Volume 30, Issue 4 (7-2023)
RJMS 2023, 30(4): 326-338 |
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Research code: 01
Ethics code: IR.IAU.KAU.REC.1401.026
Clinical trials code: 01
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Shmouli Salh Cheeni R, Naseri A. The Role of Distress Tolerance and Childhood Trauma in Predicting Borderline Personality Disorder with the Mediating Role of Experiential Avoidance. RJMS 2023; 30 (4) :326-338
URL: http://rjms.iums.ac.ir/article-1-7773-en.html
URL: http://rjms.iums.ac.ir/article-1-7773-en.html
1- MA Student in clinical psychology, Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran.
2- Assistant Professor; Department of Psychology, Firozabad Branch, Islamic Azad University, Firozabad, Iran ,dr.alinaseri@iau.ac.ir
2- Assistant Professor; Department of Psychology, Firozabad Branch, Islamic Azad University, Firozabad, Iran ,
Abstract: (939 Views)
Background & Aims: Borderline personality disorder (BPD) is a severe and complex mental health condition characterized by pervasive instability in emotional regulation, interpersonal relationships, self-image, and marked impulsivity. It is associated with significant functional impairment, high rates of psychiatric comorbidity, self-harming behaviors, and increased risk of suicide. Due to its chronic course and profound impact on individual and social functioning, BPD has been recognized as one of the most challenging personality disorders in clinical psychology and psychiatry. Over the past decades, researchers have increasingly focused on identifying psychological and developmental factors that contribute to the onset and maintenance of BPD symptoms. Among these factors, childhood trauma has consistently been highlighted as a critical environmental risk factor. Adverse childhood experiences, including emotional, physical, and sexual abuse, as well as emotional and physical neglect, have been shown to disrupt normal emotional development and increase vulnerability to maladaptive personality traits in adulthood. Individuals with a history of childhood trauma often exhibit heightened emotional sensitivity, impaired emotion regulation, and difficulties in coping with stress. In addition to early traumatic experiences, psychological constructs such as distress tolerance have gained attention in explaining vulnerability to psychopathology. Distress tolerance refers to an individual’s perceived or actual ability to withstand negative emotional states. Low distress tolerance is associated with maladaptive coping strategies, emotional dysregulation, and increased risk for various mental disorders, including personality disorders. Individuals with low distress tolerance tend to engage in avoidance-based coping mechanisms when faced with psychological distress. Experiential avoidance, defined as the tendency to avoid or escape from unwanted internal experiences such as thoughts, emotions, and bodily sensations, has been proposed as a key transdiagnostic mechanism underlying many psychological disorders. According to contemporary theoretical models, individuals exposed to early trauma and possessing low distress tolerance may develop experiential avoidance strategies as a maladaptive coping response. Over time, these patterns can become rigid and contribute to the development and maintenance of BPD symptoms. Despite growing evidence supporting the individual roles of childhood trauma and distress tolerance in personality pathology, less attention has been given to the mechanisms through which these factors interact to influence BPD. In particular, the mediating role of experiential avoidance in this relationship remains insufficiently explored. Therefore, the present study aimed to investigate the role of distress tolerance and childhood trauma in predicting borderline personality disorder, with a specific focus on the mediating role of experiential avoidance in male patients diagnosed with BPD. Methods: The present study was a descriptive correlational research design. The statistical population included all male patients diagnosed with borderline personality disorder who were hospitalized in psychiatric hospitals in Shiraz in 2022. Using purposive sampling, a total of 60 patients were selected for the study. The research instruments included the Childhood Trauma Questionnaire (Bernstein et al., 2003), the Distress Tolerance Scale (Simons & Gaher, 2005), the Acceptance and Action Questionnaire-II measuring experiential avoidance (Bond et al., 2011), and the short version of the Borderline Personality Symptom Scale (Bohus et al., 2009). Results: The findings indicated a significant negative relationship between distress tolerance and childhood trauma (R² = 0.330), as well as between distress tolerance and experiential avoidance (R² = 0.298). In contrast, a significant positive relationship was observed between childhood trauma and experiential avoidance (R² = 0.711). Furthermore, the results demonstrated that both distress tolerance and childhood trauma significantly predicted borderline personality disorder. In addition, experiential avoidance played a mediating role in the relationship between distress tolerance and borderline personality disorder. In the initial model, where only the effect of childhood trauma on borderline personality disorder was examined, this relationship was significant (path coefficient = 0.546). However, after introducing the mediating variable (experiential avoidance) into the model and placing it between distress tolerance and borderline personality disorder, the path coefficient decreased from 0.546 to 0.304, and this reduction was statistically significant. Conclusion: The findings of the present study provide important insights into the psychological mechanisms underlying borderline personality disorder. Overall, the results confirmed that both childhood trauma and distress tolerance are significant predictors of BPD symptoms, and that experiential avoidance plays a crucial mediating role in this relationship. Specifically, individuals who reported higher levels of childhood trauma and lower levels of distress tolerance were more likely to exhibit increased experiential avoidance, which in turn was associated with greater severity of borderline personality disorder symptoms. These findings are consistent with theoretical models that emphasize the role of early adverse experiences in shaping emotional and cognitive vulnerabilities. Childhood trauma may disrupt the development of adaptive emotion regulation systems, leading individuals to adopt maladaptive coping strategies in response to psychological distress. One of these strategies is experiential avoidance, which temporarily reduces discomfort but ultimately maintains and exacerbates psychological difficulties. The present study supports the view that experiential avoidance serves as a key mechanism linking early trauma and emotional vulnerability to the manifestation of borderline personality features. Furthermore, the significant role of distress tolerance highlights the importance of emotional resilience in psychological functioning. Individuals with low distress tolerance are less capable of enduring negative emotional states and are therefore more likely to engage in avoidance behaviors when confronted with distressing internal experiences. Over time, this pattern may reinforce emotional instability and impulsive behaviors, which are core features of BPD. The reduction in the direct effect of childhood trauma on BPD after introducing experiential avoidance into the model further suggests that part of the impact of early adverse experiences operates through this mediating mechanism. From a clinical perspective, the results of this study have several important implications. Interventions targeting experiential avoidance, such as Acceptance and Commitment Therapy (ACT) and dialectical behavior therapy (DBT), may be particularly effective in reducing borderline symptoms. Additionally, enhancing distress tolerance skills could help individuals better manage emotional distress and reduce reliance on maladaptive coping strategies. Addressing unresolved childhood trauma through trauma-focused therapies may also contribute to long-term improvement in emotional regulation and interpersonal functioning. In conclusion, the present study highlights experiential avoidance as a key psychological mechanism through which childhood trauma and distress tolerance influence borderline personality disorder. These findings contribute to a more comprehensive understanding of BPD etiology and emphasize the importance of integrated therapeutic approaches that address both developmental experiences and current emotion regulation processes. |
Keywords: Distress Tolerance, Childhood Trauma, Borderline Personality Disorder, Experiential Avoidance
Type of Study: Research |
Subject:
Clinical Psychiatry
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