The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder

Abstract

Borderline personality disorder (BPD) is characterized by emotional instability, impulsivity and unstable interpersonal relationships. Patients experience discomforting levels of distress, inducing symptoms like dissociation, aggression or withdrawal. Social situations are particularly challenging, and acute social stress can reduce patients’ cognitive and social functioning. In patients with Major Depressive Disorder or Posttraumatic Stress Disorder, which show high comorbidity with BPD, theendocrine stress response is characterized by Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction, which affects cognitive functioning. Compared to these clinical groups, research on HPA-axis function in BPD is relatively scarce, but evidence points towards a blunted cortisol reactivity to acute stress. Since BPD patients are particularly prone to social stress and experience high subjective difficulties in these situations, it seems plausible that HPA-axis dysregulation might contribute to de-creased social cognition in BPD. The present review summarizes findings on the HPA-axis function in BPD and its association with social cognition following acute social stress. For this purpose, we re- view literature that employed a widely used social stressor (Trier Social Stress Test, TSST) to study the effects of acute social stress on social cognition and the HPA-axis response. We contrast these findings with studies on social cognition that employed Cyberball, another widely used social stressor that lacks HPA-axis involvement. We conclude that research on social cognition in BPD reveals heter- ogeneous results with no clear relationship between social functioning and HPA-axis response. More research is needed to better understand the psychophysiological underpinnings of impaired social cog- nition in BPD.

Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder

“…More research is also needed to better understand the mechanism of such reversed autonomic patterns in BPD. Interactions with early deviations of physio-endocrinal responses, including the HPA axis and the endocannabinoid system, have been recently discussed [ 62 – 65 ].…”

Thematic Selection: Stress and Stress-related Disorders Developmental and Neuroendocrine Aspects of Stress and Stress-related Disorders (Part 1)

“…Hodes et al [ 25 ] provide an expert review on the very important and often neglected topic of gender-related differences in stress response mechanisms. The next two articles by Kulakova et al [ 26 ] and Colizzi et al [ 27 ] investigate the interaction between the HPA axis and social cognition as well as the endocannabinoid system in the examples of borderline personality disorder and psychosis, respectively. Finally, Bendau et al [ 28 ] review the neuroendocrine mechanisms and the treatment effects of exercise in different stress-related disorders [ 28 ].…”