Emotional Responsiveness in Borderline Personality Disorder: The Role of Basal Hyperarousal and Self-Reported Emotional Regulation

Dialectical Behavior Therapy in Autism

PURPOSE OF REVIEW

Recent research indicates that Dialectical Behavior Therapy (DBT) is feasible, acceptable, and effective for autistic adults. This review aims to provide conceptual arguments and empirical evidence to support DBT as a relevant therapeutic alternative for autistic individuals experiencing emotion dysregulation (ED).

RECENT FINDINGS

ED is frequent in autism whereby it is associated with severe mental health challenges. However, appropriate therapeutic options are limited. Currently, DBT has amassed the most evidence for treatment of ED across a range of clinical conditions, although it was originally developed for borderline personality disorder (BPD). In the context of autism, there is evidence supporting the efficacy of DBT for ED, life-threatening behaviors and depression, but adaptations are likely to improve its dissemination and acceptability. While similar biosocial factors seem to be involved in ED in BPD and autism, alexithymia is prominent in autism and autistic features such as sensory sensitivity and social overload also contribute to ED in autistic adults.

CONCLUSION

Given the significant impact of ED on the well-being of autistic adults, there is an urgent need to enhance our understanding of the mechanisms involved in ED in autism and the adaptations likely to improve the acceptability and dissemination of DBT for autistic people.

Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring

Background: Bipolar disorder (BD) and borderline personality disorder (BPD) share common cognitive impairments. These deficits are also shared by bipolar offspring (BD-OFF). Nevertheless, little is known regarding the association between cognitive impairments and BPD features in youth with BD and BD-OFF. Objectives: This study aimed to investigate the association between BPD features and cognitive impairments in youth with BD and BD-OFF. Methods: Thirty-nine participants (7-17 years) with BD, 18 BD-OFF, and 50 healthy controls (HCs) were recruited. BPD features were assessed using the Borderline Personality Features Scale for Children (BPFS-C). Deficits in executive functions and affective processing were assessed using tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), namely, the Cambridge gambling task (CGT), the stockings of Cambridge (SOC), and the Affective Go/No-Go (AGN) and rapid visual processing (RVP) tasks. Between-group differences were analyzed through ANOVAs. Relationships between the BPFS-C and cognitive tasks were examined using multiple linear regressions in youth with BD and BD-OFF. Results: Youth with BD and BD-OFF showed higher scores on the BPFS-C. Youth with BD had increased deficits in the CGT and SOC compared to HCs. In both youth with BD and BD-OFF, BPD features were associated with increased deficits in the CGT, and a bias toward positive emotions in the AGN task. Conclusions: In youth with BD and BD-OFF, clinical and cognitive assessments for BPD features are of relevance as they have the potential to inform targeted interventions.

Autistic Traits Are Associated with Suicidal Thoughts and Behaviors Among Patients with Borderline Personality Disorder

Background: Borderline personality disorder (BPD) is a pervasive mental health condition characterized by a heightened risk of suicidal behavior. Emerging research has suggested a potential overlap between BPD and subthreshold autistic traits (ATs), raising the possibility that these traits may influence the development, course, and severity of BPD, particularly in relation to suicidal ideation and behaviors. This study aims to evaluate the relationship between suicidal ideation, suicidal behaviors, and ATs in individuals with BPD. Methods: We assessed 106 subjects with BPD using the mood spectrum self-report version (MOODS-SR) of the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire. The sample was divided into three groups based on suicidal ideation and behaviors. Non-parametric tests compared AdAS Spectrum scores, while Spearman's correlation assessed the relationships between AdAS Spectrum scores and suicidality. Logistic regression analyses were conducted to identify predictive AdAS Spectrum domains for suicidal ideation and behaviors. Results: Subjects with suicidal behaviors and suicidal ideation showed significantly more autistic features than non-suicidal subjects. Correlation analysis revealed that all AdAS Spectrum domains, except empathy, were significantly correlated with both suicidal ideation and behaviors, with stronger correlations for suicidal behaviors. Moreover, restricted interests, rumination, and sensory sensitivity emerged as significant predictors of suicidal ideation, while the lack of empathy was a significant predictor of suicidal behavior. Conclusions: Our results confirm a strong correlation between the presence of ATs and suicidality in subjects with BPD, in particular highlighting rumination, altered sensitivity, and empathic deficits as specific predictors of suicidal thoughts and behaviors.

Metabolic Dysfunctions, Dysregulation of the Autonomic Nervous System, and Echocardiographic Parameters in Borderline Personality Disorder: A Narrative Review

Borderline personality disorder (BPD) is a complex psychiatric disorder characterized by an unstable sense of self and identity, emotional dysregulation, impulsivity, and disturbed interpersonal relationships. This narrative review examines the interplay between dysregulation of the autonomic nervous system, metabolic changes, and cardiovascular risk in BPD. Altered heart rate variability (HRV), reflecting the dysregulation of the autonomic nervous system, is associated with some BPD core symptoms, such as emotional instability and impulsivity. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, often stemming from early trauma, contributes to chronic inflammation and elevated allostatic load, which further increases cardiovascular risk. Metabolic dysfunctions in BPD, such as elevated body mass index (BMI), high blood pressure, and inflammatory markers like C-reactive protein (CRP), exacerbate these risks. Speckle-tracking echocardiography, particularly global longitudinal strain (GLS) and biomarkers such as homocysteine and epicardial fat, could be considered early predictors of cardiovascular events in individuals with BPD. Chronic stress, inflammation, and maladaptive stress responses further heighten cardiovascular vulnerability, potentially accelerating biological aging and cognitive decline. A literature search covering the period from 2014 to 2024 on PubMed identified 189 studies on this topic, of which 37 articles were deemed eligible for this review. These included cross-sectional, longitudinal, case-control, randomised controlled trials (RCTs), reviews, and meta-analysis designs, with sample sizes ranging from 14 to 5969 participants. The main limitations were that only one database was searched, the time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented on. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out a direction for future research.

Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial

BACKGROUND

Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients.

METHODS

Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery.

DISCUSSION

The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.

Autonomic vulnerability to biased perception of social inclusion in borderline personality disorder

BACKGROUND

Individuals with Borderline Personality Disorder (BPD) feel rejected even when socially included. The pathophysiological mechanisms of this rejection bias are still unknown. Using the Cyberball paradigm, we investigated whether patients with BPD, display altered physiological responses to social inclusion and ostracism, as assessed by changes in Respiratory Sinus Arrhythmia (RSA).

METHODS

The sample comprised 30 patients with BPD, 30 with remitted Major Depressive Disorder (rMDD) and 30 Healthy Controls (HC). Self-report ratings of threats toward one's fundamental need to belong and RSA reactivity were measured immediately after each Cyberball condition.

RESULTS

Participants with BPD showed lower RSA at rest than HC. Only patients with BPD, reported higher threats to fundamental needs and exhibited a further decline in RSA after the Inclusion condition.

CONCLUSIONS

Individuals with BPD experience a biased appraisal of social inclusion both at the subjective and physiological level, showing higher feelings of ostracism and a breakdown of autonomic regulation to including social scenarios.