Personality Disorders: Theory,

Research, and Treatment

Borderline Personality Disorder Affective Instability:
What You Know Impacts How You Feel
Alexandra M. Dick and Michael K. Suvak
Online First Publication, February 19, 2018. http://dx.doi.org/10.1037/per0000280

CITATION
Dick, A. M., & Suvak, M. K. (2018, February 19). Borderline Personality Disorder Affective Instability:
What You Know Impacts How You Feel. Personality Disorders: Theory, Research, and
Treatment. Advance online publication. http://dx.doi.org/10.1037/per0000280
 Personality Disorders: Theory, Research, and Treatment © 2017 American Psychological Association
2017, Vol. 0, No. 999, 000 1949-2715/17/$12.00 http://dx.doi.org/10.1037/per0000280

Borderline Personality Disorder Affective Instability:

What You Know Impacts How You Feel
Alexandra M. Dick and Michael K. Suvak
Suffolk University

The current study examined the role of conceptual knowledge and language in affective instability (AI)
associated with borderline personality disorder (BPD). Forty-six females meeting criteria for BPD and 51
nonclinical female control participants without BPD completed a measure of general vocabulary and a
semantic similarities task that provided estimates of the degree to which participants weighted informa-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

tion about valence and arousal in their understanding of emotion language. Feelings of valence and
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arousal were assessed using the Self-Assessment Manikin in response to 62 emotionally evocative
images, which was used to derive estimates of AI. BPD status was associated with valence and arousal
AI at a bivariate level, but not after controlling for language variables (general vocabulary and semantic
valence and arousal foci). Participants with stronger as opposed to weaker vocabularies exhibited less AI,
and participants who emphasized arousal more in their conceptual representations of emotions exhibited
less AI than those who emphasized it to a lesser degree. With the inclusion of language variables in a
regression equation with BPD status predicting AI, semantic arousal focus, but not general vocabulary,
was a significant predictor of AI. Consistent with psychological constructionist models of emotion that
specify an active role of language throughout the emotion generation process, these findings suggest that
language capacity (general vocabulary and the degree to which arousal influences understanding of
emotion words) is an important determinant of the AI associated with BPD.

Keywords: affective instability, psychological constructionist model of emotion, language, borderline

personality disorder, emotion regulation

Affective instability (AI) is a feature of a number of psycho-
logical disorders, perhaps most notably, borderline personality
disorder (BPD; Koenigsberg, 2010). AI refers to frequent and
drastic changes in emotions characterized by high affect intensity,
rapid emotion rise times, slow rates of return to emotional base-
line, and excessive reactivity to psychosocial cues (Koenigsberg,
2010; Trull et al., 2008). Despite its inclusion as a diagnostic
criterion for BPD (Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition, American Psychiatric Association, 2013),
the relationship between AI and BPD has not been extensively
investigated (Ebner-Priemer et al., 2007), and AI has been criti-
cized for its lack of clarity and concision (Koenigsberg, 2010;
Renaud & Zacchia, 2012). AI is a form of emotional dysregulation
(Koenigsberg, 2010; Trull et al., 2008) and may be a key etiolog-
ical and sustaining factor of BPD. Linehan’s (1993) explanation of
BPD placed emotional vulnerability and an inability to regulate
emotions as etiological factors (in addition to negative social
environments) that lead to maladaptive attempts to regulate intense
affective states. Notably, higher AI has been implicated in greater
Alexandra M. Dick and Michael K. Suvak, Department of Psychology,
Suffolk University.
This research was supported by National Institutes of Health (NIH)
Grant F31MH078426.
Correspondence concerning this article should be addressed to Alexan-
dra M. Dick, Department of Psychology, Suffolk University, 73 Tremont
Street, Boston, MA 02108. E-mail: amdick@su.suffolk.edu
suicidality (Koenigsberg, 2010; Yen et al., 2004) and impulsivity
in this population (Koenigsberg, 2010).
Several ambulatory monitoring/ecological momentary assess-
ments (Ebner-Priemer et al., 2007; Trull et al., 2008), as well as
imaging studies (Schulze et al., 2011), have demonstrated that
individuals with BPD displayed significantly more variability over
time in their positive affect (PA) and negative affect (NA) ratings,
demonstrated significantly more instability on successive ratings
(i.e., large changes), and were more likely to report extreme
changes across successive occasions than a comparison group
(Trull et al., 2008). Compared with healthy controls, BPD partic-
ipants demonstrated sudden, large decreases from positive mood
states (Ebner-Priemer et al., 2007).
Although research has documented AI in BPD, the mechanisms
contributing to this instability are not well understood. Emotions
are complex psychological states involving the combination of
several affective processes (Barrett, 2006a, 2006b). According to
the conceptual act theory (CAT), a psychological constructionist
account of emotion generation, emotions are emergent psycholog-
ical states that are constructed by a variety of more basic processes
including core affect (influenced by several biological processes)
and conceptual knowledge of emotion (Barrett, 2006a, 2006b).
Though emotions are often experienced as “natural kinds” or
tangible entities existing as discreet categories (Barrett, 2006a) and
have been examined this way empirically, CAT posits that emo-
tions occur through a process of combining incoming sensory
input (from the body and from the surroundings) with learned,
category knowledge (Barrett, 2014). Although biological factors
and core affect certainly play a role in AI (Koenigsberg, 2010),

