Psychosocial stress differentially affects emotional empathy in women with borderline personality disorder and healthy controls

The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study

Background

In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals' decisions to adhere to COVID-19 preventative behaviors.

objectives

The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors.

Methods

A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS.

Results

Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (β=-.17, t53=-2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety.

Conclusions

These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community).

Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder

Stressful social situations like social exclusion are particularly challenging for patients with borderline personality disorder (BPD) and often lead to dysfunctional reactive behaviour of aggression and withdrawal. The autonomous signature of these core symptoms of BPD remains poorly understood. The present study investigated the parasympathetic response to social exclusion in women with BPD (n = 62) and healthy controls (HC; n = 87). In a between-subjects design, participants experienced objective social exclusion or overinclusion in the Cyberball task, a virtual ball-tossing game. Need threat scores served as individual measures of perceived exclusion and the resulting frustration of cognitive-emotional needs. Five-minute measurements of high-frequency heart rate variability (HF-HRV) at three time points (before, during, after Cyberball) indicated parasympathetic tone and regulation. We observed a trend towards lowered baseline HF-HRV in BPD vs. HC in line with previous findings. Interestingly, the parasympathetic response of patients with BPD to objective and perceived social exclusion fundamentally differed from HC: higher exclusion was associated with increased parasympathetic activation in HC, while this autonomic response was reversed and blunted in BPD. Our findings suggest that during social stress, the parasympathetic nervous system fails to display an adaptive regulation in patients with BPD, but not HC. Understanding the autonomous signature of the stress response in BPD allows the formulation of clinically relevant and biologically plausible interventions to counteract parasympathetic dysregulation in this clinical group.

The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by emotional instability, impulsivity and unstable interpersonal relationships. Patients experience discomforting levels of distress, inducing symptoms like dissociation, aggression or withdrawal. Social situations are particularly challenging, and acute social stress can reduce patients' cognitive and social functioning. In patients with Major Depressive Disorder or Posttraumatic Stress Disorder, which show high comorbidity with BPD, the endocrine stress response is characterized by Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction, which affects cognitive functioning. Compared to these clinical groups, research on HPA-axis function in BPD is relatively scarce, but evidence points towards a blunted cortisol reactivity to acute stress. Since BPD patients are particularly prone to social stress and experience high subjective difficulties in these situations, it seems plausible that HPA-axis dysregulation might contribute to decreased social cognition in BPD. The present review summarizes findings on the HPA-axis function in BPD and its association with social cognition following acute social stress. For this purpose, we review literature that employed a widely used social stressor (Trier Social Stress Test, TSST) to study the effects of acute social stress on social cognition and the HPA-axis response. We contrast these findings with studies on social cognition that employed Cyberball, another widely used social stressor that lacks HPA-axis involvement. We conclude that research on social cognition in BPD reveals heterogeneous results with no clear relationship between social functioning and HPA-axis response. More research is needed to better understand the psychophysiological underpinnings of impaired social cognition in BPD.

The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample

BACKGROUND

Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD.

METHODS

We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85.

DISCUSSION

The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.

Impact of social exclusion on empathy in women with borderline personality disorder

Unstable interpersonal relationships and fear of abandonment are core symptoms of borderline personality disorder (BPD) that often intensify during stress. Psychosocial stress, which includes components of social exclusion and increases cortisol secretion, enhances emotional empathy in healthy individuals. Women with BPD, on the contrary, react with reduced emotional empathy. The aim of the present study was to investigate the effects of perceived social exclusion without accompanying cortisol increase on empathy in women with BPD and healthy women. To induce social exclusion, we randomized 98 women with BPD and 98 healthy women to either an exclusion or an overinclusion (control) condition of Cyberball, a virtual ball game. Subsequently, participants underwent the Multifaceted Empathy Test (MET), which assesses cognitive and emotional empathy. There was no increase in cortisol release after Cyberball. Cognitive empathy did not differ between groups or conditions. Women with BPD reported lower emotional empathy for positive emotions (group by valence interaction), but not for negative emotions. Exploratory analyses suggested that this effect might be more pronounced after social exclusion. Our results confirm previous findings that cognitive empathy does not differ between women with BPD and healthy women and extend this evidence to social exclusion. Emotional empathy in women with BPD seems to be more sensitive to the effects of stress or ambiguous social situations. Specifically, emotional empathy seems to be reduced for positive emotions, and might further decline after social exclusion. Empathic reactions to emotional stimuli of different valences and to specific emotions should be further investigated.

