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Rizvi SL, Ruork AK, Yin Q, Yeager A, Taylor ME, Kleiman EM. Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy. JMIR Ment Health 2024; 11:e60035. [PMID: 39383480 DOI: 10.2196/60035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/12/2024] [Accepted: 07/20/2024] [Indexed: 10/11/2024] Open
Abstract
Background Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Objective Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. Methods A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. Results On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%-92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from -0.026 to -0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Conclusions Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms.
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Affiliation(s)
- Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854, United States, 1 8484453914
| | - Allison K Ruork
- Evidence-Based Practice Institute, Seattle, WA, United States
| | - Qingqing Yin
- Department of Psychology, Rutgers University, Piscataway, NJ, United States
| | - April Yeager
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854, United States, 1 8484453914
| | - Madison E Taylor
- Department of Psychology, University of California Irvine, Irvine, CA, United States
| | - Evan M Kleiman
- Department of Psychology, Rutgers University, Piscataway, NJ, United States
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Sammito S, Thielmann B, Böckelmann I. Update: factors influencing heart rate variability-a narrative review. Front Physiol 2024; 15:1430458. [PMID: 39165281 PMCID: PMC11333334 DOI: 10.3389/fphys.2024.1430458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
Objective Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism's autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation. Methods The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors). Results The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances). Conclusion In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.
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Affiliation(s)
- Stefan Sammito
- German Air Force Centre of Aerospace Medicine, Cologne, Germany
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Beatrice Thielmann
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Irina Böckelmann
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
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Guerriero G, Liljedahl SI, Carlsen HK, López Muñoz M, Daros AR, Ruocco AC, Steingrimsson S. Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial. Trials 2024; 25:397. [PMID: 38898522 PMCID: PMC11186228 DOI: 10.1186/s13063-024-08230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients. METHODS Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery. DISCUSSION The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD. TRIAL REGISTRATION ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.
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Affiliation(s)
- Giuseppe Guerriero
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Sophie I Liljedahl
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- National Specialized Medical Care Unit for Severe Self-Harm Behavior, Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Hanne K Carlsen
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
| | - Marta López Muñoz
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - Anthony C Ruocco
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Steinn Steingrimsson
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Sammito S, Thielmann B, Klussmann A, Deußen A, Braumann KM, Böckelmann I. Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science. J Occup Med Toxicol 2024; 19:15. [PMID: 38741189 DOI: 10.1186/s12995-024-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Affiliation(s)
- Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Air Force Centre of Aerospace Medicine, Experimental Aerospace Medicine Research, Flughafenstraße 1, Cologne, 51147, Germany.
| | - Beatrice Thielmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andre Klussmann
- Competence Centre Health (CCG), Department Health Sciences, University of Applied Sciences (HAW) Hamburg, Hamburg, Germany
| | - Andreas Deußen
- Department of Physiology, Medical Faculty, TU Dresden, Dresden, Germany
| | | | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Sigrist C, Jakob H, Beeretz CJ, Schmidt SJ, Kaess M, Koenig J. Diurnal variation of cardiac autonomic activity in adolescent non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci 2024; 274:609-628. [PMID: 36871247 PMCID: PMC10995014 DOI: 10.1007/s00406-023-01574-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
Heart rate (HR) and vagally mediated heart rate variability (HRV) are two distinct biomarkers of cardiac autonomic activity. Decreased cardiac vagal activity (or decreased HRV) in particular has been linked with impairments in the functional flexibility of the central autonomic network (CAN), resulting in impaired stress and emotion regulatory capacities. Decreased HRV is widely used as trait marker of psychopathology. Repetitive engagement in non-suicidal self-injury (NSSI) in adolescence correlates with both deficits in stress and emotion regulation, as well as decreased HRV. Existing research has, however, focused on short-term recordings of HR and HRV under resting and phasic conditions. In this study, we examined whether diurnal variation of cardiac autonomic activity, indexed by cosinor parameters of HR and HRV derived from 48 h of ambulatory ECG recording under natural conditions over a weekend, are altered in female adolescents with NSSI disorder compared to controls (HC; N = 30 per study group). Several important confounds, including physical activity, were controlled for. Female adolescents with NSSI show higher rhythm-adjusted 24 h mean levels and greater respective amplitude of HR, as well as lower rhythm-adjusted 24 h mean levels and smaller respective amplitude of HRV. Peak levels in both HR and HRV in the NSSI group were reached approximately 1 h later compared to HC. Severity of exposure to early life maltreatment might be linked with altered amplitudes of 24 h HR and HRV. Diurnal rhythms of cardiac autonomic activity might hold promise as objective indicators of disordered stress and emotion regulation in developmental psychopathology, and as such should be investigated in future studies with rigorous assessment and control of potential confounds.
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Affiliation(s)
- Christine Sigrist
- Faculty of Medicine, Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, University Hospital Cologne, Cologne, Germany.
| | - Hannah Jakob
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christoph J Beeretz
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Faculty of Medicine, Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, University Hospital Cologne, Cologne, Germany
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Radimecká M, Látalová A, Lamoš M, Jáni M, Bartys P, Damborská A, Theiner P, Linhartová P. Facial emotion processing in patients with borderline personality disorder as compared with healthy controls: an fMRI and ECG study. Borderline Personal Disord Emot Dysregul 2024; 11:4. [PMID: 38360712 PMCID: PMC10870473 DOI: 10.1186/s40479-024-00245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Maladaptive behaviors and interpersonal difficulties in patients with borderline personality disorder (BPD) seem connected to biased facial emotion processing. This bias is often accompanied by heightened amygdala activity in patients with BPD as compared to healthy controls. However, functional magnetic resonance imaging (fMRI) studies exploring differences between patients and healthy controls in facial emotion processing have produced divergent results. The current study explored fMRI and heart rate variability (HRV) correlates of negative facial emotion processing in patients with BPD and healthy controls. METHODS The study included 30 patients with BPD (29 females; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 females; M = 24.66, SD = 5.28). All participants underwent the "faces" task, an emotional face perception task, in an fMRI session simultaneously with ECG. In this task, participants are presented with emotional expressions of disgust, sadness, and fear (as a negative condition) and with the same pictures in a scrambled version (as a neutral condition). RESULTS We found no differences in brain activity between patients with BPD and healthy controls when processing negative facial expressions as compared to neutral condition. We observed activation in large-scale brain areas in both groups when presented with negative facial expressions as compared to neutral condition. Patients with BPD displayed lower HRV than healthy controls in both conditions. However, there were no significant associations between HRV and amygdala activity and BPD symptoms. CONCLUSION The results of this study indicate no abnormal brain activity during emotional facial processing in patients with BPD. This result contrasts with previous studies and more studies are needed to clarify the relationship between facial emotion processing and brain activity in patients with BPD. Possible reasons for the absence of brain activity differences are discussed in the study. Consistent with previous findings, patients showed lower HRV than healthy controls. However, HRV was not associated with amygdala activity and BPD symptoms.
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Affiliation(s)
- Monika Radimecká
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic.
