Cognitive Reappraisal as a Buffer, Expressive Suppression as a Risk Factor: Moderating Effects on the Emotion Dysregulation-Personality Disorder Pathway in Pakistani University Students

Abstract

Background: Emotion dysregulation (ED) is a robust transdiagnostic predictor of personality disorder (PD) traits. However, not all individuals with elevated ED develop clinically significant PD traits, suggesting the presence of moderating factors. Cognitive reappraisal (adaptive) and expressive suppression (maladaptive) are candidate moderators, but their buffering or exacerbating effects have not been systematically tested in non-Western cultural contexts.

Objective: This study tested whether (a) cognitive reappraisal moderates (buffers) the positive relationship between ED and PD traits, and (b) expressive suppression moderates (exacerbates) this relationship. We also examined whether moderation patterns differ across PD clusters (A, B, C).

Method: University students in Pakistan (N = 366; 183 male, 183 female; age 17–19 years) completed the Emotion Regulation Questionnaire (ERQ; reappraisal, suppression), Difficulties in Emotion Regulation Scale (DERS), and Short-Form of the Coolidge Axis II Inventory (SCATI). Moderation analyses were conducted using PROCESS Macro (Model 1) with 5,000 bootstrap resamples, separately for total PD traits and for each PD cluster.

Results: Reappraisal significantly moderated the ED-PD relationship for total PD traits (interaction B = -0.14, SE = 0.05, p = .005, ΔR² = .021). The ED-PD association was strong when reappraisal was low (B = 0.52, p < .001), moderate when reappraisal was average (B = 0.38, p < .001), and weak when reappraisal was high (B = 0.24, p = .01). Suppression also moderated the ED-PD relationship (interaction B = 0.11, SE = 0.04, p = .008, ΔR² = .018), with the ED-PD association stronger when suppression was high (B = 0.49, p < .001) than when low (B = 0.27, p < .001). Cluster-specific analyses revealed that reappraisal's buffering effect was strongest for Cluster B (interaction B = -0.18, p = .002), followed by Cluster C (B = -0.11, p = .03), and weakest for Cluster A (B = -0.07, p = .12, ns). Suppression's exacerbating effect was significant only for Cluster B (interaction B = 0.15, p = .006) and Cluster C (B = 0.09, p = .048), not for Cluster A (B = 0.05, p = .34).

Conclusions: Cognitive reappraisal buffers, and expressive suppression exacerbates, the ED-PD relationship, with strongest effects for Cluster B disorders. These findings identify reappraisal as a modifiable protective factor and suppression as a modifiable risk factor in the pathway from ED to PD traits. Clinically, enhancing reappraisal skills and reducing suppression may be particularly important for individuals with elevated ED at risk for developing PDs, with cultural considerations for the Pakistani context where emotional restraint is often culturally valued.