Emotional awareness in adolescents with a borderline personality disorder: impact of defense mechanisms and adversity.

In Borderline Personality Disorder (BPD), the literature on emotion awareness revealed some discrepancies between some patients who are accurate in detecting emotional cues and others that are impaired at identifying them in themselves and others. Even though some links between childhood adversity and emotion regulation have been established, there is a need to understand the mechanisms underlying this association, and defense mechanisms, which are central to emotion regulation, and could play a key role in this pathway.: The purpose of this study is to compare levels of emotional awareness between adolescents with BPD and healthy controls and to investigate the influence of adversity (maltreatment and parental bonding) and defense mechanisms influence on emotional awareness in the two groups, as measured by the Level of Emotional Awareness Scale (LEAS). The study includes BPD adolescents ( = 41) and healthy controls (HC,  = 67). No difference was observed between the LEAS in BPD and HC, but multivariate regression models analysed highlighted links between levels of emotional awareness and adversity: low levels of self-emotion awareness were associated with maltreatment and with maternal control, while high levels of emotional awareness were linked to low levels of maternal care. In BPD, immature defense mechanisms mediated the association between maltreatment and self-emotional awareness, suggesting a key role of defense mechanisms in maintaining a normal level of emotional awareness in the face of adversity.