Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-11T15:42:38.376Z Has data issue: false hasContentIssue false
  • English
  • Français

How is affective instability defined and measured? A systematic review

Published online by Cambridge University Press:  27 September 2013

S. Marwaha ,
Z. He ,
M. Broome ,
S. P. Singh ,
J. Scott ,
J. Eyden  and
D. Wolke
S. Marwaha*
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Z. He
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
M. Broome
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
S. P. Singh
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
J. Scott
Affiliation:
Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK FondaMental Foundation, Fondation de Coopération Scientifique Hôpital A. Chenevier, Creteil, France INSERM, U 955, IMRB, Psychiatry Genetic, Creteil, France
J. Eyden
Affiliation:
Department of Psychology, University of Warwick, Coventry, UK
D. Wolke
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK Department of Psychology, University of Warwick, Coventry, UK
*
*Address for correspondence: Dr S. Marwaha, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: S.Marwaha@warwick.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Affective instability (AI) is poorly defined but considered clinically important. The aim of this study was to examine definitions and measures of AI employed in clinical populations.

Method

This study was a systematic review using the PRISMA guidelines. MEDLINE, Embase, PsycINFO, PsycArticles and Web of Science databases were searched. Also five journals were hand searched. Primary empirical studies involving randomized controlled trials (RCTs), non-RCTs, controlled before and after, and observational investigations were included. Studies were selected, data extracted and quality appraised. A narrative synthesis was completed.

Results

A total of 11 443 abstracts were screened and 37 studies selected for final analysis on the basis that they provided a definition and measure of AI. Numbers of definitions for each of the terms employed in included studies were: AI (n = 7), affective lability (n = 6), affective dysregulation (n = 1), emotional dysregulation (n = 4), emotion regulation (n = 2), emotional lability (n = 1), mood instability (n = 2), mood lability (n = 1) and mood swings (n = 1); however, these concepts showed considerable overlap in features. A total of 24 distinct measures were identified that could be categorized as primarily measuring one of four facets of AI (oscillation, intensity, ability to regulate and affect change triggered by environment) or as measuring general emotional regulation.

Conclusions

A clearer definition of AI is required. We propose AI be defined as ‘rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences’. No single measure comprehensively assesses AI and a combination of current measures is required for assessment. A new short measure of AI that is reliable and validated against external criteria is needed.

