Emot i onal Int el l i gence and Ment al Di sorder

m
Janine Hertel and Astrid Schu¨ tz
Chemnitz University
m
Claas-Hinrich Lammers
Asklepios Klinik Nord Hamburg
Emotional abilities were measured with a performance test of
emotional intelligence (The Mayer-Salovey-Caruso Emotional Intelli-
gence Test; Mayer, Salovey, & Caruso, 2002) in patients diagnosed
with major depressive disorder, substance abuse disorder, or border-
line personality disorder (BPD), and a nonclinical control group.
Findings showed that all clinical groups differed from controls with
respect to their overall emotional intelligence score, which dovetails
with previous findings from self-report measures. Specifically, we
found that the ability to understand emotional information and the
ability to regulate emotions best distinguished the groups. Findings
showed that patients with substance abuse disorder and BPD
patients were most impaired. & 2009 Wiley Periodicals, Inc. J Clin
Psychol 65:942–954, 2009.
Keywords: emotional intelligence; borderline personality disorder;
major depressive disorder; substance abuse disorder; emotion
regulation
There is growing evidence that emotional abilities are a relevant predictor of health
and well-being. For example, it was shown that emotional abilities are associated
with prosocial behavior (Lopes, Salovey, & Straus, 2003), stress management
(Gohm, Corser, & Dalsky, 2005), and physical health (Salovey, Stroud, Woolery, &
Epel, 2002). In contrast, lack of emotional skills is associated with deviant behavior
(e.g., vandalization and physical fights) and self-destructive acts (e.g., drug and
alcohol abuse, cigarette smoking) (Brackett, Mayer, & Warner, 2004).
In the research summarized above, emotional intelligence was examined according
to the ability conception of Mayer and Salovey (1997), which also forms the
background of this article. This conception, also referred to as the ability model,
describes emotional intelligence as a set of interrelated abilities organized along four
dimensions: (a) perceiving emotions, (b) using emotions to facilitate thought, (c)
Correspondence concerning this article should be addressed to: Astrid Schu¨ tz, Department of Psychology,
Chemnitz University, D-09107 Chemnitz, Germany; e-mail: astrid.schuetz@phil.tu-chemnitz.de
JOURNAL OF CLINICAL PSYCHOLOGY, Vol . 65(9), 942--954 (2009) & 2009 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI : 10. 1002/ j cl p. 20597
understanding emotional information, and (d) regulating emotions. This model can
be distinguished from other, broader conceptions termed mixed models (e.g.,
Bar-On, 2000) that include personality characteristics like empathy, happiness, or
self-esteem. Mixed models have been criticized for being too broad (e.g. Mayer &
Cobb, 2000), risking overlap in predictor and criteria (e.g. well-being), tapping into
self-concepts rather than abilities, and not having produced good validational results
(see Mayer, Roberts, & Barsade, 2008).
The ability model of emotional intelligence has been extensively studied in
nonclinical, mentally healthy (community and student) samples (for an overview see
Mayer, Salovey, & Caruso, 2004). Mayer and Salovey (1997) argue that emotional
intelligence can best be measured with ability scales (see Thingujam, 2004 for a
similar argument). Ability tests measure something directly related to the capacity to
reason and enhance thought with emotions. Unlike self-report questionnaires (which
are common tools within mixed models), they are unrelated to self-protective biases
or desirable responding (Mayer, Salovey, & Caruso, 2002; Schu¨ tz & Marcus, 2004).
The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT, version 2.0;
Mayer et al., 2002) is an ability test that measures how well people perform tasks and
solve emotional problems. The test consists of four subscales (branches) that assess
the four theoretical dimensions defined by Mayer and Salovey (1997). Currently, the
MSCEIT is the only ability test that covers all four dimensions. It has been shown
that the MSCEIT has good reliability and validity (Brackett & Salovey, 2006; Mayer
et al., 2004). Split-half reliabilitiy of the total score is above .90, for the branches
above .75 (Mayer, Salovey, Caruso, & Sitenarios, 2003). Correlational data show
that the constructs measured are different from what was previously measured in the
areas of emotion, personality, and intelligence (Mayer et al., 2004). Several studies
have provided evidence of criterion validity (for a summary, see Mayer et al., 2008).
