Altered emotional information processing in borderline personality disorder: an electrophysiological study

Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates

OBJECTIVE

Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD.

METHODS

Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews.

RESULTS

BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions.

CONCLUSIONS

Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.

Agreeableness modulates mental state decoding: Electrophysiological evidence

Agreeableness is one of the five personality traits which is associated with theory of mind (ToM) abilities. One of the critical processes involved in ToM is the decoding of emotional cues. In the present study, we investigated whether this process is modulated by agreeableness using electroencephalography (EEG) while taking into account task complexity and sex differences that are expected to moderate the relationship between emotional decoding and agreeableness. This approach allowed us to identify at which stage of the neural processing agreeableness kicks in, in order to distinguish the impact on early, perceptual processes from slower, inferential processing. Two tasks were employed and submitted to 62 participants during EEG recording: the reading the mind in the eyes (RME) task, requiring the decoding of complex mental states from eye expressions, and the biological (e)motion task, involving the perception of basic emotional actions through point-light body stimuli. Event-related potential (ERP) results showed a significant correlation between agreeableness and the contrast for emotional and non-emotional trials in a late time window only during the RME task. Specifically, higher levels of agreeableness were associated with a deeper neural processing of emotional versus non-emotional trials within the whole and male samples. In contrast, the modulation in females was negligible. The source analysis highlighted that this ERP-agreeableness association engages the ventromedial prefrontal cortex. Our findings expand previous research on personality and social processing and confirm that sex modulates this relationship.

Atypical Neural Plasticity and Behavioral Effects of Trustworthiness Learning in Borderline Personality Disorder Features

This study distinguishes interpersonal trust learning with a novel trust learning paradigm in participants high (H-BPD) and low (L-BPD) in BPD features. Neutral faces were paired with trust-relevant behaviors in four conditions: trustworthy, untrustworthy, ambiguously trustworthy, and mixed trustworthiness. After training, participants rated faces on untrustworthiness as electroencephalographic measures were recorded. H-BPD rated neutral faces as significantly more untrustworthy than L-BPD at both time periods. Negative and ambiguous trustworthiness pairing conditions led to higher ratings of untrustworthiness, whereas trustworthy and mixed descriptors led to lower ratings of untrustworthiness. Learning enhanced the amplitude of an early sensory event-related potential (ERP) component (i.e., P1) for both groups. The slow-wave ERP, an index of sustained attention, revealed greater focus after learning to trustworthy descriptors in H-BPD and to untrustworthy descriptors in L-BPD. H-BPD utilized greater effort to overcome an inherent mistrust bias and L-BPD to overcome unexpected untrustworthy information.

Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm

BACKGROUND

Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups.

METHODS

Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits.

RESULTS

Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group.

CONCLUSIONS

There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review

Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.

Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: are there differences between men and women?

Emotional dysregulation is a core feature of borderline personality disorder (BPD); it is, for example, known to influence one's ability to read other people's facial expressions. We investigated behavioral and neurophysiological foundations of emotional face processing in individuals with BPD and in healthy controls, taking participants' sex into account. 62 individuals with BPD (25 men, 37 women) and 49 healthy controls (20 men, 29 women) completed an emotion classification task with faces depicting blends of angry and happy expressions while the electroencephalogram was recorded. The cortical activity (late positive potential, P3/LPP) was evaluated using source modeling. Compared to healthy controls, individuals with BPD responded slower to happy but not to angry faces; further, they showed more anger ratings in happy but not in angry faces, especially in those with high ambiguity. Men had lower anger ratings than women and responded slower to angry but not happy faces. The P3/LPP was larger in healthy controls than in individuals with BPD, and larger in women than in men; moreover, women but not men produced enlarged P3/LPP responses to angry vs. happy faces. Sex did not interact with behavioral or P3/LPP-related differences between healthy controls and individuals with BPD. Together, BPD-related alterations in behavioral and P3/LPP correlates of emotional face processing exist in both men and women, supposedly without sex-related interactions. Results point to a general 'negativity bias' in women. Source modeling is well suited to investigate effects of participant and stimulus characteristics on the P3/LPP generators.

Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder

Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.

EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review

Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.

