD patients,
are marshalled to contain the anxiety, but compromise their capacity to acknowledge and integrate
contradictory affective states
(Gunderson, 1984).
These clinical hypotheses about borderline patients' difficulties with processing emotions are
reflected in the DSM III-R criteria for the BPD diagnosis: intense anger, affective instability, and
chronic emptiness. Similarly, the criteria of impulsivity, self-harm, and intolerance of being alone
can be viewed as maladaptive responses to intolerable emotions
(Marziali and Munroe-Blum, 1990).
Westen (1991) suggests that affect dysregulation underlies most of the diagnostic criteria for the BPD
Studies of adults' capacities for processing and regulating emotions have focused on three
areas. Psychiatric populations have been compared with normals in their capacity to recognize
facial expressions of basic emotions
(Feinberg, et al., 1986; Walker, et al., 1984). Studies of emotion
recognition with schizophrenic subjects have yielded contradictory results. Although some studies
have shown that schizophrenic patients are less accurate than depressed patients in recognizing
and labeling facial expressions
(Borod et al., 1990), others have shown no difference between these
two groups
(Zuroff and Colussy, 1986). A second focus of study has compared psychiatric patients with
normals with regard to the expression of emotion.
(Jaeger et al. (1986) found that, compared with
nondepressed controls, depressed patients were more limited in their ability to accurately produce
facial expressions of affect. They produced more intense expressions of sadness and less intense
expressions of positive feelings.
Levin et al. (1985) examined accuracy of perception of verbal and
nonverbal expressions of emotions in schizophrenic, depressed, and normal subjects. Although all
three groups were similar in their accurate perception of verbally expressed emotions, depressed
subjects showed the greatest discrepancy between intended and communicated emotion. A third
focus of study has examined the intensity with which emotions are perceived and experienced
(Larsen and Diener, 1987). The findings suggest that adult subjects who show large emotional
fluctuations, such as those at risk for cyclothymia and bipolar affective disorders, showed greater
affect intensity. In summary, studies of emotion processing in cohorts of psychiatric patients have
targeted primarily subjects with diagnoses of schizophrenia or affective disorders. Responses to
measures of emotion regulation of patients with severe personality disorders, in particular
borderline patients, are unknown.
Emotions are integral to adaptive human functioning. The experiencing and expression of
emotions occur within an interpersonal matrix
(Campos and Barret, 1984). Thus, developmentally,
emotions play important roles in organizing schema that govern expectations about self and others
(Emde, 1983). According to psychoanalytic theory, emotional development is related to the ability to
form and sustain a solid sense of self that is distinct from others
(Noy, 1982). Images of self and
others are contained in cognitive-affective structures or representations that have intrapersonal
meanings but are formed by interpersonal experiences. In normative development, representations
of self in relation to others evolve from global and undifferentiated depictions of the
infant-caretaker pair to increasingly differentiated, integrated, and complex representations of a
cohort of significant others
(Blatt and Lerner, 1983). The ability to differentiate feelings within the
context of self-other representations is associated with the capacity to tolerate and manage a full
range of emotional states
(Krystal, 1974).
Empirical evidence suggests that during development there are parallels between cognitive
maturation and stages at which certain emotions are understood and processed interpersonally
(Donaldson and Westerman, 1986; Gnepp et al., 1987). Initially, emotions are organized as external to the
self. Before age five, children describe emotions as located outside of self; for example, happiness
resides in a favority toy. With cognitive maturation, children describe emotions as internal, and
they perceive emotions in increasingly complex ways. For example, feelings can be acknowledged,
differentiated, withheld, and controlled
(Gnepp and Hess, 1986). During latency children begin to
demonstrate the ability to process mixed emotions
(Harter and Buddin, 1987).