Keywords

Affective instabilitydysregulationmood lability
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 9 , July 2014 , pp. 1793 - 1808
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, TM (1991). Manual for Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont: Burlington, VT.Google Scholar
Akiskal, HS, Benazzi, F (2003). Family history validation of the bipolar nature of depressive mixed states. Journal of Affective Disorders 73, 113–122.Google Scholar
Akiskal, HS, Bourgeois, ML, Angst, J, Post, R, Moller, HJ, Hirschfeld, R (2000). Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders 59, S5–S30.Google Scholar
Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Keller, M, Warshaw, M, Clayton, P, Goodwin, F (1995). Switching from unipolar to bipolar-II – an 11-year prospective-study of clinical and temperamental predictors in 559 patients. Archives of General Psychiatry 52, 114–123.CrossRefGoogle ScholarPubMed
Akiskal, HS, Mendlowicz, MV, Jean-Louis, G, Rapaport, MH, Kelsoe, JR, Gillin, JC, Smith, TL (2005). TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament. Journal of Affective Disorders 85, 45–52.Google Scholar
Akiskal, HS, Placidi, GF, Maremmani, I, Signoretta, S, Liguori, A, Gervasi, R, Mallya, G, Puzantian, VR (1998). TEMPS-I: delineating the most discriminant traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. Journal of Affective Disorders 51, 7–19.Google Scholar
Anestis, MD, Coffey, SF, Schumacher, JA, Tull, MT (2011). Affective vulnerabilities and self-injury in suicide. Archives of Suicide Research 15, 291–303.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Endrass, J (2003). Risk factors for the bipolar and depression spectra. Acta Psychiatrica Scandinavica Supplementum 418, 15–19.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychological Association: Washington, DC.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychological Association: Washington, DC.Google Scholar
Asherson, P (2005). Clinical assessment and treatment of attention deficit hyper activity disorder in adults. Expert Review of Neurotherapeutics 5, 525–539.Google Scholar
Barkley, RA, Murphy, KR (2010). Deficient emotional self regulation in adults with attention-deficit hyperactivity disorder (ADHD): the relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. Journal of ADHD and Related Disorders 1, 5–28.Google Scholar
Benazzi, F, Akiskal, HS (2005). A downscaled practical measure of mood lability as a screening tool for bipolar II. Journal of Affective Disorders 84, 225–232.CrossRefGoogle ScholarPubMed
Berg, CZ, Shapiro, N, Chambless, DL, Ahrens, AH (1998). Are emotions frightening? II: an analogue study of fear of emotion, interpersonal conflict, and panic onset. Behaviour Research and Therapy 36, 3–15.Google Scholar
Bernstein, GA, Garfinkel, BD (1992). The Visual Analog Scale for Anxiety – revised – psychometric properties. Journal of Anxiety Disorders 6, 223–239.Google Scholar
Black, DW, Blum, N, Letuchy, E, Carney Doebbeling, C, Forman-Hoffman, VL, Doebbeling, BN (2006). Borderline personality disorder and traits in veterans: psychiatric comorbidity, healthcare utilization, and quality of life along a continuum of severity. CNS Spectrums 11, 680–689, quiz 719.Google Scholar
Bonsall, MB, Wallace-Hadrill, SMA, Geddes, JR, Goodwin, GM, Holmes, EA (2012). Nonlinear time-series approaches in characterizing mood stability and mood instability in bipolar disorder. Proceedings of the Royal Society B-Biological Sciences 279, 916–924.Google Scholar
Bornovalova, MA, Gratz, KL, Daughters, SB, Nick, B, Delany-Brumsey, A, Lynch, TR, Kosson, D, Lejuez, CW (2008). A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment. Journal of Psychiatric Research 42, 717–726.Google Scholar
Bowen, R, Baetz, M, Hawkes, J, Bowen, A (2006). Mood variability in anxiety disorders. Journal of Affective Disorders 91, 165–170.CrossRefGoogle ScholarPubMed
Bowen, R, Baetz, M, Leuschen, C, Kalynchuk, LE (2011 a). Predictors of suicidal thoughts: mood instability versus neuroticism. Personality and Individual Differences 51, 1034–1038.Google Scholar
Bowen, R, Clark, M, Baetz, M (2004). Mood swings in patients with anxiety disorders compared with normal controls. Journal of Affective Disorders 78, 185–192.CrossRefGoogle ScholarPubMed
