Emotional Dysregulation as a Mediator Between Childhood Adversity and Negative Urgency in Borderline Personality Disorder.

BACKGROUND

The biosocial theory of borderline personality disorder (BPD) posits that emotional dysregulation develops from the transaction between a biological vulnerability and an invalidating environment (e.g., childhood adversity), and in turn leads to behavioral dyscontrol. This study aimed to empirically test this core mechanistic pathway in a non-Western clinical sample.

METHODS

We hypothesized that the relationship between childhood adversity and the hallmark BPD trait of negative urgency (acting impulsively when distressed) would be mediated by difficulties in emotion regulation. A cross-sectional study was conducted with 45 adult patients with a Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis of BPD in Hyderabad, India. Participants completed the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF), and the Short UPPS-P (urgency, premeditation, perseverance, sensation seeking, and positive urgency) Impulsive Behaviour Scale. A bootstrapping-based mediation analysis (Hayes' PROCESS Model 4) was used to test the hypothesized indirect effect.

RESULTS

The analysis revealed a significant indirect effect of childhood adversity on negative urgency through emotional dysregulation (Indirect Effect = 0.31, 95% bootstrapped CI: 0.14, 0.52). The direct effect of childhood adversity on negative urgency, which was significant in the initial correlation, became non-significant (B = 0.08, p = 0.450) after accounting for the mediator. This pattern is consistent with full mediation.

CONCLUSION

This study provides strong, mechanism-based support for the biosocial model of BPD in an under-researched Indian context. The findings demonstrate that the pathogenic impact of childhood adversity on emotion-based impulsivity is explained by its disruption of emotion regulation capacities. This offers a clear empirical rationale for prioritizing emotion regulation-focused psychotherapies, such as dialectical behavior therapy, as the primary treatment approach for BPD.