1
 2 DICK AND SUVAK
from the CAT perspective that emotions are influenced by a
confluence of factors, it seems pertinent to investigate the role of
conceptual knowledge in AI. Interestingly, several studies assess-
ing emotional reactions to standardized emotional stimuli have
failed to document peripheral physiological correlates of AI of
BPD (Herpertz, Kunert, Schwenger, & Sass, 1999; Herpertz et al.,
2000, 2001; Suvak et al., 2011; for a review, see Rosenthal et al.,
2008), suggesting that other factors in addition to biological vul-
nerability play a role in the AI component of BPD.
Conceptual knowledge about emotions is intimately intertwined
with language and is what a person “knows” conceptually about
emotions based on past experience and mental categorization
(Barrett, 2006b; Lindquist, 2009). Language provides the labels
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used to categorize affective states based on their context and on
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past information (Barrett, 2006b). The CAT perspective hypothe-
sizes that the language one possesses to describe emotional expe-
riences will actually influence the emotional experience by con-
straining how affective states are conceptualized as they are
happening (Lindquist, 2009). This is supported by burgeoning
research in this area, recently reviewed by Lindquist, Satpute, and
Gendron (2015). Two studies by Gendron, Lindquist, Barsalou,
and Barrett (2012) demonstrated that perceptual priming of emo-
tional faces was impeded when relevant emotion words were
rendered temporarily inaccessible, suggesting that the same face
was encoded differently when a word was accessible. In addition,
an empirical test of CAT (Lindquist & Barrett, 2008) demonstrated
that the activation of emotion knowledge interacted with induced
affect in generating an emotional state. When primed with con-
ceptual knowledge of fear, participants experienced an unpleasant
core affect induction as evidence that the world was threatening
relative to participants who were primed with conceptual knowl-
edge of anger or completed a nonemotional prime. The conceptual
prime (i.e., fear, anger, and neutral) did not affect the degree to
which participants viewed the world as threatening for participants
assigned to a neutral affect induction. These studies suggest that
conceptual knowledge and emotion words influence emotional
experiences.
Although Gendron and colleagues’ (2012) study suggested that
the activation/accessibility of emotion knowledge affects emo-
tional processes, relatively little is known about how individual
differences in language capabilities and processes affect emotional
functioning. Having participants rate the similarity of pairs of
emotion terms based on their understanding of the meaning of
words, what we refer to hereafter as the semantic similarities test,
is one way to examine one’s conceptual organization of emotion
knowledge based on language. Similarity judgments can be used to
index mental structure anchored in semantic knowledge or lan-
guage (Barrett, 2004; Barrett & Fossum, 2001; Shepard, 1987).
Similarity ratings for pairs of words map the cognitive structure of
those words. In multiple studies, Barrett (Barrett, 2004; Barrett &
Fossum, 2001) had participants rate the similarity of 16 emotion
terms chosen to equally represent all combinations of valence
(pleasant– unpleasant) and arousal (activated– calm), producing
120 similarity ratings (240 if both orders of each pair were pre-
sented). Analyses of similarity ratings of emotion terms using
factor analytic techniques such as multidimensional scaling (MDS)
consistently supported a two-factor model identifying valence, or
hedonic tone, (unpleasant–pleasant) and arousal (activated– calm)
as two continuous dimensions that adequately account for the
similarity ratings, a model that has been termed the valance–
arousal circumplex model (for a review, see Russell & Barrett,
1999).
Research has also demonstrated meaningful individual differ-
ences in the valence–arousal circumplex (Barrett, 2004; Barrett &
Fossum, 2001). Although these two dimensions adequately ac-
count for the similarity ratings on a nomothetic level, the degree to
which people emphasize valence and arousal varies across indi-
viduals. Barrett (2004) introduced valence focus and arousal focus
as two individual-difference variables representing variability in
the degree to which individuals emphasize valence and arousal in
their representations of emotion. For this article, we use the terms
semantic valence focus and semantic arousal focus when referring
to the degree to which individuals emphasize valence and arousal
in their cognitive structure of emotion language, as assessed by
similarity ratings. Barrett demonstrated that semantic valence and
semantic arousal foci are only modestly related to the valence and
arousal focus estimates derived from experiential sampling tech-
niques (i.e., experiential valence and arousal foci; Barrett, 2004).
From a CAT perspective, one would expect individual differ-
ences in language resources and abilities to influence emotional
responding (Lindquist et al., 2015). The current study investigated
this hypothesis by examining the relationship between AI and (a)
general vocabulary ability and (b) semantic valence and semantic
arousal foci in a sample of individuals diagnosed with BPD and a
healthy control group. Specifically, we hypothesized that better
general vocabulary, higher semantic valence focus, and higher
semantic arousal focus represent resources available to help indi-
viduals modulate their emotional responses. Therefore, we expect
significant negative associations between each of these language-
based variables and indices of AI such that individuals with more
language resources will exhibit less AI.
Method
Participants
The current investigation reanalyzed data from a larger labora-
tory study of emotional processing and BPD (Suvak et al., 2011).
Study procedures were approved by the local institutional review
board. Forty-six females meeting Diagnostic and Statistical Man-
ual of Mental Disorders, Fourth Edition (DSM-IV), criteria for
BPD (BPD group) and 51 nonclinical female control participants
without BPD or Axis I pathology (control group) participated in
the study. BPD participants were recruited from the community via
advertisements posted on a variety of Internet and community
bulletin boards (n ⫽ 38) and from an ongoing National Institute of
Mental Health-funded family study of BPD being conducted at
McLean Hospital (n ⫽ 8). Control participants were recruited
through the community via Internet and flyer advertisements. In
exchange for participation, all participants were paid $40.
Inclusion criteria for the BPD group included meeting DSM-IV
criteria for BPD as assessed by the Diagnostic Interview for
DSM-IV Personality Disorders (DIPD-IV; described later in the
text). Inclusion criteria for the control group included endorsing
two or fewer criteria of BPD and no current Axis I pathology.