The borderline interpersonal-affective systems (BIAS) model: Extending understanding of the interpersonal context of borderline personality disorder

Prominent explanatory models for borderline personality disorder (BPD) are intrapersonal in nature and hold that it is an emotional disorder. However, the empirical support for emotional models of BPD is mixed. Refinements to BPD explanatory models are needed to increase the precision with which BPD can be understood and treated. Drawing on existing theoretical and empirical research in BPD, this manuscript presents the Borderline Interpersonal-Affective Systems (BIAS) model. The BIAS model purports that harmful early life relationships and subsequent conflictual relationships lead individuals with BPD to develop a sensitivity to interpersonal threat in the form of attentional and appraisal biases. Individuals with BPD are posited to 1) experience heightened emotional reactivity specifically to perceived interpersonal threat and 2) engage in destructive behaviors both to regulate increasing emotion and to meet interpersonal needs. We review the empirical support for each component of the BIAS model, along with the role of the cognitions, emotions, and behaviors of significant others in influencing BIAS model processes in individuals with BPD over time. The BIAS model highlights a novel way of understanding and integrating interpersonal and emotional components of the disorder. Key directives for future research and clinical implications are discussed.

Evidence for Altered Neural Processing in Patients With Borderline Personality Disorder

Abstract. Borderline personality disorder (BPD) is characterized by difficulties in emotion regulation, self-identity disturbances, self-injurious behavior, and reduced inhibitory control. Event-related potential (ERP) studies have sought to reveal the neural correlates of cognitive distortions and behavioral alterations in BPD. The article presents an overview of the existing ERP literature pertaining to BPD and discusses whether any one of the electrophysiological findings could serve as a reliable and specific marker for BPD. In short, ERP studies investigating P300 tentatively suggest impaired inhibitory control. Moreover, reduced error- and feedback-related processing and impaired response inhibition seem to be associated with impulsivity and risk-taking behavior in BPD patients. However, these findings are not specific for BPD. Regarding emotional and self-referential information processing, individuals with BPD display heightened vigilance toward social threat impacting their cognitive performance in various social-cognitive tasks demonstrating alterations of early negative and late positive potentials. These multifaceted electrophysiological alterations may be attributed to dysfunctional activity and connectivity of frontal brain regions and the limbic system.

Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder

This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.

How Therapeutic Tapping Can Alter Neural Correlates of Emotional Prosody Processing in Anxiety

Anxiety disorders are the most common psychological disorders worldwide resulting in a great demand of adequate and cost-effective treatment. New short-term interventions can be used as an effective adjunct or alternative to pharmaco- and psychotherapy. One of these approaches is therapeutic tapping. It combines somatic stimulation of acupressure points with elements from Cognitive Behavioral Therapy (CBT). Tapping reduces anxiety symptoms after only one session. Anxiety is associated with a deficient emotion regulation for threatening stimuli. These deficits are compensated e.g., by CBT. Whether Tapping can also elicit similar modulations and which dynamic neural correlates are affected was subject to this study. Anxiety patients were assessed listening to pseudowords with a different emotional prosody (happy, angry, fearful, and neutral) prior and after one Tapping session. The emotion-related component Late Positive Potential (LPP) was investigated via electroencephalography. Progressive Muscle Relaxation (PMR) served as control intervention. Results showed LPP reductions for negative stimuli after the interventions. Interestingly, PMR influenced fearful and Tapping altered angry prosody. While PMR generally reduced arousal for fearful prosody, Tapping specifically affected fear-eliciting, angry stimuli, and might thus be able to reduce anxiety symptoms. Findings highlight the efficacy of Tapping and its impact on neural correlates of emotion regulation.

Neural mechanisms of affective instability and cognitive control in substance use

OBJECTIVE

We explored the impact of affect on cognitive control as this relates to individual differences in affective instability and substance use. Toward this end, we examined how different dimensions of affective instability interact to predict substance misuse and the effect of this on two event-related potential components, the reward positivity and the late positive potential, which are said to reflect the neural mechanisms of reward and emotion processing, respectively.

METHODS

We recorded the ongoing electroencephalogram from undergraduate students as they navigated two T-maze tasks in search of rewards. One of the tasks included neutral, pleasant, and unpleasant pictures from the International Affective Picture System. Participants also completed several questionnaires pertaining to substance use and personality.

RESULTS

A principal components analysis revealed a factor related to affective instability, which we named reactivity. This factor significantly predicted increased substance use. Individuals reporting higher levels of affective reactivity also displayed a larger reward positivity following stimuli with emotional content.

CONCLUSION

The current study uncovered a group of high-risk substance users who were characterized by greater levels of affective reactivity and context-specific increased sensitivity to rewards.