The association between acute stress & empathy: A systematic literature review

Empathy is a fundamental component of our social-emotional experience. Over the last decade, there has been increased interest in understanding the effects of acute stress on empathy. We provide a first comprehensive-and systematic-overview identifying emerging patterns and gaps in this literature. Regarding affective empathy, there is abundant evidence for stress contagion-the 'spillover' of stress from a stressed target to an unstressed perceiver. We highlight contextual factors that can facilitate and/or undermine these effects. Fewer studies have investigated the effects of acute stress on affective empathy, revealing a nuanced picture, some evidence suggests acute stress can block contagion of other's emotions; but again contextual differences need to be considered. Regarding cognitive empathy, most studies find no conclusive effects for simplistic measures of emotion recognition; however, studies using more complex empathy tasks find that acute stress might affect cognitive empathy differentially for men and women. This review provides an important first step towards understanding how acute stress can impact social-togetherness, and aims to aid future research by highlighting (in)congruencies and outstanding questions.

Altered psychobiological reactivity but no impairment of emotion recognition following stress in adolescents with non-suicidal self-injury

Impairments in both stress regulation and emotion recognition have been associated with borderline personality disorder (BPD) and non-suicidal self-injury (NSSI). Although it has been proposed that emotion recognition deficits particularly emerge during stress, this hypothesis has not been fully investigated. Adolescents with and without NSSI performed emotion recognition tasks before and after the employment of the Trier Social Stress Test (TSST). The psychobiological stress response was captured with psychological self-reports (affect, stress and dissociation), physiological recordings (heart rate, HR, and heart rate variability, HRV) and endocrinological sampling of saliva (cortisol and alpha-amylase). Mixed-linear models were applied to analyze stress-induced changes in emotion recognition performance and respective stress response measures. The TSST elicited altered psychobiological stress responses in adolescents with NSSI: A more pronounced decrease in positive affect, a more pronounced increase in negative affect, a less pronounced increase in HR, a less pronounced decrease in HRV and a more pronounced increase in alpha-amylase throughout the stress induction than adolescents without NSSI. Stress responses (dissociation, negative affect, cortisol and HR) differed as a function of BPD severity on a continuum, illustrating greater reactivity on self-reports but decreased biological responsiveness in those with greater BPD severity. Stress induction had similar effects on emotion recognition in adolescents with and without NSSI. Recognition sensitivity and recognition speed equally increased, in the absence of any differences in recognition accuracy. In contrast to prominent propositions, psychosocial stress does not appear to account for impaired emotion recognition across the BPD spectrum.

Altered hormonal patterns in borderline personality disorder mother-child interactions

BACKGROUND

Oxytocin, cortisol, and testosterone are involved in the processing of reward and stress and greatly influence mother-child interactions. Altered hormonal systems have been associated with borderline personality disorder (BPD), a disorder characterized by interpersonal deficits. Mothers with BPD tend to perceive interactions with the child as less rewarding and more stressful and interactions are often less reciprocal and have more negative states (i.e. constricted, tense, uncoordinated behaviors). Their children are at elevated risk for psychopathologies. Here, we studied underlying hormonal mechanisms of disrupted mother-child interaction in BPD.

METHODS

Twenty-five mothers with BPD and 29 healthy mothers with their 18- to 36-month-old toddlers participated in a free-play mother-child interaction, which was evaluated with the Coding Interactive Behavior (CIB) Manual. Maternal blood samples were analyzed at baseline for oxytocin, cortisol, and testosterone, and after interaction for oxytocin and cortisol.

RESULTS

Oxytocin decreased and cortisol remained unchanged in mothers with BPD while healthy mothers showed stable oxytocin and decreased cortisol after interaction. Testosterone basal levels were significantly higher in mothers with BPD. Cortisol reactivity and testosterone levels mediated the association between maternal BPD and dyadic negative states during interaction.

CONCLUSIONS

These findings suggest that alterations in oxytocin, cortisol, and testosterone contribute to disruptions in mother-child interaction in BPD. Interacting with their child might not result in reward and relief of stress in mothers with BPD in the same way as in healthy mothers. Further research is needed to understand more about dyadic bio-behavioral processes in order to provide targeted parenting support. This could break the cycle of transgenerational transmission and improve maternal and child well-being.