For example, emotion regulation abilities assessed with the MSCEIT were associated
with less conflict and antagonism with friends (Lopes, Brackett, Nezlek, Schu¨ tz,
Sellin, & Salovey, 2004) and higher peer ratings of interpersonal sensitivity and
prosocial tendencies among college students (Lopes, Salovey, Co˚ te´ , & Beers, 2005).
These findings remained significant even after controlling for the Big Five
personality traits.
In contrast to ability tests, the validity of questionnaire measures may be undermined
by self-enhancement, faking, and limited self-knowledge in the case of self-report
questionnaires, and by halo effects or limited knowledge of the target if the
questionnaires are used to collect informant ratings. For example, research on self-
enhancement suggests that people tend to nurture positive illusions and rate themselves
above average on a wide range of desirable traits and abilities (Taylor, 1986). Self-
report and ability measures tend to correlate weakly in both cognitive and emotional
realms (Brackett & Mayer, 2003; Goldenberg, Matheson, & Mantler, 2006), suggesting
that self-perceptions of ability are unreliable indicators of actual ability.
Research on emotional intelligence in clinical groups is still rare even though
clinical theorizing and empirical research clearly state that almost any mental
disorder is linked to emotional problems (e.g., Johnson-Laird, Mancini, & Gangemi,
2006; Legenbauer, Vocks, & Ru¨ ddel, 2008; Thoits, 1985). Certain disorders seem
especially afflicted with emotional problems; for example, affective disorders,
substance abuse disorders, and personality disorders include intense emotional
disturbances, but there is variation as to the quality and intensity of emotions (e.g.,
intense or excessive feelings of anger in borderline personality disorder, inability to
experience pleasure in patients with major depressive disorder).
943 Emotional Intelligence and Mental Disorder
Journal of Clinical Psychology DOI: 10.1002/jclp
Aims and Derivation of Hypotheses
In the present article, we focus on three syndromes in which emotional problems
play a major role: depression, borderline personality disorder (BPD), and substance
abuse disorder (SAD). Learning more about the dimensions of emotional
intelligence on which patients with certain mental disorders differ from others, in
turn, may allow for a better understanding of their state and an improvement in
therapeutic interventions. It is our aim to test for specific deficits in the emotional
abilities of these groups. In short, we expected all of the clinical groups to have lower
emotional abilities than healthy controls. Below we elaborate on the specific deficits
that we expected in the three clinical groups.
Emotional Abilities in Major Depressive Disorder
Major depressive disorder (MDD) can be considered a deficit in the reward-oriented or
approach motivation system (e.g., Joormann & Gotlib, 2006; Matsudaira & Kitamura,
2006; Tomarken, Davidson, Wheeler, & Doss, 1992; Tomarken & Keener, 1998).
Patients experience low levels of positive affect, which, in turn, results in the reduced
ability to identify and respond to positive emotional stimuli. The inability to experience
pleasure (anhedonia) as well as feelings of overwhelming sadness or fear is a typical
feature of MDD. Subclinical depression and its relation to emotional abilities have been
studied intensely in student samples using self-report data. For example, Rude and
McCarthy (2003) found mildly depressed individuals to report significantly less mood
repair than nondepressed participants. Later studies confirmed that in different cultures
depressed persons show less mood repair than healthy controls (Fernandez-Berrocal,
Salovey, Vera, Extremera, & Ramos, 2005). Mood repair is related to emotion
regulation because it is concerned with changing negative emotion experience (Gross,
1998; Simchen, Hertel, & Schu¨ tz, 2007). Consequently, we predicted that MDD patients
would score lower than nondepressed controls on the dimension of emotion regulation.
In patients with MDD, it has been suggested that there is a negativity bias in
recognizing facial expressions of emotions. For example, Kan, Mimura, Kamijima,
and Kawamura (2004) found that depressed individuals tend to project negative
emotions onto neutral facial expressions. In line with this finding, studies on facial
emotion perception found clinically depressed individuals to perform significantly
worse than controls with respect to the accuracy of emotion perception (Langenecker,
Bieliauskas, Rapport, Zubieta, Wilde, & Berent, 2005). Thus, we predicted that MDD
patients would score lower than nondisordered controls in perceiving emotions.