SIGNIFICANCE

These results help to elucidate the complex factors underlying substance use and may facilitate the creation of individually-tailored treatment programs for those struggling with substance use disorders.

Dialectical Behaviour Therapy for Emotion Regulation Difficulties: A Systematic Review

While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.

Childhood trauma affects processing of social interactions in borderline personality disorder: An event-related potential study investigating empathy for pain

Objectives: Patients with borderline personality disorder (BPD) have difficulties in empathising with others and show disturbances in social interactions. Using a 'Social Interaction Empathy Task', we found that BPD patients judged neutral and psychologically painful conditions as more painful than healthy subjects. Here, we present the neural correlates underlying these differences in empathy for pain. Methods: Female BPD patients and healthy controls completed the 'Social Interaction Empathy Task' during EEG recording. Event-related potentials (ERP) were analysed for an early anterior component and a late latency positivity. Empathic abilities were assessed using the Interpersonal Reactivity Index and early aversive experiences were measured by the Childhood Trauma Questionnaire (CTQ). Results: ERPs in the patient group matched the behaviour results and correlated with the level of personal distress and CTQ. In addition, ERPs of patients were predicted by childhood maltreatment and stress. Conclusions: Taken together, our findings indicate that the observed behavioural differences between patients with BPD and controls might be due to modulatory effects of empathic abilities on the evaluation of pain-related social stimuli, which are supposed to be based on childhood maltreatment.

Remnants and changes in facial emotion processing in women with remitted borderline personality disorder: an EEG study

According to longitudinal studies, most individuals with borderline personality disorder (BPD) achieve remission. Since BPD is characterized by disturbed emotion recognition, this study investigated behavioral and electrophysiological correlates of facial emotion classification and processing in remitted BPD. 32 women with remitted BPD (rBPD), 32 women with current BPD (cBPD), and 28 healthy women (HC) participated in an emotion classification paradigm comprising blends of angry and happy faces while behavioral and electroencephalographic (event-related potentials) data were recorded. rBPD demonstrated a convergence in behavior towards HC in terms of responses and reaction times. They evaluated maximally ambiguous faces more positively and exhibited faster reaction times when classifying predominantly happy faces compared to cBPD. Group × facial emotion interaction effects were found in early electrophysiological processes with post hoc tests indicating differences between rBPD and cBPD but not between rBPD and HC. However, BPD-like impairments were still found in rBPD in later processing (P300). Our results suggest a reduction in negativity bias in rBPD on the behavioral level and a normalization of earlier stages of facial processing on the neural level, while alterations in later, more cognitive processing do not remit. Early processing may be more state-like, while later impairments may be more trait-like. Further research may need to focus on these stable components.

Past, present, and future of genetic research in borderline personality disorder

Borderline Personality Disorder (BPD) is a major mental illness with a lifetime prevalence of approximately 1-3%, characterized by a persistent pattern of instability in relationships, mood, impulse regulation, and sense of self. This results in impulsive self-damaging behavior, high suicide rates, and severe functional impairment. BPD has a complex, multifactorial etiology, resulting from an interaction among genetic and environmental substrates, and has moderate to high heritability based on twin and family studies. However, our understanding of the genetic architecture of BPD is very limited. This is a critical obstacle since genetics can pave the way for identifying new treatment targets and developing preventive and disease-modifying pharmacological treatments which are currently lacking. We review genetic studies in BPD, with a focus on limitations and challenges and future directions. Genetic research in BPD is still in its very early stages compared to other major psychiatric disorders. Most early genetic studies in BPD were non-replicated association studies in small samples, focused on single candidate genes. More recently, there has been one genome-wide linkage study and a genome-wide association study (GWAS) of subclinical BPD traits and a first GWAS in a relatively modest sample of patients fulfilling full diagnostic criteria for the disorder. Although there are adequate animal models for some of the core dimensions of BPD, there is a lack of translational research including data from animal models in BPD. Research in more pioneering fields, such as imaging genetics, deep sequencing and epigenetics, holds promise for elucidating the pathophysiology of BPD and identifying new treatment targets.