Impaired empathic functioning in chronic depression: Behavioral evidence for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model proposes preoperational functioning as a core feature of persistent depressive disorders (PDD). Empathy deficits comprise one aspect. Resulting from childhood maltreatment, empathy deficits may aggravate social isolation, a key factor in the maintenance of depression. CBASP targets empathy by teaching patients to disengage from past experiences and to engage successfully in present social interactions. However, behavioral evidence for empathy deficits in PDD has remained elusive. We reasoned that deficits become apparent only under stress and that these deficits improve after CBASP-treatment. Twenty-two patients and 21 controls performed two parallel versions of the Multifaceted Empathy Test. For stress induction, a negative autobiographical event was presented before performing the task. A neutral event served as control. Fifteen patients performed the experiment twice, before and after a 12-week inpatient CBASP-treatment. Supporting our hypotheses, patients showed reduced empathy under stress, while no group difference was found in the absence of stress. Reduced empathy correlated with the level of re-experiencing negative memories. Pre-post-treatment comparison revealed that the stress-induced empathy deficit improved in patients over time. Post-treatment empathic capacity correlated positively with clinical improvement. Our findings provide empirical support for the CBASP model, but highlight an important new aspect: Empathy is not generally deficient in PDD but becomes impaired under stress. In real-life situations, stress-induced empathy impairments may exacerbate interpersonal conflicts. CBASP's interpersonal focus improved empathy, accompanied by clinical improvement as the model predicts.

Brain Mineralocorticoid receptor in health and disease: from molecular signaling to cognitive and emotional function

Brain mineralocorticoid receptors (MR) mediate effects of glucocorticoid hormones in stress adaptation, as well as the effects of aldosterone itself in relation to salt homeostasis. Brain stem MRs respond to aldosterone, whereas forebrain MRs mediate rapid and delayed glucocorticoid effects in conjunction with the glucocorticoid receptor (GR). MR‐mediated effects depend on age, gender, genetic variations, and environmental influences. Disturbed MR activity through chronic stress, certain (endocrine) diseases or during glucocorticoid therapy can cause deleterious effects on affective state, cognitive and behavioural function in susceptible individuals. Considering the important role MR plays in cognition and emotional function in health and disease, MR modulation by pharmacological intervention could relieve stress‐ and endocrine‐related symptoms. Here, we discuss recent pharmacological interventions in the clinic and genetic developments in the molecular underpinnings of MR signalling. Further understanding of MR‐dependent pathways may help to improve psychiatric symptoms in a diversity of settings.

Patient and Therapist In-Session Cortisol as Predictor of Post-Session Patient Reported Affect

The importance of the role of affect in psychotherapy for major depressive disorder (MDD) is well established, but the common use of self-reported measures may limit our understanding of its underlying mechanisms. A promising predictor of patient affect is the stress hormone cortisol. To date, no studies have studied in-session changes in cortisol in psychotherapy for MDD. We investigated whether an increase in patient cortisol over the course of a session correlated with higher negative and lower positive affect. Given previous findings on healthy individuals on the contagious nature of stress, an additional aim was to examine whether these relationships are moderated by therapist cortisol. To this end, 40 dyads (including 6 therapists) provided saliva samples before and after four pre-specified sessions (616 samples). After each session, the patients provided retrospective reports of in-session affect. We found no association between patient cortisol and affect. However, increases in patient cortisol predicted negative affect when the therapists exhibited decreases in cortisol, and increases in patient cortisol predicted positive affect when the therapists showed increases. Our study provides initial evidence for the importance of the social context in the cortisol-affect relationship in MDD.

