A Trans-Diagnostic Comparison of Emotion Dysregulation in Mental Health: Implications for NIMH Research Domain Criteria

Background and purpose:  The regulation of emotion is central to mental health and hypothesized to be a trans-diagnostic target for promoting recovery from mental illness, yet few cross-diagnostic studies have been conducted showing the relevance of this construct to people with a range of different psychiatric disabilities.  Schizophrenia and severe personality disorders in the DSM-5 Cluster B grouping are serious and persistent mental disorders that are remarkably distinct, but may be commonly characterized by significant impairments in the regulation of emotion. Understanding the shared role of emotion dysregulation across these conditions has important implications for the National Institute of Mental Health Research Domain Criteria (RDoC) initiative by identifying a common construct that can potentially unify treatment targets across a large number of mental disorders.  Employing an original psychometrically sound brief measure of emotion dysregulation, this study compared samples of individuals with schizophrenia, Cluster-B personality disorders and healthy volunteers on individual criteria and overall scores, hypothesizing that both clinical groups would demonstrate clinically meaningful impairments relative to the control group, with individuals with personality disorders evidencing the most elevated ratings.

Method:  A total of 62 individuals with schizophrenia or schizoaffective disorder, 99 individuals with a Cluster B personality disorder, and 302 healthy volunteers were recruited from outpatient services, inpatient services, community centers and a large university in the greater Pittsburgh area.  All participants completed the General Emotion Dysregulation Measure. A series of general linear models adjusting for between-group demographic differences were used to conduct cross-diagnostic comparisons in emotion dysregulation among individuals with schizophrenia, personality disorder, and healthy volunteers.

Results: The three groups were significantly different in terms of average age, race and gender. The three groups also evidenced significant differences across total GEDM scores and the majority of the individual scale items (p<.001) with healthy controls having the lowest GEDM scores (average=2.70/5), and the two clinical groups scoring significantly higher (schizophrenia average=3.19/5; personality disorders average=4.27/5) thus supporting our main hypothesis. Scores on the GEDM also evidenced racial differences with non-white subjects in the clinical groups scoring higher on the GEDM than white subjects.

Conclusions and implications:  Individuals with schizophrenia and those who meet criteria for Cluster-B personality disorders commonly evidence substantial problems with emotion regulation, despite their categorical differences in the diagnostic nomenclature. These findings support emotion dysregulation as a key therapeutic domain in NIMH RDoC.  Social workers are the primary providers of psychosocial treatment to individuals with serious mental illness and excel at providing the types of psychosocial treatments shown effective in targeting emotion regulation problems. For schizophrenia, cognitive enhancement therapy supplemented with emotion regulation and distress tolerance skill training is recommended and, for individuals with Cluster-B personality disorders, cognitive behavioral therapies such as dialectical behavior therapy, which targets emotion regulation problems, can help. The development of a unifying emotion regulation approach that can be widely applied across mental disorders is greatly needed.  Such treatments can improve psychosocial functioning and recovery in the community, potentially relieving burden for the clients, their families, psychiatric emergency and inpatient care, and their communities.