Comprehensive Psychiatry · Published 2026-05-23 · DOI 10.1016/j.comppsych.2026.152717
Ana Macchia, Dimitri Löchner, Ann-Christin Haag, Christian Montag, Birgit Abler
While digital phenotyping has shown potential in linking smartphone use to mental health, there is no evidence on how specific smartphone behaviors are associated with symptom dynamics in borderline personality disorder (BPD) in real time. This study examines how communication versus entertainment app use relates to inner tension and state dissociation, both in terms of momentary associations within individuals and in terms of average associations across individuals.We tracked smartphone use in 49 individuals with BPD during an 8-week inpatient Dialectical Behavior Therapy and concurrently assessed inner tension and state dissociation every two hours. For up to 56 treatment days, we recorded hourly app session usage duration and frequency for communication (e.g., WhatsApp) and entertainment (e.g., Netflix), along with phone calls. Between-person associations based on mean scores for inner tension, state dissociation, and smartphone usage were examined with Spearman correlations. We investigated within-person momentary associations per hour with linear mixed models applied to the first 21 treatment days with sufficient data.Higher mean inner tension levels were linked to longer daily use of communication apps. We found an association between a greater average number of incoming, but not outgoing, phone calls and higher mean levels of inner tension and state dissociation. Within-person analyses related a longer use of entertainment applications to reduced inner tension, but not dissociation, both at the category and at the app level (Netflix and YouTube). In contrast, more frequent communication app uses increased state inner tension and dissociation, which was mirrored in app-level analyses with WhatsApp.Our findings are consistent with a dialectical perspective of smartphone use in BPD: While passive entertainment may represent an adaptive short-term self-regulation strategy, smartphone communication may trigger BPD-related emotional or dissociative responses.Trial registration: https://osf.io/dfq9y/?view_only=4c19b891bb6448009b22f60b2552bd73.
Abstract from DOAJ. Public domain (CC0 1.0).
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Macchia, A., Löchner, D., Haag, A., et al. (2026). A dialectical perspective on smartphone use in borderline personality disorder: Communication fosters inner tension and dissociation, while entertainment provides momentary relief. Comprehensive Psychiatry. https://doi.org/10.1016/j.comppsych.2026.152717