Finally, Rude and McCarthy (2003) observed that mildly depressed individuals
reported lower attention to feelings and less clarity of feelings than their
nondepressed counterparts (see also Ellwart, Rinck, & Becker, 2003; Lim & Kim,
2005). Other evidence suggested that depressed persons exhibit reduced sensitivity to
changing emotional contexts when compared with nondepressed controls (e.g.,
Gehricke & Shapiro, 2000). Because reduced sensitivity seems related to the inability
to understand and use emotional information, we expected MDD patients to score
lower than controls on these dimensions.
Emotional Abilities in Borderline Personality Disorder
As BPD is characterized by emotional deficits, we felt it prudent to include patients
with BPD in our study. The core dimensions in the diagnosis of BPD are affective
dysregulation and impulsivity (Bohus, Schmahl, & Lieb, 2004). It is typical of BPD
944 Journal of Clinical Psychology, September 2009
Journal of Clinical Psychology DOI: 10.1002/jclp
patients to show marked impulsivity, instability of mood, and changing interpersonal
relationships as well as self-destructive tendencies. Because of frequent mood swings,
BPD has also been labeled an emotion-regulation disorder (Linehan, 1993) and
therapeutic programs tend to focus on improving skills dealing with emotional
regulation (see also Gratz, 2007). Using a self-report scale, Leible and Snell (2003)
showed that students who were relatively high in symptoms related to that of
borderline personality disorder reported less mood repair than healthy controls. In a
similar vein, Taylor and Reeves (2007) showed that BPD symptoms in college
students were related to affective instability. All of this led us to hypothesize that
BPD patients would score lower than controls on the ability to regulate emotions.
Emotional sensitivity is another central feature in BPD patients (e.g., Lynch,
Rosenthal, Kosson, Cheavens, Lejuez, & Blair, 2006; Yen, Zlotnick, & Costello, 2002).
For example, Lynch et al. (2006) showed that BPD individuals identified negative and
positive emotions faster than controls. They are apparently very sensitive to emotional
expressions and seem to detect even subtle expressions of emotions. On the other hand,
BPD individuals often seem to be overly sensitive and tend to overreact to minor
events or situations. This fact may be due to a misinterpretation of emotional
information and a lack of understanding feelings (see v. Ceumern-Lindenstjerna et al.,
2007). Leible and Snell (2003), for example, showed that students with symptoms
related to that of borderline personality disorder reported less clarity of feelings than
others. In light of this evidence, we expected BPD patients to have higher abilities than
healthy controls in perceiving emotions, but lower abilities in understanding emotional
information. We did not have specific expectations with respect to using emotions.
Emotional Abilities in Substance Abuse Disorder
A number of disorders are related to the use of psychoactive substances, e.g.,
alcohol, cannabinoids, or nicotine (e.g., Hall, Room, & Bondy, 1999). Substance
abuse results in neurochemical modifications, which, in turn, lead to serious
impairments in memory, learning, and impulse control (e.g., Rist, 2004). There is
also evidence that substance abuse is related to affective lability (Simons & Carey,
2002). Furthermore, substance abuse has been related to deficits in emotion
regulation (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996) and in perceiving and
using emotions (Brackett et al., 2004). Specifically, it has been found that alcohol-
dependent individuals show reduced sensitivity to emotional expressions and have
lower emotion perception accuracy rates (Frigerio, Burt, Montagne, Murray, &
Perrett, 2002). These results show severe impairments across the range of emotional
abilities and we therefore expected SAD patients to score lower than controls in the
ability to perceive, use, understand, and regulate emotions.
Method
Participants
The three clinical samples included patients with three distinct categories of mental
disorders. The first sample consisted of 31 (10 men and 21 women, M
age
539.19,
SD513.57) patients with unipolar depression seeking treatment at the Klinikum
Chemnitz, a department for affective disorders. The second sample consisted of 19
female BPD patients (M
age
528.53, SD57.72) seeking treatment at the Charite´ Berlin,
a department for personality disorders. The third sample included 35 (26 men and 9
women, M
age
523.43, SD53.62) patients with a substance abuse disorder (about 90%
945 Emotional Intelligence and Mental Disorder
Journal of Clinical Psychology DOI: 10.1002/jclp
had an alcohol abuse disorder) seeking treatment at the Alte Flugschule GroXru¨ ck-
erswalde, an institution specializing in the treatment of SAD. All three institutions are
located in northeastern Germany. The never-disordered control group were 31 men
and 63 women (M
age
536.98, SD58.99) from the areas of Berlin and Chemnitz.
