Altered interoception in patients with borderline personality disorder: a study using heartbeat-evoked potentials

Abstract

Background Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown. Methods We utilized an electrophysiological marker of interoception, i.e. heartbeat-evoked potentials (HEP), and examined its relationship with electrocardiographic correlates of autonomic nervous system (ANS) functioning (heart rate variability), and with self-report measures of alexithymia, dissociation and borderline symptom severity in patients with BPD. Results Individuals with BPD had higher HEP amplitudes over frontal electrodes compared to healthy controls. Sympathetic ANS activity was greater in BPD patients than in controls. Across groups, HEP amplitudes were associated with parasympathetic activity over central electrodes and correlated with alexithymia over frontal electrodes. Conclusions These findings support the idea that difficulties in emotional awareness in BPD are reflected in altered frontal electrophysiological markers of interception. Therefore, emotional awareness can be understood as failures of modulation between interoceptive and exteroceptive attention. Future research may aim to investigate whether altered interoception and its electrophysiological correlates are malleable by therapeutic intervention.

Allostatic-Interoceptive Overload in Frontotemporal Dementia

“…As in other populations (hypertensive patients (19) and patients with borderline personality disorder (47,50)), the increased trait-like rsHEP in bvFTD patients was consistent with the opposite pattern (more positive HEP amplitude) reported during active interoceptive-emotional tasks (17,61,75). These results can be understood in the twofold model of neurovisceral integration (22,58,59). In this model, neurovisceral responses at resting (increased rsHEP) can be interpreted as basal interoceptive hyperactivation driven by allostaticinteroceptive overload.…”

“…The reduced autonomic responsiveness during task (decreased HEP) can be understood as a lack of regulation triggered by exacerbated baseline modulations. These results suggest that a trait-like basal allostatic interoceptive overload is accompanied by impaired neurovisceral responsiveness to external demands (22,(58)(59)(60). Further combined assessment of resting state and active task HEP modulations would confirm this interpretation.…”

Short-Term Fasting and Ingestion of Caloric Drinks Affect Heartbeat-Evoked Potentials and Autonomic Nervous System Activity in Males

“…While feelings of satiety are mediated by vagal afferents (Guarino et al, 2017), the present study additionally suggests that interoception (i.e., amplitude of HEP) is associated with low sympathetic ANS activity in satiated individuals. In support of the association of HRV with HEP, we showed in a previous study with patients with personality disorder and healthy participants that HEP amplitudes were positively associated with PNS activity (Flasbeck et al, 2020).…”

Anti-Heartbeat-Evoked Potentials Performance in Event-Related Potentials-Based Mental Workload Assessment

“…Neuronal connectivity causes an evoked potential (i.e., alpha rhythms) in brain waves, known as the HEP (Schandry and Montoya, 1996;McCraty et al, 2009;Park et al, 2015). Many previous studies have used the HEP phenomenon in various research fields, such as attention (Petzschner et al, 2019), anxiety (Judah et al, 2018;Pang et al, 2019), mental workload (Park et al, 2015), emotion (Couto et al, 2015), sleep (Lechinger et al, 2015), and medicine (Leopold and Schandry, 2001;Perogamvros et al, 2019;Flasbeck et al, 2020). We divided the ERP trials into three conditions according to whether the heartbeat had an effect on the evoked potential on EEG oscillations.…”