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Martin Lamoš
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martin Jáni
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Patrik Bartys
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Alena Damborská
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
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Kulakova E, Graumann L, Cho AB, Deuter CE, Wolf OT, Roepke S, Otte C, Wingenfeld K. Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:129-138. [PMID: 37650962 PMCID: PMC10786993 DOI: 10.1007/s00406-023-01678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Stressful social situations like social exclusion are particularly challenging for patients with borderline personality disorder (BPD) and often lead to dysfunctional reactive behaviour of aggression and withdrawal. The autonomous signature of these core symptoms of BPD remains poorly understood. The present study investigated the parasympathetic response to social exclusion in women with BPD (n = 62) and healthy controls (HC; n = 87). In a between-subjects design, participants experienced objective social exclusion or overinclusion in the Cyberball task, a virtual ball-tossing game. Need threat scores served as individual measures of perceived exclusion and the resulting frustration of cognitive-emotional needs. Five-minute measurements of high-frequency heart rate variability (HF-HRV) at three time points (before, during, after Cyberball) indicated parasympathetic tone and regulation. We observed a trend towards lowered baseline HF-HRV in BPD vs. HC in line with previous findings. Interestingly, the parasympathetic response of patients with BPD to objective and perceived social exclusion fundamentally differed from HC: higher exclusion was associated with increased parasympathetic activation in HC, while this autonomic response was reversed and blunted in BPD. Our findings suggest that during social stress, the parasympathetic nervous system fails to display an adaptive regulation in patients with BPD, but not HC. Understanding the autonomous signature of the stress response in BPD allows the formulation of clinically relevant and biologically plausible interventions to counteract parasympathetic dysregulation in this clinical group.
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Affiliation(s)
- Eugenia Kulakova
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Livia Graumann
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - An Bin Cho
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Eric Deuter
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University, Bochum, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Goreis A, Prillinger K, Bedus C, Lipp R, Mayer A, Nater UM, Koenig J, Plener PL, Kothgassner OD. Physiological stress reactivity and self-harm: A meta-analysis. Psychoneuroendocrinology 2023; 158:106406. [PMID: 37783020 DOI: 10.1016/j.psyneuen.2023.106406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carolin Bedus
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ronja Lipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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Bourvis N, Cohen D, Benarous X. Therapeutic and Preventive Interventions in Adolescents with Borderline Personality Disorder: Recent Findings, Current Challenges, and Future Directions. J Clin Med 2023; 12:6668. [PMID: 37892806 PMCID: PMC10607502 DOI: 10.3390/jcm12206668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) has long suffered from overshadowing in adolescents and hopelessness from the psychiatrists themselves. Comprehensive guidelines for this age group are lacking. AIMS This narrative review aims to describe current recommendations for BPD and recent empirical evidence on effective treatments (both pharmacological and non-pharmacological) and preventive approaches. Innovative approaches, based on recent and original research on BPD adolescents, are also discussed. RESULTS Very low-certainty evidence has supported that medication has a positive effect on core BPD symptoms in adolescents. Medication prescribed for suicidal crises or associated disorders should be included in a global therapeutic plan, including efficacy reassessment, treatment duration, and a security plan. The overall benefit of structured psychotherapy for adolescents with BPD (cognitive behavioral therapy, mentalization-based therapy, dialectic behavioral therapy, and group therapy) is more important for self-harm behaviors than other BPD symptoms. Their specific efficacy, although difficult to distinguish from the overall non-specific effect of integrative care. CONCLUSIONS structured care of young BPD individuals should be based on the following principles: (1) setting the frame of care, including recognition of the diagnosis, and sharing information with patients and families about symptoms, prognosis, and putative psychological mechanisms involved; and (2) promoting comprehensive approaches, including both specific and non specific therapy, ecological interventions, community care, and preventive interventions in at-risk groups.
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Affiliation(s)
- Nadège Bourvis
- Centre Hospitalier Intercommunal Toulon la Seyne (CHITS), 83000 Toulon, France
- Maison des Adolescents du Var, 83000 Toulon, France
- Service Universitaire de Psychiatrie Infanto Juvenile, Aix-Marseille Université, 13009 Marseille, France
| | - David Cohen
- Institut des Systèmes Intelligents et Robotique, APHP-Sorbonne Université, 75651 Paris, France; (D.C.); (X.B.)
- GH Pitié-Salpêtrière, 75013 Paris, France
| | - Xavier Benarous
- Institut des Systèmes Intelligents et Robotique, APHP-Sorbonne Université, 75651 Paris, France; (D.C.); (X.B.)
- GH Pitié-Salpêtrière, 75013 Paris, France
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10
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van der Venne P, Mürner-Lavanchy I, Höper S, Koenig J, Kaess M. Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity. J Affect Disord 2023; 339:64-73. [PMID: 37390927 DOI: 10.1016/j.jad.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Preliminary evidence indicates altered hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) response to experimental pain in individuals with nonsuicidal self-injury (NSSI). This study investigated effects of NSSI severity and severity of psychopathology on the HPA axis and ANS response to pain. METHODS N = 164 adolescents with NSSI and n = 45 healthy controls received heat pain stimulation. Salivary cortisol, α-amylase and blood pressure were repeatedly assessed before and after painful stimulation. Heart rate (HR) and heart rate variability (HRV) were assessed continuously. NSSI severity and comorbid psychopathology were derived from diagnostic assessments. Main and interaction effects of time of measurement and NSSI severity, adjusted for severity of adverse childhood experiences, borderline personality disorder and depression, on HPA axis and ANS response to pain were examined using regression analyses. RESULTS Increasing NSSI severity predicted an increasing cortisol response (χ2(3) = 12.09, p = .007) to pain. After adjusting for comorbid psychopathology, greater NSSI severity predicted decreased α-amylase levels following pain (χ2(3) = 10.47, p = .015), and decreased HR (χ2(2) = 8.53, p = .014) and increased HRV(χ2(2) = 13.43, p = .001) response to pain. LIMITATIONS Future research should implement several NSSI severity indicators, potentially revealing complex associations with the physiological response to pain. Assessing physiological responses to pain in NSSI in a naturalistic setting presents a promising avenue for future research in NSI. CONCLUSIONS Findings indicate an increased pain-related HPA axis response and an ANS response characterized by reduced sympathetic and increased parasympathetic activity associated with NSSI severity. Results support claims for dimensional approaches to NSSI and its related psychopathology alongside shared, underlying neurobiological correlates.
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Affiliation(s)
- Patrice van der Venne
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Saskia Höper
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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11
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Geiss L, Stemmler M, Beck B, Hillemacher T, Widder M, Hösl KM. Dysregulation of the autonomic nervous system in adult attention deficit hyperactivity disorder. A systematic review. Cogn Neuropsychiatry 2023; 28:285-306. [PMID: 37702351 DOI: 10.1080/13546805.2023.2255336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/07/2023] [Indexed: 09/14/2023]
Abstract
Background: Adult Attention Deficit Hyperactivity Disorder (aADHD) is characterised by inattention, hyperactivity, impulsivity, and emotional instability, all of which were linked to altered modulation of the autonomic nervous system. This and the clinical effectiveness of sympathomimetic medication raised the question if autonomic modulation is altered in aADHD patients.Methods: We systematically searched PubMed, Cochrane Library, and Web Of Science for publications investigating autonomic modulation in aADHD and controls during resting-state and/or under task conditions.Results: We reviewed 15 studies involving 846 participants (424 aADHD and 422 controls), including 4 studies on sympathetic tone at rest, 13 studies on sympathetic modulation during tasks, 3 studies on resting state parasympathetic modulation and 3 papers on task-related parasympathetic modulation. Studies comprised measurements of electrodermal activity, heart rate variability, blood pressure variability, blood volume pulse, pre-ejection period, and baroreflex sensitivity. 2 studies reported reduced sympathetic tone in aADHD; 7 papers described lower sympathetic reactivity to task demands in this cohort. One study linked aADHD to impaired vagal tone, while no indications of altered tasks-related parasympathetic reactivity in aADHD patients were reported.Conclusion: The reviewed data revealed impaired cardiovascular autonomic modulation in aADHD patients, predominantly in sympathetic modulation and during stress exposure.