Participants were included in the MDD group if they met the criteria according to
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV;
American Psychiatric Association, 1994) for MDD, but did not meet current or
lifetime criteria for BPD or SAD. Participants were included in the BPD group if
they met DSM-IV criteria for BPD, but did not meet criteria for current or lifetime
MDD or SAD. Participants were included in the SAD group if they met the DSM-
IV criteria for SAD, but did not meet current or lifetime criteria for MDD or BPD.
Based on structured clinical interviews with the SKID (Wittchen, Zaudig, & Fydrich,
1997), all diagnoses were given by a team of trained and experienced clinicians. The
never-disordered control group consisted of individuals with no current diagnosis
and no history of mental disorder. Participants were included only if they had stated
that they had never suffered from a mental disorder, had never been in psychological
or psychiatric treatment, and had a Symptom Checklist (SCL-90-R; Derogatis, 1977;
German version, Franke, 1995) score below the cutoff for clinical groups (see below).
Psychological and emotional distress in the samples was assessed with the German
version of the Revised Symptom Checklist (SCL-90-R; Derogatis, 1977; German
version, Franke, 1995), a reliable and well-validated measure. The SCL-90-R
consists of nine subscales: hostility, depression, anxiety, interpersonal sensitivity,
somatization, psychoticism, paranoid thinking, phobic fear, and compulsivity.
Participants rate the extent to which they experienced each symptom of distress
during the past week on a 5-point scale ranging from 1 (not at all) to 5 (extremely).
The global severity of symptoms score (GSS) reliably assesses the subjective
experience of symptoms. In the current sample, Cronbach’s alpha was .98. With
all three mental disorders there was a high ratio of physical and psychological
distress (M
MDD
5103.35, SD551.10; M
SAD
575.11, SD544.65; M
BPD
5143.85,
SD541.58) compared with the nonclinical control group (M526.68, SD516.23),
which is in accordance with the expectations about the clinical groups. All groups
differed significantly from the never-disordered controls in their SCL-90-R global
severity of symptoms score ( po.001).
Measures
Emotional intelligence was assessed with the German version of the Mayer-Salovey-
Caruso-Emotional-Intelligence Test (MSCEIT, version 2.0; Mayer et al., 2002;
German version: Steinmayr, Schu¨ tz, Hertel, & Schro¨ der-Abe´ , 2008). The test is
based on the ability model of emotional intelligence and consists of four subscales
(branches) that assess the four theoretical dimensions defined by Mayer and Salovey
(1997). It includes 141 items and yields a total score and four branch scores.
To assess emotional perception, participants were asked to identify emotions in
photographs of faces, designs, and landscapes. The section assessing one’s ability to
use emotions required respondents to match emotions with nonemotional
vocabulary and indicate the feelings that may facilitate or hinder the performance
of various cognitive and behavioral tasks. The section on understanding emotions
assessed the respondents’ ability to identify how and under what circumstances
emotional states can change and how blends of emotions result in complex feelings.
Finally, in the part on emotion regulation, respondents rated the effectiveness of
946 Journal of Clinical Psychology, September 2009
Journal of Clinical Psychology DOI: 10.1002/jclp
different strategies in dealing with emotionally challenging intrapersonal and
interpersonal situations depicted in brief vignettes.
Standardized scores are computed based on consensus or expert norms
(M5100, SD515). The correlation between the two scoring methods is very high
(Mayer, Salovey, & Caruso, 2000, 2002). In the current study, we used expert norms
because they are less subject to cultural bias (the expert panel was more
internationally diverse than the normative sample). Split-half reliabilities, corrected
by the Spearman-Brown formula, ranged from .60 (using) to .75 (understanding) and
.77 for the total emotional intelligence score. Previous studies have shown that the
4-week test–retest reliability of the German version was .85 (Schu¨ tz & Hertel, 2006)
and have provided evidence of its validity (Lopes et al., 2004).
