The Association between Emotions and Interpersonal Problems Among a Diverse Group of People with Cluster B Personality Disorders

Background/Purpose: Personality disorders are relatively common, with treatment and management of such individuals exceptionally challenging. Erratic unstable emotions are most characteristic of the DSM-5 Cluster-B personality disorders, with symptoms often causing significant behavioral and emotional impairments across social, occupational, and interpersonal functioning. Such functional impairment can result in repeated hospitalization, incarceration, and loss of social support resulting in considerable suffering for the affected individuals, their families and society. Improved understanding of the nature of emotion regulation problems can lead to more effective interventions with this population.

Methods: Our study was part of a larger study to develop a measure of emotion dysregulation for individuals with Cluster B personality disorders. The participants were comprised of 100 in-and-outpatients with Cluster B personality disorders recruited from a large hospital system in an eastern state. Overall, our sample had good representation across racial/ethnic groups: 34% of individuals were African American/black, 62% were white, and 4% were Hispanic or biracial. Ages ranged from 18 to 59 (Mean=36, SD=9.5).

Measures: Positive emotions (e.g. inspired, attentive) and negative emotions (e.g. anger, shame) were examined using the Positive and Negative Affect Schedule-2 (PANAS-2) with three additional items added by the authors. Interpersonal problems, such as response to other’s criticism, were measured by personality disorder subscales from the Inventory of Interpersonal Problems (IIP-PD).

Analyses: Factor analyses were conducted to explore the factor structure of each measure. After identifying the factors, summed scores of items from each factor were used to represent that construct. Subsequently, we conducted a series of multivariate linear regression models to assess associations among several emotions and interpersonal problems, controlling for racial and gender differences. The emotional symptoms (PANAS factors) were treated as predictors whereas behavioral symptoms (IIP factors) were specified as outcome variables.

Results: Results of the PANAS factor analysis revealed four factors: Positive emotions, negative emotions (non-shame/anger-related), shame, and anger. Three factors resulted from IIP factor analyses: Sensitivity to rejection, defiance and anger against authority, and aggressive thoughts or behaviors. Two IIP items (“I am too envious and jealous of other people” and “it is hard for me to trust other people”) had factor loadings less than 0.3, and were dropped.

Multivariate linear models indicated that positive emotions were negatively associated with aggression (b=-.51, t=-2.62, p<.05) and defiance against authority (b=-.68, t=-2.31, p<.05); negative emotions were positively correlated with aggression (b=.55, t=3.09, p<.001) and defiance against authority (b=.58, t=2.13, p<.05); and shame was positively correlated with aggression (b=.70, t=2.27, p<.05), controlling for racial and gender differences. Finally, whites endorsed significantly lower aggressive thoughts in comparison to blacks (b=-6.18, t=-2.66, p<.001).

Conclusion and Implications: Our results suggest positive emotions may be a protective factor buffering the effect of aggressive thoughts or behaviors; whereas negative emotions can increase risk for aggression and other interpersonal problems. Targeting emotional problems in treatment can potentially lead to improvement of behavioral symptoms. Importantly, there existed significant differences between blacks and whites in emotional expression and handling interpersonal issues, highlighting the importance of understanding racial or cultural variations of clinical symptoms.