Alexithymia in borderline personality disorder is not associated with deficits in automatic visual processing of negative emotional stimuli

Previous studies have suggested that alexithymia may be related to impairments in automatic emotion processing. While it is well established that alexithymia is highly prevalent in individuals with borderline personality disorder (BPD), it is unknown whether this is reflected by an altered automatic processing of emotional stimuli. In the present study we investigated visually evoked event-related potentials using neutral and negative images from the International Affective Pictures System in 26 BPD patients and 26 healthy controls. In line with previous reports, all subjects showed increased late positive potentials (LPP) for negative compared to neutral images. There were, however, no between-group differences at any time point. Crucially, there was no difference between alexithymic and non-alexithymic BPD patients in the expression of LPP. Our study is the first to show that automatic emotion processing in the visual domain appears to be normal in BPD and unaffected by alexithymia.

A Neurobiological Model of Borderline Personality Disorder: Systematic and Integrative Review

Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.

The impact of stimulus arousal level on emotion regulation effectiveness in borderline personality disorder

Basic emotion theory suggests that the effectiveness of different emotion regulation strategies vary with the intensity of the emotionally-salient stimulus. Although findings from studies using healthy samples are concordant with what is proposed by theory, it is unclear whether these relationships hold true among individuals with borderline personality disorder (BPD). Twenty-five individuals with BPD and 30 HCs were exposed to negative images of varying levels of emotional arousal and were instructed to either react as they normally would, distract, or use mindful awareness. Self-reported negativity ratings, heart rate, and skin conductance level (SCL) were monitored throughout. SCL data indicated that increases in image arousal resulted in larger reductions in SCL when distracting but not when implementing mindful awareness. Self-report data suggested that, in HCs, the effectiveness of mindful awareness decreased to a greater extent than distraction when image arousal increased. These findings are consistent with basic emotion research and suggest that some forms of emotion regulation (distraction) are more suited to high emotion arousal contexts than others (mindful awareness) and that, compared with HCs, individuals with BPD may be more resilient to the deteriorating effectiveness of mindful awareness with respect to increasing emotional arousal.

Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review

Reduced capacity to cognitively regulate emotional responses is a common impairment across major neuropsychiatric disorders. Brain systems supporting one such strategy, cognitive reappraisal of emotion, have been investigated extensively in the healthy population, a research focus that has led to influential meta-analyses and literature reviews. However, the emerging literature on neural substrates underlying cognitive reappraisal in clinical populations is yet to be systematically reviewed. Therefore, the goal of the current review was to summarize the literature on cognitive reappraisal and highlight common and distinct neural correlates of impaired emotion regulation in clinical populations. We performed a two-stage systematic literature search, selecting 32 studies on cognitive reappraisal in individuals with mood disorders (n=12), anxiety disorders (n=14), addiction (n=2), schizophrenia (n=2), and personality disorders (n=5). Comparing findings across these disorders allowed us to determine underlying mechanisms that were either disorder-specific or common across disorders. Results showed that across clinical populations, individuals consistently demonstrated reduced recruitment of the ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC) during downregulation of negative emotion, indicating that there may be a core deficit in selection, manipulation and inhibition during reappraisal. Further, in individuals with mood disorders, amygdala responses were enhanced during downregulation of emotion, suggesting hyperactive bottom-up responses or reduced modulatory capacity. In individuals with anxiety disorders, however, emotion regulation revealed reduced activity in the dorsal anterior cingulate cortex (dACC) and inferior/superior parietal cortex, possibly indicating a deficit in allocation of attention. The reviewed studies thus provide evidence for both disorder-specific and common deficits across clinical populations. These findings highlight the role of distinct neural substrates as targets for developing/assessing novel therapeutic approaches that are geared towards cognitive regulation of emotion, as well as the importance of transdiagnostic research to identify both disorder specific and core mechanisms.

A multi-method laboratory investigation of emotional reactivity and emotion regulation abilities in borderline personality disorder

BACKGROUND AND OBJECTIVES

Borderline personality disorder (BPD) is conceptualized as a disorder of heightened emotional reactivity and difficulties with emotion regulation. However, findings regarding emotional reactivity in BPD are mixed and there are limited studies examining emotion regulation capabilities in this population.

METHODS

Twenty-five individuals with BPD and 30 healthy controls (HCs) engaged in a baseline assessment followed by the presentation of neutral and BPD-relevant negative images. Participants were instructed to react as they naturally would to the image, or to use a mindfulness-based or distraction-based strategy to feel less negative. Self-reported and physiological (i.e., heart rate, electrodermal activity, and respiratory sinus arrhythmia) measures were collected.

