This is an ongoing assignment and will be worked on each week. This is what is required this week. I also picked to focus on Borderline Personality for my topic.Select the topic for your Critical Revi

BRIEF REPORT The Interaction of Borderline Personality Disorder Symptoms and Relationship Satisfaction in Predicting Affect Katherine Kuhlken, Christopher Robertson, Jessica Benson, and Rosemery Nelson-Gray University of North Carolina at Greensboro Previous research has suggested that stable, marital relationships may have overall prognostic signifi- cance for individuals with borderline personality disorder (BPD); however, research focused on the impact of nonmarital, and perhaps short-term, romantic relationships is lacking. Thus, the primary goal of this study was to examine the impact of the interaction of BPD symptoms and relationship satisfaction on state negative affect in college undergraduates. It was predicted that individuals who scored higher on measures of BPD symptoms and who were in a satisfying romantic relationship would report less negative affect than comparable individuals in a less satisfying romantic relationship. Questionnaires assessing BPD symptoms, relationship satisfaction, and negative affect were administered to 111 women, the majority of whom then completed daily measures of relationship satisfaction and negative affect over a 2-week follow-up period. Hierarchical multiple regression and hierarchical linear modeling were used to test the hypotheses. The interaction of BPD symptoms with relationship satisfaction was found to significantly predict anger, as measured at one time point, suggesting that satisfying romantic relation- ships may be a protective factor for individuals scoring high on measures of BPD symptoms with regard to anger.

Keywords:borderline personality disorder, hierarchical linear modeling, negative affect, relationship satisfaction, experience sampling methodology Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in interpersonal relationships and self-image, intense and unstable affect, and marked impulsivity that persists across multiple contexts. The prevalence of BPD in the general population is estimated to be around 2%, with higher rates in outpatient mental-health clinics (10%) and among psychi- atric inpatients (20%;American Psychiatric Association [APA], 2000). Notably, up to 10% of those who meet criteria for BPD commit suicide, a rate that is 50 times higher than that found in the general population (APA, 2001). Recurrent job losses, broken marriages, and interrupted education are also common (APA, 2000).

One of the defining characteristics of BPD is affective insta- bility; in particular, unstable highnegativeaffect (Zeigler-Hill & Abraham, 2006). In individuals with BPD, negative affect is most commonly expressed as depression or dysphoria, irritabil- ity, anger, and anxiety (APA, 2000;Gunderson, 1984;Linehan, 1993). The ongoing dysphoric mood of those with BPD is ofteninterrupted by episodes of anger, panic, or despair. It has been suggested that these episodes reflect extreme reactivity to stres- sors, often interpersonal (APA, 2000;Glaser, Van Os, Mengel- ers, & Myin-Germeys, 2008;Gunderson & Phillips, 1991; Stiglmayr et al., 2005). The episodes of anger, in particular, are often brought about when a caregiver or lover is thought to be acting in a neglectful, uncaring, abandoning, or withholding manner (APA, 2000). To illustrate, an experience-sampling study conducted byBerenson, Downey, Rafaeli, Coifan, and Paquin (2011)found a significant association between self- reports of perceived interpersonal rejection and rage for partic- ipants with BPD. It has been suggested that, in some cases, the real or perceived return of the caregiver’s attention results in a reduction of symptoms (APA, 2000).

As is evident from the term “instability,” these extreme changes in mood typically last no more than a few days, oftentimes lasting only hours (Linehan, 1993;Trull et al., 2008). For example, having measured the morning and evening moods of groups of women, Cowdry, Gardner, O’Leary, Leibenluft, and Rubinow (1991)dis- covered that the 14-day pattern for women with BPD showed unpredictable mood change from one day to the next. In addition, Stein (1996)assessed affective instability via an experience- sampling procedure over 10 days and found that BPD individuals demonstrated greater instability of their negative affect than did controls.

Also highly characteristic of BPD is “a pattern of unstable and intense interpersonal relationships characterized by alter- nating between extremes of idealization and devaluation” This article was published Online First February 11, 2013.

Katherine Kuhlken, Christopher Robertson, Jessica Benson, and Rose- mery Nelson-Gray, Department of Psychology, University of North Car- olina at Greensboro.

