inability to withstand present-moment experiences in borderline personality disorder: a meta-analytic review

Objective: Recently, some studies have been examining the relationship between Borderline Personality Disorder (BPD) features and Experiential Avoidance (EA), Thought Suppression (TS) and Distress Intolerance (DI). This interest arose from data which showed a strong link between the previous constructs and problematic behaviors (e.g. self-harm) related to BPD. These dimensions describe a more general inability to withstand undesirable present-moment experiences. The aims of this work are to evaluate the extent of this problem in BPD and to hypothesize if it would be considered another core feature of BPD in addition to emotion dysregulation. Method: We included studies which show relationships between BPD features and EA, TS, DI, using valid and reliable instruments (e.g. PAI-BOR; AAQ; WBSI; DTS). Cohen’s d was computed as effect size measure. Overall pooled effect sizes (dw) was estimated. Heterogeneity in effect sizes was computed using Q statistic and I² index. We proposed multiple comparisons of each outcome variable using Bonferroni correction. Bias publication was evaluated (Egger’s regression). Results: The final sample included 21 studies (4823 subjects). Large effect sizes were found in general inability to withstand present-moment experiences (dw= 0,92), EA (dw= 0,98) and TS (dw= 1,04). Medium effect size emerged in DI (dw= 0,60). It was observed high heterogeneity for overall effect size (I² =79,51%). Publication bias was not detected. Further, DI was significantly less manifest than EA and TS in BPD. Conclusions: These results show that the inability to withstand present-moment experiences is largely manifest in BPD and they suggest that this difficulty it might represent another core feature of BPD. These findings support mindfulness-based intervention in treating BPD. In addition, future research will be necessary to explain the relationship between emotion dysregulation, EA, TS and DI.