Exclusion criteria included a lifetime diagnosis of schizophrenia or
schizoaffective disorder, current psychotic symptoms, a manic
episode in the past 6 months, any major medical conditions that
 EMOTION KNOWLEDGE, LANGUAGE, AFFECTIVE INSTABILITY
could affect physiology or produce psychiatric symptoms, a his-
tory of major head injury, current hearing problems, and a history
of significant neurological problems (see Suvak et al., 2011 for
more details on participant screening and diagnostic verification).
The average age of the final sample was 21.64 years (SD ⫽
3.01, range ⫽ 18 –33). A majority of participants were Caucasian
(58.8%), with fewer numbers of individuals identifying as Asian
(10.3%), African American (6.2%), Hispanic (4.1%), Pacific Is-
lander (2.1%), biracial (12.4%), and other (e.g., African and West
Indian; 6.2%). Participants completed an average of 15.04 years of
education (SD ⫽ 1.92; range ⫽ 11–20). Median annual family
income fell in the range of $60,000 –$70,000 per year, with a mode
(n ⫽ 23) response of “$100,000 and above.”
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BPD and control participants did not differ in age, t(95) ⫽ .77,
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p ⫽ .44; ethnicity, ␹2(6, N ⫽ 97) ⫽ 1.91, p ⫽ .93; or annual family
income category, ␹2(12, N ⫽ 89) ⫽ 10.45, p ⫽ .58. Although
participants with BPD (M ⫽ 14.62) reported completing slightly
fewer years of education than control participants (M ⫽ 15.41),
t(95) ⫽ .2.06, p ⫽ .04, the associated effect size (␩2 ⫽ .04)
suggests a small difference.
As expected, participants with BPD demonstrated high rates of
comorbidity, with 95.7% of participants with BPD receiving an
additional current or lifetime diagnosis. Eight (17.4%) met criteria
for a current major depressive episode, 37 (80.4%) for a past major
depressive episode, one (2.2%) for a past manic episode, three
(6.5%) for panic disorder without agoraphobia, four (8.7%) for
panic disorder with agoraphobia, four (8.7%) for agoraphobia
without panic disorder, 12 (26.1%) for social phobia, two (4.4%)
for obsessive– compulsive disorder, 15 (32.6%) for posttraumatic
stress disorder, 18 (39.2%) for generalized anxiety disorder, four
(6.5%) for anorexia, four (8.7%) for bulimia, and seven (13.7%)
for an eating disorder not otherwise specified.
Measures
Diagnostic interviews. The BPD module of the DIPD-IV
(Zanarini, Frankenburg, Sickel, & Yong, 1996) was used to assess
the nine DSM-IV criteria for BPD. The use of the DIPD-IV in the
collaborative longitudinal personality disorders study has provided
data in support of its reliability and validity. Median ␬ coefficients
ranged from .69 to .97 for all Axis II disorders (Zanarini et al.,
2000), and factor analytic studies have provided support for four of
the DSM-IV Axis-II constructs measured by the DIPD-IV (schizo-
typal, BPD, avoidant, and obsessive– compulsive; Sanislow et al.,
2002, 2009). Select modules (mood disorders, anxiety disorders,
psychotic screen, and eating disorders) from the Structured Clin-
ical Interview for DSM-IV–Text Revision Axis I Disorders (First,
Spitzer, Gibbon, & Williams, 2002) were administered to assess
the presence of Axis I diagnoses.
Trait measures of emotional behavior. The 20-item Positive
and Negative Affect Schedule (PANAS) measured two primary
dimensions of mood: PA (10 items) and NA (10 items). The trait
version instructing participants to report “how you feel in general”
was used for current study. The PANAS is widely used in exper-
imental studies and has good reliability and validity (Watson,
Clark, & Tellegen, 1988). The 40-item Affect Intensity Measure
(AIM; Larsen & Diener, 1987) was administered to assess emo-
tional reactions to everyday events and mood traits. Although
originally conceptualized as a unidimensional construct, a series of
3
confirmatory factor analyses identified a three-factor model that
included 27 of the original 40 AIM items, with subscales labeled
as Negative Intensity, Negative Reactivity, and Positive Intensity/
Reactivity (Bryant, Yarnold, & Grimm, 1996). The scoring of the
AIM described by Bryant and colleagues (1996) was used in the
current study, and we used the Negative Intensity subscale of
the AIM for all analyses reported in the current manuscript.1
General vocabulary ability. The Shipley Institute of Living
Scale, Vocabulary subscale (Shipley, 1940) was used to measure
overall verbal (vocabulary) performance. For 40 multiple-choice
items, respondents must choose which one of the four words is
closest in meaning to a target word (i.e., a synonym). Psychometric
data suggested that this scale provides an accurate estimate of
overall vocabulary performance (Dalton, Pederson, & McEntyre,
1987).
Semantic valence and arousal foci. A paper-and-pencil ver-
sion of the semantic similarities task was administered at the
beginning of the laboratory session. The semantic similarities task
involved having participants rate the similarity of all possible pairs
of 16 emotion terms that equally represented all octants of the
affective circumplex (i.e., all combinations of valence and
arousal), resulting in 120 ratings. The terms used in the current
study were as follows: afraid, aroused, calm, disappointed, enthu-
siastic, happy, nervous, peppy, quiet, relaxed, sad, satisfied,
sleepy, sluggish, still, and surprised (from Barrett, 2004, Study 2).
Participants were instructed to rate the degree to which they
thought the words were conceptually similar strictly on the basis of
the meanings of words. Ratings were made on a 7-point Likert
scale, ranging from 1 (extremely dissimilar) to 7 (extremely simi-
lar). The adjective pairs were presented in a single random order.
Similarity judgments are believed to represent cognitive organiza-
tion. Suvak et al. (2011) reported in detail the results of MDS
applied to the semantic similarities data. Consistent with past
research, a two-factor valence and arousal solution best fit the data.
Most relevant for the current investigation is the application of an
individual difference MDS (INDSCAL) technique to derive esti-
mates of semantic valence focus and semantic arousal focus.
INDSCAL analyses provide information about what overall struc-
ture best accounts for the similarity ratings and compute dimension
weights for each individual, quantifying the extent a particular
attribute or dimension influenced the similarity ratings. With our
two-factor valence–arousal solution, INDSCAL weights represent
the degree to which individuals weigh valence and arousal when
making similarity judgments, in other words, estimates of semantic
valence and arousal foci. For more details on the MDS analyses
and derivation of estimates of semantic valence and arousal foci,
see Suvak et al. (2011).
Self-Assessment Manikin. Current feelings of valence and
arousal were assessed using the Self-Assessment Manikin (SAM;
Bradley & Lang, 1994; Lang, 1980). SAM is an animated, inter-
active computer display that uses a cartoon figure that participants
1
We conducted all analyses using three different scales/subscales of the
