TY - JOUR
T1 - Emotion word repertoire in the adult attachment interview predicts a reduction of non-suicidal self-injury in the psychotherapy of borderline personality disorder
AU - Schmitz-Riol, S.
AU - Fuchshuber, J.
AU - Herpertz, J.
AU - Buchheim, A.
AU - Hörz-Sagstetter, S.
AU - Rentrop, M.
AU - Fischer-Kern, M.
AU - Buchheim, P.
AU - Taylor, J.
AU - Tmej, A.
AU - Weihs, K. L.
AU - Lane, R. D.
AU - Doering, S.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/12
Y1 - 2025/12
N2 - Background: Borderline personality disorder (BPD) is characterized by mental representation deficits and emotion dysregulation, with non-suicidal self-injury (NSSI) often occurring as a maladaptive regulation strategy. The ability to verbally express emotions might be advantageous for coping with emotion dysregulation and benefiting from psychotherapy. Methods: In the present study, we used a novel text-based measure of emotional awareness to examine whether a greater emotion word repertoire (EWR) predicts improvement in psychotherapy for patients with BPD regarding NSSI, suicide attempts, attachment representations, mentalization, and personality organization. We conducted a secondary analysis of a randomized controlled trial comparing the efficacy of Transference-Focused Psychotherapy (TFP) vs. treatment as usual over one year in a sample of female BPD outpatients. The German electronic Levels of Emotional Awareness Scale (eLEAS) scoring system was applied to Adult Attachment Interviews (AAI) administered at baseline (n = 87; Mage = 27.4, SDage = 7.4) and upon treatment termination (n = 52; Mage = 28.6, SDage = 7.2). Results: In both treatment groups, EWR at baseline was positively correlated with a reduction of NSSI after one year of psychotherapy (r =.46, p <.001). No significant correlations were found between baseline EWR and changes in other outcome measures. Compared to baseline, mean EWR scores significantly decreased after one year of treatment. Discussion: Our findings indicate that a borderline patient’s ability to verbalize emotions might be a resource facilitating a reduction of NSSI in psychotherapy. We discuss strengths and limitations of applying the eLEAS scoring system to open-ended texts in a psychotherapy context. Given the exploratory nature of this study, replication in future studies is warranted. Trial registration: ClinicalTrials.gov (identifier NCT00714311, registration date 07/09/2008).
AB - Background: Borderline personality disorder (BPD) is characterized by mental representation deficits and emotion dysregulation, with non-suicidal self-injury (NSSI) often occurring as a maladaptive regulation strategy. The ability to verbally express emotions might be advantageous for coping with emotion dysregulation and benefiting from psychotherapy. Methods: In the present study, we used a novel text-based measure of emotional awareness to examine whether a greater emotion word repertoire (EWR) predicts improvement in psychotherapy for patients with BPD regarding NSSI, suicide attempts, attachment representations, mentalization, and personality organization. We conducted a secondary analysis of a randomized controlled trial comparing the efficacy of Transference-Focused Psychotherapy (TFP) vs. treatment as usual over one year in a sample of female BPD outpatients. The German electronic Levels of Emotional Awareness Scale (eLEAS) scoring system was applied to Adult Attachment Interviews (AAI) administered at baseline (n = 87; Mage = 27.4, SDage = 7.4) and upon treatment termination (n = 52; Mage = 28.6, SDage = 7.2). Results: In both treatment groups, EWR at baseline was positively correlated with a reduction of NSSI after one year of psychotherapy (r =.46, p <.001). No significant correlations were found between baseline EWR and changes in other outcome measures. Compared to baseline, mean EWR scores significantly decreased after one year of treatment. Discussion: Our findings indicate that a borderline patient’s ability to verbalize emotions might be a resource facilitating a reduction of NSSI in psychotherapy. We discuss strengths and limitations of applying the eLEAS scoring system to open-ended texts in a psychotherapy context. Given the exploratory nature of this study, replication in future studies is warranted. Trial registration: ClinicalTrials.gov (identifier NCT00714311, registration date 07/09/2008).
KW - Borderline personality disorder
KW - Emotion dysregulation
KW - Emotion word repertoire
KW - Emotional awareness
KW - Non-suicidal self-injury
UR - https://www.scopus.com/pages/publications/105014728609
UR - https://www.scopus.com/pages/publications/105014728609#tab=citedBy
U2 - 10.1186/s12888-025-07300-6
DO - 10.1186/s12888-025-07300-6
M3 - Article
C2 - 40877786
AN - SCOPUS:105014728609
SN - 1471-244X
VL - 25
JO - BMC Psychiatry
JF - BMC Psychiatry
IS - 1
M1 - 832
ER -