Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls

Stoffels, Malou; Nijs, M G; Spinhoven, Philip; Mesbah, Rahele; Hagenaars, Muriel A.

doi:10.1016/j.jbtep.2017.02.001

Cited by 11 publications

(10 citation statements)

References 64 publications

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“…Our findings also match with two studies that found increased body sway in PTSD patients compared to controls in response to eye closure and no bradycardia in patients with borderline personality disorder compared to controls in response to unpleasant pictures (39, 42). Overall, our study demonstrates reduced freezing in PTSD measured by both its physical markers (reduced body sway and bradycardia).…”

Section: Discussionsupporting

confidence: 92%

“…Most importantly, impaired freezing might be related not only to PTSD but also to other psychiatric threat-related disorders as well, such as anxiety disorders and borderline personality disorder. Reduced bradycardia (as an indicator of freezing) has indeed been reported for patients with borderline personality disorder (42). Speculatively, impaired freezing may be a transdiagnostic symptom, reflecting a disordered downregulation of stress responses or anxiety-related reduced risk taxation and automatic avoidance behavior (62).…”

Section: Discussionmentioning

confidence: 77%

“…However, there was no specific effect on unpleasant and anxiogenic pictures (which represent the threatening cues), and HR was not recorded. Freezing responses as indicated by HR deceleration have also been examined in patients with borderline personality disorder (42), yielding an absence of freezing-like responses in patients but not healthy controls while watching unpleasant pictures. Importantly, decreased bradycardia was related to a lower tolerance of distress, i.e., a higher tendency to avoid or suppress negative emotions, which may confirm the process of taxing the threat during freezing.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Freezing in Posttraumatic Stress Disorder Patients while Watching Affective Pictures

et al. 2017

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Besides fight and flight responses, animals and humans may respond to threat with freezing, a response characterized by bradycardia and physical immobility. Risk assessment is proposed to be enhanced during freezing to promote optimal decision making. Indeed, healthy participants showed freezing-like responses to threat cues. Posttraumatic stress disorder (PTSD) patients are characterized by hypervigilance and increased threat responsiveness. We propose that threat responses will be characterized by decreased freezing in PTSD, eliminating possibilities for rejecting cognitive distortions, such as harm expectancy, and thereby contributing to the maintenance of the disorder. However, freezing responses have hardly been investigated in PTSD. Using a stabilometric platform to assess body sway as an indicator of freezing-like behavior, we examined whether veterans with PTSD would show diminished freezing responses to unpleasant versus neutral and pleasant pictures. Fourteen PTSD patients and 14 healthy matched controls watched the pictures, while body sway and heart rate (HR) were continuously assessed. Replicating previous findings, healthy controls showed decreased body sway and HR in response to unpleasant pictures, indicative of freezing-like behavior. In contrast, this response pattern was not observed in PTSD patients. The results may indicate a reduced freezing response in PTSD. As reduced freezing may hinder appropriate risk assessment, it may be an important factor in the maintenance of PTSD. Future research might clarify whether impaired freezing is a PTSD-specific or a transdiagnostic symptom, being present in threat-related disorders.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Reduced Freezing in Posttraumatic Stress Disorder Patients while Watching Affective Pictures

et al. 2017

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“…Research also showed that experienced fire fighters showed less threat-induced freezing than inexperienced fire fighters, which suggests that people can get used to dealing with threat and probably feel less threatened (Ly, Roijendijk, Hazebroek, Tonnaer, & Hagenaars, 2017). At the same time, reduced freezing has also been found in people with PTSD and borderline personality disorder (Adenauer, Catani, Keil, Aichinger, Neuner, 2010;Fragkaki, Roelofs, Stins, Jongedijk, & Hagenaars, 2017;Stoffels, Nijs, Spinhoven, Mesbah, & Hagenaars, 2017), which is likely explained by increased hyperarousal and vigilance that tends to attenuate freezing (see also Ly et al, 2017).…”