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Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Mark Stemmler
- Department of Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael Widder
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
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12
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Miller ML, Sanzari CM, Timko CA, Hormes JM. Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report. Int J Eat Disord 2023; 56:1449-1460. [PMID: 37464977 DOI: 10.1002/eat.23942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin. METHOD We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points. RESULTS We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain. DISCUSSION Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings. PUBLIC SIGNIFICANCE Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.
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Affiliation(s)
- McKenzie L Miller
- Department of Psychology, University at Albany, Albany, New York, USA
| | | | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, Albany, New York, USA
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Chen W, Zhong Q, Chen H, Chen S. Heart rate variability in children and adolescents with major depressive disorder: A systematic review and meta-analysis. J Affect Disord 2023; 335:204-215. [PMID: 37178829 DOI: 10.1016/j.jad.2023.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/23/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Although reduced heart rate variability (HRV) has been observed in adults with major depressive disorder (MDD), the correlation between HRV and MDD in children and adolescents remains uncertain and requires to be systematically reviewed. Our meta-analysis included ten articles comprising 410 MDD patients and 409 healthy controls. Adolescents with MDD showed significant reductions in most HRV measures, such as HF-HRV, RMSSD, and PNN50, and depressive symptom severity was statistically associated with RMSSD, HF-HRV, and LF/HF ratio. A large heterogeneity across studies was detected. Sensitivity analysis revealed that removal of a specific study would significantly decline the heterogeneity for measures of HF-HRV, LF-HRV, and SDNN, and meta-regression analysis found that sample size and year of publication substantially moderated the differences between depressed samples and controls in RMSSD. Compared with adults, depression-induced autonomic dysfunction was more detectable in children and adolescents with substantial effects. Moreover, excluded studies which reported both HRV and MDD or depression symptoms were summarized based on objectives. Findings indicate that it is promising for HRV to be an appropriate and objective candidate biomarker for clinically depressed children and adolescents.
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Affiliation(s)
- Wanlin Chen
- Department of Psychological and Behavioral Science, Zhejiang University, No.866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China
| | - Qing Zhong
- Department of Psychological and Behavioral Science, Zhejiang University, No.866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China
| | - Hang Chen
- College of Biomedical Engineering and Instrument Science, Zhejiang University, No.38 Zheda Road, Hangzhou, Zhejiang 310027, China
| | - Shulin Chen
- Department of Psychological and Behavioral Science, Zhejiang University, No.866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China.
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14
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Critchley HD, Sherrill SP, Ewing DL, van Praag CG, Habash-Bailey H, Quadt L, Eccles JA, Meeten F, Jones AM, Garfinkel SN. Cardiac interoception in patients accessing secondary mental health services: A transdiagnostic study. Auton Neurosci 2023; 245:103072. [PMID: 36709619 DOI: 10.1016/j.autneu.2023.103072] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Abnormalities in the regulation of physiological arousal and interoceptive processing are implicated in the expression and maintenance of specific psychiatric conditions and symptoms. We undertook a cross-sectional characterisation of patients accessing secondary mental health services, recording measures relating to cardiac physiology and interoception, to understand how physiological state and interoceptive ability relate transdiagnostically to affective symptoms. METHODS Participants were patients (n = 258) and a non-clinical comparison group (n = 67). Clinical diagnoses spanned affective disorders, complex personality presentations and psychoses. We first tested for differences between patient and non-clinical participants in terms of cardiac physiology and interoceptive ability, considering interoceptive tasks and a self-report measure. We then tested for correlations between cardiac and interoceptive measures and affective symptoms. Lastly, we explored group differences across recorded clinical diagnoses. RESULTS Patients exhibited lower performance accuracy and confidence in heartbeat discrimination and lower heartbeat tracking confidence relative to comparisons. In patients, greater anxiety and depression predicted greater self-reported interoceptive sensibility and a greater mismatch between performance accuracy and sensibility. This effect was not observed in comparison participants. Significant differences between patient groups were observed for heart rate variability (HRV) although post hoc differences were not significant after correction for multiple comparisons. Finally, accuracy in heartbeat tracking was significantly lower in schizophrenia compared to other diagnostic groups. CONCLUSIONS The multilevel characterisation presented here identified certain physiological and interoceptive differences associated with psychiatric symptoms and diagnoses. The clinical stratification and therapeutic targeting of interoceptive mechanisms is therefore of potential value in treating certain psychiatric conditions.
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Affiliation(s)
- Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland.
| | - Samantha P Sherrill
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Donna L Ewing
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Humanities and Social Science, University of Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Cassandra Gould van Praag
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Department of Psychiatry, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Haniah Habash-Bailey
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Fran Meeten
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, United Kingdom of Great Britain and Northern Ireland
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15
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Wesarg C, Van den Akker AL, Oei NY, Wiers RW, Staaks J, Thayer JF, Williams DP, Hoeve M. Childhood adversity and vagal regulation: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 143:104920. [DOI: 10.1016/j.neubiorev.2022.104920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
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16
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Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis. Healthcare (Basel) 2022; 10:healthcare10112212. [PMID: 36360553 PMCID: PMC9690873 DOI: 10.3390/healthcare10112212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background: While perceived social support can mediate the relationship between perceived stress and depression, little is known about the differences between individuals with high and low borderline personality disorder symptoms (BPDS). This study aimed to investigate the associations among perceived stress, perceived social support, and depression, and compare low and high levels of BPDS. Methods. This cross-sectional analysis was a secondary analysis of data from the SI-Bord study. University students across Thailand completed a screening instrument for borderline personality disorder, the Perceived Stress Scale (PSS), the Revised Thai Multi-dimensional Scales of Perceived Social Support (MSPSS), and the Patient-Health Questionnaire (PHQ)-9. Mediation analysis using PROCESS was applied to test the direct and indirect effects of perceived stress on depression. Multigroup mediational analysis was adopted to compare low and high levels of BPDS. Results. The mean age of the 330 participants was 20.27 (SD, 1.4) and 80% were female. Significant correlations were observed between the PSS, MSPSS, and PHQ scores, with greater magnitude among the high-level BPDS group (p < 0.001). A significant direct effect on perceived stress and a significant indirect effect on depression through perceived social support were noted. Of all the sources of social support, only the significant others variable significantly differed between the two groups (p < 0.05). Conclusion. Perception of social support had a significant mediating role in perceived stress and depression. The magnitude of associations was remarkably high for individuals with high BPDS compared to those with low BPDS. Unlike those with low BPDS, all sources of social support were significant mediators between the two groups.
