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

Abstract

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.

Emotion dysregulation in nonsuicidal self-injury: Dissociations between global self-reports and real-time responses to emotional challenge

“…Given that BPD often presents with NSSI (e.g., Nock et al, 2006) and is associated with greater affect instability (for reviews, see Houben et al, 2015;Schmahl et al, 2014), researchers have suggested that altered subjective and physiological responding in NSSI may reflect underlying dimensional BPD psychopathology (Hooley & Franklin, 2018;Kaess et al, 2021). In line with this proposal, Koenig et al, (2022) recently demonstrated that negative affect and heart rate reactivity to stress differed not only between adolescents with and without NSSI, but also as a function of dimensional BPD severity. Thus, these mixed findings may indicate that amplified emotional responding is comorbid with, rather than characteristic of, NSSI.…”

“…We offer three possible avenues for investigation. First, research to date has focused on emotional responding to strong negative challenges (e.g., acute stress, Kaess et al, 2012;Koenig et al, 2022;Tatnell et al, 2018), raising concerns about potential ceiling effects. More subtle interpersonal challenges may better capture the nature of emotion dysregulation in NSSI (although see, Robinson et al, 2023).…”

“…Again, some studies have found that, compared to controls, people who self-injure show greater electrodermal responding (EDR; Nock & Mendes, 2008) and respiratory sinus arrhythmia (RSA; HRV created by the respiration cycle; Crowell et al, 2005) reactivity, while others have found no difference in EDR (Crowell et al, 2005;Tatnell et al, 2018), RSA (Kaufman et al, 2020), or heart rate (Kaess et al, 2012) responses to emotional challenge. Still other studies have found that, compared to controls, people who self-injure show reduced heart rate (Koenig et al, 2022;Naoum et al, 2016) and HRV (Koenig et al, 2022;Reitz et al 2015) responses to emotional challenge.…”

“…The colour of the rectangle (red, green, blue, yellow, purple, or orange; randomized) changed every 1000ms (inter-trial interval: 500ms). This 'vanilla baseline' was designed to be minimally demanding and is similar to baseline tasks used in affective science research with clinical groups (e.g., Gratz et al, 2019;Koenig et al, 2022) as the task results in less anxiety than sitting quietly without instruction (Jennings et al, 1992).…”

Mechanisms and intervention strategies of emotional dysregulation in individuals with nonsuicidal self-injury

“…Some studies have shown that individuals engaged in NSSI showed suppression of vagus nerve-mediated HRV while at rest 65 . Such finding suggested that the activity of the parasympathetic nervous system in individuals engaged in NSSI decreases during the resting state, suggesting that the sympathetic nervous system activity may be the main component of NSSI neural activity 66 . Therefore, the ED in NSSI may be related to the low level of parasympathetic nervous system activity and the high level of sympathetic nervous system activity, which requires further research to prove this hypothesis.…”