Bowen, RC, Mahmood, J, Milani, A, Baetz, M (2011 b). Treatment for depression and change in mood instability. Journal of Affective Disorders 128, 171–174.Google Scholar
Campbell-Sills, L, Barlow, DH (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In Handbook of Emotion Regulation (ed. Gross, J. J.), pp. 542–559. Guilford: New York.Google Scholar
Campbell-Sills, L, Barlow, DH, Brown, TA, Hofmann, SG (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion 6, 587–595.Google Scholar
Chanen, AM, Jackson, HJ, McGorry, PD, Allot, KA, Clarkson, V, Yuen, HP (2004). Two-year stability of personality disorder in older adolescent outpatients. Journal of Personality Disorders 18, 526–541.CrossRefGoogle ScholarPubMed
Clayton, PJ, Ernst, C, Angst, J (1994). Premorbid personality-traits of men who develop unipolar or bipolar disorders. European Archives of Psychiatry and Clinical Neuroscience 243, 340–346.Google Scholar
Conklin, CZ, Bradley, R, Westen, D (2006). Affect regulation in borderline personality disorder. Journal of Nervous and Mental Disease 194, 69–77.CrossRefGoogle ScholarPubMed
Conners, CK, Erhardt, D, Sparrow, E (1999). Conners' Adult ADHD Rating Scales (CAARS) Technical Manual. Multi-Health Systems, Inc.: North Tonawanda.Google Scholar
Coutinho, J, Ribeiro, E, Ferreirinha, R, Dias, P (2010). The Portuguese version of the Difficulties in Emotion Regulation Scale and its relationship with psychopathological symptoms. Revista De Psiquiatria Clinica 37, 152–158.Google Scholar
Ebner-Priemer, UW, Eid, M, Kleindienst, N, Stabenow, S, Trull, TJ (2009). Analytic strategies for understanding affective (in)stability and other dynamic processes in psychopathology. Journal of Abnormal Psychology 118, 195–202.Google Scholar
Ebner-Priemer, UW, Kuo, J, Kleindienst, N, Welch, SS, Reisch, T, Reinhard, I, Lieb, K, Linehan, MM, Bohus, M (2007 a). State affective instability in borderline personality disorder assessed by ambulatory monitoring. Psychological Medicine 37, 961–970.Google Scholar
Ebner-Priemer, UW, Welch, SS, Grossman, P, Reisch, T, Linehan, MM, Bohus, M (2007 b). Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder. Psychiatry Research 150, 265–275.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, AE (2000). Attention-deficit/hyperactivity disorder in adults: an overview. Biological Psychiatry 48, 9–20.CrossRefGoogle ScholarPubMed
Garnet, KE, Levy, KN, Mattanah, JJF, Edell, WS, McGlashan, TH (1994). Borderline personality disorder in adolescents: ubiquitous or specific? American Journal of Psychiatry 151, 1380–1382.Google Scholar
Goodman, R (1997). The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry 38, 581–586.Google Scholar
Gratz, KL, Gunderson, JG (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy 37, 25–35.CrossRefGoogle Scholar
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41–54.Google Scholar
Gratz, KL, Rosenthal, MZ, Tull, MT, Lejuez, CW, Gunderson, JG (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology 115, 850–855.Google Scholar
Gross, JJ (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology 2, 271–299.CrossRefGoogle Scholar
Gross, JJ (1999). Emotion regulation: past, present, future. Cognition and Emotion 13, 551–573.Google Scholar
Gross, JJ (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39, 281–291.CrossRefGoogle ScholarPubMed
Gross, JJ, John, OP (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology 85, 348–362.Google Scholar
Gunderson, JG (2001). Borderline Personality Disorder: A Clinical Guide. American Psychiatric Publishing: Washington, DC.Google Scholar
Harvey, PD, Greenberg, BR, Serper, MR (1989). The Affective Lability Scales – development, reliability, and validity. Journal of Clinical Psychology 45, 786–793.Google Scholar
Henry, C, Mitropoulou, V, New, AS, Koenigsberg, HW, Silverman, J, Siever, LJ (2001). Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. Journal of Psychiatric Research 35, 307–312.Google Scholar
Henry, C, Van den Bulke, D, Bellivier, F, Roy, I, Swendsen, J, M'Bailara, K, Siever, LJ, Leboyer, M (2008 a). Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Research 159, 1–6.CrossRefGoogle ScholarPubMed