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17
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Yoo HJ, Nashiro K, Min J, Cho C, Bachman SL, Nasseri P, Porat S, Dutt S, Grigoryan V, Choi P, Thayer JF, Lehrer PM, Chang C, Mather M. Heart rate variability (HRV) changes and cortical volume changes in a randomized trial of five weeks of daily HRV biofeedback in younger and older adults. Int J Psychophysiol 2022; 181:50-63. [PMID: 36030986 PMCID: PMC11195601 DOI: 10.1016/j.ijpsycho.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022]
Abstract
Previous studies indicate that the structure and function of medial prefrontal cortex (PFC) and lateral orbitofrontal cortex (OFC) are associated with heart rate variability (HRV). Typically, this association is assumed to reflect the PFC's role in controlling HRV and emotion regulation, with better prefrontal structural integrity supporting greater HRV and better emotion regulation. However, as a control system, the PFC must monitor and respond to heart rate oscillatory activity. Thus, engaging in regulatory feedback during heart rate oscillatory activity may over time help shape PFC structure, as relevant circuits and connections are modified. In the current study with younger and older adults, we tested whether 5 weeks of daily sessions of biofeedback to increase heart rate oscillations (Osc+ condition) vs. to decrease heart rate oscillations (Osc- condition) affected cortical volume in left OFC and right OFC, two regions particularly associated with HRV in prior studies. The left OFC showed significant differences in volume change across conditions, with Osc+ increasing volume relative to Osc-. The volume changes in left OFC were significantly correlated with changes in mood disturbance. In addition, resting low frequency HRV increased more in the Osc+ than in the Osc- condition. These findings indicate that daily biofeedback sessions regulating heart rate oscillatory activity can shape both resting HRV and the brain circuits that help control HRV and regulate emotion.
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Affiliation(s)
- Hyun Joo Yoo
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Jungwon Min
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Christine Cho
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Shelby L Bachman
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Padideh Nasseri
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Shai Porat
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Shubir Dutt
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Vardui Grigoryan
- University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - Paul Choi
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Julian F Thayer
- University of California, Irvine, Irvine, CA 92697, United States of America
| | - Paul M Lehrer
- Rutgers University, Piscataway, NJ 08854, United States of America
| | - Catie Chang
- Vanderbilt University, TN 37235, United States of America
| | - Mara Mather
- University of Southern California, Los Angeles, CA 90089, United States of America.
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18
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Altered psychobiological reactivity but no impairment of emotion recognition following stress in adolescents with non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci 2022; 273:379-395. [PMID: 36203100 PMCID: PMC10070238 DOI: 10.1007/s00406-022-01496-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
Impairments in both stress regulation and emotion recognition have been associated with borderline personality disorder (BPD) and non-suicidal self-injury (NSSI). Although it has been proposed that emotion recognition deficits particularly emerge during stress, this hypothesis has not been fully investigated. Adolescents with and without NSSI performed emotion recognition tasks before and after the employment of the Trier Social Stress Test (TSST). The psychobiological stress response was captured with psychological self-reports (affect, stress and dissociation), physiological recordings (heart rate, HR, and heart rate variability, HRV) and endocrinological sampling of saliva (cortisol and alpha-amylase). Mixed-linear models were applied to analyze stress-induced changes in emotion recognition performance and respective stress response measures. The TSST elicited altered psychobiological stress responses in adolescents with NSSI: A more pronounced decrease in positive affect, a more pronounced increase in negative affect, a less pronounced increase in HR, a less pronounced decrease in HRV and a more pronounced increase in alpha-amylase throughout the stress induction than adolescents without NSSI. Stress responses (dissociation, negative affect, cortisol and HR) differed as a function of BPD severity on a continuum, illustrating greater reactivity on self-reports but decreased biological responsiveness in those with greater BPD severity. Stress induction had similar effects on emotion recognition in adolescents with and without NSSI. Recognition sensitivity and recognition speed equally increased, in the absence of any differences in recognition accuracy. In contrast to prominent propositions, psychosocial stress does not appear to account for impaired emotion recognition across the BPD spectrum.
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Fitzpatrick S, Varma S, Kuo JR. Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm. Psychol Med 2022; 52:2319-2331. [PMID: 33198829 DOI: 10.1017/s0033291720004225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
| | - Sonya Varma
- Department of Psychology, York University, Canada
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, USA
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20
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McBride SD, Roberts K, Hemmings AJ, Ninomiya S, Parker MO. The impulsive horse: comparing genetic, physiological and behavioral indicators to that of human addiction. Physiol Behav 2022; 254:113896. [PMID: 35777460 DOI: 10.1016/j.physbeh.2022.113896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/10/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
Stress and genotype elicit changes in impulse control in a range of species that are attributable to adaptations in both the central and peripheral nervous system. We examined aspects of this mechanism in the horse by assessing the effect of a dopamine receptor genotype (DRD4) and central dopaminergic tone (measured via spontaneous blink rate [SBR] and behavioral initiation rate [BIR]), on measures of impulsivity, compulsivity (3-choice serial reaction time task) and sympathetic/ parasympathetic system balance (heart rate variability [HRV]). Genotype did not have a significant effect on any of the parameters measured. SBR but not BIR correlated significantly with levels of impulsivity. There was no clear association of HRV parameters with either measures of central dopaminergic activity or impulsivity/compulsivity. Overall, some elements of the data suggest that the horse may be a useful animal model for assessing the genetic and environmental factors that lead to the physiological and behavioral phenotype of human addiction, particularly when considering the relationship between central dopaminergic tone and impulsivity.
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Affiliation(s)
- S D McBride
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, SY23 3DA
| | - K Roberts
- Royal Agricultural University, Stroud Road, Cirencester, Gloucestershire, GL7 6JS
| | - A J Hemmings
- Royal Agricultural University, Stroud Road, Cirencester, Gloucestershire, GL7 6JS
| | - S Ninomiya
- Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido Gifu 501-1193, Japan
| | - M O Parker
- School of Pharmacy and Biomedical Science, University of Portsmouth, White Swan Road, Portsmouth, Hampshire, PO1 2DT
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21
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Wang WL, Hung HY, Chung CH, Hsu JW, Huang KL, Chan YY, Chien WC, Chen MH. Risk of Personality disorders among childhood maltreatment victims: A nation-wide population-based study in Taiwan. J Affect Disord 2022; 305:28-36. [PMID: 34965397 DOI: 10.1016/j.jad.2021.12.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan. METHODS We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders. RESULTS Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p < 0.001). CONCLUSIONS The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.
