Contribution des formes de tristesse aux symptômes du trouble de personnalité borderline

Painful dysphoric affects are an important part of the phenomenology of individuals suffering from borderline personality disorder (BPD). Previous research has distinguished this dysphoria from major depression, underlining its relational, hostility-laden, and undifferentiated nature. We have previously noted that the processing of loss was absent from BPD individuals’ discussion of sadness-laden interactions and that lower levels of mentalization of sadness were strongly associated with BPD traits.

Objectives

We wish to pursue our exploration of painful depressive affects in BPD by framing the definition of dysphoria in terms of differing qualities of sadness or, in other words, differing levels of mentalization of sadness. We conceptualize BPD as presenting both high levels of poorly mentalized sadness and low levels of well-mentalized sadness. Stated differently, a greater experience of psychic pain at a psychic equivalence level, combined with a lack of mentalized or mentalizing sadness (or a lack of adaptive sadness, or the capacity to mourn).

Method

To test this hypothesis, 208 undergraduate students (mean age: 22.4; 87.5% female) completed two online questionnaires: the Forms of Sadness Questionnaire (FSQ) and the McLean Screening Instrument for BPD (MSI-BPD). The FSQ assesses two forms/qualities, or levels of mentalization, of sadness: pathological sadness (here, self-critical sadness) and adaptive sadness (here, tolerated sadness). Correlations and hierarchical regression analysis were conducted.

Results

Correlations indicate that the number of self-reported BPD criteria is more strongly associated with self-critical sadness (pathological or less mentalized sadness: r = 0.51**, large effect size) and also, but less strongly, with tolerated sadness (adaptive or mentalized sadness: r = –0.35**, medium effect size). A hierarchical regression analysis was computed in order to assess the unique contribution of pathological and adaptive sadness on the prediction of BPD traits, over and above the contribution of the potential confounding variables of sex and age. Results indicate that both forms of sadness, as well as age, predict self-reported BPD traits. The strongest predictor is pathological, or less mentalized, sadness.

Conclusions

The findings give an indirect indication that BPD dysphoria is composed of at least two types of subjective “depressive” or dysphoric experiences: mostly a type of suffering or sadness that is subjectively recognized through the perception of difficult to tolerate forms of mental pain; and also, a lack of a form of subjectively tolerable sadness, felt as productive. Since adaptive sadness contributes to BPD traits while the contribution of pathological sadness is statistically removed, the findings indicate that adaptive sadness is not reducible to pathological sadness, that it is not simply the reverse or absence of pathological sadness. This observation is even more significant when it is underscored that both forms of sadness are felt as at least somewhat dysphoric (both involve feeling “intense sadness”), reinforcing the idea that sadness can be an adaptative, although quite painful, experience. A clinical implication of these results might be that psychotherapy for individuals experiencing BPD symptoms should aim not only to reduce distress but also to cultivate a capacity to tolerate sadness in order to “suffer better” and mourn interpersonal losses.