Developmental hypotheses about the precursors of borderline patients' problems with emotion
regulation can be inferred from studies of children's capacities for recognizing and processing
emotions. The few studies with disturbed children show developmental delays in the capacity to
identify and manage emotions
(Camras et al., 1983; Reichenbach and Masters, 1983). However, there are
no studies of emotion processing in patients with BPD, despite the fact that clinical problems with
affect regulation figure prominently in adults with the borderline diagnosis.
The aim of the reported study was to examine emotion recognition and processing in a cohort
of BPD patients. Their responses to a series of measures of emotions were compared with a group
of nonborderline subjects. Four dimensions of emotion processing were included: 1) the ability to
differentiate feelings, 2) the capacity to coordinate mixed valence feelings, 3) the accuracy at
recognizing facial emotions, and 4) the intensity of affective experience. It was hypothesized that
when compared with the control group, the BPD patients would exhibit lower capacity for
processing emotions on all four dimensions.
Study Subjects
Clinically diagnosed BPD patients were referred from the outpatient departments of a
psychiatric hospital, a mental health clinic, and private psychotherapists. Thiry-eight subjects with
the clinical diagnosis of BPD were screened for the diagnosis with the use of the structured clinical
interview for DSM-III-R (SCID, Axis II;
Spitzer, et al., 1989), which was administered by an
interviewer trained to reliably use this instrument. Thirty subjects met the SCID criteria for BPD. To
ensure a balance that reflects the incidence of the BPD disorder by gender, 20 of the BPD subjects
were female and 10 were male. The nonpsychiatric comparison group of subjects were obtained
through advertisements posted in a general hospital. To control for the effects of age and
education, the comparison subjects were matched to the borderline sample on age and educational
level. The nonborderline group was split evenly by gender. The control subjects were also screened
on the SCID-Axis II and none met the criteria for BPD. Informed consent was obtained from all
subjects. Subjects were paid a small stipend for their participation in the study.
Measures of Emotion Processing
There are few measures of emotion processing that have been tested on adult populations.
Thus, the measures chosen have been primarily tested on younger nonpsychiatric populations.
Where necessary, a measure was adapted for use in the study.
The levels of emotion awareness scale (LEAS)
4 captures the respondents' ability to differentiate
emotions in self and others. Twenty vignettes of two-person situations elicit four emotions: anger,
fear, happiness, and sadness. Subjects' responses are tape recorded, transcribed, and scored.
Scores of each vignette are assigned according to five levels of complexity, ranging from no
awareness of emotion to awareness of discrete, multiple emotions, e.g., “he feels disappointed and
relieved.” In addition to a total score, three subscale items are estimated for this study to capture
the nuances of emotional awareness: 1) “self” scale, estimates awareness of one's own feelings, 2)
“other” scale, estimates awareness of others' feelings, and 3) “empathy” scale,
5 distinguishes
complex feelings of self from those of others. Previous testing on undergraduate students showed
good inter-rater reliability (intra-class R.84) and internal consistency (Cronbach's alpha.81), as well
as construct validity when correlated with scores on Loevinger's (Loevinger and Wessler, 1970) sentense
completion test (a measure of ego function;
Lane et al., 1990). Two rates were trained by manual to
score the LEAS by using responses of nonstudy subjects to the LEAS. Cohen's Kappa coefficients
showed high between rater reliability: self-scale.93; other scale.91; empathy scale.93.
The ambivalence questionnaire (AMBQ)
6 was originally designed to tap children's capacities to
coordinate mixed emotions and mixed trait descriptions of others, that is, ambivalent responses.