Correspondence concerning this article should be addressed to Katherine Kuhlken, Department of Psychology, 296 Eberhart Building, P.O. Box 26170, University of North Carolina at Greensboro, Greensboro, NC 27402-6170. E-mail:[email protected] This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Personality Disorders: Theory, Research, and Treatment© 2013 American Psychological Association 2014, Vol. 5, No. 1, 20 –251949-2715/14/$12.00 DOI:10.1037/per0000013 20 (APA, 2000, p. 710).Hill et al. (2008)found evidence that BPD was the only disorder among multiple psychological disorders whose symptoms specifically predicted romantic relationship dysfunction. In fact, this level of dysfunction, although gener- ally present in all interpersonal relationships for those with BPD, tends to increase as the intimacy of the relationship increases, making romantic relationships especially vulnerable (Oliver, Perry, & Cade, 2008).

It has been suggested that the characteristic chaotic patterns in the intimate relationships of those with BPD may contribute to the main- tenance of disordered affect (Oliver et al., 2008). According to Line- han, “. . . borderline individuals, more so than most, seem to do well when in stable, positive relationships and to do poorly when not in such relationships” (1993, p. 11). Studies looking at the influence of marriage on outcome for BPD individuals have provided support for its potential positive impact. For example,Quinton, Rudder, and Liddle (1984)found that, for institutionally raised girls, good out- comes related to BPD symptoms in young adulthood were connected with being in a stable marriage. In another study, it was established that older, caregiving husbands could lessen borderline psychopathol- ogy in their young wives (Paris & Braverman, 1995). Similarly,Links and Stockwell (2001)found that marital status was a significant predictor of improved functioning, both related to employment and global functioning. However, there is a paucity of studies examining the impact of satisfying, nonmarital, and perhaps short-term, romantic relationships on outcome—specifically, negative affect, in individuals with BPD. In light of this gap in the existing literature, the primary goal of this study was to investigate the impact of romantic relation- ships on state-negative affect across a continuum of BPD traits.

As such, the first hypothesis for this study was that the interac- tion of BPD symptoms and relationship satisfaction would be a significant predictor of negative affect above and beyond the contribution of either alone. Specifically, individuals who scored higher on measures of BPD symptoms and were in a satisfying romantic relationship were predicted to report less negative affect than those who also scored higher on measures of BPD symptoms but were in a less satisfying romantic relationship.

Hypotheses 2, 3, and 4 examined the relations of BPD symptoms, relationship satisfaction, and affect in daily life. Given the instability of affect and relationship satisfaction in BPD, it would have been negligent to examine these characteristics at only one time point. The second hypothesis was that greater ratings of BPD symptoms would be associated with less relationship satisfaction and greater negative affect, on a daily basis. The third hypothesis was that daily ratings of relationship satisfaction would be inversely associated with daily ratings of negative affect. The fourth hypothesis was that daily rela- tionship satisfaction would moderate the relations of BPD symptoms and daily negative affect. Specifically, these relations were predicted to be stronger, and positive, for participants who endorsed lower levels of relationship satisfaction. Method Participants The initial sample consisted of 123 female college undergrad- uates age 18 and older who were enrolled in an introductory psychology course. Participants were required to have been in a current romantic relationship with a duration of at least 2 months.Despite being in a romantic relationship at the time of recruitment, 12 participants were no longer in a relationship at the time of participation and were dropped from the sample. The remaining 111 participants ranged in age from 18 to 27 (M 18.67,SD 1.20) and were primarily Caucasian (59.5%) and African Ameri- can (29.7%). The sample was restricted to females because the vast majority of individuals who meet criteria for BPD are female (APA, 2000;Linehan, 1993). In an effort to ensure adequate representation at the upper ranges of BPD symptoms, 29 of the 111 participants were recruited based on their BPD symptom scores obtained during a psychology department mass screening proce- dure. These participants were required to have scored at or above .75 standard deviations above the mean of the screening sample on measures of BPD symptoms.

Research has demonstrated the benefit of testing BPD hypoth- eses with college students.Trull (1995,2001) andTrull, Useda, Conforti, & Boan (1997)found that college students who score high on the PAI-BOR (Personality Assessment Inventory– Borderline Features Scale) possess several affective and behav- ioral problems that are associated with BPD. Specifically, studies have shown that using a raw score cutoff of 38 as a guideline has resulted in the correct classification of 77.3% of nonclinical female college students assessed (Bell-Pringle, Pate, & Brown, 1997).

