Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis

Sophie Mattingley, George J. Youssef, Victoria Manning, Liam Graeme, Kate Hall

Research output: Contribution to journalReview ArticleResearchpeer-review

20 Citations (Scopus)


Background: Distress tolerance (DT) has received increased attention in recent years due its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology. Methods: A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, or BPD. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender. Results: DT shared significant, negative, medium correlations with PSU (r = –.18,), DEB (r = –.20), and BPD (r = –.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships. Limitations: The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures. Conclusions: The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.

Original languageEnglish
Pages (from-to)492-504
Number of pages13
JournalJournal of Affective Disorders
Publication statusPublished - 1 Mar 2022


  • Borderline personality disorder
  • Disordered eating
  • Distress tolerance
  • Problematic substance use
  • Transdiagnostic

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