Chapter 5 152 BPD is typically first diagnosed in early adulthood (18-25 years of age) and often mildens in later years (40-50 years of age) [12, 14-16]. The disorder is more common in woman than man, with a ratio of 70 to 30 percent [12]. Due to the age of onset and course of the disorder present-day patients are usually highly familiar with the use of modern mobile technology. As they generally experience high levels of psychological burden, these patients experience a strong need to find help and relief, what makes it likely they will also try mHealth coaching apps they come across. As stated at patient-sites like PatientsLikeMe.com: “Patients with few options will not wait for normal science to design studies, recruit patients, measure, analyze, and report” [17]. For this reason, it seems ever so important ‘normal or institutional science’ dóes get involved. Studies show prevalence rates for BPD between 0.5 % and 1.8 % of the total population [12, 14]. A recent study in the Netherlands shows a prevalence rate (five or more symptoms of the disorder present) of 1.1%; in 3.8 % of the population multiple BPD symptoms were present (3–4 symptoms), in other words (just) below the diagnostic threshold [14]. Two studies, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions, have found higher rates, of 2.7 % and 5.9 % respectively, but these higher rates are probably dependent on less strict diagnostic rules that were applied [14, 18, 19]. As with many mental health disorders, BPD is a very heterogeneous category with patients varying in severity of the disorder, their personality profiles, issues of comorbidity, age and so on [12]. The difficulties they encounter with regard to the regulation of their emotions are manifold, as are the proposed underlying deficits responsible for it. Yet, one of the deficits gathering increased attention in recent years is a profound lack of emotional awareness, sometimes addressed in clinical literature as ‘alexithymia’ [20]: a psychological construct in which a lack of emotional awareness is a key characteristic [21-26]. Although not unique to the disorder, difficulties in recognizing and identifying emotions are found to be related to BPD to an above average degree [27-33]. Lower levels of emotional awareness have also been linked to impairments in mentalization, which is a more general capacity to represent psychic contents consciously and explicitly as thoughts, feelings and intentions, and there is evidence that multimodal inpatient psychotherapy has the capacity to transform emotional awareness from an implicit to an explicit level [34]. Available evidence suggests that there is a particular need to improve the awareness of the ‘arousal’ component of emotions in BPD: results from experimental testing found BPDpatients to focus significantly less on personal emotional arousal than control participants [30]. Also, high levels of emotional arousal seem to act as loud ‘background noise’ that hampers the ability of emotion identification in patients with
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