Within- and Between-Persons Effects of Self-Esteem and Affective State as Antecedents and Consequences of Dysfunctional Behaviors in the Everyday Lives of Patients With Borderline Personality Disorder

Dysfunctional behaviors are conceptualized as maladaptive affective coping attempts in borderline personality disorder (BPD). The recent benefits-and-barriers model extended the affective function assumption by adding self-esteem as a barrier to engaging in dysfunctional behaviors. Patients with BPD (N = 119) carried e-diaries to report their current self-esteem, emotional valence, tense arousal, and whether they engaged in dysfunctional behaviors 12 times a day for 4 days. Dynamic structural equation modeling revealed that on the within-person level, high momentary negative affect predicted dysfunctional behaviors, and on the between-person level, low trait self-esteem predicted dysfunctional behaviors. We also found an association between engaging in dysfunctional behaviors and momentary self-esteem and trait levels of valence and tense arousal. Moreover, our results indicate a deterioration of, rather than relief from, negative affective state after dysfunctional behaviors. These findings highlight the importance of emotion-regulation skills and reestablishing a positive self-view as important treatment targets to reduce dysfunctional behaviors in BPD.