RESULTS

Compared with the HCs, the BPD group exhibited elevated heart rate and reduced respiratory sinus arrhythmia at baseline. However, there were no differences in emotional reactivity in self-report or physiological indices between the two groups. In addition, the BPD group did not exhibit deficits in the ability to implement either emotion regulation strategy, with the exception that the BPD group reported less positive emotions while distracting compared with the HCs.

LIMITATIONS

This study is limited by a small sample size and the inclusion of a medicated BPD sample.

CONCLUSIONS

Emotion dysregulation in BPD might be better accounted for by abnormal baseline emotional functioning rather than heightened emotional reactivity or deficits in emotion regulation. Treatments for BPD might be enhanced by directly targeting resting state emotional functioning rather than emotional reactions or regulatory attempts.

The spectrum of borderline personality disorder: a neurophysiological view

Borderline Personality Disorder (BPD) has been defined as a personality disorder in all editions of DSM since 1980; namely, DSM III through V. The criteria are a mixture of symptoms and traits; the etiology, a heterogeneous array of genetic, constitutional, and environmental factors. Until recently the diagnosis relied on clinical descriptions. In the last two decades, neurophysiological data, including MRI and fMRI, have established correlates in various brain regions, particularly those involving the frontal lobes and various limbic structures, that show promise of providing a more substantial basis for diagnosis-relying primarily on (internal) brain changes, rather than on (external) clinical observation. Some of the changes in BPD consist of decreased volume in the orbitofrontal and dorsolateral prefrontal cortices and smaller volume in both the amygdala and hippocampus, though with heightened reactivity in the amygdala. Similar abnormalities have been noted in bipolar disorders (BDs) and in ADHD, both of which often accompany BPD and share certain clinical features. Persons with strong genetic predisposition to BDs can develop BPD even in the absence of adverse environmental factors; those with extreme adverse environmental factors (chiefly, early sexual molestation) can develop BPD in the absence of bipolar vulnerability. In some BPD patients, both sets of factors are present. As ideal treatment depends on careful analysis of these factors, neurophysiological testing may permit both more rational, brain-based diagnostic decisions and more appropriate therapeutic strategies.

Facial reactions during emotion recognition in borderline personality disorder: a facial electromyography study

BACKGROUND

Previous studies have suggested increased sensitivity for emotional facial expressions and subtle impairments in emotion recognition from facial expressions in borderline personality disorder (BPD). It has been proposed that facial mimicry contributes to emotion recognition of and emotional response to facial expressions. This study investigated whether BPD patients differ in facial reactions, emotion recognition and their subjective emotional response to faces showing different emotional expressions.

METHOD

Twenty-eight female BPD patients and 28 healthy controls underwent a facial recognition task with dynamic facial pictures while facial muscle activity (occipitofrontalis, corrugator supercilii, levator labii superioris, zygomaticus major and orbicularis oculi) was recorded. Furthermore, participants rated the emotional intensity of the presented faces and the intensity of their subjective feeling of this emotion.

RESULTS

Compared to controls, BPD patients showed enhanced responses of the corrugator supercilii muscle in response to angry, sad and disgusted facial expressions, and attenuated responses of the levator labii superioris in response to happy and surprised faces. There were no overall group differences regarding emotion recognition performance or intensity ratings.

CONCLUSION

These results do not support the view that facial recognition in BPD is impaired or that there is a general hypersensitivity to the emotional state of others. Instead, they suggest a negativity bias in BPD, expressed by reduced facial responding to positive social signals and increased facial responding to negative social signals. This is a pattern of facial reactions that might contribute to the difficulties in social interactions frequently reported by patients with this disorder.

Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder

Evidence suggests that heightened negative affectivity is a prominent feature of Borderline Personality Disorder (BPD) that often leads to maladaptive behaviors. Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions. Dialectical Behavior Therapy (DBT) is an effective treatment for BPD, hypothesized to reduce negative affectivity (Linehan, 1993a). The present study analyzes secondary data from a randomized controlled trial with the aim to assess the unique effectiveness of DBT when compared to Community Treatment by Experts (CTBE) in changing the experience, expression, and acceptance of negative emotions. Suicidal and/or self-injuring women with BPD (n = 101) were randomly assigned to DBT or CTBE for one year of treatment and one year of follow-up. Several indices of emotional experience and expression were assessed. Results indicate that DBT decreased experiential avoidance and expressed anger significantly more than CTBE. No differences between DBT and CTBE were found in improving guilt, shame, anxiety, or anger suppression, trait, and control. These results suggest that DBT has unique effects on improving the expression of anger and experiential avoidance, whereas changes in the experience of specific negative emotions may be accounted for by general factors associated with expert therapy. Implications of the findings are discussed.