AIM: the total AIM score and the Negative Intensity and Negative Reac-
tivity subscales. The pattern of results was identical, with only minor
variations in the strength of associations. We decided to use the Negative
Intensity score in the revised manuscript because this was the AIM score
that exhibited the strongest bivariate association with BPD status (.83 for
Negative Intensity, .63 for total AIM, and .31 for Negative Reactivity).
 4 DICK AND SUVAK
use to rate how “happy” or “unhappy” (valence) and how “calm”
or “excited” (arousal scale) they felt during the presentation of
each picture. Valence and arousal scale scores both ranged from 1
(most unpleasant/least pleasant, most calm/least activated) to 9
(least unpleasant/most pleasant, least calm/most activated). SAM
is extensively used as a nonverbal assessment of subjective emo-
tional reactions in investigations of emotion. The SAM ratings
were used to derive estimates of AI. AI was operationalized using
the mean square successive difference (MSSD) score as described
by Jahng, Wood, and Trull (2008). MSSD is calculated by sum-
ming the squared differences between the outcome variable at one
time point and the outcome at the previous time point and dividing
this sum by the number of assessments minus 1. The MSSD has
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several advantages over other estimates of within-subject variabil-
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ity (e.g., within-person variance) including taking into consider-
ation multiple sources of variability (i.e., variability due to disper-
sion of states and variability due to temporal order or serial
correlation; Jahng et al., 2008). Two estimates of AI were com-
puted using the SAM ratings. AI-Valence and AI-Arousal were
derived by computing the MSSD for the SAM-valence and SAM-
arousal ratings, respectively, across all pictures.
Images
Sixty-two images were selected from the International Affective
Picture System (IAPS; Lang, Bradley, & Cuthbert, 2005). Past
research that systematically varied valence and arousal using IAPS
images was reviewed (Bradley, Codispoti, Cuthbert, & Lang,
2001; Bradley, Codispoti, Sabatinelli, & Lang, 2001; Barrett,
2004). Great care was taken to ensure that within each valence
category (i.e., unpleasant and pleasant), valence was matched as
closely as possible across arousal conditions (low, medium, and
high). In addition, great care was also taken to ensure that arousal
levels matched as closely as possible across valence categories.
Normative data of self-reports of valence and arousal in response
to the image were used to select the images. The final IAPS set
contained 24 pleasant (12 high, six medium, and six low arousal),
24 unpleasant (same arousal breakdown), and 14 neutral images
(12 low and two high arousal), and two neutral highly arousing
images.2
Procedure
Participants were mailed copies of the informed consent form
and a packet of questionnaires that assessed trait-like characteris-
tics (e.g., Demographics Questionnaire, PANAS-Trait, and AIM).
On arrival, study procedures were described, and written informed
consent was obtained. Consent was followed by the administration
of the clinical interviews and completion of a questionnaire packet
that included measures assessing state-like processes, which were
not used for the current investigation, and the Shipley Institute of
Living Scale, Vocabulary Subscale.
The tasks of the current study were administered as part of a
larger laboratory procedure. Here we describe in detail only the
components of the procedure directly related to the semantic
similarities and emotion labeling tasks. After completing the di-
agnostic interviews and self-report measures, participants were
seated in a padded recliner directly in front of a 21-in. computer
monitor. Their eyes were positioned at a distance of ⬃40 in. from
the monitor and 6 in. below the center of the screen such that they
were gazing up at a slight angle. The sensors used for measuring
physiological activity were first attached.
The primary component of the laboratory procedure was the
picture-processing paradigm developed by Peter Lang and col-
leagues (Bradley et al., 2001). A trial consisted of an IAPS image
presented for 6 s, the presentation of a startle probe occurring
3.5–7 s after the onset of the IAPS image (emotion modulation of
the eyeblink startle response was the primary physiological indi-
cator of emotion), a recovery period lasting 6 s, a 4-s delay, and
finally SAM and emotion labeling ratings. An intertrial interval
ranging from 12 to 24 s followed the last rating. All participants
viewed the 62 pictures described earlier. To minimize order ef-
fects, a complex counterbalancing schema was developed consist-
ing of the creation of six different stimuli presentation orders. The
primary goal of counterbalancing was to eliminate order effects
(e.g., fatigue and habituation) across each Valence ⫻ Arousal
combination (seven: neutral, pleasant/low, pleasant/medium,
pleasant/high, unpleasant/low, unpleasant/medium, and unpleas-
ant/high). Participants were randomly assigned to one of the or-
ders.
Data Analysis
We computed bivariate correlations and conducted a series of
hierarchical multiple regression analyses to examine relation-
ships among BPD status, valence and arousal instability, the
language variables (general vocabulary ability, semantic va-
lence focus, and semantic arousal focus), and dispositional
emotional variables (NA, PA, and affect intensity). The primary
purposes of the multiple regression analyses were to (a) exam-
ine whether the language variables accounted for differences in
valence and arousal AI as a function of BPD status and (b)
identify the most robust predictors of AI, with a particular focus
on the association between the language variables and AI when
controlling for the trait affect measures (NA, PA, and affect
intensity). We conducted separate multiple regression analyses
for valence AI and arousal AI entering BPD status in Step 1, the
language variables in Step 2, and trait emotion variables in
Step 3.
Results
Bivariate associations (correlations) and descriptive statistics
for all variables are presented in Table 1. Several significant
associations emerged between valence and arousal AI and the
predictor variables including significant positive relationships
between the AI variables and BPD status, NA, and self-reported
affect intensity. This indicates that individuals diagnosed with
BPD exhibited more instability in affect ratings than those
without BPD. In addition, individuals who reported higher
levels of trait NA and affect intensity exhibited higher levels of
instability than participants reporting lower levels of these
affective traits. Significant negative relationships between both
AI variables and general vocabulary suggest that people with
better vocabularies tended to exhibit less AI than people with
2
The list of the IAPS slides used can be obtained from the correspond-
ing author.
 EMOTION KNOWLEDGE, LANGUAGE, AFFECTIVE INSTABILITY 5

