The Relationship of Borderline Personality Disorder with Self-esteem and Emotion Regulation: The Mediating Role of Anxiety and Coping Strategies

Psychiatric disorders and its causes have always been taken into consideration by psychologists and psychiatrists. Adolescence can be the beginning period of many psychiatric disorders. Most versions of Diagnostic and Statistical Manuals of Mental Disorders (DSM) of American Psychiatric Association do not indicate that adolescents may develop borderline personality disorder. But the grounds for this disorder have their roots in childhood and adolescence. The DSM-5 defines this disorder as "a pervasive pattern of instability in interpersonal relationships and self-image and a distinctly impulsive mood that begins in early adulthood and it appears in different environments and situations." Today, psychological stress has become an integral part of human life and is important to determining the health or illness of individuals. People seem to use different coping methods in stressful situations. People with borderline personality disorder have a special need for adaptive coping strategies. These strategies reduce vulnerability in stressful situations. A review of previous research shows that there is a relationship between anxiety and coping disorders, emotion regulation and borderline personality disorder. Clinical signs of borderline personality disorder include: "insane" actions to avoid real or imagined abandonment; An unstable and stressful pattern of personal relationships characterized by fluctuations between the two poles of idealization and devaluation; Identical and persistent self-reported identity disorder and instability; Impulsive behavior in at least two areas where there is a potential for personal harm (eg, extravagance, sex, substance abuse, reckless driving, overeating periods; threats, gestures or repeated suicidal behaviors, or self-injurious behavior); Emotional instability due to the reactive nature of the mood (eg, severe boredom, irritability, or anxiety) that usually lasts for hours and rarely days; Chronic feeling of emptiness; Severe and disproportionate anger or difficulty controlling anger (such as recurring mood swings, persistent anger, or recurring quarrels) and temporary paranoid thinking associated with stress or severe breakdown symptoms (2). The word anxiety comes from the Latin word Anxius, which means a feeling of tightness in the chest. Anxiety refers to fear without a definite origin; That is, one does not know why one is afraid or that one's fear of danger seems disproportionate. Anxious often expresses a feeling of shortness of breath in the chest: I just feel anxious. Our brain is affected by many movements at any given moment, some of which are conscious or voluntary and many of which are unconscious and involuntary. These movements come from three different areas: the external environment, the body and the brain. Anxiety, then, is a vague and undesirable emotional state accompanied by external manifestations, panic, and turmoil that occurs as a result of a threat and a lack of proper response to it. The purpose of this study was to study the relationship of borderline personality disorder with self-esteem and emotion regulation by mediating role of anxiety and coping strategies in adolescents.

The method of this research is a correlational survey. The statistical population was all first and second high school students in Tuyserkan in the academic year 1393-94. 331 students were selected by stratified random sampling. Before conducting the research, participants were given explanations on how to answer the questionnaires and the confidentiality of their information. Data were analyzed using SPSS and Lisrel software using descriptive methods (mean and standard deviation), heuristic factor analysis, confirmatory factor analysis and structural equation modeling. Rosenberg self-esteem (1965), Grass and John's emotion regulation (2003), Andler & Parker coping strategies (1990), emotional disorders related to anxiety (2000), and borderline personality disorder (1991) questionnaires were completed. The validity and reliability of all these tools have been confirmed in previous research. In this study, Cronbach's alpha coefficients were calculated for the desired and reliable questionnaires. Data were analyzed using descriptive, factor analysis and structural equation modeling using SPSS and Lisrel.

The Descriptive findings of this study showed that the highest mean is related to coping strategies (128.66) and the lowest mean is related to self-esteem (7.36). The obtained correlation coefficient between each of the variables is statistically significant at the error level less than 0.01 (P < 0.01). Shows the structural relationships between self-esteem, borderline personality, coping strategies, anxiety, and borderline personality. Among the estimated pathways, the highest coefficient is related to the relationship between coping strategies and borderline personality (0.78) and the lowest is related to emotion regulation with anxiety (0.57). Analysis of direct, indirect, and total effects between the studied variables showed that the highest effect was obtained between coping strategies with borderline personality and the lowest effect was obtained between emotion regulation and anxiety. The results showed that the borderline personality of adolescents is related to self-esteem and their emotional regulation with mediation of anxiety and coping strategies (P < 0.001). Helping goodness of fit indexes, the estimated model was desirable in the structural equation model (NFI = 0.97, GFI 0.88, CFI 0.92, and RMSEA = 0.021).

The Psychiatric disorders, especially anxiety disorders and personality disorders, severely affect people's performance. These disorders affect family relationships; one falls short in education; His job and social performance are impaired and he generally feels inefficient and dissatisfied. On the one hand, lack of self-esteem and on the other hand, lack of effective coping skills in the individual and also difficulty in regulating emotions are issues and problems that cause both anxiety and borderline personality disorder and the range of difficulties of anxious patients. And expands boundaries and makes decision-making difficult to solve problems caused by the disorder and treatment. Various health models always pay attention to prevention. Like physical health, in the field of mental health, prevention requires knowledge of the contexts and causes of disorders and diseases. This study used structural equation modeling to investigate some areas of borderline personality development. Therefore, it can be concluded that the variables such as self-esteem, emotional regulation, anxiety and coping strategies affect the appearance of borderline personality in adolescent. Explaining the findings of this study, it can be said that borderline personality can be related with psychological contextual variables such as self-esteem, emotion regulation and coping. This means that the less self-esteem a person has, the more likely he or she is to develop such disorders; because people with low self-esteem usually have more limited relationships, their audacity is low, it causes instability in the behavior and feelings of the person and the person can not achieve unity. In this regard, the regulation of emotion as a variable that is necessary to maintain balance and psychological stability in the individual, has a decisive role (13). This means that people with high emotion regulation are less likely to develop personality disorders, especially borderline personality disorders. One of the most important symptoms of borderline personality disorder is emotional instability. When a person is not able to regulate their emotions well, they are more likely to have problems. Also, the way a person copes with problems and issues has an effect on the occurrence or non-occurrence of psychiatric disorders. Problem-oriented coping is often associated with mental health, but emotional coping is not; One who has an ineffective confrontation fails; Has trouble communicating with others; His academic and professional performance declines; He is emotionally disturbed and cognitively disturbed, and in general, someone who has little ability to deal effectively with problems is at greater risk of developing psychiatric disorders. One of the limitations of this study is the self-report of the collected data with the questionnaires used in it. Also, due to the limited statistical population (students), caution should be exercised in generalizing the findings of this study. Researchers interested in research in the field of psychiatric disorders are advised to examine the relationship of variables such as attachment, resilience, empathy, and efficiency with these disorders in addition to self-esteem, emotion regulation, and coping strategies. Also, the study of other statistical communities can be considered for similar studies in this study.