Although level of BPD symptoms was viewed as continuous in this study, approximately 20% of the participants scored at or above a 38 on the PAI-BOR. Materials Demographic form.Basic demographic information was col- lected and included age and ethnicity. In addition, a question concerning the length of one’s current romantic relationship was included.

Positive and Negative Affect Schedule (PANAS).The PA- NAS (Watson, Clark, & Tellegen, 1988) is a 20-item self-report questionnaire comprised of two 10-item mood scales (positive affect and negative affect). Each item is rated on a 5-point scale ranging fromvery slightly or not at alltoextremelyto indicate the extent to which the respondent has felt this way in the indicated time period. The time frame used in this study wasin the past week. Each item consists of a one word feeling or emotion, such as irritable, nervous, upset(negative affect) orexcited, proud, strong (positive affect). The authors have demonstrated both internal consistency reliability ( .84 –.90) and external validity for this measure.

Beck Depression Inventory-II (BDI-II).The BDI–II (Beck, Steer, & Brown, 1996) is a 21-item, multiple-choice self-report measure of depressive symptomology. Participants are asked to rate to what degree they have experienced each symptom during the past 2 weeks. Well-established validity and reliability ( .91–.93) have been demonstrated in outpatient samples (Beck et al., 1996;Dozois, Dobson, & Ahnberg, 1998).

One adaptation was made to this measure. Participants were asked to make their choices based on how they had been feeling over the past week, rather than the past 2 weeks. This adaptation was proposed to account for the high degree of affective instability characteristic of BPD.

Beck Anxiety Inventory (BAI).The BAI (Beck & Steer, 1990) is a 21-item, multiple-choice self-report measure of anxiety This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 21 BORDERLINE PERSONALITY AND ROMANTIC RELATIONSHIPS severity, designed to discriminate anxiety from depression. Partic- ipants are instructed to rate to what degree they have been bothered by each symptom during the past week. The BAI has shown high internal consistency ( .92) and a 1-week test–retest reliability of .75 (Beck, Epstein, Brown, & Steer, 1988).

State–Trait Anger Scale (STAS).The STAS (Spielberger & London, 1983) is a 30-item self-report measure of state and trait anger. This study employed only the state-anger scale (SAS), as it better reflects the dynamic nature of affect for individuals with BPD. Participants were instructed to indicate how they feltat that moment. The internal consistency for the state-anger measure has been shown to be .93 for male and female Navy recruits. Support for concurrent validity has also been demonstrated (Spielberger, Jacobs, Russel, & Crane, 1983;Spielberger & London, 1983).

Dyadic Adjustment Scale (DAS).The DAS (Spanier, 1976) is a 32-item self-report measure of the quality of marriage or similar dyads. However, it can be used as a general measure of relationship satisfaction when the total score is used, as was done in this study. The DAS has demonstrated known-groups validity by discerning between married and divorced couples on each item.

In addition, the DAS has evidenced concurrent validity.

Wisconsin Personality Disorders Inventory–IV (WISPI-IV).

The WISPI-IV (Klein et al., 1993) is a 214-item self-report of continuous symptoms of theDSM-IVpersonality disorders. Al- though all scales were administered, only the BPD scale was used in the present study. Items are self-descriptive and rated on a 10-point Likert scale ranging fromnever/not at alltoalways/ extremely. The WISPI-IV has demonstrated excellent internal re- liability and 2-week test–retest reliability, as well as good discrim- inant and concurrent validity (Barber & Morse, 1994;Hyler et al., 1988;Klein et al., 1993;Millon, 1982).

Personality Assessment Inventory (PAI).The PAI (Morey, 1991) is a 344-item self-report measure of adult psychopathology.

Each item is scored on a 4-point Likert scale ranging fromFalse toVery True. Contained within the PAI are 22 nonoverlapping scales, including the PAI–Borderline Features Scale, which was the only scale administered in the present study. This scale has shown excellent validity and reliability (Gardner & Qualter, 2009; Morey, 1991;Stein, Pinsker-Aspen, & Hillsenroth, 2007).