Table 1
Descriptive Statistics for and Bivariate Relationships Among All Study Variables

Variable 1 2 3 4 5 6 7 8 9 M SD

1. Valence AI — 10.02 5.34

2. Arousal AI .75ⴱⴱ — 7.30 4.52
3. Vocabulary (Shipley) ⫺.34ⴱⴱ ⫺.23ⴱ — 31.94 3.40
4. Semantic valence focus ⫺.01 .01 ⫺.16 — 0.68 0.07
5. Semantic arousal focus ⫺.32ⴱⴱ ⫺.35ⴱⴱ .42ⴱⴱ ⫺.57ⴱⴱ — 0.59 0.10
6. BPD .26ⴱ .31ⴱⴱ ⫺.33ⴱⴱ ⫺.06 ⫺.26ⴱⴱ — 0.47 0.50
7. NA .22ⴱ .34ⴱⴱ ⫺.33ⴱⴱ ⫺.08 ⫺.25ⴱ .81ⴱⴱ — 20.72 10.49
8. PA .12 .15 0 .20ⴱ ⫺.11 ⫺.35ⴱⴱ ⫺.36ⴱⴱ — 32.19 7.97
9. NA intensity .19 .29ⴱⴱ ⫺.23ⴱ .10 ⫺.21ⴱ .83ⴱⴱ .86ⴱⴱ ⫺.33ⴱⴱ — 3.30 1.26
Note. AI ⫽ affective instability; BPD ⫽ borderline personality disorder; NA ⫽ negative affect; PA ⫽ positive affect.
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ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.
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poorer vocabularies. Significant and negative associations be-
tween both AI variables and semantic arousal focus indicated
that participants who tended to emphasize arousal more when
making similarity judgments of pairs of emotions terms exhib-
ited less AI than those who tended to emphasize arousal less
when making similarity judgments. Semantic valence focus and
PA were not significantly associated with AI.
The results of the regression analyses are depicted in Table 2.
A few interesting findings emerged in Step 2 of both of the
hierarchical multiple regressions. First, the association between
BPD status and AI was no longer significant when controlling
for the language variables. Second, overall general vocabulary
was no longer associated with AI (both valence and arousal)
when controlling for semantic valence and arousal foci as well
as BPD status. Third, the association between semantic valence
focus and both valence AI and arousal AI was statistically
significant and negative. This third finding was unexpected, as
reported earlier, the bivariate association between semantic
valence focus and both types of AI was close to zero and not
significant (see Table 1). Therefore, this is an example of a
suppressor effect (MacKinnon, Krull, & Lockwood, 2000),
when a nonsignificant bivariate association becomes statisti-
cally significant in multivariate analysis controlling for addi-
tional predictor variables.
We conducted follow-up analyses to evaluate more precisely how
the language variables accounted for the association between BPD
and AI. Figure 1 depicts the direct effect from BPD to AI (path c=) and
the indirect effects from BPD to AI through semantic valence focus
and semantic arousal focus (ab paths). To test the significance of the
indirect ab paths, the 95% confidence interval for this estimate was
computed using the RMediation software program (Tofighi & MacK-
innon, 2011). Figure 1 shows that a significant indirect effect through
semantic arousal focus, but not semantic valence focus, for both AI
variables emerged, suggesting that semantic arousal focus may ac-
count for at least some of the relationship between BPD and AI.
Because semantic arousal focus did partially account for the relation-
ship between BPD status and AI, and semantic valence focus did not,
we contend that the significant association between semantic valence
focus and AI that emerged in Step 2 of the regression analyses is
likely a suppressor effect due to the substantial association between
semantic valence and arousal foci (r ⫽ ⫺.57) that is not readily
interpretable and does not require further interpretation.