Henry, JD, Rendell, PG, Green, MJ, McDonald, S, O'Donnell, M (2008 b). Emotion regulation in schizophrenia: Affective, social, and clinical correlates of suppression and reappraisal. The Journal of Abnormal Psychology 117, 473–478.CrossRefGoogle ScholarPubMed
Higgins, J, Green, S (2011). Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. John Wiley & Sons: Chichester.Google Scholar
Hirschfeld, RM, Williams, JB, Spitzer, RL, Calabrese, JR, Flynn, L, Keck, PE, Lewis, L, McElroy, SL, Post, RM, Rapport, DJ, Russell, JM, Sachs, GS, Zajecka, J (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry 157, 1873–1875.Google Scholar
Hotopf, M, Churchill, R, Lewis, G (1999). Pragmatic randomised controlled trials in psychiatry. British Journal of Psychiatry 175, 217–223.Google Scholar
Howes, OD, Lim, S, Theologos, G, Yung, AR, Goodwin, GM, McGuire, P (2011). A comprehensive review and model of putative prodromal features of bipolar affective disorder. Psychological Medicine 41, 1567–1577.Google Scholar
Kamen, C, Pryor, LR, Gaughan, ET, Miller, JD (2010). Affective lability: separable from neuroticism and the other big four? Psychiatry Research 176, 202–207.Google Scholar
Koenigsberg, H (2010). Affective instability: toward an integration of neuroscience and psychological perspectives. Journal of Personality Disorders 24, 60–82.Google Scholar
Koenigsberg, HW, Harvey, PD, Mitropoulou, V, Schmeidler, J, New, AS, Goodman, M, Silverman, JM, Serby, M, Schopick, F, Siever, LJ (2002). Characterizing affective instability in borderline personality disorder. American Journal of Psychiatry 159, 784–788.CrossRefGoogle ScholarPubMed
Korten, NCM, Comijs, HC, Lamers, F, Penninx, BWJH (2012). Early and late onset depression in young and middle aged adults: differential symptomatology, characteristics and risk factors? Journal of Affective Disorders 138, 259–267.Google Scholar
Kraepelin, E (1921). Manic-Depressive Insanity and Paranoia. Translated by Barclay, RM. E and S Livingstone: Edinburgh.Google Scholar
Kring, AM, Werner, KH (2004). Emotion regulation and psychopathology. In The Regulation of Emotion (ed. Feldman, P. P. R. S.), pp. 359–395. Erlbaum: Mahwah, NJ.Google Scholar
Kröger, C, Theysohn, S, Hartung, D, Vonau, M, Lammers, C-H, Kosfelder, J (2010). Die Skala zur Erfassung der Impulsivitat der Borderliine-Personlichkeitsstorung (IS-27) – ein Beitrag zur Qualitatssicherung in der Psychotherapy [The scale measuring impulsiveness of Borderline Personality Disorder (IS-27) – A contribution to quality assurance in psychotherapy]. Diagnostica 56, 178–189.Google Scholar
Kröger, C, Vonau, M, Kliem, S, Kosfelder, J (2011). Emotion dysregulation as a core feature of borderline personality disorder: comparison of the discriminatory ability of two self-rating measures. Psychopathology 44, 253–260.Google Scholar
Larsen, RJ, Diener, E, Emmons, RA (1986). Affect intensity and reactions to daily life events. Journal of Personality and Social Psychology 51, 803–814.CrossRefGoogle Scholar
Lauer, CJ, Bronisch, T, Kainz, M, Schreiber, W, Holsboer, F, Krieg, JC (1997). Pre-morbid psychometric profile of subjects at high familial risk for affective disorder. Psychological Medicine 27, 355–362.Google Scholar
Linehan, MM (1993). Cognitive-Behavioral Treatment for Borderline Personality Disorder. Guilford: New York.Google Scholar
Linehan, MM, Heard, HL (1992). Dialectical behavior therapy for borderline personality disorder. In Borderline Personality Disorder: Clinical and Empirical Perspectives (ed. Clarkin, J. F., Marziali, E. and Munroe-Blum, H.), pp. 248–267. Guilford Press: New York.Google Scholar
Links, PS, Eynan, R, Heisel, MJ, Nisenbaum, R (2008). Elements of affective instability associated with suicidal behaviour in patients with borderline personality disorder. Canadian Journal of Psychiatry 53, 112–116.CrossRefGoogle ScholarPubMed
Liverant, GI, Brown, TA, Barlow, DH, Roemer, L (2008). Emotion regulation in unipolar depression: the effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy 46, 1201–1209.Google Scholar
Livesley, WJ, Jang, KL (2008). The behavioral genetics of personality disorder. Annual Review of Clinical Psychology 4, 247–274.Google Scholar
Look, AE, Flory, JD, Harvey, PD, Siever, LJ (2010). Psychometric properties of a short form of the Affective Lability Scale (ALS-18). Personality and Individual Differences 49, 187–191.CrossRefGoogle Scholar
