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The Experience of Tension in Patients with Borderline Personality Disorder Compared to Other Patient Groups and Healthy Controls

People displaying a pattern of thinking, feeling, and behaving that is sufficiently severe to exceed a set of formal diagnostic criteria of borderline personality disorder (BPD) report states of aversive inner tension, which they attempt to alleviate by impulsive self–harming behavior. Further research is needed to understand the actual experience of inner tension and its meaning and origin. The present study involves a systematic examination of different clinical groups' experience of inner tension. 117 participants (30 participants fulfilling the diagnostic criteria of borderline personality disorder, 30 participants fulfilling the diagnostic criteria of depression, and 27 participants fulfilling the diagnostic criteria of anxiety disorders as well as 30 participants without any mental diagnosis) were asked about their experiences of inner tension using an open questionnaire. Qualitative Content Analysis (Mayring, 2000) was applied for coding participants' self reports. Among all groups inner tension is represented as an unpleasant state of arousal. However, in participants fulfilling diagnostic criteria the experience of tension is triggered by a sense of inner helplessness and inaction whereas healthy controls experience the stress of a pressure to perform well. The quantitative analyzes revealed significant disorder–specific differences relating to the experience of inner tension, e.g., that the states of tension in participants with BPD are related to a negative view of the self and participants with anxiety disorders show the highest frequency of health concerns. The term “tension” carries various meanings for different client populations. In the clinical setting, different approaches need to be applied to address different meanings and aspects of the experience of inner tension.