Table 2
Summary of Multiple Regression Analyses Predicting Affective Instability (AI)

Predicting valence AI Predicting arousal AI

Variable B SE B ␤ p pr B SE B ␤ p pr

Step 1 (R2 ⫽ .06, p ⫽ .014) (R2 ⫽ .10, p ⫽ .002)

BPD diagnosis 2.70 1.07 .25 .01 .25 2.78 0.89 .31 .002 .31
Step 2 (⌬R2 ⫽ .15, p ⫽ .001) (⌬R2 ⫽ .12, p ⫽ .004)
BPD diagnosis 0.84 1.10 .08 .45 .08 1.54 0.93 .17 .10 .17
General vocabulary ⫺0.31 0.17 ⫺.20 .07 ⫺.19 ⫺0.04 0.14 ⫺.03 .80 ⫺.03
Semantic valence focus ⫺20.83 9.41 ⫺.28 .03 ⫺.23 ⫺17.62 7.93 ⫺.28 .03 ⫺.23
Semantic arousal focus ⫺22.52 7.82 ⫺.39 .01 ⫺.29 ⫺22.74 6.58 ⫺.46 .001 ⫺.34
Step 3 (⌬R2 ⫽ .12, p ⫽ .546) (⌬R2 ⫽ .07, p ⫽ .051)
BPD diagnosis 1.63 2.00 .15 .42 .09 0.64 1.63 .07 .70 .04
General vocabulary ⫺0.30 0.17 ⫺.18 .09 ⫺.18 ⫺0.01 0.14 0 .99 0
Semantic valence focus ⫺21.04 9.50 ⫺.28 .03 ⫺.23 ⫺16.61 7.75 ⫺.26 .04 ⫺.22
Semantic arousal focus ⫺20.09 8.05 ⫺.35 .02 ⫺.26 ⫺18.83 6.57 ⫺.38 .01 ⫺.29
NA 0 0.10 0 .98 0 0.13 0.09 .29 .14 .16
PA 0.10 0.07 .15 .15 .15 0.15 0.06 .25 .02 .26
NA intensity ⫺0.04 0.89 ⫺.01 .96 ⫺.01 ⫺0.10 0.72 ⫺.03 .89 ⫺.01
Note. BPD ⫽ borderline personality disorder; NA ⫽ negative affect; PA ⫽ positive affect; pr ⫽ partial correlation.
 6 DICK AND SUVAK
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Figure 1. The indirect relationship of borderline personality disorder (BPD) with affective instability (AI)
through semantic valence and arousal foci. Unstandardized and standardized coefficients are presented in
parenthesis (unstandardized, standardized). ⴱ p ⬍ .05. SF Val ⫽ semantic valence focus; SF ARS ⫽ semantic
arousal focus; Ars ⫽ arousal; Val ⫽ valence; ab ⫽ the indirect effect of SF Val through SF Ars on AI; CI ⫽
confidence interval.

