Construct validity of a short, self report instrument assessing emotional dysregulation☆
Introduction
Emotion dysregulation reflects deficits in awareness and acceptance of emotions as well as in regulation strategies to manage intense negative emotional states (Gross and Thompson, 2007). In some disorders, such as borderline personality disorder (BPD), emotion dysregulation is a hallmark symptom that may lead to the development of other symptoms as well as functional problems (Bornovalova et al., 2008; Linehan, 1993; Tragesser et al., 2007). However, with increasing research now points to the importance of emotion dysregulation in understanding both current psychological functioning and risk for psychopathology, even in psychiatric disorders where emotion dysregulation is not a diagnostic criterion (Charney, 2004, Green et al., 2007, Lei et al., 2014, McLaughlin et al., 2009, Svaldi et al., 2012). For example, although emotion dysregulation is not explicitly a symptom of posttraumatic stress disorder (PTSD), a number of the symptoms of PTSD also represent failures to effectively regulate the experience and expression of emotions (e.g., anger/irritability) and others reflect efforts to regulate emotions that impair adaptive functioning (e.g., avoidance behaviors). It can also be seen as a risk factor that may lead to PTSD. Emotion dysregulation is now understood as a transdiagnostic process that impacts many psychological disorders, spanning mood, anxiety, substance use, and personality disorders (Berenbaum et al., 2003, Bradley et al., 2011b, Brockmeyer et al., 2012, Hopper et al., 2007, Kring, 2008).
Difficulties with emotion regulation are often found in individuals exposed to traumatic events, particularly in early life (Kim and Cicchetti, 2010, Maughan and Cicchetti, 2002, Shields and Cicchetti, 1998). Developmental research suggests that a combination of inherent temperamental or biological factors and adverse childhood experiences (e.g., childhood abuse) may increase risk for adult emotion regulation deficits. The deficits are a risk factor for adult psychopathology, including substance abuse, depression, and PTSD (Burns et al., 2010, Romens and Pollak, 2012). Therefore, emotion dysregulation appears to be an important potential mechanism by which early life adversity confers lifetime risk for psychological disorders.
In the past, emotion dysregulation and negative affect were often conceptualized as two components of a common construct, with emotion dysregulation thought to fall into the broader category of negative affect. There is already a well-established body of literature demonstrating the importance of negative affect in many psychological disorders, with research showing that negative affect is a higher order construct fundamental to various psychiatric conditions, including personality pathology, depression, PTSD, and more (Krueger, 1999, Watson and Clark, 1992). While emotion dysregulation is clearly related to negative affect, recent evidence suggests it is a distinct construct (Gyurak et al., 2011, John and Gross, 2004). Broadly speaking, negative affect reflects types of emotions people have (e.g., anger, sadness), while emotion regulation reflects the ability to adaptively manage emotions (including negative ones) as they arise. The distinct importance of emotion dysregulation in psychological health is supported by the increasing number of interventions that now incorporate components focused on decreasing emotional dysregulation in individuals with varying types of psychopathology (Fehlinger et al., 2013, McMain et al., 2001, Mennin, 2006). This is done through a variety of techniques including psychoeduation regarding emotional experience, building emotional understanding and acceptance, and teaching patients strategies for how to manage intense, negative emotions as they arise.
While emotional dysregulation is likely to be most accurately and thoroughly assessed through a multi-method approach using structured clinical interview, behavioral tasks, and/or functional magnetic resonance imaging (fMRI) strategies, many large-scale studies that focus on risk and resilience to psychiatric disease do not have the capacity to do such lengthy or time-consuming assessments. Several self-report instruments of emotion dysregulation have been created to assess this construct and have been validated and shown to relate to psychopathology and general functioning in various populations (Bradley et al., 2011a, Bradley et al., 2011b, Catanzaro and Mearns, 1990, Ehring and Quack, 2010, Gratz and Roemer, 2004, Smith et al., 2014, Tull et al., 2007). However, longer self-report measures such as the 36-item Difficulties in Emotion Regulation Scale (DERS, Gratz and Roemer, 2004), one of the most widely used measures of emotion dysregulation, may still take more time to complete than is feasible to large scale genetic or epidemiological studies. The development of a very brief scale indexing individual differences in emotion dysregulation could allow for greater usability in such studies and for enhanced knowledge about the presence and impact of emotion dysregulation across varied populations. A short self-report emotion dysregulation measure could also be beneficial in clinical practice to provide clinicians with a quick evaluation of whether emotion regulation difficulties are present for a given client.
We developed a 12-item self-report instrument of emotion dysregulation, the Emotion Dysregulation Scale, short version (EDS-short) which is based on previous research using the clinician-rated Affect Regulation and Experience Q-sort Questionnaire (Westen et al., 1997, Zittel and Westen, 2005). The EDS-short is a time-efficient questionnaire that captures multiple aspects of emotion dysregulation including emotional experiencing, cognition, and behavior. This manuscript is an initial effort to validate this short measure in a highly traumatized, urban population and demonstrate the construct validity of the instrument through 1) comparison with another already validated measure of emotion dysregulation and 2) the evaluation of the association between EDS-short and various important outcome measures. More specifically, the associations between EDS-short scale and depressive symptoms, PTSD symptoms, substance abuse symptoms, BPD symptoms, number of suicide attempts and psychiatric hospitalizations, positive affect, and resilient coping was assessed. For this study, we focused on outcome variables that have been previously linked with emotion dysregulation, including those that represent common psychiatric problems in this population (i.e., suicidality, depression, PTSD, substance use disorders, and personality disorders), as well as problematic outcomes (i.e., psychiatric hospitalizations) and potential resiliency factors (i.e., positive affect, coping; El-Bassel et al., 2003, Gillespie et al., 2009, Gratz et al., 2008, Meadows et al., 2005). Because emotion dysregulation has been associated with varying types of psychopathology, we did not expect to find divergence across psychiatric symptoms and instead predicted that emotion dysregulation would show positive association with mood, substance, anxiety, and personality disorder symptoms, while showing negative associations with resiliency factors.
Section snippets
Procedure
Participants were drawn from an NIMH-funded study of risk factors for the development of PTSD in a low socioeconomic, primarily African American urban population. Participants were recruited from waiting rooms in the gynecology and primary care medical (non-psychiatric) clinics at Grady Memorial Hospital, a publicly funded hospital in Atlanta, Georgia. Interviewers approached participants waiting for appointments. To be eligible for participation, subjects had to be at least 18 years old and
Cross-validation with DERS
In order to examine the construct validity of the EDS-short in measuring emotion dysregulation, we first examined the relationship between the EDS-short scale and another well-validated measure of emotion dysregulation, the DERS (Sample 1). There was a large, significant positive association between EDS-short and DERS total. Correlations of the EDS-short with the subscales of the DERS varied, but remained significant at p<0.01 (see Table 2). The associations with impulse control and lack of
Discussion
Our findings indicate that this brief, self-report measure of emotion dysregulation shows good construct validity, relating to other measures of emotion dysregulation as well as a range of criterion variables relating to both risk and resiliency for psychopathology. More specifically, the EDS-short was highly correlated with the DERS, an already well-validated longer self-report measure of emotion dysregulation (e.g., Ehring and Quack, 2010, Gratz and Roemer, 2004, Tull et al., 2007). The
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This work was primarily supported by the National Institute of Mental Health (MH071537, MH100122, MH102890) and the National Institute of Child Health and Human Development (HD071982). Support also included Emory and Grady Memorial Hospital General Clinical Research Center, NIH National Centers for Research Resources (M01 RR00039), and the Burroughs Welcome Fund.