Norms for grade school and university students indicate that the capacity for mixed emotions
increases significantly with maturation. Testing on subjects from grade school through university
showed good internal consistency (Cronbach's alpha.80)
7 and interrater reliability on the free
response item (weighted Cohen's Kappa coefficients ranged from.83 to.91). For the present study,
the researchers adapted this measure by changing the venue of questions from child/adolescent
situations to an adult employment situation. In addition, the range of single and multiple emotion
responses was expanded. For instance, an item that describes receiving praise from a teacher in
front of friends was transformed to receiving praise from an employer in front of colleagues. In
order to tap a wider range of single and multiple feelings, the choices “angry” and “jealous and
angry” were added to the respondents' choices for how the colleague would feel. On the “free
response” question of the AMBQ, the subjects are asked to describe in three words a particular
character presented in a vignette. Responses are coded as positive (e.g., “good friend, honest,
truthful”), negative (e.g., “irresponsible, dishonest and unworthy”) or mixed (e.g., “careless,
honest, irresponsible”). Two raters were trained to code the responses. High interrater reliability
was achieved (Cohen's Kappa coefficient.88).
The pictures of facial affect (PFA;
Ekman and Friesen, 1984) tests the ability to recognize emotions
from facial expressions. Twenty-one photographs of male and female subjects display six basic
emotions-anger, disgust, fear, happiness, sadness, surprise, and neutral expressions. These
pictures are presented randomly to subjects who are asked to select, on a prepared answer sheet,
the word that best described the expression in the photograph. Responses are scored for total
accuracy of recognition (number of errors) and for accuracy on each specific emotion category
(distribution of errors within each emotion category). As such, subscale analyses on each emotion
were performed for this study. Reliability (kappas on 180 photographs significant beyond p <.01
level) and validity have been supported through replications of findings with normative populations
across 10 different cultures
(Ekman et al., 1987). Feinberg et al. (1986) found this measure to distinguish
schizophrenic patients from normal subjects in the capacity to recognize facial emotion.
The affect intensity measure (AIM;
Larsen and Diener, 1987) assesses the intensity with which
feelings are experienced. Intensity is defined as strength of response and is distinct from frequency
of response. Respondents rate, on a six-point scale, the strength of their reactions to 40 ordinary
life events. Items include manifestations of reactions such as bodily responses and subjective
experiences. The measure was tested on a nonpsychiatric adult population. Test-retest reliability at
intervals of 3 months and 2 years was.81 and.75, respectively. Concurrent and construct validity of
the AIM have been established. In normative populations, the AIM correlated significantly (R =.61,
p <.01) with a measure of average daily affect intensity and (R =.33, p <.05) with a measure that
identifies people at risk for developing cyclothymia and bipolar affective disorders
(Larsen and Diener,
. For this study, a negative emotions score (AIMNEG) was estimated from the negative feeling
items, and a positive emotions score (AIMPOS) was estimated from the positive feeling items.
Demographic Variables
For the entire cohort, the age range was 23 to 56 years (mean ± SD, 37.55 ± 7.81 years).
Education level included high school or less (level I), education beyond high school but not beyond
university (level II), and postgraduate education (level III). There was a significantly higher
frequency of single and divorced subjects in the borderline group (X
=6.04, p <.05), which is
consistent with previous findings
(Swartz et al., 1990). The borderline group had more treatment
contact, including hospitalizations, than the controls. Seventeen borderline subjects (14 women, 3
men) had previous or current therapeutic contact, defined as at least 6 consecutive months of
group or individual therapy. None of the control subjects had any hospitalizations for a mental
disorder. Twelve control subjects (six women and six men) had been previously or were currently
in therapy. Fourteen BPD subjects (nine women, five men) were unemployed, whereas none of the
control subjects were unemployed.
Correlation of Four Measures of Emotion Processing
An intercorrelational matrix was computed for the four measures of emotion processing with
the use of the responses of the entire cohort. Only the correlation between the AMBQ and the LEAS
indicated a moderate degree of overlap between measures (R[68]=.55, p <.01). The other
correlation coefficients were either nonsignificant or of a low magnitude (i.e., <.30), suggesting
that each measure is capturing different elements of emotion processing. Nevertheless, group
differences on these four measures were analyzed using a multivariate model.
