Emotional Reactivity to Personally-Relevant and Standardized Sounds in Borderline Personality Disorder

The influence of sleep on emotion dysregulation in borderline personality disorder, generalized anxiety disorder, and healthy controls

Emotion dysregulation is central to borderline personality disorder (BPD) and exacerbated by sleep disruptions. This study investigated whether homeostatic (i.e., sleep efficiency), circadian (i.e., chronotype), and subjective (i.e., sleep quality) sleep elements predict emotion dysregulation in BPD, healthy controls (HCs), and a generalized anxiety disorder (GAD) group. Participants (N = 120) with BPD, GAD, and HCs completed daily sleep measures for seven days prior to an experiment wherein baseline emotion, emotional reactions to stressors (i.e., reactivity), and the extent to which they can decrease their emotion using mindfulness and distraction (i.e., emotion regulation) were measured across self-reported, sympathetic, and parasympathetic emotion. Across groups, earlier chronotypes and higher sleep quality predicted less self-reported baseline negative emotion, and higher sleep quality predicted better parasympathetic emotion regulation. For HCs, higher sleep efficiency and lower sleep quality predicted higher parasympathetic baseline emotion, and higher sleep efficiency predicted more self-reported baseline negative emotion. Also in HCs, earlier chronotype predicted better sympathetic emotion regulation, and there was a quadratic relationship between sleep efficiency and self-reported emotion regulation. Optimizing sleep quality and improving alignment between chronotype and daily living may improve baseline emotion and emotion regulation. Healthy individuals may be particularly vulnerable to high or low sleep efficiency.

Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm

BACKGROUND

Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups.

METHODS

Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits.

RESULTS

Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group.

CONCLUSIONS

There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

The Impact of Homeostatic and Circadian Sleep Processes on Non-Suicidal Self-Injury and Suicide Urges in Borderline Personality Disorder

OBJECTIVE

Borderline personality disorder (BPD) involves high rates of non-suicidal self-injury (NSSI) and suicidal behaviors, which are often preceded by urges. Disrupted sleep processes have been linked to NSSI and suicidal behaviors. However, it is unclear which specific sleep processes influence NSSI and suicide urges at rest (i.e., baseline) or in response to distress (i.e., reactivity) in BPD, and thus require targeting in BPD-specific interventions. This study examined whether two distinct homeostatic sleep processes (i.e., total sleep time [TST] and time in bed [TIB]), and one circadian sleep process (i.e., chronotype, or tendencies toward early versus late bed and rise times) predict baseline NSSI and suicide urges and urge reactivity in BPD.

METHODS

Forty adults with BPD completed a seven-day sleep diary to measure average TST and TIB. They then completed a questionnaire to measure chronotype and underwent an experiment wherein they rated NSSI and suicide urges at baseline and following an emotion induction.

RESULTS

Generalized estimating equations revealed that higher TST was associated with lower baseline NSSI urges, and lower suicide urge reactivity. Additionally, higher TIB predicted higher NSSI urge reactivity.

CONCLUSIONS

Sleep deprivation and extended time in bed may increase proclivity toward NSSI and/or suicide. Targeting these variables in BPD interventions may ultimately facilitate the reduction of NSSI and suicidal acts. HighlightsHigher total sleep time predicts lower baseline NSSI urges, suicide urge reactivityHigher time in bed predicts higher NSSI urge reactivityReducing sleep deprivation in BPD may facilitate reductions in suicide, NSSI urges.

Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder

Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.

["Ear rage": misophonia : Review and current state of knowledge]

Die Misophonie ist eine Intoleranz auf bestimmte Alltagsgeräusche. Hierbei fungieren als „Trigger“ „menschliche Körpergeräusche“, z. B. Schlucken/Schmatzen/Atemgeräusche oder Geräusche, die von Menschen, aber nicht vom menschlichen Körper erzeugt werden (z. B. Klicken Kugelschreiberknopf), ferner Tier‑/Maschinengeräusche. Die Betroffenen verspüren sofort eine negativ-emotionale Reaktion wie Wut, Aggression, Ekel u.a. Objektivierbare Veränderungen sind Herzfrequenzerhöhung und Blutdruckveränderungen. Die emotionale Reaktion ist individuell und hängt z. B. von Geräuschart, persönlicher Vorerfahrung, sozialem Kontext oder psychologischem Profil ab. Die Misophonie ist bisher als Krankheit nicht definiert und keinem offiziellen Diagnosesystem zugeordnet, sie scheint eine eigenständige Störung zu sein: Assoziationen bestehen u. a. mit Aufmerksamkeits‑/Zwangsstörungen, Tinnitus, Hyperakusis, Autismus-Spektrum-Krankheiten. Definitionskriterien wurden 2013 veröffentlicht; verschiedene, validierte Fragebögen wurden bisher zur Misophonieausprägung entwickelt. Studien mit funktionellen MRT-Untersuchungen des Kopfes zeigten eine übermäßige Aktivierung des anterioren Inselkortex (AIC) und seiner benachbarten Regionen, die für Emotionsverarbeitung/-regulation verantwortlich sind. Bisher gibt es keine randomisierten kontrollierten Studien zur Therapie. Einzelne Publikationen beschreiben kognitive Verhaltensinterventionen, Retrainingtherapien und Schallmaskierungssysteme. Zur Triggerreduktion werden Ohrstöpsel/Musikkopfhörer verwendet. Auch HNO-Ärzte können mit Misophoniepatienten konfrontiert werden, z. B. zur Klärung des Hörvermögens oder Beratung von Therapiemöglichkeiten. Der Bericht stellt eine Übersicht des aktuellen Wissensstands zur Misophonie sowie ihrer Diagnostik und Therapie dar.