Effects of glucocorticoid and noradrenergic activity on implicit and explicit facial emotion recognition in healthy young men

The ability to recognize emotions from facial expressions is crucial for social interaction. Only few studies have examined the effect of stress hormones on facial emotion recognition, although stressful events affect social interactions on a daily basis. Those studies that examined facial emotion recognition mostly used explicit prompts to trigger consciously controlled processing. However, facial emotions are processed mainly implicitly in real life. Therefore, we investigated separate and combined effects of noradrenergic and glucocorticoid stimulation on implicit and explicit facial emotion recognition. One hundred and four healthy men (mean age = 24.1 years ±SD 3.5) underwent the Face Puzzle task to test implicit and explicit facial emotion recognition after receiving either 10 mg hydrocortisone or 10 mg yohimbine (an alpha 2-adrenergic receptor antagonist that increases noradrenergic activity) or 10 mg hydrocortisone/10 mg yohimbine combined or placebo. Salivary cortisol and salivary alpha amylase (sAA) were measured during the experiment. Compared to the placebo condition hydrocortisone significantly increased salivary cortisol and yohimbine significantly increased sAA. Participants were better and faster in explicit than in implicit facial emotion recognition. However, there was no effect of separate and combined noradrenergic and glucocorticoid stimulation on implicit and explicit facial emotion recognition performance compared to placebo. Our results do not support an essential role of the glucocorticoid and noradrenergic system in FER in young healthy men.

Sex-hormone status and emotional processing in healthy women

Fluctuations of sex hormones across the menstrual cycle allow investigating the role of 17-β estradiol and progesterone in emotional processing. We examined emotional memory, empathy-related measures, as well as mimic and skin-conductance responses to affective stimuli in 72 women either in the mid-cycle (MC-group: moderate to high estradiol, low progesterone), the later cycle (LC-group: high progesterone, moderate estradiol), or during oral contraceptive use (OC-group: low endogenous ovarian-hormone levels). In the first session, affective pictures were presented (memory encoding) while recording mimic and skin-conductance responses. Additionally, participants were exposed to a post-encoding stressor (cold pressor test). After 24 h, we tested surprise recall as well as empathy-related performance. Emotional memory was not affected by the hormone-status group, stressor, or salivary hormone levels. For the cognitive empathy-related measure, hormone status interacted with the protagonist gender. Women in the LC- and OC-groups identified emotions more accurately if depicted by female protagonists, yet the MC-group identified emotions depicted by men and women equally well. Correspondingly, the number of correctly identified emotions from male protagonists correlated positively with estradiol levels. In the affective empathy-related ratings, the OC-group showed a negativity bias, rating negative (vs. positive) emotions higher, although not associated with hormone levels. Mimic responses were not modulated by hormone-status group or related to hormone levels. Skin-conductance responses to negative pictures were heightened in the LC-group and correlated positively with progesterone levels. These data suggest a differential impact of female sex hormones on emotional processing, i.e., empathy-related performance and affective sympathetic reactivity, but not in emotional memory or affective mimic reactivity.

Psychosocial stress increases testosterone in patients with borderline personality disorder, post-traumatic stress disorder and healthy participants

BACKGROUND

The gonadal hormone testosterone not only regulates sexual behavior but is also involved in social behavior and cognition in both sexes. Changes in testosterone secretion in response to stress have been reported. In addition, stress associated mental disorders such as borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are characterized by alterations in basal testosterone metabolism. However, testosterone changes to stress have not been investigated in mental disorders such as BPD and PTSD so far.

METHODS

In the study described, we investigated testosterone reactivity to an acute psychosocial stressor, the Trier Social Stress Test (TSST). Our sample consisted of young adult women with BPD (n = 28), PTSD (n = 22) or both disorders (n = 22), and healthy control (n = 51). Based on previous studies on basal testosterone secretion in these disorders, we expected the stress-associated testosterone reactivity to be higher in the BPD group and lower in the PTSD group, when compared to the healthy control group.

RESULTS

The study could demonstrate an increase in testosterone after acute stress exposure across all groups and independent of BPD or PTSD status. Different possible explanations for the absence of a group effect are discussed.

CONCLUSIONS

From the results of this study, we conclude that stress-related changes in testosterone release are not affected by BPD or PTSD status in a female patient population. This study expands the knowledge about changes in gonadal hormones and stress reactivity in these disorders.