Demographic Variables and Emotion Processing
For the total cohort, correlations between age and education level and each measure's total
score were computed to address potential factors that might affect subject response. Subjects' age
was not found to be significantly correlated with any of the measures of emotion. However, level of
education correlated significantly with the LEAS (R[68]=.33, p <.01) and with the AIMNEG (R[68]=
-.31, p <.01) and was therefore entered as a covariate into subsequent analyses.
Measures of Emotion Processing
The measures were analyzed using a two-way multivariate analysis of covariance (MANCOVA),
with group and gender as between-subjects factors, covarying for education. The main effect for
group (BPD versus non-BPD) was significant (F[1,65] = 23.58, p <.001). Univariate F-tests showed
that the two groups differed significantly on all four measures of emotion processing
(Table 1). On
the LEAS, the BPD group showed lower levels of emotional awareness than did the control group
(F[1,65] = 77.19, p <.001). The BPD group showed significantly fewer mixed valence responses
than did the control group on the AMBQ (F[1,65] = 21.38, p <.001). The BPD group was
significantly less accurate than the control group at recognizing facial expressions of emotions on
the PFA (F[1,65] = 17.96, p <.001). On the AIM, the BPD group showed significantly greater
intensity of negative emotions than did controls (F[1,65] = 15.03, p <.001) but did not differ from
controls for intensity of positive emotions. There was also a significant main effect for gender
(F[1,65] = 2.44, p <.04); univariate F-tests showed that females obtained higher scores than
males on the LEAS (F[1,65] = 7.21, p <.01) and the AMBQ (F[1,65] = 5.51, p <.02). The group by
gender interaction was not significant.
TABLE 1 Significant Group Differences on Measures of Emotion Processing
LEAS and PFA Subscales
Group differences on the subscales of the LEAS and the PFA were also examined. Owing to
heterogeneity of variance, group differences on the LEAS self subscale measuring awareness of
one's own emotions were analyzed with the use of a Kruskal-Wallis one-way analysis of variance.
The overall analysis was significant ([chi]
= 28.37, df = 3, p <.001). Posthoc Mann-Whitney
U-tests revealed that the BPD group showed lower levels of awareness of their own emotions
compared with the control group (z = 5.05, p <.001).
Results of a one-way analysis of covariance (controlling for education) on the LEAS subscale
measuring awareness of others' emotions revealed significant main effects for group and gender
but no group by gender interaction. The BPD group showed lower levels of awareness of others'
emotions when compared with the control group (F[1,65] = 78.49, p <.001). Females exhibited
higher levels of awareness of others' emotions than did males (F[1,65] = 4.61, p <.05).
The empathy subscale of the LEAS examines presence or absence of empathic responses.
Group differences were therefore analyzed with the use of chi-square, because the empathy scale
yields categorical data. The results showed that control subjects had a significantly higher
frequency of empathic responses when compared with the BPD subjects ([chi]
= 9.65, df = 1, p
A multivariate analysis of variance (MANOVA) was performed to examine for group differences
on the various emotions elicited by the PFA. There were significant main effects for group (F[7,60]
= 3.69, p <.002) and gender (F[7,60] = 2.12, p <.05) but no group by gender interaction. BPD
subjects were less accurate than controls at recognizing facial expressions of three emotions: anger
(F[1,66] = 11.02, p <.001); fear (F[1,66] = 7.15, p <.01); and disgust (F[1,66] = 7.81, p <.01).
In addition, females made fewer errors in recognizing the facial expression of fear than did males
(F[1,65] = 5.96, p <.05).
The study results showed that BPD subjects differ from non-BPD subjects in their capacities for
processing four dimensions of emotions: emotion differentiation in self and others, ambivalence,
facial expression of emotion, and affect intensity. The prevalent pattern was one that confirms the
difficulties that BPD patients experience in recognizing, differentiating, and integrating emotions. In
addition, their responses to negative emotions were more intense.