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Affiliation(s)
- Wei-Li Wang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hao-Yuan Hung
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Yu Chan
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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22
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Constantin KL, Moline RL, Pillai Riddell R, Spence JR, Fiacconi CM, Lupo‐Flewelling K, McMurtry CM. Parent and child self‐ and co‐regulation during pediatric venipuncture: Exploring heart rate variability and the effects of a mindfulness intervention. Dev Psychobiol 2022; 64:e22277. [DOI: 10.1002/dev.22277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/25/2022] [Accepted: 03/20/2022] [Indexed: 12/21/2022]
Affiliation(s)
| | - Rachel L. Moline
- Department of Psychology University of Guelph Guelph Ontario Canada
| | - Rebecca Pillai Riddell
- Department of Psychology York University Toronto Ontario Canada
- Department of Psychiatry Research The Hospital for Sick Children Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | | | | | | | - C. Meghan McMurtry
- Department of Psychology University of Guelph Guelph Ontario Canada
- Pediatric Chronic Pain Program McMaster Children's Hospital Hamilton Ontario Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry Western University London Ontario Canada
- Department of Anesthesia McMaster University Hamilton Ontario Canada
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23
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Automated Classification of Cognitive Workload Levels Based on Psychophysiological and Behavioural Variables of Ex-Gaussian Distributional Features. Brain Sci 2022; 12:brainsci12050542. [PMID: 35624928 PMCID: PMC9138891 DOI: 10.3390/brainsci12050542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
The study is focused on applying ex-Gaussian parameters of eye-tracking and cognitive measures in the classification process of cognitive workload level. A computerised version of the digit symbol substitution test has been developed in order to perform the case study. The dataset applied in the study is a collection of variables related to eye-tracking: saccades, fixations and blinks, as well as test-related variables including response time and correct response number. The application of ex-Gaussian modelling to all collected data was beneficial in the context of detection of dissimilarity in groups. An independent classification approach has been applied in the study. Several classical classification methods have been invoked in the process. The overall classification accuracy reached almost 96%. Furthermore, the interpretable machine learning model based on logistic regression was adapted in order to calculate the ranking of the most valuable features, which allowed us to examine their importance.
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24
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Back SN, Schmitz M, Koenig J, Zettl M, Kleindienst N, Herpertz SC, Bertsch K. Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity. J Neural Transm (Vienna) 2022; 129:409-419. [PMID: 35275249 PMCID: PMC9007810 DOI: 10.1007/s00702-022-02482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.
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Affiliation(s)
- Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Marius Schmitz
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Zettl
- Institute of Psychosocial Prevention, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Medical Faculty Mannheim, Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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25
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Geiss L, Beck B, Hitzl W, Hillemacher T, Hösl KM. Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder. Neuropsychobiology 2022; 80:359-373. [PMID: 33582662 DOI: 10.1159/000511543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). METHODS In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. RESULTS During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. CONCLUSION Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.
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Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany,
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
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26
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Psychopathy, the Four Facet Model, and Fearlessness: Testing Sympathetic and Parasympathetic Nervous System Reactivity in a Late Adolescent Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-021-09948-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Cavelti M, Rinnewitz L, Walter M, van der Venne P, Parzer P, Josi J, Bertsch K, Brunner R, Resch F, Koenig J, Kaess M. Psychobiological Correlates of Aggression in Female Adolescents with Borderline Personality Disorder. Psychopathology 2022; 55:37-48. [PMID: 34872101 DOI: 10.1159/000520228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD. METHODS Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment. RESULTS Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed. DISCUSSION There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,
| | - Lena Rinnewitz
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Moritz Walter
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Patrice van der Venne
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Johannes Josi
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilans-University Munich, Munich, Germany.,Department of Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University of Regensburg, Regenbsurg, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Section for Experimental Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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28
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Beutler S, Mertens YL, Ladner L, Schellong J, Croy I, Daniels JK. Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients. Eur J Psychotraumatol 2022; 13:2132599. [PMID: 36340007 PMCID: PMC9635467 DOI: 10.1080/20008066.2022.2132599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Neurophysiological models link dissociation (e.g. feeling detached during or after a traumatic event) to hypoarousal. It is currently assumed that the initial passive reaction to a threat may coincide with a blunted autonomic response, which constitutes the dissociative subtype of post-traumatic stress disorder (PTSD). Objective: Within this systematic review we summarize research which evaluates autonomic nervous system activation (e.g. heart rate, blood pressure) and dissociation in PTSD patients to discern the validity of current neurophysiological models of trauma-related hypoarousal. Method: Of 553 screened articles, 28 studies (N = 1300 subjects) investigating the physiological response to stress provocation or trauma-related interventions were included in the final analysis. Results: No clear trend exists across all measured physiological markers in trauma-related dissociation. Extracted results are inconsistent, in part due to high heterogeneity in experimental methodology. Conclusion: The current review is unable to provide robust evidence that peri- and post-traumatic dissociation are associated with hypoarousal, questioning the validity of distinct psychophysiological profiles in PTSD.
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Affiliation(s)
- Sarah Beutler
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Yoki L Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Liliana Ladner
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany.,Department of Clinical Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Judith K Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
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29
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Krause-Utz A, Walther JC, Kyrgiou AI, Hoogenboom W, Alampanou M, Bohus M, Schmahl C, Lis S. Severity of childhood maltreatment predicts reaction times and heart rate variability during an emotional working memory task in borderline personality disorder. Eur J Psychotraumatol 2022; 13:2093037. [PMID: 35816658 PMCID: PMC9262367 DOI: 10.1080/20008198.2022.2093037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Background: Difficulties in emotion regulation are a core symptom of borderline personality disorder (BPD) and often interfere with cognitive functions, such as working memory (WM). Traumatic childhood experiences, including severe maltreatment, can contribute to emotion dysregulation, possibly mediated by changes in high-frequency heart rate variability (HF-HRV). However, it is not yet entirely understood if HF-HRV alterations underlie impaired WM during emotional distraction in BPD and if this is related to traumatic childhood experiences and to comorbid post-traumatic stress disorder (PTSD). Objective: Our aim was to investigate performance (reaction times, RTs) and HF-HRV during an emotional working memory task (EWMT) in relation to childhood maltreatment severity and comorbid PTSD in BPD. Method: Eighty-one women (n = 28 healthy controls (HC) and n = 53 BPD patients of which n = 18 had comorbid PTSD) performed an adapted Sternberg item recognition WM task with neutral and negative social cues (interpersonal scenes from the International Affective Picture System (IAPS), and neutral, fearful, and angry faces) as distractors. Dependent variables were RTs of correct trials and HF-HRV. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. Results: Compared to healthy participants, patients with BPD showed prolonged RTs across all distractor conditions with social cues, regardless of their emotional valence. Patients with BPD, especially those with PTSD, demonstrated reduced HF-HRV both at rest and during EWMT. Severity of childhood maltreatment predicted longer RTs and lower HF-HRV during the EWMT. Conclusions: Findings suggest that adverse childhood experiences accelerate difficulties in shifting attention away from social information and that these are more pronounced in individuals with BPD. Reduced HF-HRV (low parasympathetic-tonus) may be an important psychophysiological mechanism underlying impaired WM in the presence of distracting social cues in patients with BPD, especially in those with comorbid PTSD. HIGHLIGHTS This study provides evidence that childhood maltreatment experiences are associated with hypersensitivity to social information and reduced high-frequency heart rate variability during a working memory task in borderline personality disorder.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Akrivi I Kyrgiou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - William Hoogenboom
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Myrto Alampanou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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30
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Sigrist C, Reichl C, Schmidt SJ, Brunner R, Kaess M, Koenig J. Cardiac autonomic functioning and clinical outcome in adolescent borderline personality disorder over two years. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110336. [PMID: 33915219 DOI: 10.1016/j.pnpbp.2021.110336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022]
Abstract
The present study aimed to expand on previous findings that pre-treatment autonomic nervous system (ANS) functioning serves as a predictor of clinical outcome in adolescent borderline personality disorder (BPD), while examining whether the relationship between ANS functioning and treatment outcome may vary as a function of early life maltreatment (ELM). ANS stress response was examined considering changes in heart rate (HR) and vagally-mediated heart rate variability (vmHRV) over different conditions of the Montreal Imaging Stress Task (MIST) in a clinical sample of N = 27 adolescents across the spectrum of BPD severity. Participants received in- and/or outpatient treatment, while clinical data was assessed at routine follow-ups. Clinical outcome was defined by change in the number of fulfilled BPD criteria (as measured using the SCID-II), severity of psychopathology (CGI-S), and global level of functioning (GAF), measured 12 and 24 months after baseline assessments. Mixed-effects (random-intercept/random slope) linear regression models were calculated to examine markers of ANS function as potential predictors of clinical outcome. Irrespective of the presence of ELM exposure, both vmHRV resting-state and stress recovery measures were identified as significant predictors of clinical outcome over time. This study adds to the existing literature by replicating and expanding on preliminary findings, considering also physiological reactivity and recovery in addition to resting-state measures of ANS functioning. The present results further highlight the potential of markers of ANS functioning to serve as objective measures in the process of monitoring patient progress and to make predictions regarding treatment outcome in psychiatry research.
