Ecological momentary assessment of affective instability, impulsivity, and alcohol use in borderline personality disorder

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] The present study examined the momentary and within-day relationships between mood states, impulsivity, and alcohol use. Participants included 48 psychiatric outpatients with a DSM-IV-TR diagnosis of borderline personality disorder, who met the affective instability criterion, and 26 psychiatric outpatients currently experiencing a major depressive episode or dysthymia. Participants reported their moods, impulsivity, and alcohol use using ecological momentary assessment methodology, six times per day for approximately 28 days. Hierarchical linear modeling results indicate a positive relationship between negative affect and impulsivity, when measured concurrently and over the course of a given day. Results also indicate that the presence and quantity of alcohol use is concurrently related to increased positive affect and decreased negative affect. The presence of alcohol use within a given day is associated with increased instability of positive affect, hostility, and sadness. The quantity of alcohol use in a given evening is associated with increasing fear, decreasing sadness, and greater instability of hostility over the course of the same day. The present findings support major theoretical models of the relationships between affective instability and impulsivity in borderline personality disorder, as well models of emotion regulation and reinforcement relevant to substance use disorders.