Reduced sensitivity to emotional facial expressions in borderline personality disorder: effects of emotional valence and intensity

A heightened sensitivity towards negative emotional stimuli has been described for Borderline Personality Disorder (BPD). We investigated whether a faster and more accurate detection of negatively valent information in BPD can be confirmed by means of a visual search task which required subjects to detect a face with an incongruent emotional expression within a crowd of neutral faces. Twenty eight BPD patients and 28 nonpatients were asked to indicate whether a set of schematic neutral faces (3 × 3, 4 × 4 matrices) contained a happy or an angry face. Besides valence, the intensity of the target's emotion was varied in two steps. BPD patients and nonpatients both demonstrated an anger-superiority effect. However, no higher sensitivity towards negative stimuli was observed in BPD compared to nonpatients. BPD patients seem to rely to a stronger extent on controlled, i.e., serial, attention demanding processes when searching more subtle social-emotional information with positive valence.

Functional significance of the emotion-related late positive potential

The late positive potential (LPP) is an event-related potential (ERP) component over visual cortical areas that is modulated by the emotional intensity of a stimulus. However, the functional significance of this neural modulation remains elusive. We conducted two experiments in which we studied the relation between LPP amplitude, subsequent perceptual sensitivity to a non-emotional stimulus (Experiment 1) and visual cortical excitability, as reflected by P1/N1 components evoked by this stimulus (Experiment 2). During the LPP modulation elicited by unpleasant stimuli, perceptual sensitivity was not affected. In contrast, we found some evidence for a decreased N1 amplitude during the LPP modulation, a decreased P1 amplitude on trials with a relatively large LPP, and consistent negative (but non-significant) across-subject correlations between the magnitudes of the LPP modulation and corresponding changes in d-prime or P1/N1 amplitude. The results provide preliminary evidence that the LPP reflects a global inhibition of activity in visual cortex, resulting in the selective survival of activity associated with the processing of the emotional stimulus.

Beta receptor-mediated modulation of the late positive potential in humans

RATIONALE

Electrophysiological studies have identified a scalp potential, the late positive potential (LPP), which is modulated by the emotional intensity of observed stimuli. Previous work has shown that the LPP reflects the modulation of activity in extrastriate visual cortical structures, but little is known about the source of that modulation.

OBJECTIVES

The present study investigated whether beta-adrenergic receptors are involved in the generation of the LPP.

METHODS

We used a genetic individual differences approach (experiment 1) and a pharmacological manipulation (experiment 2) to test the hypothesis that the LPP is modulated by the activation of β-adrenergic receptors.

RESULTS

In experiment 1, we found that LPP amplitude depends on allelic variation in the β1-receptor gene polymorphism. In experiment 2, we found that LPP amplitude was modulated by the β-blocker propranolol in a direction dependent on subjects' level of trait anxiety: In participants with lower trait anxiety, propranolol led to a (nonsignificant) decrease in the LPP modulation; in participants with higher trait anxiety, propranolol increased the emotion-related LPP modulation.

CONCLUSIONS

These results provide initial support for the hypothesis that the LPP reflects the downstream effects, in visual cortical areas, of β-receptor-mediated activation of the amygdala.

Depressive-type emotional response pattern in impulsive-aggressive patients with borderline personality disorder

INTRODUCTION

Borderline personality disorder (BPD) is typically characterized by severe affective dysregulation leading to impulsive behaviors. Accordingly, preliminary data suggest the hypothesis that BPD patients could have a specific and altered pattern of subjective emotional response to stimuli. The nature of the emotional response in BPD can be compared with other affective disorders and provide further insight on the nosological proximity with other psychiatric disorders.

METHODS

Subjective emotional response was investigated in 19 patients with DSM-IV BPD with no current depressive episode and in 19 healthy control subjects by using the International Affective Picture System (IAPS). The intensity of arousal, valence and dominance was rated in response to 60 images categorized as pleasant, unpleasant and neutral by using a self-assessment instrument. ANOVA of multiple factors was used for between-groups comparisons.

RESULTS

The obtained pattern showed that BPD patients considered the unpleasant and neutral images as less aversive than controls, but the activation that these images induced was higher. Patients showed significantly greater arousal than controls for unpleasant and neutral images (p<0.05) but presented greater valence (more positive emotion) for these images (p<0.05). In addition, BPD patients showed lower dominance (greater insecurity and dyscomfort) for positive images (p<0.05).

