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Randomized Controlled Trial
. 2025 Aug 28;25(1):832.
doi: 10.1186/s12888-025-07300-6.

Emotion word repertoire in the adult attachment interview predicts a reduction of non-suicidal self-injury in the psychotherapy of borderline personality disorder

S Schmitz-Riol  1   2   3 , J Fuchshuber  2   3   4 , J Herpertz  5 , A Buchheim  6 , S Hörz-Sagstetter  7 , M Rentrop  8   9 , M Fischer-Kern  2   3 , P Buchheim  10 , J Taylor  11 , A Tmej  2   3 , K L Weihs  12 , R D Lane  12 , S Doering  13   14
Affiliations
Randomized Controlled Trial

Emotion word repertoire in the adult attachment interview predicts a reduction of non-suicidal self-injury in the psychotherapy of borderline personality disorder

S Schmitz-Riol et al. BMC Psychiatry. .

Abstract

Background: Borderline personality disorder (BPD) is characterized by mental representation deficits and emotion dysregulation, with non-suicidal self-injury (NSSI) often occurring as a maladaptive regulation strategy. The ability to verbally express emotions might be advantageous for coping with emotion dysregulation and benefiting from psychotherapy.

Methods: In the present study, we used a novel text-based measure of emotional awareness to examine whether a greater emotion word repertoire (EWR) predicts improvement in psychotherapy for patients with BPD regarding NSSI, suicide attempts, attachment representations, mentalization, and personality organization. We conducted a secondary analysis of a randomized controlled trial comparing the efficacy of Transference-Focused Psychotherapy (TFP) vs. treatment as usual over one year in a sample of female BPD outpatients. The German electronic Levels of Emotional Awareness Scale (eLEAS) scoring system was applied to Adult Attachment Interviews (AAI) administered at baseline (n = 87; Mage = 27.4, SDage = 7.4) and upon treatment termination (n = 52; Mage = 28.6, SDage = 7.2).

Results: In both treatment groups, EWR at baseline was positively correlated with a reduction of NSSI after one year of psychotherapy (r = .46, p < .001). No significant correlations were found between baseline EWR and changes in other outcome measures. Compared to baseline, mean EWR scores significantly decreased after one year of treatment.

Discussion: Our findings indicate that a borderline patient's ability to verbalize emotions might be a resource facilitating a reduction of NSSI in psychotherapy. We discuss strengths and limitations of applying the eLEAS scoring system to open-ended texts in a psychotherapy context. Given the exploratory nature of this study, replication in future studies is warranted.

Trial registration: ClinicalTrials.gov (identifier NCT00714311, registration date 07/09/2008).

Keywords: Borderline personality disorder; Emotion dysregulation; Emotion word repertoire; Emotional awareness; Non-suicidal self-injury.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was carried out in accordance with the recommendations of the ethics committee of the Medical University of Vienna which approved the protocol under the signature 207/2004. All subjects gave written informed consent in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Moderation effect of baseline emotion word repertoire (EWR) on change in Global Severity Index (GSI) in Transference-Focused Psychotherapy (TFP) vs. treatment as usual (TAU)
See this image and copyright information in PMC

References

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