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Affiliation(s)
- Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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31
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Guerriero G, Wartenberg C, Bernhardsson S, Gunnarsson S, Ioannou M, Liljedahl SI, Magnusson K, Svanberg T, Steingrimsson S. Efficacy of transcutaneous vagus nerve stimulation as treatment for depression: A systematic review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Gerra ML, Ardizzi M, Martorana S, Leoni V, Riva P, Preti E, Marino BFM, Ossola P, Marchesi C, Gallese V, De Panfilis C. Autonomic vulnerability to biased perception of social inclusion in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:28. [PMID: 34794518 PMCID: PMC8600701 DOI: 10.1186/s40479-021-00169-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals with Borderline Personality Disorder (BPD) feel rejected even when socially included. The pathophysiological mechanisms of this rejection bias are still unknown. Using the Cyberball paradigm, we investigated whether patients with BPD, display altered physiological responses to social inclusion and ostracism, as assessed by changes in Respiratory Sinus Arrhythmia (RSA). METHODS The sample comprised 30 patients with BPD, 30 with remitted Major Depressive Disorder (rMDD) and 30 Healthy Controls (HC). Self-report ratings of threats toward one's fundamental need to belong and RSA reactivity were measured immediately after each Cyberball condition. RESULTS Participants with BPD showed lower RSA at rest than HC. Only patients with BPD, reported higher threats to fundamental needs and exhibited a further decline in RSA after the Inclusion condition. CONCLUSIONS Individuals with BPD experience a biased appraisal of social inclusion both at the subjective and physiological level, showing higher feelings of ostracism and a breakdown of autonomic regulation to including social scenarios.
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Affiliation(s)
| | - Martina Ardizzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Martorana
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Veronica Leoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Riva
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Paolo Ossola
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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de Looff PC, Cornet LJM, de Kogel CH, Fernández-Castilla B, Embregts PJCM, Didden R, Nijman HLI. Heart Rate and Skin Conductance Associations with Physical Aggression, Psychopathy, Antisocial Personality Disorder and Conduct Disorder: An Updated Meta-Analysis. Neurosci Biobehav Rev 2021; 132:553-582. [PMID: 34774587 DOI: 10.1016/j.neubiorev.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023]
Abstract
The associations between physiological measures (i.e., heart rate and skin conductance) of autonomic nervous system (ANS) activity and severe antisocial spectrum behavior (AB) were meta-analyzed. We used an exhaustive partitioning of variables relevant to the ANS-AB association and investigated four highly relevant questions (on declining effect sizes, psychopathy subscales, moderators, and ANS measures) that are thought to be transformative for future research on AB. We investigated a broad spectrum of physiological measures (e.g., heart rate (variability), pre-ejection period) in relation to AB. The search date for the current meta-analysis was on January 1st, 2020, includes 101 studies and 769 effect sizes. Results indicate that effect sizes are heterogeneous and bidirectional. The careful partitioning of variables sheds light on the complex associations that were obscured in previous meta-analyses. Effects are largest for the most violent offenders and for psychopathy and are dependent on the experimental tasks used, parameters calculated, and analyses run. Understanding the specificity of physiological reactions may be expedient for differentiating between (and within) types of AB.
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Affiliation(s)
- Peter C de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Den Dolder, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands.
| | - Liza J M Cornet
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Catharina H de Kogel
- Research and Documentation Centre (WODC), Ministry of Justice and Security, The Hague, the Netherlands
| | | | - Petri J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands; Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands
| | - Henk L I Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Den Dolder, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands
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Weise S, Parzer P, Fürer L, Zimmermann R, Schmeck K, Resch F, Kaess M, Koenig J. Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology. World J Biol Psychiatry 2021; 22:535-545. [PMID: 33522370 DOI: 10.1080/15622975.2020.1858155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor. METHODS N = 43 (95.4% female, Mage = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up. N = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses. RESULTS Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome. CONCLUSION This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
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Affiliation(s)
- Sindy Weise
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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35
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Maiß C, Engemann L, Kern K, Flasbeck V, Mügge A, Lücke T, Brüne M. Cardiac parasympathetic activity in female patients with borderline personality disorder predicts approach/avoidance behavior towards angry faces. Biol Psychol 2021; 163:108146. [PMID: 34252482 DOI: 10.1016/j.biopsycho.2021.108146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Among other features, Borderline Personality Disorder (BPD) is characterized by difficulties in regulating affiliative behavior. Here, we examined the association of heart rate variability (HRV) with approach/avoidance behavior in BPD. Accordingly, HRV parameters (RMSSD and HF-HRV) were measured in 42 female patients with BPD and 50 controls before performing an Approach Avoidance Task (AAT). Half of participants were previously exposed to social exclusion in a virtual ball-tossing game. Overall, HRV was lower in patients with BPD compared to controls. Moreover, low HRV was associated with attenuated approach for angry faces with an averted gaze. Following social exclusion, the BPD group showed the largest approach to happy faces and the least approach for angry faces, a pattern which differed from controls and patients in the control condition. Our findings indicate an association of cardiac parasympathetic activity with social behavior. Moreover, social exclusion may foster avoidance of angry faces in BPD patients.
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Affiliation(s)
- Clara Maiß
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Luisa Engemann
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Katharina Kern
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Vera Flasbeck
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Andreas Mügge
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Thomas Lücke
- St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Neuropediatrics and Social Pediatrics, Ruhr University Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany.