The results suggest that BPD patients, when compared with nonborderline control subjects,
have more limited capacities for processing emotional information related to self and others,
including conflicted and ambiguous emotional states. The findings are consistent with clinical
descriptions of the nature of BPD patients' affect dysregulation. Clinical observations characterize
borderlines as lacking in the ability to discriminate feelings
(Noy, 1982) as shifting between opposing
views of themselves and others
(Kroll, 1988) and as being overwhelmed by intense negative affects
(Gunderson, 1984). BPD patients' affects are frequently managed through impulsive actions, including
self-harm. When emotions remain unprocessed, they exist as global, undifferentiated affective
states. The meanings of discrete emotions are ignored, which results in an inability to translate
feelings into appropriate behavioral responses. This paradigm for describing the discontinuity
between emotion regulation and behavior may well apply to BPD. If this is so, an essential aspect
of treatment of BPD patients would be the inclusion of strategies that focus on understanding the
associations between experienced affective states and specific behaviors, especially self/other
destructive behaviors
(Waldinger and Gunderson, 1987).
The findings that BPDs show impairments in accuracy at recognizing negative emotions along
with the findings that they experience negative emotions more intensely than positive emotions are
also consistent with the BPD clinical picture. Recognition of facial emotion is a task that requires
accurate decoding of others' affective cues, whereas intensity is a dimension of subjective
experience. BPD difficulties in recognizing others' facial emotions may be related to cognitive
distortions that are precipitated by overwhelming negative affective states
(Kroll, 1988). When
confronted with facial affect, BPDs may form only a global impression rather than an accurate
picture of the visual emotional stimulus.
Although previous studies have not explored the various dimensions of emotion processing in
borderline adults, studies that examined BPD patients' abilities to differentiate a sense of self from
perceptions of others
(Marziali and Oleniuk, 1990; Westen, et al., 1990) found that BPD patients generally
showed lower conceptual levels of self-object differentiation. In a similar fashion, the findings of the
present study may support developmental hypotheses about BPD subjects that reflect delayed or
developmentally lower capacities for processing four dimensions of emotions, capacities necessary
for stable self-object differentiation. Also consistent with other studies was the finding that showed
BPD subjects' intense reactions to negative emotions. For example,
Richman and Sokolove (1992) and
Stuart et al. (1990) found that BPD patients' self-other representations were marked by a more
negative or malevolent affect tone. The finding of gender differences in this study was neither
expected nor surprising, given the equivocal results regarding the effect of gender on emotion
(Mufson and Nowicki, 1991; Parker, et al., 1993).
The major limitation of the study was the selection of 1 of 11 Axis II personality disorders
American Psychiatric Association, 1987). Clearly, patients with personality disorders other
than BPD would be expected to show problems in processing emotions. For example, differences in
emotion processing might vary across the three clusters of Axis II personality disorders, whereas
diagnostic groups within each cluster may be similar in their patterned ways of processing
emotions. Also, there exists the potentially confounding effects of comorbid Axis I disorders, as
only a diagnosis of schizophrenia was specifically excluded. In particular, BPD patients' responses
to the emotion measures could not be distinguished with regard to the presence or absence of a
concomitant mood disorder. Finally, although DSM-III-R criteria were used, the difference between
(American Psychiatric Association, 1994) criteria for BPD is of minimal significance
to the study. The DSM-IV includes an additional criterion, “transient, stress-related paranoid
ideation or severe dissociative symptoms” (p. 281), but all other DSM-III-R criteria for the BPD
have been retained; thus, consistency in assigning the diagnosis is expected.
In summary, the results of this study demonstrate that adult subjects with severe personality
problems such as borderline personality disorder are impaired in their capacities for processing
emotions. Thus, the assessment and diagnosis of the borderline disorder would be enhanced by
carefully examining each patient's capacity for recognizing and managing a broad spectrum of
emotions. Similarly, the study findings confirm therapists' observations of BPD patients'
within-treatment misperceptions of emotions, both their own and the therapists'. Each measure
used in the study targets a different facet of emotion recognition and processing. The dimensions
included in the measures in this study (emotion differentiation, ambivalence, emotion intensity, and
facial expression of emotion) provide operational definitions of forms of emotion processing that are
useful for observing and interpreting BPD patients' responses within the context of psychotherapy.