The most notable results in Step 3 (see Table 2) were that NA semantic valence and arousal foci) relate to AI. Several interesting
and affect intensity were not associated with either of the AI findings emerged. First, although BPD status was associated with
outcomes (both showed significant positive associations to AI at both valence and arousal AI at the bivariate level, BPD was no
the bivariate level), and the association between both the semantic longer associated with AI when controlling for the language vari-
focus variables and the AI outcomes remained largely unaffected ables (general vocabulary and semantic valence and arousal foci).
by adding in the emotional variables into the analyses. A signifi- General vocabulary and semantic arousal focus, but not semantic
cant association emerged between PA and arousal AI. However, valence focus, were negatively associated with both AI outcomes
because the bivariate association between PA and arousal AI was at the bivariate level. Participants with a stronger vocabulary
not significant, this is likely another suppressor effect. Because the exhibited less AI than those with weaker vocabularies, and partic-
primary reason for Step 3 was to evaluate the language effects ipants who emphasized arousal to a greater degree in their con-
when controlling for the emotional variables, this association will ceptual representations of emotions exhibited less AI than those
not be interpreted. The language effects present in Step 2 main- emphasizing arousal to a smaller degree. When all three of these
tained when adding the emotional variables into the model. language variables were entered into a regression equation with
Although we did not have a self-report measure of AI per se,
affect intensity as measured by the Negative Affect Intensity
subscale of the AIM was the most similar construct that we did Table 3
assess via self-report. We conducted an additional regression anal- Summary of Multiple Regression Analysis Predicting Negative
ysis with the Negative Affect Intensity subscale as the dependent Affect Intensity
variable (instead of as a predictor in Step 3 as it was in the
previously reported regression analyses) to evaluate whether or not Predicting negative affect intensity
the language variables accounted for self-reports of NA intensity,
Variable B SE B ␤ p pr
similar to the way in which they accounted for the AI estimates
derived from the SAM ratings. These findings are summarized in Step 1 (R2 ⫽ .69, p ⫽ 0)
Table 3. Step 2 indicated that the language variables did not BPD diagnosis 2.08 0.15 .83 0 .83
Step 2 (⌬R2 ⫽ .01, p ⫽ .636)
significantly predict NA intensity (individually or combined), and BPD diagnosis 2.09 0.16 .83 0 .81
the association between BPD status and NA intensity remained General vocabulary 0.02 0.03 .06 .38 .09
statistically significant in all steps. This pattern of results suggests Semantic valence focus ⫺1.27 1.31 ⫺.07 .34 ⫺.10
that semantic arousal focus is related to some emotional processes Semantic arousal focus ⫺0.67 1.00 ⫺.05 .51 ⫺.07
associated with BPD (i.e., assessment-to-assessment changes in Step 3 (⌬R2 ⫽ .10, p ⫽ 0)
BPD diagnosis 1.00 0.21 .40 0 .45
valence and arousal), but not others (i.e., the tendency for individ- General vocabulary 0.03 0.02 .09 .12 .17
uals with BPD to describe themselves as emotionally labile). Semantic valence focus ⫺0.37 1.09 ⫺.02 .74 ⫺.04
Semantic arousal focus ⫺0.07 0.84 ⫺.01 .93 ⫺.01
NA 0.07 0.01 .57 0 .58
Discussion PA 0 0 .02 .77 .03
This study examined how BPD, general vocabulary, and con- Note. BPD ⫽ borderline personality disorder; NA ⫽ negative affect;
ceptual organization of emotion knowledge based in language (i.e., PA ⫽ positive affect; pr ⫽ partial correlation.
 EMOTION KNOWLEDGE, LANGUAGE, AFFECTIVE INSTABILITY
BPD status predicting AI, general vocabulary was no longer a
significant predictor. Semantic arousal, however, remained a sig-
nificant predictor of AI, and the relationship between semantic
valence focus and arousal focus became statistically significant.
Follow-up analyses suggested that the significant association
between semantic valence focus and AI in the multiple regression,
which was not significant at a bivariate level, was a suppressor
effect. Semantic valence focus was likely only associated with AI
in the multiple regression because of its association with semantic
arousal focus, which showed a substantial bivariate association
with both AI variables. The results of the current study suggest that
the degree to which participants emphasize arousal in their
semantic-based representations of emotion is the most robust pre-
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dictor of AI. This relationship held when controlling for trait NA,
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PA, and AI. The language variables accounted for the relationship
between BPD and AI, as this association was no longer significant
when controlling for the language variables. In sum, these results
suggest that one’s language capacity (general vocabulary and the
degree to which arousal influences understanding of emotion
words) is an important determinant of AI, accounting for the
relationship between BPD and AI.
We hypothesized that all three language-based variables would
be negatively associated with AI. Semantic arousal focus emerged
as the most robust and primary language variable negatively as-
sociated with AI. Many theories of emotion described valence as
a basic building block of emotion life (Barrett, 2006c). Why then
would semantic arousal focus be a more robust predictor of AI
then valence focus? Many emotion researchers thought that valu-
ation, or determining the hedonic tone (i.e., valence), of a stimulus
is largely driven by automatic processes to quickly identify poten-
tial threats in the environment (Barrett, 2006c; Barrett, Ochsner, &
Gross, 2007; LeDoux, 2000; Öhman & Mineka, 2001). The robust,
nomothetic, and automatic role of valence in the construction of
emotions likely minimizes the role of individual differences in
valence, providing an opportunity for individual differences in
arousal to play an important role in emotional responding. This is
consistent with previous work that has shown that semantic arousal
focus, but not semantic valence focus, was associated with indi-
vidual differences in emotional granularity, or the ability to make
fine-grained distinctions among similarly valenced states (Barrett,
2004).
Traditionally, the primary focus on the association between
language and emotion has been the communicative role of emo-
tions (Lindquist et al., 2015). There is a consensus that the rich
information contained in verbal and nonverbal expressions of
emotion facilitates communication, and facilitating communica-
tion is one of the important functions of emotion. However, recent
psychological constructionist models of emotion have proposed an
expanded role of language in generating, constructing, and regu-
lating emotional experience (Barrett, 2014; Lindquist et al., 2015),
and research has begun to provide empirical support for this role of
language in emotion. For instance, a series of studies used seman-
tic satiation to experimentally manipulate accessibility of emotion
word meaning. This procedure reduced the accessibility of words
representing basic emotion categories (e.g., “anger” and “fear”)
before having participants complete emotion perception tasks,
such as making judgments of facial behaviors depicting emotion or
completing emotional priming tasks. Across five studies, semantic
satiation of word meaning interfered with the perception of emo-
7
tion including reducing the speed and accuracy in perceiving facial
behaviors depicting emotion (Lindquist, Barrett, Bliss-Moreau, &
Russell, 2006) and the disruption of emotional priming (i.e., the
effect of a brief presentation of an emotional stimulus on subse-
quent cognitive activity; Gendron et al., 2012). These findings
suggest that language affects emotion generation at an early stage,
during the initial perception of emotional stimuli.
Other studies have shown that language affects the generation of
emotion in latter stages after an initial response has begun. A
number of studies revealed that putting labels to emotions serves
an emotion regulation function. For example, Lieberman et al.
(2007) showed that affect labeling was associated with decreased
amygdala activity and increased activity in the right ventrolateral
prefrontal cortex by way of the medial frontal cortex. Exposure to
aversive images combined with affect labeling led to greater
attenuation in long-term autonomic reactivity compared with ex-
posure alone (Tabibnia, Lieberman, & Craske, 2008). Labeling
was also associated with reduced skin conductance response and
fear responding compared with reappraisal or distraction (Kircan-
ski, Lieberman, & Craske, 2012). Participants were unaware of the
effect of affect labeling on emotion regulation even after it led to
