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Borderline Personality Disorder;cluster analysis;Dialectical Behavior Therapy;emotion;emotional profiles;exploratory analysis


Antonio Pascual-Leone



Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.


Borderline Personality Disorder (BPD) can have various clinical presentations and is also difficult to treat. Researchers have investigated whether subtypes of BPD could explain variability in clinical presentations and outcomes after treatment. Previous research has identified subtypes of BPD based on temperament, which explain some variation in symptoms and outcomes. However, subtypes have typically been created using extensive self-report or structured-interview data. Instead, creating identifiable emotion profiles based on observational data could have a wider range of clinical and research applications, while helping to explain heterogeneity in BPD presentations and outcomes. This thesis is designed to look at emotion profiles in clients with BPD undergoing Dialectical Behaviour Therapy (DBT). Session video recordings were coded and analyzed for 54 clients with BPD, treated in a 12-month randomized controlled trial of DBT at Toronto’s Center for Addiction and Mental Health. Thus, a secondary data set was generated based on clients’ within-session expression of various emotional states, as defined by the coding of affective meaning states (CAMS). This observational measure has been used to analyze within-session therapy processes and to predict outcome data for a wide range of disorders and therapeutic modalities. Across a range of emotion codes, three unique profiles were found using cluster analysis: a Distressed profile, an Ashamed profile, and an Angry/Flexible profile. Additionally, these early observations of emotion profiles were associated with differential treatment outcomes between groups at 6- and 12-months. Most critically, the group with a primarily Ashamed profile showed a lack of reduction in their rates of self-harm at the end of treatment when compared to the other two groups. The main implication of the present study is that early observations of within-session emotion can be prognostic indicators for assessment and treatment planning in DBT.