Expressed Emotion in Significant Others of Individuals With Borderline Personality Disorder

Expressed emotion (EE; involving emotional overinvolvement and critical comments) in close contacts (CCs) is known to exacerbate other mental illnesses and be elevated in individuals with borderline personality disorders' (BPDs') CCs. However, its relationship to BPD severity and the impulsive, self-destructive behaviors that characterize BPD is unclear. Furthermore, the extent to which the occurrence of EE in CCs is related to BPD pathology itself, the subjective and objective burden that it elicits, or both is unknown. This study aimed to identify (a) whether EE predicts BPD severity and impulsive behaviors in those with BPD; and (b) whether BPD pathology (general severity and impulsive behaviors) and objective and subjective burden predict EE in CCs. CCs (N = 46) of those with probable BPD/BPD diagnoses completed informant-report measures of BPD severity and impulsive behaviors, and self-report measures of EE and burden, monthly for 3 months. Generalized estimating equations revealed that there was weak evidence for higher emotional involvement, but not critical comments, predicting higher BPD severity. Higher subjective, but not objective, burden predicted higher critical comments and emotional overinvolvement, and higher impulsive behaviors in those with BPD predicted lower critical comments in CCs. Emotional overinvolvement in CCs may accommodate and reinforce BPD severity, and CCs of people who engage in more impulsive behaviors may avoid critical or distressing conversations for fear of eliciting them. CCs' subjective burden may also be an important clinical target in reducing EE. More research examining these relationships in both CCs and those with BPD is needed.