Daily Diary Questionnaire.The Daily Diary Questionnaire, created specifically for this study, consisted of nine questions designed to broadly assess for current romantic relationship satis- faction, positive affect, and negative affect. The questions relevant to the hypotheses of this study were as follows:

(1) How satisfied are you today in your current romantic relationship?

(2) How happy are you with your partner today?

(3) How strongly do you want to continue in your relation- ship today?

(4) How angry do you feel today?

(5) How anxious do you feel today?

(6) How sad do you feel today? and (7) How stressful was your day today?All questions were rated on a 7-point Likert scale, with a higher number indicating greater satisfaction, anger, so on and so forth.

Participants’ responses for Questions 1–3 were averaged to form one relationship satisfaction score per day ( .91). Questions 4 –7 were indicative of participants’ daily anger, anxiety, sadness, and general negative affect, respectively. Procedure Packets of questionnaires were administered to groups of one to 12 participants in lecture halls. Following completion, participants who chose to continue their participation were instructed to log onto Survey Monkey daily for 2 weeks and fill out a brief ques- tionnaire. A reminder e-mail was sent to each participant daily.

Seventy-six participants from the initial session chose to partici- pate in the 2-week repeated-measures portion of the study. Partic- ipants completed the Daily Diary Questionnaire, on average, 10.66 (SD 2.53) out of 14 days for the follow-up period. At the end of the 2-week period, participants were awarded course credit. Results The BPD scale of the WISPI-IV and the PAI were entered into an unrotated principal components analysis in order to extract factors of symptoms of BPD. This analysis resulted in one factor, known as “BPD symptoms,” with an eigenvalue of 1.64, account- ing for 81.80% of the variance.Table 1contains the means, standard deviations, ranges, skewness, kurtosis, and alphas of the one-time measures, as well as BPD symptoms. Four variables were positively skewed: depressive symptoms, anxiety symptoms, an- ger, and general negative affect. Depressive symptoms, anxiety symptoms, and general negative affect were normalized using a square-root transformation. Anger, being highly skewed, was nor- malized using the logarithmic transformation lg 10(x 1).Table 2 contains the means, standard deviations, ranges, and alphas (when applicable) of relationship satisfaction, anger, anxiety, sadness, and general negative affect, assessed daily with the Daily Diary Questionnaire.

Given that approximately 30% of the individuals who partici- pated in the initial study session chose not to participate in the 2-week follow-up portion of the study, one-way ANOVAs were conducted in order to determine whether these individuals differed significantly on variables measured at the initial session from individuals who participated in both portions of the study. The results of these analyses indicated no significant differences. Analyses of Initial Session Data The first hypothesis, concerning the interaction of BPD symp- toms and relationship satisfaction, was tested using hierarchical multiple regression with negative affect as the criterion variable.

Rather than creating a latent variable for negative affect, this analysis was run once with each type of negative affect measured as the criterion variable. Before conducting the regression analysis, relationship satisfaction was standardized. BPD symptoms were entered into the first step of the model and standardized relation- ship satisfaction was entered in the second step. The interaction of BPD symptoms and relationship satisfaction (created by multiply- ing these variables) was entered into the third step to determine if there was a moderating effect. This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 22 KUHLKEN, ROBERTSON, BENSON, AND NELSON-GRAY When anger was entered as the criterion variable, the overall model was significant,F(3, 107) 5.13,p .01, and accounted for 13% of the variance in anger. Furthermore, the interaction between BPD symptoms and relationship satisfaction was signif- icant ( .19,p .05). A simple-slopes analysis indicated that BPD symptoms interacted with relationship satisfaction such that BPD symptoms had a stronger positive relationship with anger when relationship satisfaction was lower. As relationship satisfac- tion increased, the relation between BPD symptoms and anger became nonsignificant. The slope of the line for high relationship satisfaction, across levels of BPD symptoms, was not significantly different from zero.