MacKinnon, DF, Pies, R (2006). Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders. Bipolar Disorders 8, 1–14.Google Scholar
Marshall-Berenz, EC, Morrison, JA, Schumacher, JA, Coffey, SF (2011). Affect intensity and lability: the role of posttraumatic stress disorder symptoms in borderline personality disorder. Depression and Anxiety 28, 393–399.CrossRefGoogle ScholarPubMed
Marwaha, S, Parsons, N, Flanagan, S, Broome, M (2013). The prevalence and clinical associations of mood instability in adults living in England: results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Research 205, 262–268.Google Scholar
McGlashan, TH, Grilo, CM, Sanislow, CA, Ralevski, E, Morey, LC, Gunderson, JG, Skodol, AE, Shea, MT, Zanarini, MC, Bender, D, Stout, RL, Yen, S, Pagano, M (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of Axis II disorders. American Journal of Psychiatry 162, 883–889.CrossRefGoogle Scholar
Miller, JD, Pilkonis, PA (2006). Neuroticism and affective instability: the same or different? American Journal of Psychiatry 163, 839–845.Google Scholar
Mitchell, JT, Robertson, CD, Anastopolous, AD, Nelson-Gray, RO, Kollins, SH (2012). Emotion dysregulation and emotional impulsivity among adults with attention-deficit/hyperactivity disorder: results of a preliminary study. Journal of Psychopathology and Behavioral Assessment 34, 510–519.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Grp, P (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Medicine 6, e1000097.Google Scholar
Moore, SR, Gresham, LS, Bromberg, MB, Kasarkis, EJ, Smith, RA (1997). A self report measure of affective lability. Journal of Neurology, Neurosurgery and Psychiatry 63, 89–93.Google Scholar
Morey, LC (1991). Personality Assessment Inventory: Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Newhill, CE, Mulvey, EP, Pilkonis, PA (2004). Initial development of a measure of emotional dysregulation for individuals with cluster B personality disorders. Research on Social Work Practice 14, 443–449.Google Scholar
Oliver, MNI, Simons, JS (2004). The Affective Lability Scales: development of a short-form measure. Personality and Individual Differences 37, 1279–1288.Google Scholar
Ozgurdal, S, van Haren, E, Hauser, M, Strohle, A, Bauer, M, Assion, H-J, Juckel, G (2009). Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis. Psychopathology 42, 337–342.Google Scholar
Reich, DB, Zanarini, MC, Bieri, KA (2009). A preliminary study of lamotrigine in the treatment of affective instability in borderline personality disorder. International Clinical Psychopharmacology 24, 270–275.Google Scholar
Reimherr, FW, Marchant, BK, Olsen, JL, Halls, C, Kondo, DG, Williams, ED, Robison, RJ (2010). Emotional dysregulation as a core feature of adult ADHD: its relationship with clinical variables and treatment response in two methyl-phenidate trials. Journal of ADHD and Related Disorders 1, 53–64.Google Scholar
Reimherr, FW, Marchant, BK, Strong, RE, Hedges, DW, Adler, L, Spencer, TJ, West, SA, Soni, P (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry 58, 125–131.Google Scholar
Reimherr, FW, Williams, ED, Strong, RE, Mestas, R, Soni, P, Marchant, BK (2007). Double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. Journal of Clinical Psychiatry 68, 93–101.Google Scholar
Rihmer, Z, Benazzi, F (2010). Impact on suicidality of the borderline personality traits impulsivity and affective instability. Annals of Clinical Psychiatry 22, 121–128.Google Scholar
Sharp, C, Goodyer, IM, Croudace, TJ (2006). The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7- through 11-year-old children. Journal of Abnormal Child Psychology 34, 379–391.CrossRefGoogle ScholarPubMed
Shedler, J, Westen, D (2004). Dimensions of personality pathology: an alternative to the five-factor model. American Journal of Psychiatry 161, 1743–1754.CrossRefGoogle ScholarPubMed
Siever, LJ, Davis, KL (1991). A psychobiological perspective on the personality-disorders. American Journal of Psychiatry 148, 1647–1658.Google Scholar
Skirrow, C, Asherson, P (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders 147, 80–86.Google Scholar