Therefore, the dimensions and subscales within each measure are potentially useful for identifying
specific emotions that precipitate confusion and heightened anxiety for the BPD patient.
Quinlan DM, Lane RD, Schwartz, GE (1988). The levels of emotional awareness scale and
guidelines for scoring. Unpublished manuscript.
[Context Link]
Grayson J (1990) Levels of affect differentiation: Application of affect theory to chronic
somatizers, podiatry students and psychology students. (Doctoral dissertation, California School of
Professional Psychology, 1990).
[Context Link]
Westen D, Gaborit M (1989). Children's understanding of ambivalence. Unpublished
[Context Link]
M Gaborit, personal communication, 1992. [Context Link]
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders (3rd. rev ed).
Washington, D.C.: Author.
[Context Link]
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (4th ed).
Washington, D.C.: Author.
[Context Link]
Blatt S, Lerner H (1983) The psychological assessment of object representations. J Pers Asses 47:7-28.
[Context Link]
Borod J, Welkowitz J, Alpert M, Brozgold A, Martin C, Peselow E, Diller L (1990) Parameters of emotion
processing in neuropsychiatric disorders: Conceptual issues and a battery of tests. J Communication Disord
[Context Link]
Campos J, Barrett K (1984) Towards an understanding of emotions and their development. In C Izard, J
Kagan, R Zajonc (Eds), Emotions, cognition and behaviour. Cambridge: Cambridge University Press.
Camras L, Grow J, Ribordy S (1983) Recognition of emotional expression by abused children. J Clin Child
Psych 12:325-328.
[Context Link]
Donaldson SK, Westerman MA (1986) Development of children's understanding of ambivalence and causal
theories of emotion. Devel Psychol 22:655-662.
[Context Link]
Ekman P, Friesen W (1984) Unmasking the face. Palo Alto: Consulting Psychologists Press.
[Context Link]
Ekman P, Friesen W, O'Sullivan M, Chan A, Diacoyanni-Tarlatzis I, Heider K, Krause R, Lecompte W, Pitcairn
T, Ricci-Bitti P, Scherer K, Tomita M, Tzavaras A (1987) Universals and cultural differences in the
judgements of facial expressions of emotion. J Pers Soc Psychol 53:712-717.
[Context Link]
Emde R (1983) The pre-representational self and its affective core. Psychoanal Study Child 38:165-192.
[Context Link]
Feinberg T, Rifkin A, Schaffer C, Walker E (1986) Facial discrimination and emotional recognition in
schizophrenia and affective disorders. Arch Gen Psychiatry 43:276-279.
Bibliographic Links [Context Link]
Gnepp J, Hess D (1986) Children's understanding of verbal and facial display rules. Devel Psychol
[Context Link]
Gnepp J, McKee E, Domanic J (1987) Children's use of situational information to infer emotion:
Understanding emotionally equivocal situations. Devel Psychol 23:114-123.
[Context Link]
Gunderson JG (1984) Borderline personality disorder. Washington, D.C.: American Psychiatric Association
[Context Link]
Harter S, Buddin B (1987) Children's understanding of the simultaneity of two emotions: A five-stage
developmental acquisition sequence. Devel Psychol 23:388-399.
[Context Link]
Hartocollis P (1977) Affects in borderline disorders. In P Hartocollis (Ed), Borderline Personality Disorders.
New York: International Universities Press.
[Context Link]
Jaeger J, Borod J, Peselow E (1986) Facial expressions of positive and negative emotions in patients with
unipolar depression. J Affective Disord 11:43-50.
[Context Link]
Kroll J (1988) The challenge of the borderline patient. New York: W.W. Norton and Company. [Context Link]
Krystal H (1974) The genetic development of affects and affect regression. Annu Psychoanal II:98-126.