When anxiety was entered as the criterion variable, the overall model was significant,F(3, 107) 12.18,p .001, and accounted for 26% of the variance in anxiety symptoms. BPD symptoms had a significant main effect ( .48,p .001), with greater levels of BPD symptoms related to higher anxiety, regardless of relation- ship satisfaction. Relationship satisfaction did not have a signifi- cant main effect. The interaction was also not significant. When depression was entered as the criterion variable, the overall model was significant,F(3, 107) 28.44,p .001, and accounted for 44% of the variance in depressive symptoms. BPD symptoms ( .64,p .001) and relationship satisfaction ( .16,p .05) had significant main effects, suggesting that greater levels of BPD symptoms and lower relationship satisfaction are related to more depressive symptoms; however, the interaction was not significant.

Finally, when general negative affect was entered as the criterionvariable, the overall model was also significant,F(3, 107) 4.97, p .01, and accounted for 12% of the variance in general negative affect. BPD symptoms ( .31,p .01) had a significant main effect, suggesting that greater levels of BPD symptoms are related to more negative affect, regardless of relationship satisfaction.

Relationship satisfaction ( .17,p .06) showed a trend toward significance, suggesting that greater relationship satisfac- tion is associated with less negative affect, regardless of BPD symptoms. However, the interaction was not significant. Analyses of Repeated-Measures Data Repeated-measures data, as collected during the 2-week follow-up period, have a hierarchical structure in which repeated- measures ratings (Level 1) are nested within participants (Level 2); thus, the remainder of the hypotheses were tested using hierarchi- cal linear modeling (HLM). In these analyses, the Level 1 data are comprised of the daily questionnaire ratings of relationship satis- faction, anger, anxiety, sadness, and general negative affect; Level 2 data are comprised of the participants’ ratings of BPD symptoms at one time point (initial session).

Prior to conducting HLM analyses, assumptions were tested using the full model. The full model included relationship satis- faction at Level 1 (group-mean centered) and BPD symptoms at Level 2 (grand-mean centered) in predicting affect. Some of the assumptions were not upheld when tested. In response to these violations, the Level 1 variables were transformed and the results of the analyses using these models were interpreted with caution.

To test the second hypothesis, which examined the relation of BPD symptoms to daily ratings of relationship satisfaction, anger, anxiety, sadness, and general negative affect, a HLM means-as- outcomes model was run. The results of this model indicated that BPD symptoms were not a significant predictor of relationship satisfaction measured daily; however, they were a significant pre- dictor of anger ( 01 .10,p .01), anxiety ( 01 .17,p .01), sadness ( 01 .15,p .001), and general negative affect ( 01 .12,p .01) measured daily, as predicted.

To test the third and fourth hypotheses, which examined (a) the relation between relationship satisfaction and anger, anxiety, sad- ness, and general negative affect, all of which were measured daily, and (b) the change in slope for the interaction of BPD symptoms and daily negative affect across levels of daily relation- Table 1 Means, Standard Deviations, Ranges, Skewness, Kurtosis, and Alphas of Anxiety Symptoms, Depressive Symptoms, Anger, General Negative Affect, Relationship Satisfaction, and BPD Symptoms MeanStandard deviation RangeSkewness (SE .23)Kurtosis (SE .46) Alpha ( ) Anxiety symptoms 11.40 9.75 0–43 1.14 0.88 .91 Anxiety symptoms 3.03 1.50 0–6.56 0.11 0.43 — Depressive symptoms 6.58 5.98 0–33 1.69 4.31 .87 Depressive symptoms 2.24 1.25 0–5.74 0.03 0.02 — Anger 3.64 6.75 0–34 2.84 8.00 .94 LG10(Anger 1) 0.40 0.44 0–1.54 0.88 0.09 — General negative affect 11.51 7.74 0–37 0.96 0.51 .85 General negative affect3.19 1.16 0–6.08 0.08 0.16 — Relationship satisfaction 115.41 15.81 69–143 0.46 0.15 .89 BPD symptoms 0.00 1.00 1.57–2.63 0.70 0.24 — Note.BPD symptoms latent BPD variable. Table 2 Means, Standard Deviations, Ranges, and Alphas of Relationship Satisfaction, Anger, Anxiety, Sadness, and Negative Affect, Measured Daily MeanStandard deviation RangeAlpha ( ) Relationship satisfaction 5.05 1.37 0–6 .91 Anger 0.85 1.41 0–6 — Anxiety 1.54 1.76 0–6 — Sadness 0.94 1.40 0–6 — Negative affect 1.72 1.74 0–6 — This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 23 BORDERLINE PERSONALITY AND ROMANTIC RELATIONSHIPS ship satisfaction, a cross-level interaction model was run. The results of this model indicated that daily relationship satisfaction was significantly and negatively related to daily anger ( 10 1.20,p .001), anxiety ( 10 .28,p .01), sadness ( 10 .98,p .001), and general negative affect ( 10 .37, p .01), as predicted. In addition, the results indicated that daily relationship satisfaction did not moderate the relation of BPD symptoms and daily anger, anxiety, sadness, or general negative affect, contrary to prediction. Discussion Previous research has suggested that satisfying romantic rela- tionships may have a positive impact on the prognosis of BPD symptomology, including negative affect; however, this has not been well-established, particularly for nonmarital and possibly short-term relationships. Thus, this study sought to examine the impact of satisfying romantic relationships on negative affect in individuals scoring higher on measures of BPD symptoms. In an effort to account for the instability of romantic relationships and affect characteristic of BPD, this study assessed these constructs in participants not only at an initial time point, but also daily for 2 weeks, subsequently. Strengths of this study include the use of a repeated-measures data collection period and oversampling for individuals scoring higher on measures of BPD symptoms.

