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Exploring the Roles of Trauma, Emotion Dysregulation, and Negative Affect In Title Page Exploring the Roles of Trauma, Emotion Dysregulation, and Negative Affect in Borderline Personality Disorder Symptoms among Young Women by Yan Yuan, MSW, LCSW Bachelor of Arts, Nanjing University, 2008 Master of Social Work, School of Social Policy and Practice, University of Pennsylvania, 2010 Submitted to the Graduate Faculty of the School of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2020 ii Committee Membership Page UNIVERSITY OF PITTSBURGH SCHOOL OF SOCIAL WORK This dissertation was presented by Yan Yuan It was defended on August 12, 2020 and approved by Christina Newhill, Ph.D., Professor, School of Social Work, University of Pittsburgh Shaun Eack, Ph.D., Professor, School of Social Work and Psychiatry, University of Pittsburgh Rachel Fusco, Ph.D., Associate Professor, School of Social Work, University of Georgia Lori Scott, Ph.D., Assistant Professor of Psychiatry, University of Pittsburgh Dissertation Director (Chair): Christina Newhill, Ph.D., Professor, School of Social Work, University of Pittsburgh iii Copyright © by Yan Yuan 2020 iv Exploring the Roles of Trauma, Emotion Dysregulation, and Negative Affect in Borderline Personality Disorder Symptoms among Young Women Yan Yuan, MSW, LCSW University of Pittsburgh, 2020 Abstract By analyzing repeated measures data through advanced statistical methods, this study investigates the critical roles of trauma, emotion dysregulation and negative affect (NA) in terms of influencing borderline personality disorder (BPD) features among a group of urban city young women. Our results evidence significant connections between distinct trauma types and NA aspects, as well as a decline of NA and BPD features during emerging adulthood. Implications from our findings extended prior explorations by showing that several distinct NA-related forms of ED, such as proneness to anger expression, shame, and guilt, may serve as critical channels driving the significant link between emotional abuse and BPD symptoms. More importantly, our findings would potentially lead to novel trauma-informed treatments effectively targeting multiple ED forms among people with BPD. Finally, we contribute critical new information to the nascent topic area on emerging adulthood. v Table of Contents 1.0 Introduction ............................................................................................................................. 1 1.1 Statement of the Problem and the Importance of the Study ...................................... 2 1.2 Definitions (Key Terms and Variables) ........................................................................ 3 1.2.1 Conceptualizations of BPD and the Etiological Factors ...................................3 1.2.2 Trauma in Relation to BPD Development .........................................................7 1.2.3 Emotion Dysregulation & Negative Affect ........................................................9 1.3 Theoretical Foundations of the Study ......................................................................... 11 1.3.1 Biosocial Theory .................................................................................................11 1.3.2 Attachment Theory ............................................................................................15 1.3.3 Trauma Theory ..................................................................................................18 1.3.4 Synthesis ..............................................................................................................23 1.4 Statement of the Purpose ............................................................................................. 24 1.4.1 Study Aims ..........................................................................................................25 2.0 Literature Review ................................................................................................................. 29 2.1 Overview of the Problem ............................................................................................. 29 2.1.1 Basic Demographics ...........................................................................................29 2.1.2 Variation in BPD Symptomatology .................................................................29 2.1.3 Previously Studied Etiological Factors ............................................................30 2.2 Prior Research in Relation to BPD Etiology .............................................................. 38 2.2.1 Prior Research in Relation to BPD Etiology ...................................................38 2.2.2 Foci and Topics ...................................................................................................38 vi 2.2.3 Limitations and Resolutions ..............................................................................39 2.3 Past Interventions ......................................................................................................... 42 2.3.1 Psychotherapy ....................................................................................................42 2.3.2 Pharmacotherapy ...............................................................................................48 2.3.3 Underserved Populations ..................................................................................49 2.3.4 Synthesis ..............................................................................................................49 2.4 Relevance to Social Work ............................................................................................ 53 3.0 Methodology .......................................................................................................................... 55 3.1 Overview of the Study .................................................................................................. 55 3.1.1 Research Questions ............................................................................................57 3.2 Study Design .................................................................................................................. 58 3.2.1 Data .....................................................................................................................58 3.2.2 Participants ........................................................................................................59 3.3 Variables and Measures ............................................................................................... 60 3.3.1 Independent Variables .......................................................................................60 3.3.2 Dependent Variables ..........................................................................................63 3.3.3 Mediator ..............................................................................................................64 3.3.4 Covariates ...........................................................................................................64 3.4 Data Analysis ................................................................................................................ 66 3.4.1 Aim 1 ...................................................................................................................67 3.4.2 Aim 2 ...................................................................................................................68 3.4.3 Aim 3 ...................................................................................................................68 3.4.4 Missing Data .......................................................................................................69 vii 3.4.5 Sample Size Justification ...................................................................................72 4.0 Results .................................................................................................................................... 72 4.1 Participant Characteristics .......................................................................................... 73 4.2 Preliminary Analyses ................................................................................................... 76 4.2.1 Internal Consistency if Measures .....................................................................76 4.2.2 Control Variables ...............................................................................................82 4.3 Aim 1 ............................................................................................................................. 82 4.3.1 Regression ...........................................................................................................82 4.3.2 Cross-lagged Models ..........................................................................................85 4.4 Aim 2 .............................................................................................................................. 96 4.5 Aim 3 ............................................................................................................................ 105 5.0 Discussion ........................................................................................................................... 108 5.1 Findings ....................................................................................................................... 109 5.1.1 Distinct Trauma Types and NA Types ...........................................................109 5.1.2 A Decline of NA and BPD Features ................................................................112
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