Section: Introductionmentioning

confidence: 95%

Freezing in response to social threat: a replication

Noordewier

Scheepers

Hilbert

2019

Psychological Research

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Freezing is an adaptive defensive response to a stressful event. Recent research suggests that freezing not only occurs in response to physical threats but also in response to social threats (e.g., angry faces; Roelofs et al. in Psychol Sci 21:1575-1581, 2010). Given the practical and theoretical importance of this finding, the current study aimed to replicate and extend it. Following the original study, we measured heart rate while participants viewed emotional faces (angry, happy, neutral). Extending the original study, we included a baseline measure and performed additional, more fine-grained analyses. Our results support the hypothesis that participants show physiological signs of freezing when looking at angry faces. Importantly, we also find this effect when comparing heart rate in the angry block to baseline levels. Interestingly, the heart rate effects are explained by deceleration in the first 30 s of the 1-min angry block, but not in the second 30 s. Like Roelofs et al., we find evidence that the effects are modulated by state anxiety, but our effects are only marginal and we do not replicate the negative correlation between heart rate and state anxiety in the angry block. In general, we thus find evidence for physiological signs of freezing in response to social threat. We discuss implications and venues for future research.

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“…Therefore, we hypothesized that freezing is adaptive, but that alterations in this defensive response early in life—in the form of longer freezing—will predict increasing levels of internalizing symptoms in childhood to late adolescence. In addition, given emerging evidence for a proposed nonlinear association between freezing and psychopathology (Fragkaki, Roelofs, Stins, Jongedijk, & Hagenaars, ), we also explored potential detrimental outcomes associated with reduced freezing behavior: Absence of or reduced freezing—in a context where freezing is a typical response in most individuals—may reflect maladaptive stress coping, which in turn could be related to internalizing symptoms as well (Adenauer, Catani, Keil, Aichinger, & Neuner, ; Fragkaki et al., ; Stoffels, Nijs, Spinhoven, Mesbah, & Hagenaars, ).…”

Section: Introductionmentioning

confidence: 99%

The relation between infant freezing and the development of internalizing symptoms in adolescence: A prospective longitudinal study

Niermann

Tyborowska

Cillessen

et al. 2018

Developmental Science

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Given the long-lasting detrimental effects of internalizing symptoms, there is great need for detecting early risk markers. One promising marker is freezing behavior.Whereas initial freezing reactions are essential for coping with threat, prolonged freezing has been associated with internalizing psychopathology. However, it remains unknown whether early life alterations in freezing reactions predict changes in internalizing symptoms during adolescent development. In a longitudinal study (N = 116), we tested prospectively whether observed freezing in infancy predicted the development of internalizing symptoms from childhood through late adolescence (until age 17). Both longer and absent infant freezing behavior during a standard challenge (robot-confrontation task) were associated with internalizing symptoms in adolescence. Specifically, absent infant freezing predicted a relative increase in internalizing symptoms consistently across development from relatively low symptom levels in childhood to relatively high levels in late adolescence. Longer infant freezing also predicted a relative increase in internalizing symptoms, but only up until early adolescence. This latter effect was moderated by peer stress and was followed by a later decrease in internalizing symptoms. The findings suggest that early deviations in defensive freezing responses signal risk for internalizing symptoms and may constitute important markers in future stress vulnerability and resilience studies. K E Y W O R D S 5-HTTLPR, adolescence, defensive stress response, infancy, internalizing symptoms, longitudinal analysis Highlights • This prospective longitudinal study investigated whether and how deviations in infant freezing predict changes in internalizing symptoms from childhood into late adolescence. • Deviations in infant freezing-both absent and longer freezing-were associated with relative increases in internalizing symptoms. • Whereas absent infant freezing predicted a continuous increase from relatively low to relatively high internalizing symptoms up until late adolescence, longer infant freezing predicted increased internalizing symptoms during early adolescence only. • Early deviations in freezing may mark an individual's risk to develop internalizing symptoms and may be important to consider in future stress vulnerability and resilience studies. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Niermann HCM, Tyborowska A, Cillessen AHN, et al. The relation between infant freezing and the development of internalizing symptoms in adolescence: A prospective longitudinal study. Dev Sci.

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Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls

Cited by 11 publications

References 64 publications

Reduced Freezing in Posttraumatic Stress Disorder Patients while Watching Affective Pictures

Reduced Freezing in Posttraumatic Stress Disorder Patients while Watching Affective Pictures

Freezing in response to social threat: a replication

The relation between infant freezing and the development of internalizing symptoms in adolescence: A prospective longitudinal study

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