Procedure
Patients completed the MSCEIT and the SCL-90-R in the first week after having been
admitted. As part of their course requirement, psychology students recruited the
nonclinical control group. Once recruited, the control group completed the test at
home and returned it in sealed envelopes, by mail, or through the students. A research
assistant assured anonymity and made sure that the participants clearly understood the
instructions. Finally, participants provided written consent to participate in the study.
Results
We conducted multivariate analyses of covariance with the four MSCEIT
dimensions and the total emotional intelligence score as dependent variables and
the three clinical groups and the nonclinical control group as independent variables
while controlling for age and sex.
1
Findings showed that the groups differed in their
abilities to understand emotion, F(3, 173) 58.81, po.001, w
2
5.13, and to regulate
emotion, F(3, 173) 52.93, po.05, w
2
5.05, as well as in their total emotional
intelligence score, F(3, 173) 55.15, po.01, w
2
5.08. There was a marginal difference
with using emotion, F(3, 173) 52.15, po.10, w
2
5.04.
We computed pairwise comparisons using the Sidak adjustment for multiple
comparisons. Findings revealed that scores of each clinical group were significantly
lower than those of the nonclinical control group with respect to the total emotional
intelligence score and understanding emotions (see Table 1). Regarding their ability
to understand emotions, MDD patients performed significantly better than SAD
patients and BPD patients. Regarding emotion regulation, SAD patients and BPD
patients differed from the nonclinical control group.
2
Within the clinical groups,
1
As about 80% of patients seeking therapy for BPD are women (Paris, 2005), our sample was exclusively
female. We therefore conducted additional comparisons and compared the BPD sample with the women
only in the nonclinical sample. Findings from the mixed samples were confirmed.
2
We checked for correlations with age and gender differences. There was a small positive correlation of age
with the ability to use information to facilitate thought (r 5.14, pr.05) and a small to medium correlation
with the ability to regulate emotions in oneself and others (r 5.25, pr.01). These correlations are in the
expected direction as compared with previous findings. With respect to gender differences the findings
indicate that females score somewhat higher in the MSCEIT than males. Again, this is consistent with the
literature. Significant differences were found in the nonclinical control group with respect to the ability to
perceive emotions in self and others, t(92) 5À2.7, po.01, and the ability to use emotions to facilitate
thought, t(92) 5À2.3, po.05. In the MDD sample there were significant differences with respect to the
ability to perceive emotions, t(29) 5À2.1, po.05) and the ability to regulate emotions in oneself and
others, t(29) 5À2.6, po.05). No other gender differences were found. Because of the relations of
emotional intelligence with age and gender we controlled for these variables in the following analyses.
947 Emotional Intelligence and Mental Disorder
Journal of Clinical Psychology DOI: 10.1002/jclp
SAD patients scored marginally lower than MDD patients on that dimension. With
respect to using emotions, SAD patients differed significantly from controls; MDD
patients differed marginally from controls (see Table 1).
Discussion
This study focused on differences in emotional abilities in patients with major
depressive disorder, patients with substance abuse disorder, and patients with
borderline personality disorder. We also compared the clinical groups with
nondisordered controls. Instead of relying on self-report measures of emotional
abilities, which are susceptible to self-deception and social desirability, we
administered a performance test, the MSCEIT, to patients and a community
sample. Most studies on emotional abilities that discuss clinical issues are centered
around depressive symptoms in student samples and rely on self-report measures.