The borderline interpersonal-affective systems (BIAS) model: Extending understanding of the interpersonal context of borderline personality disorder

Prominent explanatory models for borderline personality disorder (BPD) are intrapersonal in nature and hold that it is an emotional disorder. However, the empirical support for emotional models of BPD is mixed. Refinements to BPD explanatory models are needed to increase the precision with which BPD can be understood and treated. Drawing on existing theoretical and empirical research in BPD, this manuscript presents the Borderline Interpersonal-Affective Systems (BIAS) model. The BIAS model purports that harmful early life relationships and subsequent conflictual relationships lead individuals with BPD to develop a sensitivity to interpersonal threat in the form of attentional and appraisal biases. Individuals with BPD are posited to 1) experience heightened emotional reactivity specifically to perceived interpersonal threat and 2) engage in destructive behaviors both to regulate increasing emotion and to meet interpersonal needs. We review the empirical support for each component of the BIAS model, along with the role of the cognitions, emotions, and behaviors of significant others in influencing BIAS model processes in individuals with BPD over time. The BIAS model highlights a novel way of understanding and integrating interpersonal and emotional components of the disorder. Key directives for future research and clinical implications are discussed.

Emotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory Studies

Emotional hyperreactivity (Linehan, 1993) is the most investigated construct in borderline personality disorder (BPD). However, experimental studies revealed mixed results on the topic. Our main objective is to comprehensively summarize the results on emotional reactivity in BPD compared to healthy controls (HCs), using a meta-analytic approach, considering different emotional response systems (physiology, behavior, self-report). We included 31 experimental studies (1,675 subjects). We observed null to small effect sizes for several physiological and behavioral outcomes. Conversely, BPD subjects revealed a moderate to large difference in valence attributed to emotional stimuli and a small difference in self-reported arousal. Significant differences in pooled effect sizes were found between self-report and physiological outcomes. Several sources of heterogeneity were explored. In general, the hyperreactivity hypothesis was not supported. Additional dysfunctional processes should be taken into consideration to understand BPD emotional responsiveness.

Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder

This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.

Borderline personality disorder traits and affect reactivity to positive affect induction followed by a stressor

BACKGROUND AND OBJECTIVES

Affective hyperreactivity is a core feature of Borderline Personality Disorder (BPD), yet little is known about reactivity of positive affect (PA). Objectives were to explore the relationship between BPD traits and affect reactivity in response to a personalized PA-induction and a subsequent stressor. Patient status (seeking outpatient treatment for personality-related problems; yes/no), depressive symptoms, and age were examined as alternative predictors of affect reactivity.

METHODS

One hundred and eight females (35 patients) reported on their BPD and depressive symptoms. They completed the Best Possible Self-exercise and a modified Trier Social Stress Task. Trajectories of high and low arousal PA (HAP and LAP) and negative affect (NA) were analyzed with mixed regression modelling.

RESULTS

Patient status (for HAP) and depressive symptoms (for LAP and NA) predicted affect reactivity better than BPD traits. Patients showed a weaker HAP increase after PA-induction, and a similar HAP decrease after the stressor, compared to non-patients. Higher depressive symptoms predicted stronger improvement of LAP and NA after PA-induction, and less pronounced deterioration of LAP and NA after the stressor, relative to baseline.

LIMITATIONS

The sample was a convenience sample amplified with outpatients. Future research should (1) use clinical groups, (2) randomize to neutral vs. PA-induction, and (3) continue to differentiate between HAP and LAP.

CONCLUSIONS

Our results do not support models postulating BPD-specific affective hyperreactivity. HAP and LAP have different trajectories, depending on the degree of psychopathology. The resilience-enhancing potential of a PA-focus in psychotherapy needs further research.

Cross-Domain Assessment of Distress Intolerance: Associations With Borderline Personality Disorder Features

Distress tolerance (DT) is central to major etiological theories of, and popular treatments for, borderline personality disorder (PD), but empirical evidence for the connection between DT and borderline PD is inconclusive. Such inconsistency is partly due to limited concordance across DT indices from different measurement domains (e.g., behavioral, physiological). In a student sample (N = 267), we assessed subjective perceptions of DT capabilities, task performance on a distressing laboratory challenge, and borderline pathology. Subjective and behavioral indices of DT were largely unrelated. Further, borderline PD features were moderately associated with self-perceived DT (r = -.53); in contrast, they were weakly related to performance on the DT task (r = -.09). We conclude that there is mixed evidence for an association between borderline pathology and DT. Further, we propose a systematic approach to examining the construct validity of DT in multimethod, multimeasure research that might resolve the equivocal results from prior work.

Emotional Responsiveness in Borderline Personality Disorder: The Role of Basal Hyperarousal and Self-Reported Emotional Regulation

The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.

Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda

Misophonia is a neurobehavioral syndrome phenotypically characterized by heightened autonomic nervous system arousal and negative emotional reactivity (e. g., irritation, anger, anxiety) in response to a decreased tolerance for specific sounds. The aims of this review are to (a) characterize the current state of the field of research on misophonia, (b) highlight what can be inferred from the small research literature to inform treatment of individuals with misophonia, and (c) outline an agenda for research on this topic. We extend previous reviews on this topic by critically reviewing the research investigating mechanisms of misophonia and differences between misophonia and other conditions. In addition, we integrate this small but growing literature with basic and applied research from other literatures in a cross-disciplinary manner.

Emotional reactivity to appraisals in patients with a borderline personality disorder: a daily life study

BACKGROUND

Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD.

METHODS

Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others.

RESULTS

Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group.

CONCLUSIONS

These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life.