lowered distress (Lieberman, Inagaki, Tabibnia, & Crockett,
2011). Affect labeling may also come with a cost, which is
dampened affective responses in general, and therefore diminished
self-reported pleasure rather than specifically alleviating negative
affect (Lieberman et al., 2011).
Recently, Brooks and colleagues (2017) conducted a meta-
analysis of 386 neuroimaging studies from 1993 to 2014 examin-
ing the role of language in the experience and perception of
emotion. They found that when emotion words (e.g., “anger” and
“disgust”) as opposed to affect words (e.g., “pleasant” and “un-
pleasant”) were present, regions related to semantic processing
were activated, whereas when emotion words were not present, the
amygdala and parahippocampal gyrus were more frequently acti-
vated. These findings suggest that when emotion concepts are
inaccessible, the meaning of affective experiences and perceptions
are ambiguous. Amygdala activation signals this uncertainty, and
emotion concept words may help refine the meaning of otherwise
ambiguous affective states, allowing a person to know what the
affective state means, what to do about it, and how to regulate it
(Brooks et al., 2017). This process decreases the arousing nature of
the stimuli, providing an inherent emotion regulation function
(Brooks et al., 2017; Lieberman et al., 2011). In sum, there is
substantial evidence that labeling emotional experience modifies
the subsequent course of the emotional experience and expression.
An intriguing avenue for future research would be to examine
individual differences in labeling emotions and emotion regula-
tion, exploring the possible benefits of being able to label emotions
in a precise, nuanced manner (i.e., high in emotion differentiation
or emotional granularity; Barrett, 2004; Smidt & Suvak, 2015).
There is some evidence suggesting that the ability to experience
emotions in a nuanced manner facilitates emotion regulation (Bar-
rett, Gross, Christensen, & Benvenuto, 2001); however, the role of
language in this association remains unexplored.
The negative association between semantic arousal focus and AI
that emerged in the current study has implications not only for our
understanding of the role of language in the generation and regu-
lation of emotion broadly but also for the role of AI in BPD and
other types of psychopathology. AI has been a cardinal feature of
 8 DICK AND SUVAK
BPD since it entered the diagnostic nomenclature with the publi-
cation of Diagnostic and Statistical Manual of Mental Disorders,
Third Edition (American Psychiatric Association, 1980). Although
a body of research has shown increased AI in individuals diag-
nosed with BPD compared with healthy controls, recent research
suggest that AI may be a transdiagnostic mechanism underlying
several different types of psychopathology including posttraumatic
stress disorder, bulimia nervosa, and avoidant personality disorder
(Santangelo et al., 2014; Snir, Bar-Kalifa, Berenson, Downey, &
Rafaeli, 2017). The finding that one’s conceptual organization of
emotion knowledge based on language is associated with AI
supports treatments that teach individuals how to identify and
verbally label emotions, such as dialectical behavior therapy (Line-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
han, 1993). On the basis of a review of recent neuroimaging
This document is copyrighted by the American Psychological Association or one of its allied publishers.
studies of the effect of psychotherapy, Messina, Sambin, Bes-
choner, and Viviani (2016) concluded that areas implicated in
coding semantic representations play an important role in en-
hanced emotion regulation facilitated by therapy. Helping clients
develop more nuanced and precise language to describe their
emotional experiences may contribute to increased efficacy of
interventions for emotional disorders.
What is the extent of the role of language in emotional processes
related to BPD? The bivariate associations between BPD status
and AI were moderate (rs ⫽ .26 and .31) for valence and arousal
AI, respectively, which fall in the medium effect size range ac-
cording to Cohen (1988). Simultaneously, our follow-up analysis
demonstrated that the language variables did not account for the
tendency for individuals diagnosed with BPD to describe them-
selves as experiencing negative emotions intensely via self-report.
Although BPD and AI (as operationalized by assessment-to-
assessment changes in valence and arousal ratings in response to
emotionally evocative images) are only modestly associated, we
contend that the findings of the current study are important. As we
have described, extant research on emotional processes contribut-
ing to BPD is mixed. On the one hand, the tendency for individuals
diagnosed with BPD to describe themselves as emotionally vola-
tile/labile is well replicated (Ebner-Priemer et al., 2007). On the
other hand, studies that have relied on objective measures of
emotional responding (such as psychophysiological assessments)
or responses to discrete emotional stimuli (in contrast to global,
retrospective self-reports) have generally failed to document ab-
normal emotional functioning in individuals with BPD (Herpertz
et al., 1999; Kuo & Linehan, 2009). In the context of the larger
research literature, documenting a statistically significant relation-
ship between BPD and emotional responding not assessed via
global, self-reports, even through modest association, is notable.
Our findings suggest that the language variables examined in the
current study do not account for all emotional processes contrib-
uting to BPD (i.e., language variables may play a role in
assessment-to-assessment changes in valence and arousal but do
not account for the tendency for individuals diagnosed with BPD
to describe themselves as emotionally labile). However, the find-
ings of the current study suggest that research examining the role
of language and emotion is a potentially fruitful avenue for future
research attempting to build a comprehensive and coherent ac-
count of emotion and BPD.
Examining AI in a sample of individuals meeting criteria for
BPD and healthy controls is associated with strengths and weak-
nesses. AI has been empirically identified as an important feature
of BPD, so the findings of the current study can inform efforts to
understand emotional processes contributing to BPD. However,
we cannot say anything about the generalizability of the findings
of the current study. Future research is needed to investigate the
role of language and AI in the general population and in a diverse
array of clinical populations. The cross-sectional, nonexperimental
nature of our design limits our ability to draw conclusions about
causality. It is possible that affective stability helps individuals
develop a more precise understanding of the semantic meaning of
emotion words. However, the research cited earlier examining the
effect of language accessibility on emotion perception and the
effect of labeling emotions on regulation provided initial support
for the causal role of language in the generation and regulation of
emotion. Examining brief reactions to discrete emotionally evoc-
ative images in a laboratory setting introduces a degree of exper-
imental control. However, this increased experimental control may
come at the expense of costs to external/ecological validity; thus,
replication of the current findings in future research using proce-
dures such as ecological momentary assessment (Ebner-Priemer,
& Trull, 2009) is needed. Another limitation of the current study is
that only female participants were included. Future research needs
to evaluate whether these findings would generalize to males with
BPD or are moderated by gender.
A notable strength of the current study is that emotional reac-
tions in response to the images used to derive AI estimates were
assessed via SAM ratings, an extensively used nonverbal assess-
ment of subjective emotional reactions, reducing contamination
that may have been introduced by using a more language-based
assessment of emotional reactions. The findings of the current
study are consistent with current psychological constructionist
models of emotion that specify an active role of language through-
out the emotion generation process. Future research is needed to
explore the generalizability of these findings, which can inform
whether AI should be conceptualized as a transdiagnostic or a
disorder-specific mechanism, and whether individual differences
in language contribute to AI across a range of conditions. The
current findings also support interventions designed to increase the
precision of the use of emotion labels, a strategy that is at the heart
of many psychotherapeutic interventions. An exciting direction for
future research would be to evaluate whether semantic represen-
tations of emotion can change as the result of psychological
interventions and whether these changes lead to reductions in AI.
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