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
diagnosis.
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