CONCLUSIONS

The subjective emotional response pattern of BPD patients suggests a trait of vulnerability to pleasant stimuli and is similar to the pattern found in depressive patients in previous studies. This supports the evidence that BPD could in part be related with the spectrum of the affective temperament and affective disorders.

Impact of personality on the cerebral processing of emotional prosody

While several studies have focused on identifying common brain mechanisms governing the decoding of emotional speech melody, interindividual variations in the cerebral processing of prosodic information, in comparison, have received only little attention to date: Albeit, for instance, differences in personality among individuals have been shown to modulate emotional brain responses, personality influences on the neural basis of prosody decoding have not been investigated systematically yet. Thus, the present study aimed at delineating relationships between interindividual differences in personality and hemodynamic responses evoked by emotional speech melody. To determine personality-dependent modulations of brain reactivity, fMRI activation patterns during the processing of emotional speech cues were acquired from 24 healthy volunteers and subsequently correlated with individual trait measures of extraversion and neuroticism obtained for each participant. Whereas correlation analysis did not indicate any link between brain activation and extraversion, strong positive correlations between measures of neuroticism and hemodynamic responses of the right amygdala, the left postcentral gyrus as well as medial frontal structures including the right anterior cingulate cortex emerged, suggesting that brain mechanisms mediating the decoding of emotional speech melody may vary depending on differences in neuroticism among individuals. Observed trait-specific modulations are discussed in the light of processing biases as well as differences in emotion control or task strategies which may be associated with the personality trait of neuroticism.

Superior 'theory of mind' in borderline personality disorder: an analysis of interaction behavior in a virtual trust game

To gain further insight into interpersonal dysfunction in Borderline Personality Disorder (BPD) we investigated the effects of emotional cues and the fairness of a social partner on the ability to infer other peoples' intentions in a virtual social exchange. 30 BPD patients and 30 nonpatients were asked to play a multiround trust game with four virtual trustees. The trustees varied in regard to fairness and presence of emotional facial cues which were both linked to repayment ratio. BPD patients adjusted their investment to the fairness of their partner. In contrast, nonpatients disregarded the trustees' fairness in the presence of emotional facial expressions. Both groups performed equally in an emotion recognition task and assessed the trustees' fairness comparably. When the unfair trustee provided emotional cues, BPD patients assessed their own behavior as more fair, while the lack of cues led patients to assess their own behavior as unfair. BPD patients are superior in the attribution of mental states to interaction partners when emotional cues are present. While the emotional expressions of a partner dominated the exchange behavior in nonpatients, BPD patients used the objective fairness of their social counterparts to guide their own behavior despite the existence of emotional cues.

Neuronal correlates of cognitive reappraisal in borderline patients with affective instability

BACKGROUND

Borderline personality disorder has been characterized by enhanced emotional reactivity and deficient emotion regulation in behavioral and functional imaging studies. We aimed to validate patients' difficulties in the cognitive regulation of negative emotions and investigated if emotion regulation deficits are restricted to the decrease of negative emotions. A cognitive reappraisal paradigm was used and hence a regulation strategy that is typically applied in cognitive-behavioral therapy.

METHODS

Fifteen unmedicated female borderline patients with affective instability and 15 healthy female control subjects underwent functional magnetic resonance imaging during a delayed reappraisal paradigm. Hemodynamic responses were measured in response to aversive pictures in an initial viewing phase and a subsequent reappraisal phase with three different conditions: decreasing, increasing, and maintaining the initial emotional reaction.

RESULTS

Patients demonstrated enhanced activation of left amygdala and right insula during the initial viewing of aversive stimuli. During attempting to decrease the initial emotional reaction, patients showed attenuated activation of the left orbitofrontal cortex and increased activation of the bilateral insula. The attempt to increase negative emotions resulted in enhanced activity in amygdala and insula, whereas no group differences were found.

CONCLUSIONS

The results point to the role of two distinguishable processes of emotional difficulties in borderline personality disorder: enhanced emotional reactivity as well as deficits of voluntarily decreasing aversive emotions by means of cognitive reappraisal. The results suggest the neuronal substrate of deficits in explicit emotion regulation in the orbitofrontal cortex, which is in line with previous findings of a dysfunctional prefrontal network in borderline personality disorder.