Table 1
Mean Differences of the MSCEIT Between Nonclinical Controls and Patients Based on
MANCOVAs Controlling for Gender and Age
Nonclinical control group Clinical groups
(N594) MDD (N535) BPD (N519) SAD (N531)
MSCEIT ability to perceive emotions
M (SD) 96.52 (1.64) 94.15 (2.73) 98.49 (3.62) 97.52 (3.16)
M Difference
a
2.37 À1.97 À1.00
M Difference
b
À4.33 À3.37
M Difference
c
.97
MSCEIT ability to use emotions to facilitate thought
M (SD) 98.09 (1.77) 92.47 (2.94) 94.17 (3.90) 88.95 (3.40)
M Difference
a
5.62
ÃÃÃÃ
3.92 9.14
ÃÃ
M Difference
b
À1.70 3.52
M Difference
c
5.22
MSCEIT ability to understand emotional information
M (SD) 92.26 (1.16) 87.76 (1.93) 81.01 (2.55) 80.99 (2.22)
M Difference
a
4.50
Ã
11.26
ÃÃÃ
11.27
ÃÃÃ
M Difference
b
6.75
Ã
6.77
Ã
M Difference
c
.02
MSCEIT ability to regulate emotions
M (SD) 90.16 (1.28) 87.87 (2.13) 83.96 (2.82) 82.17 (2.46)
M Difference
a
2.29 6.20
Ã
7.99
ÃÃ
M Difference
b
3.90 5.69
ÃÃÃÃ
M Difference
c
1.79
MSCEIT total emotional intelligence
M (SD) 90.82 (1.26) 85.85 (2.09) 83.64 (2.76) 80.68 (2.41)
M Difference
a
4.97
Ã
7.18
ÃÃ
10.15
ÃÃÃ
M Difference
b
2.21 5.17
M Difference
c
2.96
Note. MSCEIT5Mayer-Salovey-Caruso Emotional Intelligence Test; BPD5Borderline personality
disorder; MDD5major depressive disorder; SAD5substance abuse disorder.
Ã
pr.05.
ÃÃ
pr.01.
ÃÃÃ
pr.001.
ÃÃÃÃ
pr.10.
a
Mean difference of ability scores between controls and inpatient groups.
b
Mean difference between patients with affective disorders and the remaining two clinical groups.
c
Mean difference between patients with borderline personality disorder and patients with substance abuse
disorder.
948 Journal of Clinical Psychology, September 2009
Journal of Clinical Psychology DOI: 10.1002/jclp
Therefore, the present results provide new insight into emotional skills and deficits in
clinical groups.
When comparing MDD patients with controls, we found differences in the ability
to understand emotional information and the overall emotional intelligence score.
Depressed patients were worse at understanding emotional information than
controls. This finding is consistent with the earlier evidence that depressed persons
exhibit reduced sensitivity to changing emotional contexts when compared with
controls (e.g., Gehricke & Shapiro, 2000; Mackie, Holahan, & Gottlieb, 2001). This
may be due to information processing that is either negatively biased or one-sided.
As we did not have the option to analyze positive and negative emotion expressions
separately, this tentative finding should be explored further in later studies.
Regarding the ability to use emotions to facilitate thought, MDD patients in our
study tended to be less skilled than controls. This finding is in accord with a
negativity bias often found in MDD patients (e.g., Kan et al., 2004; Ridout, Astell,
Reid, Glen, & O’Carroll, 2003); their emotional attention is guided into a negative
direction, which is usually not helpful when fast and efficient decisions have to be
made (cf., Forgas, 1989; Fredrickson, 2001). Our expectation that MDD patients are
worse than nondisordered controls at perceiving emotions accurately was not
confirmed. As the relevant MSCEIT subtest does not distinguish between the
perception of positive and negative emotions, it is possible that deficits in perceiving
positive emotions and sensitivity in detecting negative ones have cancelled each other
out. Future research should distinguish emotional valence in the ability to perceive
emotions. Our next hypothesis, that MDD patients have poor emotion regulation
skills, was not confirmed either. Previous research has found low self-perceived
mood repair to be associated with depression (Fernandez-Berrocal et al., 2005), but
emotion regulation measured with the MSCEIT again refers to regulation of positive
and negative emotions. As stated above, future research should disentangle effects
on positive and negative emotions. It is possible that MDD patients are not generally
less able to regulate their emotions, but have specific deficits in regulating negative
moods.
Borderline personality disorder is considered an emotion-regulation disorder
(Linehan, 1993). Nevertheless, deficits in emotional intelligence (as measured with an
ability test) have not yet been demonstrated in BPD. Our findings supported our
hypotheses in that BPD patients scored lower on the overall emotional intelligence
score. In agreement with previous findings (Leible & Snell, 2003), we found BPD
patients to be less skilled than controls in regulating emotions and less able in
understanding emotional information. Considering the hierarchical order of
emotional abilities (Mayer & Salovey, 1997), these results may mean that the more
complex skill of regulating emotions is impaired due to a deficit in understanding
the meaning that emotions convey. This explanation dovetails with findings by
Ebner-Priemer, Welch, Grossman, Reisch, Linehan, and Bohus (2007) who observed
that BPD patients reported both the experience of several emotions simultaneously
and the difficulty of separating and identifying each of them. No differences were
found with using emotions and we had not hypothesized that there were differences.