Facial emotion recognition in borderline patients is unaffected by acute psychosocial stress

Borderline Personality Disorder (BPD) is characterized by difficulties in social cognition and social interactions, which exacerbate under stress. A previous study found better facial emotion recognition (FER) in patients with personality disorders and healthy controls (HC) after stress. We recently reported that emotional empathy scores, i.e. the emotional response to another person's emotional state, were significantly lower in BPD patients than in HC after psychosocial stress. Cognitive empathy scores remained unaltered. The present study aims to further investigate the effect of psychosocial stress induced by the Trier Social Stress Test (TSST) on FER as part of social cognition in patients with BPD. We randomized 43 women with BPD and 46 female HC to either the TSST or a placebo condition. Afterwards, participants were asked in an emotion recognition test to identify emotions in faces showing anger or sadness at low and high intensity. Both groups recognized emotions better at high intensity compared with low intensity. There was no effect of stress on FER performance and we found no difference between groups. This is in line with prior research on social cognition in BPD patients demonstrating that the ability to understand another person's perspective might be unaffected by acute stress.

The effects of acute stress and stress hormones on social cognition and behavior: Current state of research and future directions

Stress encompasses profound psychological and physiological changes that are observable on all levels, from cellular mechanisms, humoral changes, and brain activation to subjective experience and behavior. While the impact of stress on health has already been studied for decades, a more recent field of research has revealed effects of stress on human social cognition and behavior. Initial studies have attempted to elucidate the underlying biological mechanisms of these stress-induced effects by measuring physiological responses or by using pharmacological approaches. We provide an overview of the current state of research on the effects of acute stress induction or pharmacological manipulations of stress-related neuro circuitry on social cognition and behavior. Additionally, we discuss the methodological challenges that need to be addressed in order to gain further insight into this important research topic and facilitate replicability of results. Future directions may help to disentangle the complex interplay of psychological and biological stress variables and their effects on social cognition and behavior on health and in disorders with social deficits.

An efficient acute stress response in Chinese individuals with high interdependent self-construal

BACKGROUND AND OBJECTIVE

An efficient stress response comprises both quick reactivity and rapid recovery. Studies have found an enhanced stress response in Chinese people with high interdependent self-construal (ISC). ISC is a personality trait that is well-matched with Chinese collectivistic culture, and whether they exhibit an efficient stress response has not been exclusively examined.

DESIGN

We conducted a novel experiment to examine the stress response change rate in Chinese participants with varying levels of ISC，then performed a validation analysis against previous data to examine the reliability of current results.

METHODS

In our experiment, 84 healthy (42 high-ISC and 42 low-ISC), young, native Chinese were randomly assigned to either the Trier Social Stress Test (TSST), or the control condition. In the published study, 46 native Chinese participants (23 high-ISC and 23 low-ISC) had undergone the TSST. Data were collected throughout the two experiments.

RESULTS

Compared to low-ISC participants, cortisol and subjective stress levels in high-ISC participants peaked sooner and declined rapidly, suggesting quick stress reactivity and rapid recovery. This finding was supported by the previous study.

CONCLUSIONS

High-ISC individuals display an efficient stress response pattern, manifested by fast reactivity and rapid recovery, which may be adaptive in Chinese collectivistic culture.

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.

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

BACKGROUND

Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive.

METHODS

Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined.

RESULTS

Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms.

CONCLUSION

Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.

Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology

BACKGROUND

Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology.

METHODS

We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5-12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology.

RESULTS

Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress.

CONCLUSION

The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.

Hedione Reduces Subjective Vicarious Stress

Observing another person in a stressful situation can cause a full-blown physiological stress response in the observer, which is referred to as empathic stress. One way through which stress-related information might be transmitted between individuals under conditions of empathic stress is chemosensory communication. In the present study, we investigated whether the odorant Hedione, as a potential chemosignal, affects the empathic stress response at a physiological and psychological level. For this purpose, two experiments were designed, each testing one group of participants in an odor-free room and a second group in a room scented with Hedione. In Experiment 1, 60 participants (25 males) watched a video of an unknown female participant in the Trier Social Stress Test (TSST). In Experiment 2, 37 free-cycling females watched a live video of a male participant in the TSST. Observers’ psychological and physiological stress response was captured via repeated measurements of salivary cortisol, alpha-amylase, and self-report ratings. Empathy with the stressed participants was assessed on the dimensions of personal distress and empathic concern of the Emotional Response Scale (ERS). Our results show no substantial physiological stress response in the observers and no effect of Hedione on physiological stress measures. Further, in Experiment 1, there was no subjective stress elicited by the video and no effect of Hedione. In Experiment 2, the observation was perceived as stressful and Hedione reduced subjective vicarious stress. The subjective stress response was associated with the Observers’ direct personal distress, but not with their empathic concern for the target in both experiments. Based on the findings presented above, we conclude that under conditions of empathic stress, Hedione alleviates subjectively perceived stress felt when observing another person being stressed, while leaving empathic concern for the target unaffected. In this regard, future research is warranted to clarify the underlying mechanisms of this effect.

Dysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic Review

After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.

The association between childhood maltreatment and empathic perspective taking is moderated by the 5-HTT linked polymorphic region: Another example of "differential susceptibility"

Previous research has suggested that the short (S)-allele of the 5-HT transporter gene-linked polymorphic region (5-HTTLPR) may confer “differential susceptibility” to environmental impact with regard to the expression of personality traits, depressivity and impulsivity. However, little is known about the role of 5-HTTLPR concerning the association between childhood adversity and empathy. Here, we analyzed samples of 137 healthy participants and 142 individuals diagnosed with borderline personality disorder (BPD) focusing on the 5-HTTLPR genotype (S/L-carrier) and A/G SNP (rs25531), in relation to childhood maltreatment and empathy traits. Whereas no between-group difference in 5-HTTLPR genotype distribution emerged, the S-allele selectively moderated the impact of childhood maltreatment on empathic perspective taking, whereby low scores in childhood trauma were associated with superior perspective taking. In contrast, L-homozygotes seemed to be largely unresponsive to variation in environmental conditions in relation to empathy, suggesting that the S-allele confers “differential susceptibility”. Moreover, a moderation analysis and tests for differential susceptibility yielded similar results when transcriptional activity of the serotonin transporter gene was taken into account. In conclusion, our findings suggest that the S-allele of the 5-HTTLPR is responsive to early developmental contingencies for “better and worse”, i.e. conferring genetic plasticity, especially with regard to processes involving emotional resonance.

Mineralocorticoid receptor function and cognition in health and disease

The steroid hormone cortisol is released in response to stress and exerts its effects in the brain via two different receptors: the mineralocorticoid receptor (MR) and the glucocorticoid receptor (GR). This review - dedicated to Dirk Hellhammer - focusses on the role of MR on cognitive and emotional function in healthy individuals and in stress-associated disorders such as major depressive disorder (MDD) or borderline personality disorder (BPD). Animal data and studies from healthy individuals converge such that MR play an important role in the appraisal of new situations and the following response selection. Decision-making and empathy are important determinants of this response selection and both are affected by MR function. Furthermore, MR are crucially involved in visuospatial navigation and memory in young and elderly healthy individuals whereas the exact physiological role of MR in verbal learning and verbal memory needs to be further characterized. In contrast to studies in healthy participants, age played a moderating role on the effects of MR stimulation on cognition in depressed patients. In young depressed patients, MR stimulation exerted beneficial effects on verbal memory and executive function, whereas in elderly depressed patients MR stimulation led to impaired verbal learning and visuospatial memory. Similar to healthy controls, BPD patients showed enhanced emotional empathy but not cognitive empathy after MR stimulation. Accordingly, this make MR an interesting target for potential pharmacological augmentation of psychotherapy in BPD. Given the important role MR play in cognitive and emotional function in health and disease, further studies should examine whether MR modulation can alleviate cognitive and emotional problems in patients with stress-associated disorders.

Assessing self-reported empathy and altruism in patients suffering from enduring borderline personality disorder

Self-report studies on empathy in adults with borderline personality disorder (BPD) have based upon the Interpersonal Reactivity Index (IRI) and generally identified deficits in perspective taking abilities in this group, but indicated less coherent results regarding empathic concern. These two constructs are considered subcomponents of cognitive (CE) and affective empathy (AE), respectively. However, the IRI does not enable for valid investigation of overall levels of these empathy types. Surprisingly, although some findings from the general population suggest that empathy types may be positively related to altruism, neither this link nor general altruism have been examined in BPD. Additionally, these constructs have not been sufficiently studied in this group in the context of alexithymia or potential clinical confounders. Hence, women with BPD (N = 30) and healthy women (N = 38) completed, i.a., the Questionnaire of Cognitive and Affective Empathy, Self-Report Altruism Scale, TAS-20, STAI, and CESD-R. Patients with BPD reported significantly decreased overall CE (including worse online simulation abilities - conceptually similar to perspective taking from the IRI), but a similar level of overall AE. They also demonstrated lower altruism. Taken together, these results suggest that BPD patients have difficulties with imagining what emotions others are feeling and with altruistic responding to their needs.

