Susceptibility to Distraction by Social Cues in Borderline Personality Disorder

Abstract

Background/Aims: Individuals with borderline personality disorder (BPD) are highly sensitive to social rejection and show alterations in social perception. Increased susceptibility to social cues in patients with BPD might interfere with executive functions that play an important role in goal-directed behavior. The aim of this study was to investigate the influence of task-irrelevant (neutral vs. negatively arousing) social cues on working memory performance in BPD patients compared to healthy controls (HC). Methods: 28 unmedicated female BPD patients and 28 female HC (matched for age and education) performed a Sternberg item recognition task, while being distracted by neutral versus negatively arousing pictures from the International Affective Picture System (interpersonal scenes) and the Karolinska Directed Emotional Faces Set (faces). Additionally, self-ratings of aversive inner tension were assessed and correlated with task performance. Results: Compared to HC, BPD patients showed significantly impaired accuracy after distraction by negatively arousing stimuli (both scenes and faces) and neutral faces (but not neutral scenes). Significant negative correlations between overall accuracy and self-reported aversive inner tension were observed in BPD patients. Conclusions: Findings of the present study suggest increased susceptibility to distracting (negatively arousing) social cues in individuals with BPD, which might interfere with cognitive functioning.

Amygdala and Dorsal Anterior Cingulate Connectivity during an Emotional Working Memory Task in Borderline Personality Disorder Patients with Interpersonal Trauma History

“…As previously reported, we found that this paradigm was capable of inducing emotional distraction in terms of slower reaction times (Krause-Utz et al, 2012 ; Krause-Utz et al, 2014a ) and increased activity of the amygdala compared to distraction by neutral pictures.…”

“…Interpersonal disturbances, including difficulties in developing trust in others, a hypersensitivity to social rejection, feelings of being socially excluded even in apparently neutral situations, and a tendency to interpret normative neutral stimuli as more negatively, are important core features of BPD (Donegan et al, 2003 ; Koenigsberg et al, 2009b ; Frick et al, 2012 ; Lis and Bohus, 2013 ; Mier et al, 2013 ; Roepke et al, 2013 ; Krause-Utz et al, 2014a ). A stronger emotional involvement while processing social stimuli may hinder social-cognitive processing in patients with BPD (Mier et al, 2013 ).…”

“…The experimental design of our paradigm is depicted in Figure 1 . The EWMT was an adapted Sternberg item recognition task (Sternberg, 1966 ), modified by Oei and colleagues (Oei et al, 2009 ; Oei et al, 2010 ; Oei et al, 2012 ; Krause-Utz et al, 2012 ; Krause-Utz et al, 2014a ). The present version consisted of 48 trials, each starting with the presentation of a set with three uppercase letters (memoranda, 1000 ms).…”

“…In previous studies that used the EWMT, patients with BPD showed prolonged reaction times associated with increased amygdala activity during emotional distraction (presentation of negative IAPS pictures) compared to healthy controls (HC) (Krause-Utz et al, 2012 ; Prehn et al, 2013 ; Krause-Utz et al, 2014a ). Studies that applied similar paradigms observed a failure to activate the ACC (Wingenfeld et al, 2009 : Emotional Stroop Task; Silbersweig et al, 2007 : Emotional GoNoGo Task) or increased ACC activation (Holtmann et al, 2013 : Emotional Flanker Task) along with amygdala hyperreactivity in BPD patients compared to healthy participants.…”

Attention to emotional stimuli in borderline personality disorder – a review of the influence of dissociation, self-reference, and psychotherapeutic interventions

“…If reaction times are longer, more mistakes or better memory is exhibited for emotional compared to control stimuli, they are assumed to attract more attention. Previous studies partially revealed longer reaction times and/or less accuracy during the presentation of negative [ 69 – 74 ] and positive [ 70 ] in contrast to neutral content in those with BPD compared to healthy controls. However, a substantial number of studies have not found any group differences [ 75 – 78 ].…”