Elsevier

Biological Psychiatry

Volume 69, Issue 6, 15 March 2011, Pages 574-582
Biological Psychiatry

Archival Report
Emotional Vulnerability in Borderline Personality Disorder Is Cue Specific and Modulated by Traumatization

https://doi.org/10.1016/j.biopsych.2010.10.024Get rights and content

Background

A general emotional vulnerability (intense, easily triggered affective reactions) is considered a core symptom in borderline personality disorder (BPD), but evidence from psychophysiological studies for this hypothesis is not very consistent. Given the high comorbidity of posttraumatic stress disorder (PTSD) in BPD patients, current comorbid PTSD might also modulate emotional reactivity. In the present study using a script-driven imagery paradigm, idiographic aversive, disorder-specific (scenes about rejection and abandonment), and standard unpleasant, neutral, and pleasant scripts were presented to investigate emotional reactivity in patients with BPD.

Methods

Forty nonmedicated BPD patients and 32 healthy control subjects first read and then imagined the scripts. Acoustic startle probes were presented during reading and imagery and the eye-blink responses, as well as changes in heart rate and skin conductance level were recorded.

Results

Imagery of disorder-specific scripts resulted in a clear potentiation of the startle responses and increased autonomic arousal in BPD patients but not in control subjects. Borderline personality disorder patients with current comorbid PTSD (n = 26 out of 40) showed attenuated startle potentiation during aversive imagery that was not the case in BPD patients without current PTSD. This effect was most pronounced in BPD patients with severe PTSD.

Conclusions

Scenes about rejection and abandonment are specifically able to activate defensive response mobilization in BPD patients. These findings suggest that BPD patients are not more physiologically reactive to emotional cues in general but show increased emotional vulnerability if borderline-specific schemas are activated. Moreover, emotional reactivity is attenuated in BPD patients with PTSD.

Section snippets

Participants

Forty BPD patients (3 male patients) and 32 healthy control subjects (5 male subjects) matched for age, education, and nicotine consumption participated in this experiment (Table 1). Individuals with BPD were inpatients from the Clinic of Psychiatry at the University of Greifswald. All patients met DSM-IV criteria for BPD, assessed with the Structured Clinical Interview for Axis II Disorders (German version) (28). Comorbidity of Axis I disorders was assessed with the Structured Clinical

Startle Reflex Magnitudes

Blink magnitudes were significantly modulated by the emotional categories of the scripts during imagery [category, F(3,192) = 5.84, p < .01] but not during reading of the scripts.3 Startle responses elicited during imagery of idiographic aversive and unpleasant scripts were potentiated relative to neutral contents, while blink

Discussion

Confirming previous research with this paradigm, imagery of unpleasant scenes prompted a clear potentiation of the startle response and increased autonomic arousal. Thus, script-driven imagery is an efficient method to activate emotional networks in the brain. In the current study, emotional modulation of the defensive reflexes and the autonomic responses did not vary between BPD patients and healthy control subjects if standardized emotional scripts were used. These data confirm previous

References (46)

  • Y. Dwivedi et al.

    Differential regulation of serotonin (5HT)2A receptor mRNA and protein levels after single and repeated stress in rat brain: Role in learned helplessness behavior

    Neuropharmacology

    (2005)
  • M.M. Linehan

    Cognitive-Behavioral Treatment of Borderline Personality Disorder

    (1993)
  • J.J. Russell et al.

    Stability and variability of affective experience and interpersonal behavior in borderline personality disorder

    J Abnorm Psychol

    (2007)
  • C.E. Stiglmayr et al.

    Aversive tension in patients with borderline personality disorder: A computer-based controlled field study

    Acta Psychiatr Scand

    (2005)
  • S.C. Herpertz et al.

    Affective responsiveness in borderline personality disorder: A psychophysiological approach

    Am J Psychiatry

    (1999)
  • P.J. Lang et al.

    International Affective Picture System (IAPS): Technical Manual and Affective Ratings

    (1997)
  • B.N. Cuthbert et al.

    The psychophysiology of anxiety disorder: Fear memory imagery

    Psychophysiology

    (2003)
  • P.J. Lang et al.

    Fearful imagery and the anxiety disorder spectrum

  • E.W. Cook et al.

    Emotional imagery and the differential diagnosis of anxiety

    J Consult Clin Psychol

    (1988)
  • P.J. Lang et al.

    The anxiety disorder spectrum: Fear imagery, physiological reactivity, and differential diagnosis

    Anxiety Stress Coping

    (2009)
  • L. Laporte et al.

    Traumatic childhood experiences as risk factors for borderline and other personality disorders

    J Pers Disord

    (1996)
  • M.C. Zanarini et al.

    Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients

    J Nerv Ment Dis

    (2002)
  • J.A. Golier et al.

    The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events

    Am J Psychiatry

    (2003)
  • Cited by (0)

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