Psychophysiological stress response and memory in borderline personality disorder

Background: Previously, we found that patients with borderline personality disorder (BPD) but not healthy controls (HC) showed improved memory retrieval after hydrocortisone administration. Objective: In this study, we examined whether increases in endogenous cortisol after psychosocial stress are associated with memory function in patients with BPD and in healthy individuals. Methods: We recruited 49 female patients with BPD and 49 female HC. All participants were exposed to a psychosocial stressor, the Trier Social Stress Test (TSST) and a control condition (Placebo (P-)TSST) in randomized order. Salivary cortisol, alpha amylase (sAA) and blood pressure were measured in response to stress. Subsequently, we examined free recall of a previously learned word list, autobiographical memory, and working memory. Results: We found a stress*time*group interaction effect for the cortisol response and for sAA to stress, which is mainly triggered by a slightly different increase in cortisol between groups from pre to post TSST. Furthermore, BPD patients showed a less pronounced increase in diastolic blood pressure compared to HC after stress. There was no effect of stress on memory performance in any tests, either in healthy controls or in patients with BPD. Conclusion: Our results suggest a slightly blunted response of the HPA axis and the sympathetic nervous system to stress in BPD compared to healthy women. In contrast to hydrocortisone administration, psychosocial stress did not improve memory retrieval in BPD patients. This might be explained by lower cortisol concentrations and parallel increases in norepinephrine and negative affect after stress.

Borderline personality disorder, trauma, and the hypothalamus-pituitary-adrenal axis

Borderline personality disorder (BPD) is a complex psychiatric illness for which treatment poses a significant challenge due to limited effective pharmacologic treatments, and under-resourced psychological interventions. BPD is one of the most stigmatized conditions in psychiatry today, but can be understood as a modifiable, neurodevelopmental disorder that arises from maladaptive responses to trauma and stress. Stress susceptibility and reactivity in BPD is thought to mediate both the development and maintenance of BPD symptomatology, with trauma exposure considered an early life risk factor of development, and acute stress moderating symptom trajectory. An altered stress response has been characterized in BPD at the structural, neural, and neurobiological level, and is believed to underlie the maladaptive behavioral and cognitive symptomatology presented in BPD. The endocrine hypothalamus-pituitary-adrenal (HPA) axis represents a key stress response system, and growing evidence suggests it is dysfunctional in the BPD patient population. This theoretical review examines BPD in the context of a neurodevelopmental stress-related disorder, providing an overview of measurements of stress with a focus on HPA-axis measurement. Potential confounding factors associated with measurement of the HPA system are discussed, including sex and sex hormones, genetic factors, and the influence of sample collection methods. HPA-axis dysfunction in BPD largely mirrors findings demonstrated in post-traumatic stress disorder and may represent a valuable neuroendocrine target for diagnostic or treatment response biomarkers, or for which novel treatments can be investigated.

Interdependent self-construal, social evaluative threat and subjective, cardiovascular and neuroendocrine stress response in Chinese

Interdependent self-construal (ISC) is a concept positing that people define their self through social roles and relationships with others. We investigated in two independent studies whether ISC had an effect on psychological and endocrine stress responses. Study 1 collected data of 295 healthy young Chinese participants' subjective report of ISC using the self-construal scale, and daily levels of stress using the daily stress inventory. Correlational analyses showed that individuals with higher ISC perceived higher levels of stress in daily life. Study 2 added biological measures of stress by analyzing both basal cortisol levels and reactive cortisol level of high/low ISC individuals (23 high and 23 low ISC healthy young Chinese participants recruited from a total of 440 participants), in response to the Trier Social Stress test. Participants with high ISC showed higher cortisol stress responses, higher heart rate measurements, and higher subjective stress reports when compared to low ISC participants. Further analyses suggested that participants' perception of social evaluative threat mediated the association between ISC and the cortisol stress response. Taken together, these findings suggest a significant role of ISC in regulating the biological and psychological stress response. These findings are discussed in the context of other personality factors known to affect the stress response, and the cultural-related self-construal literature. We also discuss the possible application of the ISC personality factor for future stress studies.