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36
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McGowan NM, Saunders KEA. The Emerging Circadian Phenotype of Borderline Personality Disorder: Mechanisms, Opportunities and Future Directions. Curr Psychiatry Rep 2021; 23:30. [PMID: 33835306 PMCID: PMC8035096 DOI: 10.1007/s11920-021-01236-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW We review the recent evidence suggesting that circadian rhythm disturbance is a common unaddressed feature of borderline personality disorder (BPD); amelioration of which may confer substantial clinical benefit. We assess chronobiological BPD studies from a mechanistic and translational perspective and highlight opportunities for the future development of this hypothesis. RECENT FINDINGS The emerging circadian phenotype of BPD is characterised by a preponderance of comorbid circadian rhythm sleep-wake disorders, phase delayed and misaligned rest-activity patterns and attenuated amplitudes of usually well-characterised circadian rhythms. Such disturbances may exacerbate symptom severity, and specific maladaptive personality dimensions may produce a liability towards extremes in chronotype. Pilot studies suggest intervention may be beneficial, but development is limited. Endogenous and exogenous circadian rhythm disturbances appear to be common in BPD. The interface between psychiatry and chronobiology has led previously to novel efficacious strategies for the treatment of psychiatric disorders. We believe that better characterisation of the circadian phenotype in BPD will lead to a directed biological target for treatment in a condition where there is a regrettable paucity of accessible therapies.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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37
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Schmitz M, Müller LE, Seitz KI, Schulz A, Steinmann S, Herpertz SC, Bertsch K. Heartbeat evoked potentials in patients with post-traumatic stress disorder: an unaltered neurobiological regulation system? Eur J Psychotraumatol 2021; 12:1987686. [PMID: 34804381 PMCID: PMC8604531 DOI: 10.1080/20008198.2021.1987686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Early life maltreatment is a risk factor for psychiatric disorders, including post-traumatic stress disorder (PTSD). Post-traumatic stress disorder is a severe and heterogeneous disorder with fluctuating states of emotional over- and undermodulation, including hypervigilance, dissociation, and emotion regulation deficits. The perception and regulation of emotions have been linked to interoception, the cortical representation and sensing of inner bodily processes. Although first therapeutic approaches targeting bodily sensations have been found effective in patients with PTSD, and deficits in interoceptive signal representation have been reported in other trauma-related disorders, such as borderline personality disorder (BPD), the role of interoception remains largely unexplored for PTSD. OBJECTIVE The objective was to investigate the cortical representation of cardiac interoceptive signals in patients with PTSD and its associations with early life maltreatment, trait dissociation, and emotion dysregulation. METHODS Twenty-four medication-free patients with PTSD and 31 healthy controls (HC) completed a 5-min resting electrocardiogram (ECG) with parallel electroencephalogram (EEG). Heartbeat evoked potential (HEP) amplitudes as a measure for cortical representation of cardiac interoceptive signals were compared between groups and correlated with self-report questionnaires. RESULTS We did not find significantly different mean HEP amplitudes in patients with PTSD compared to HC, although HEPs of patients with PTSD were descriptively higher. No significant associations between mean HEP amplitudes and early life maltreatment, trait dissociation or emotion dysregulation were obtained within the groups. CONCLUSION The current finding does not indicate deficits in interoceptive signal representation at rest in individuals with PTSD. Whether patients with PTSD show altered HEP modulations during emotion regulation tasks and might benefit from therapeutic approaches aiming at changing the perception of bodily signals, needs to be investigated in future studies.
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Affiliation(s)
- Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Institute of Psychology, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, LMU Munich, Munich, Germany
| | - Laura E Müller
- Clinic for Psychosomatic Medicine and Psychotherapy, Clinic Darmstadt, Darmstadt, Germany
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - André Schulz
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Sylvia Steinmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, LMU Munich, Munich, Germany
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Koenig J, Thayer JF, Kaess M. Psychophysiological concomitants of personality pathology in development. Curr Opin Psychol 2020; 37:129-133. [PMID: 33461056 DOI: 10.1016/j.copsyc.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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Affiliation(s)
- Julian Koenig
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Julian F Thayer
- Department of Psychological Science, The University of California Irvine, Irvine, CA, USA
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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39
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Heiss S, Vaschillo B, Vaschillo EG, Timko CA, Hormes JM. Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an "ideal range". Neurosci Biobehav Rev 2020; 121:144-155. [PMID: 33309905 DOI: 10.1016/j.neubiorev.2020.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/02/2020] [Indexed: 01/21/2023]
Abstract
Heart rate variability (HRV), a measure of the variability in intervals between subsequent heart beats, is now widely considered an index of emotion regulatory capacity and the ability to adapt flexibly to changing environmental demands. Abnormalities in HRV are implicated in a host of psychopathologies, making it a potentially powerful transdiagnostic biobehavioral change mechanism in treatment interventions. While most mental illnesses are associated with low HRV, eating disorders have been linked to elevated HRV. We examined 62 research articles on HRV in psychopathology to test the hypothesis that there is an "ideal range" of HRV that predicts optimal functioning. Relationships between symptom severity and parameters that quantify HRV were examined graphically. More extreme time-domain HRV measures, both high and low, were associated with psychopathology, whereas healthy controls displayed mid-range values. Findings preliminarily support the hypothesis that there is an "ideal range" of HRV that could be targeted in biofeedback interventions.
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Affiliation(s)
- Sydney Heiss
- Department of Psychology, University at Albany, State University of New York, USA.
| | - Bronya Vaschillo
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, USA
| | - Evgeny G Vaschillo
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, USA
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40
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Bortolla R, Galli M, Ramella P, Sirtori F, Visintini R, Maffei C. Negative bias and reduced visual information processing of socio-emotional context in borderline Personality Disorder: A support for the hypersensitivity hypothesis. J Behav Ther Exp Psychiatry 2020; 69:101589. [PMID: 32502878 DOI: 10.1016/j.jbtep.2020.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Current studies on emotional dysregulation in BPD suggest that it might be manifested by altered appraisal and biased attentional mechanisms, rather than by hyperreactivity. The aim of this study was to acquire more evidence on this topic by testing the hypothesis that BPD patients are characterized by a negative evaluation bias and reduced visual exploration in response to socio-emotional content. Moreover, the association between the previous conceptualizations and typical dysfunctional processes in BPD were evaluated. METHODS Fifty-four socio-emotional pictures were administered to 20 female BPD patients and 20 healthy controls (HCs) divided into three blocks characterized by different stimulus durations (500 ms, 3s, 18s). Self-reported and eye-tracking data were collected during the experiment. RESULTS BPD patients showed lower valence ratings and reduced visual exploration of socio-emotional pictures compared to HCs. Visual exploration in BPD was affected by exposure time with reduced exploration in response to prolonged stimuli presentation. Dysfunctional features and pre-task negative affectivity level in BPD were correlated with self-reported evaluations and eye-tracking data. LIMITATIONS Possible effects of gender on emotional responsivity could not be addressed given the female composition of our sample. Moreover, the role of psychiatric symptoms and medications should be addressed in future research. CONCLUSIONS This study presented evidence on dysfunctional mechanisms sustaining emotional dysregulation in BPD. This construct seemed supported by a well-established negative bias towards emotional stimuli together with a reduced processing of social information as manifestations of emotional hypersensitivity.
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Affiliation(s)
- Roberta Bortolla
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy.
| | - Marco Galli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Pietro Ramella
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Sirtori
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaele Visintini
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
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41
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Sigrist C, Mürner-Lavanchy I, Peschel SKV, Schmidt SJ, Kaess M, Koenig J. Early life maltreatment and resting-state heart rate variability: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 120:307-334. [PMID: 33171141 DOI: 10.1016/j.neubiorev.2020.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/28/2020] [Accepted: 10/28/2020] [Indexed: 01/28/2023]
Abstract
Recent focus on the consequences of early life adversity (ELA) in neurobiological research led to a variety of findings suggesting alterations in several physiological systems, such as the cardiovascular system. In this systematic review and meta-analysis, we focused on the relationship between early life maltreatment (ELM), one form of ELA, and resting vagal activity indexed by resting-state heart rate variability (HRV). A systematic search of the literature yielded 1'264 hits, of which 32 studies reporting data for group comparisons or correlations were included. By quantitative synthesis of existing studies using random-effect models, we found no evidence for a relationship between ELM exposure and resting vagal activity in principal. Conducting meta-regression analyses, however, we found the relationship between ELM and resting vagal activity to significantly vary as a function of both age and the presence of psychopathology. In light of the current multitude of vastly unclear pathways linking ELM to the onset of disease, we emphasize the need for further research and outline several aspects to consider in future studies.