Skirrow, C, McLoughlin, G, Kuntsi, J, Asherson, P (2009). Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Review of Neurotherapeutics 9, 489–503.Google Scholar
Solhan, MB, Trull, TJ, Jahng, S, Wood, PK (2009). Clinical assessment of affective instability: comparing EMA indices, questionnaire reports, and retrospective recall. Psychological Assessment 21, 425–436.CrossRefGoogle ScholarPubMed
Stein, DJ, Phillips, KA, Bolton, D, Fulford, KWM, Sadler, JZ, Kendler, KS (2010). What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychological Medicine 40, 1759–1765.CrossRefGoogle ScholarPubMed
Stone, AA, Shiffman, S, Schwartz, JE, Broderick, JE, Hufford, MR (2002). Patient non-compliance with paper diaries. British Medical Journal 324, 1193–1194.Google Scholar
Stone, AS, Shiffman, S (1994). Ecological Momentary Assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine 16, 199–202.Google Scholar
Thompson, RJ, Berenbaum, H, Bredemeier, K (2011). Cross-sectional and longitudinal relations between affective instability and depression. Journal of Affective Disorders 130, 53–59.Google Scholar
Trull, TJ, Solhan, MB, Tragesser, SL, Jahng, S, Wood, PK, Piasecki, TM, Watson, D (2008). Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. Journal of Abnormal Psychology 117, 647–661.CrossRefGoogle ScholarPubMed
Wender, PH (1995). Attention-Deficit Hyperactivity Disorder in Adults. Oxford University Press: New York.Google Scholar
Werner, KH, Goldin, PR, Ball, TM, Heimberg, RG, Gross, JJ (2011). Assessing emotion regulation in social anxiety disorder: the emotion regulation interview. Journal of Psychopathology and Behavioral Assessment 33, 346–354.Google Scholar
Werner, KW, Gross, JJ (2009). Emotion regulation and psychopathology: a conceptual framework. In Emotion Regulation and Psychopathology (ed. Sloan, A. K. D.). Guilford: New York.Google Scholar
Westen, D (1991). Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality-disorders. Clinical Psychology Review 11, 211–230.Google Scholar
Westen, D, Muderrisoglu, S, Fowler, C, Shedler, J, Koren, D (1997). Affect regulation and affective experience: individual differences, group differences, and measurement using a Q-sort procedure. Journal of Consulting and Clinical Psychology 65, 429–439.CrossRefGoogle ScholarPubMed
Widiger, TA, Mangine, S, Corbitt, EM, Ellis, CG, Thomas, GV (1995). Personality Disorder Interview-IV: A Semistructured Interview for the Assessment of Personality Disorders. Psychological Assessment Resources: Odessa, FL.Google Scholar
Williams, KE, Chambless, DL, Ahrens, A (1997). Are emotions frightening? An extension of the fear of fear construct. Behaviour Research and Therapy 35, 239–248.Google Scholar
Williams, LM, Hermens, DF, Palmer, D, Kohn, M, Clarke, S, Keage, H, Clark, CR, Gordon, E (2008). Misinterpreting emotional expressions in attention-deficit/hyperactivity disorder: evidence for a neural marker and stimulant effects. Biological Psychiatry 63, 917–926.Google Scholar
Wing, JK, Cooper, JE, Sartorius, N (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Wolke, D, Schreier, A, Zanarini, MC, Winsper, C (2012). Bullied by peers in childhood and borderline personality symptoms at 11 years of age: a prospective study. Journal of Child Psychology and Psychiatry 53, 846–855.Google Scholar
Woyshville, MJ, Lackamp, JM, Eisengart, JA, Gilliland, JAM (1999). On the meaning and measurement of affective instability: clues from chaos theory. Biological Psychiatry 45, 261–269.Google Scholar
Yen, S, Shea, MT, Sanislow, CA, Grilo, CM, Skodol, AE, Gunderson, JG, McGlashan, TH, Zanarini, MC, Morey, LC (2004). Borderline personality disorder criteria associated with prospectively observed suicidal behavior. American Journal of Psychiatry 161, 1296–1298.Google Scholar
Yen, S, Zlotnick, C, Costello, E (2002). Affect regulation in women with borderline personality disorder traits. Journal of Nervous and Mental Disease 190, 693–696.Google Scholar
Zanarini, MC, Horwood, J, Wolke, D, Waylen, A, Fitzmaurice, G, Grant, BF (2011). Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. Journal of Personality Disorders 25, 607–619.Google Scholar
Supplementary material: File

Marwaha Supplementary Material

Table S1

Download Marwaha Supplementary Material(File)
File 431.1 KB