Rest, Reactivity, and Recovery: A Psychophysiological Assessment of Borderline Personality Disorder

Abstract

Difficulty regulating emotion is a cardinal feature of borderline personality disorder (BPD), yet little is known about the automatic psychophysiological processes involved in this phenotype. Inconsistent findings have emerged from studies that employed limited assessments (e.g., heart rate variability, skin conductance) of autonomic nervous system response to emotional contexts, and compared groups based on the presence or absence of BPD as a categorical diagnosis. This exploratory study assessed a comprehensive set of autonomic nervous system processes in 44 individuals (22 with BPD) at rest, in response to emotionally evocative stimuli, and during a subsequent recovery period. BPD was characterized with a dimensional measure of BPD symptom severity, as a well by categorical diagnosis. At baseline and across experimental tasks, higher heart rate was observed in those diagnosed with BPD compared to controls, and in those expressing greater BPD symptom severity. These effects, however, were fully mediated by differences in physical exercise. In contrast, during recovery from emotional activation, greater symptom severity predicted consistently higher levels of multiple sympathetic and parasympathetic processes compared to lower symptom severity. Overall, these findings suggest that the heart rate elevations sometimes observed in those diagnosed with BPD may be associated with individual and group differences in levels of physical exercise. Results further indicate that adaptive psychophysiological recovery responses following emotional challenge may be disrupted in proportion to BPD symptom severity, independently of exercise. Results highlight the utility of considering lifestyle factors and symptom severity in studies of emotional activation and regulation processes in BPD.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder

“…Several results from our investigation are inconsistent with earlier studies: otherwise than Eddie and colleagues [15], we found reduced BRS in BPD patients. Aleknaviciute et al [32], Eddie et al [15], Kuo and Linehan [12], and Weinberg et al [13] consistently reported increased sympathetic tone in BPD.…”

“…Vagal tone is commonly measured as heart rate variability (HRV), the variation of time intervals between consecutive heart beats [11]. Several authors investigated resting state vagal tone in BPD and reported mixed results: Kuo and Linehan [12] as well as Weinberg and colleagues [13] reported reduced resting state vagal tone in BPD patients, while Dixon-Gordon et al [14], Eddie et al [15], Austin et al [7], Gratz et al [16], and Meyer et al [17] did not find significant resting state differences in vagal tone between BPD patients and controls [18]. Koenig and colleagues [18] aggregated data from Austin et al [7], Dixon-Gordon et al [14], Gratz et al [16], Kuo and Linehan [12], and Weinberg et al [13] in a consolidating meta-analysis and reported overall reduced resting state vagal tone in BPD patients.…”

Physical exercise in attention deficit hyperactivity disorder – evidence and implications for the treatment of borderline personality disorder

“…In a recently published study, Ligeza et al [68] found that women who exercised on a regular basis showed more efficient control of negative emotions. One relevant study in this context [31] compared autonomic nervous system processes between patients with BPD and healthy controls. It was found that elevations of heart rate in BPD patients at rest and in response to emotional stimuli were fully mediated by exercise activities in the past year (less in BPD patients than in healthy controls).…”

Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study

“…The actual emergence and intensity of emotions depend on an array of psychological characteristics such as personality, learning experiences and cognition and the situational context, but also on the type and intensity of the perceived stimulus 19. Emotional stimuli that activate specific, self-relevant information seem to arouse a more intense emotional reaction than more general emotional stimuli 5 20. Therefore, to elicit a distinctive and BPD-specific emotional response, the stimulus material needs to have high relevance for persons with BPD and needs to trigger sensitivities that relate to BPD 5 9.…”

“…Emotional stimuli that activate specific, self-relevant information seem to arouse a more intense emotional reaction than more general emotional stimuli 5 20. Therefore, to elicit a distinctive and BPD-specific emotional response, the stimulus material needs to have high relevance for persons with BPD and needs to trigger sensitivities that relate to BPD 5 9. Such a BPD-specific event could include the presentation of material used for non-suicidal self-injury (NSSI).…”