[Context Link]
Krystal H (1975) Affect tolerance. Annu Psychoanal III. New York: International Universities Press.
Lane RD, Quinlan DM, Schwartz GE, Walker PA, Zeitlin SB (1990) The levels of emotional awareness scale:
A cognitive-developmental measure of emotion. J Pers Assess 55:124-134.
Bibliographic Links [Context Link]
Larsen R, Diener E (1987) Affect intensity as an individual difference characteristic: A review. J Res Pers
Bibliographic Links [Context Link]
Levin S, Hall J, Knight R, Alpert M (1985) Verbal and nonverbal expression of affect in speech of
schizophrenic and depressed patients. J Abnorm Psychol 94:487-497.
Full Text Bibliographic Links
[Context Link]
Linehan M, Heard H (1992) Dialectical behaviour therapy for borderline personality disorder. In J Clarkin, E
Marziali, H Munroe-Blum (Eds), Borderline personality disorder: Clinical and empirical perspectives. New
York: Guilford Press.
[Context Link]
Loevinger J, Wessler R (1970) Measuring Ego Development. Volume 1: Construction and Use of a Sentence
Completion Test. San Francisco: Jossey Bass.
[Context Link]
Marziali E, Munroe-Blum H (1990) Interpersonal factors in borderline pathology. In P Links (Ed), Family
Environment and the borderline personality disorder. Washington, D.C.: American Psychiatric Association
[Context Link]
Marziali E, Oleniuk J (1990) Object representations in descriptions of significant others: A methodological
study. J Pers Assess 54:105-115.
Bibliographic Links [Context Link]
Mufson L, Nowicki S Jr (1991) Factors affecting the accuracy of facial recognition. J Soc Psychol
Bibliographic Links [Context Link]
Noy P (1982) A revision of the psychoanalytic theory of affect. Annual Psychoanal X:139-186. [Context Link]
Parker JD, Taylor GJ, Bagby RM (1993) Alexithymia and the recognition of facial expressions of emotion.
Psychother and Psychosomatics 59:197-202.
[Context Link]
Reichenbach L, Masters J (1983) Children's use of expressive and contextual cues in judgments of emotion.
Child Devel 54:993-1004.
[Context Link]
Richman NE, Sokolove RL (1992) The experience of aloneness, object representation and evocative memory
in borderline and neurotic patients. Psychoanal Psychol 9:77-91.
[Context Link]
Spitzer RL, Williams JB, Gibbon M, First MB (1989) Instruction manual for the structured clinical interview
for DSM-III-R (SCID, 6/1/89, Revision). New York: Biometrics Research Department.
[Context Link]
Stuart J, Westen D, Lohr N, Benjamin J, Becker S, Vorus N, Silk K (1990) Object relations in borderlines,
depressives, and normals: An examination of human responses on the Rorschach. J Pers Assess
Bibliographic Links [Context Link]
Swartz M, Blazer D, George L, Winfield I (1990) Estimating the prevalence of borderline personality disorder
in the community. J Pers Disord 4:257-272.
[Context Link]
Waldinger RJ, Gunderson JG (1987) Effective psychotherapy with borderline patients. New York: MacMillan.
[Context Link]
Walker E, McGuire M, Bettes B (1984) Recognition and identification of facial stimuli by schizophrenics and
patients with affective disorders. Br J Clin Psychol 23:37-44.
Bibliographic Links [Context Link]
Westen, D (1991) Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline
personality disorders. Clin Psychol Rev 11:211-230.
Full Text Bibliographic Links [Context Link]
Westen D, Lohr N, Silk K, Gold L, Kerber K (1990) Object relations and social cognition in borderlines, major
depressives and normals: A thematic apperception test analysis. Psychol Assess: J Consult Clin Psychol
[Context Link]
Zuroff DC, Colusssy SA (1986) Emotion recognition in schizophrenic and depressed patients. J Clin Psychol
Bibliographic Links [Context Link]
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