Antecedents and motives for smoking in borderline personality disorder
Though borderline personality disorder (BPD) is associated with higher rates of substance use, including cigarette smoking (Carpenter, Wood, & Trull, 2016; Rohde, Lewinsohn, Brown, Gau, & Kahler, 2003; Trull, Jahng, Tomko, Wood, & Sher, 2010), relatively little is known about motives for smoking among those with BPD. The current study examined contextual and subjective triggers of smoking as well as self-monitored motives for smoking in borderlines (n = 29) and healthy controls (n = 13). Data were collected via ecological momentary assessment (EMA) over a three-week period. Analyses using a "case-crossover" analytic strategy identified a number of unique antecedents of smoking but did not indicate any group differences in smoking triggers. Notably, negative affect was not found to be an antecedent to smoking events. Analyses of self-monitored motives for smoking individual cigarettes indicate that craving, habit, and boredom were the most highly endorsed motives for smoking and that coping with negative affect and enhancing positive affect were more highly endorsed by those in the BPD group than controls. Supplementary analyses examined smoking motives assessed by self-report questionnaire and diary-reported consequences of smoking events. BPD patients tended to endorse most motives on the questionnaire more highly than controls, but these differences were not statistically significant in this small sample. Participants reported that smoking events were highly pleasurable, modestly relieving, and rarely punishing. Relative to controls, BPD individuals reported stronger acute relief from smoking. Overall, the findings tend to indicate that negative affect is an uncommon smoking trigger, but support the hypothesis that smoking among borderlines may be especially driven by attempts to manage affect.