Individuals diagnosed with BPD often experience many types of negative affect; however, the experience of anger or irritability seems to be particularly common. TheDSM-IV-TRcriteria for BPD include not only affective instability in general, but also a criterion that is specific to anger, “inappropriate, intense anger or difficulty controlling anger” (APA, 2000, p. 710). In addition, it has been suggested that anger, in particular, often emerges in an individual with BPD when they perceive a romantic partner as being neglectful or abandoning (APA, 2000;Berenson et al., 2011). The results of this study provide support for the interaction of BPD symptoms and relationship satisfaction in predicting anger above and beyond the contribution of either alone, such that individuals who scored higher on measures of BPD symptoms and were in satisfying romantic relationships reported significantly less anger than comparable individuals who were in less satisfying romantic relationships. This finding supports the observation that the return of a romantic partner’s attention, whether real or per- ceived, sometimes results in a reduction of anger (APA, 2000).

Furthermore, the simple-slopes analysis of this interaction sug- gested that the amount of anger reported by individuals who scored lower on measures of BPD symptoms and were in a satisfying romantic relationship was not statistically distinguishable from the amount of anger reported by individuals who scored higher on measures of BPD symptoms and were in a satisfying romantic relationship. Overall, this suggests that satisfying romantic rela- tionships may be a protective factor for individuals scoring higher on measures of BPD symptoms with regard to anger.

Contrary to prediction, the results for the repeated-measures data did not provide support for daily relationship satisfaction moderating the relation of BPD symptoms (Level 2) and anger, as measured on a daily basis. However, individually, BPD symptoms were significantly positively associated with daily anger, and re- lationship satisfaction was significantly negatively associated with daily anger, as predicted. The lack of a significant interaction maybe attributable to the fact that each of these main effects, on its own, was quite robust. It appears that all participants, regardless of level of BPD symptoms, exhibited less anger when they were feeling more satisfied in their relationships. This suggests that the findings for both the initial-session and repeated-measures data are not in conflict; instead, both appear to suggest that satisfying romantic relationships are associated with reduced anger in indi- viduals scoring higher on measures of BPD symptoms.

One limitation of the study was the fact that causal implications could not be made regarding the association between relationship satisfaction and negative affect. Given the data, it could not be determined whether relationship satisfaction led to a change in affect; affect led to a change in relationship satisfaction; or some third variable contributed to a change in both. In addition, it is possible that 2 weeks may not have been a long enough period to capture noticeable disruptions in relationship satisfaction, particu- larly in a nonclinical population. There was not much variability in relationship satisfaction across 2 weeks, which was also true of daily affect ratings. We chose to use brief daily measures of relationship satisfaction and affect in order to increase compliance over the 2-week period. Our compliance rate was high; however, it seems to have come at a cost—low measure variability.

Future research may expand on the current study in a number of ways. The findings of this study should be replicated with a clinical sample so as to be generalizable to this population. Given that most of the previous literature discusses a general improve- ment of BPD symptoms associated with relationship satisfaction, future research may also seek to explore other outcome variables characteristic of BPD, such as impulsive behavior or self-injury.

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