Unexpectedly, no differences were found with perceiving emotions. The MSCEIT is
not a speed test and provides rather clear expressions of emotion. It does not assess
the ability to identify emotions quickly or to respond to subtle cues of emotion
expression. Most studies that found differences in emotion perception between
disordered individuals and controls slowly morphed a computer-generated face out
of a neutral expression to a fully expressed emotion (e.g., Lynch et al., 2006). In
949 Emotional Intelligence and Mental Disorder
Journal of Clinical Psychology DOI: 10.1002/jclp
those studies, participants were asked to stop when they recognized the emotional
expression. In contrast, our study allowed for the identification of clear expressions
of emotions and moods without time pressure. It is possible that only when emotions
have to be identified quickly that there is a deficit in these groups.
The third clinical group consisted of patients with a substance abuse disorder. As
expected, we found SAD patients to differ from controls in their abilities to use
emotions to facilitate thought, to understand emotional information, and to regulate
emotions, as well as in their total emotional intelligence score. Our prediction that
SAD patients would score lower in their ability to perceive emotions was not
confirmed, however. Again, this may be due to the way in which perception is
measured in the MSCEIT. Impairments in perceiving emotions may be especially
prominent under time pressure.
Overall, the three clinical groups showed significant deficits in emotional abilities
when compared with nonclinical controls. There are specific differences between the
groups, which suggests that deficits in emotion skills are more than an overall
phenomenon of mental illness or a result of conceptual overlap between the
measures used. Within the clinical groups SAD patients showed the largest
impairments.
Limitations and Future Research Directions
Though the presented findings are instructive, our study is limited in several ways.
Because of time constraints, we did not include a measure of cognitive abilities and
can therefore not rule out the possibility that deficits detected by the MSCEIT are
due to deficits in cognitive abilities. Future research should control for this possible
confound. Because of the small sample size, we could only control for gender and age
rather than looking at interaction effects. Future research should elaborate on these
first basic findings by looking at such interactions. We were also unable to
differentiate subgroups within the three types of mental disorder due to sample size.
The SAD sample, for example, included participants with alcohol abuse, drug abuse,
or both. As alcohol and drug abuse are related to different deficits in emotional
abilities at the phenomenological or at the neurological level (Kornreich et al., 2003)
differences in emotional intelligence should be checked between the groups. Because
of the small number on nonalcohol related substance abuse we could not check for
such differences in the present sample. Also because of the small sample sizes, we
could not take into account the effects of medication either, a factor that may
influence emotional sensitivity or emotion regulation ability. Future studies should
control for such effects. Last but not least, future research should compare the
perception of emotion with and without time pressure as well as the perception and
regulation of positive versus negative emotions.
Conclusions
Some of the early symptoms of mental illness are related to emotional problems. To
be able to successfully perceive, use, understand, and regulate emotions is highly
relevant to healthy daily functioning, and mental illness is marked by deficits in such
abilities. Our study has shown that three kinds of mental disorders, namely major
depressive disorder, borderline personality disorder, and substance abuse disorder
are associated with significant deficits in emotional abilities. All three types of mental
disorders suffered some emotional deficits, with patients with BPD and patients with
SAD proving to be even more impaired than patients with major depressive disorder.
950 Journal of Clinical Psychology, September 2009
Journal of Clinical Psychology DOI: 10.1002/jclp
Besides deficits in emotion regulation, there are clear deficits in the ability to
understand emotional information. Previous research has emphasized emotion
regulation as the factor most relevant to social functioning (Lopes et al., 2005),
which suggests that the ability to understand emotional information deserves more
attention.
In recent years, there has been an emphasis on conceding emotions a central place
in treatment or at least implementing emotion work in psychotherapy (e.g.,
Greenberg & Paivio, 1997; Ka¨ mmerer, 2002; Znoj, 2002). Learning more about the
specific deficits related to perceiving, understanding, using, and regulating emotions
in clinical groups seems essential in helping patients, their relatives, friends, and
therapists better understand, explain, and cope with certain types of behavior that go
along with a mental disorder. Furthermore, knowledge of the deficits can be used in
treatment programs to tailor specific interventions.
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