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Affiliation(s)
- Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephanie K V Peschel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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42
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Kocsis A, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Grent-‘t-Jong T, Uhlhaas PJ. Altered Autonomic Function in Individuals at Clinical High Risk for Psychosis. Front Psychiatry 2020; 11:580503. [PMID: 33240132 PMCID: PMC7677235 DOI: 10.3389/fpsyt.2020.580503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Alterations in autonomic functioning in individuals diagnosed with schizophrenia are well-documented. Yet, it is currently unclear whether these dysfunctions extend into the clinical high-risk state. Thus, we investigated resting heart rate (RHR) and heart rate variability (HRV) indices in individuals at clinical high-risk for psychosis (CHR-P). Methods: We recruited 117 CHR-P participants, 38 participants with affective disorders and substance abuse (CHR-N) as well as a group of 49 healthy controls. CHR-P status was assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). We obtained 5 min, eyes-open resting-state MEG data, which was used for the extraction of cardiac field-related inter-beat-interval data and from which heart-rate and heart-rate variability measures were computed. Results: Compared to both CHR-N and healthy controls, CHR-P participants were characterized by an increased RHR, which was not explained by differences in psychopathological comorbidity and medication status. Increased RHR correlated with the presence of subthreshold psychotic symptoms and associated distress. No differences between groups were found for heart-rate variability measures, however. Furthermore, there was an association between motor-performance and psychophysiological measures. Conclusion: The current study provides evidence of alterations in autonomic functioning as disclosed by increased RHR in CHR-P participants. Future studies are needed to further evaluate this characteristic feature of CHR-P individuals and its potential predictive value for psychosis development.
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Affiliation(s)
- Anna Kocsis
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Andrew I. Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M. Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Tineke Grent-‘t-Jong
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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43
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Interoceptive Processing in Borderline Personality Pathology: a Review on Neurophysiological Mechanisms. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Mainali P, Rai T, Rutkofsky IH. From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: Exploring the Neuromorphological and Epigenetic Pathway. Cureus 2020; 12:e9474. [PMID: 32874803 PMCID: PMC7455386 DOI: 10.7759/cureus.9474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023] Open
Abstract
Borderline personality disorder (BPD) is one of the most common personality disorders seen in the general population. Among multiple identified risk factors, one of the most influential elements is exposure to an adverse childhood experience in terms of emotional, physical, or sexual abuse. A cascade of neuromorphological and epigenetic changes occurs in response to these childhood stressors, which may have a strong link to the development of BPD. PubMed and Google Scholar were searched for articles relevant to child abuse and the development of BPD. The search was not restricted to any time frame or geographic location. Significant epigenetic and neuromorphological changes are seen with child abuse, contributing to the development of BPD. Chronic stressors lead to hypothalamic-pituitary axis (HPA) activation, releasing cortisol that acts on the prefrontal cortex, amygdala, and hippocampus, producing the behavioral patterns seen in BPD. Overstimulation of gray matter leads to permanent neuromorphological changes, which can be visualized in functional MRI/brain scans. Hypermethylation of messenger ribonucleic acid in various sites suggests the impact of child abuse on the genetic level. Interestingly, the prevalence of BPD is seen equally in both genders but is diagnosed more frequently in females because they tend to be more likely to seek help. Understanding the impact of early age life stressors into adulthood calls for serious focus on early diagnosis and intervention. This implies the need for more studies in patients with BPD with or without any childhood traumatic experience and a better understanding of the changes that occur biopsychologically and genetically in response to trauma.
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Affiliation(s)
- Pranita Mainali
- Psychiatry, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tehrima Rai
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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45
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A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder. Harv Rev Psychiatry 2020; 27:217-232. [PMID: 31219881 DOI: 10.1097/hrp.0000000000000212] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.
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O'Brien JR, Lewis JK, Zalewski M. Maternal emotion dysregulation and physiological concordance in mother‐preschooler dyads. INFANT AND CHILD DEVELOPMENT 2020. [DOI: 10.1002/icd.2184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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47
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Anderson G. Pathoetiology and pathophysiology of borderline personality: Role of prenatal factors, gut microbiome, mu- and kappa-opioid receptors in amygdala-PFC interactions. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109782. [PMID: 31689444 DOI: 10.1016/j.pnpbp.2019.109782] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
The pathoetiology and pathophysiology of borderline personality disorder (BPD) have been relatively under-explored. Consequently, no targetted pharmaceutical treatments or preventative interventions are available. The current article reviews the available data on the biological underpinnings of BPD, highlighting a role for early developmental processes, including prenatal stress and maternal dysbiosis, in BPD pathoetiology. Such factors are proposed to drive alterations in the infant's gut microbiome, in turn modulating amygdala development and the amygdala's two-way interactions with other brain regions. Alterations in opioidergic activity, including variations in the ratio of the mu-and kappa-opioid receptors seem a significant aspect of BPD pathophysiology, contributing to its comorbidities with depression, anxiety, impulsivity and addiction. Stress and dysphoria are commonly experienced in people classed with BPD. A growing body of data, across a host of medical conditions, indicate that stress and mood dysregulation may be intimately associated with gut dysbiosis and increased gut permeability, coupled to heightened levels of oxidative stress and immune-inflammatory activity. It urgently requires investigation as to the relevance of such gut changes in the course of BPD symptomatology. Accumulating data indicates that BPD symptom exacerbations may be linked to cyclical variations in estrogen, in turn decreasing serotonin and local melatonin synthesis, and thereby overlapping with the pathophysiology of migraine and endometriosis, which also have a heightened association with BPD. Future research directions and treatment implications are indicated.
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Smith TW, Deits‐Lebehn C, Williams PG, Baucom BRW, Uchino BN. Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation, emotion, and interpersonal processes. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020. [DOI: 10.1111/spc3.12516] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | | | - Bert N. Uchino
- Department of PsychologyUniversity of Utah Salt Lake City Utah
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Menstrual Cycle Changes in Vagally-Mediated Heart Rate Variability are Associated with Progesterone: Evidence from Two Within-Person Studies. J Clin Med 2020; 9:jcm9030617. [PMID: 32106458 PMCID: PMC7141121 DOI: 10.3390/jcm9030617] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
A recent meta-analysis revealed that cardiac vagal activity (mostly indicated by vagally-mediated heart rate variability; HRV) decreases significantly from the follicular to luteal menstrual cycle phase in naturally-cycling participants. However, the question remains as to whether cyclical changes in estradiol (E2), progesterone (P4), or both are responsible for HRV fluctuations. We present the first studies to use repeated measures of E2, P4, and HRV across the cycle to model both the unique and interactive effects of person-centered E2 and P4 on HRV in multilevel models. In study one, 40 naturally-cycling participants were assessed weekly across four weeks, and were blind to the cycle focus of the study. In study two, 50 naturally-cycling participants were examined in three precisely defined cycle phases via ovulation testing. Both studies revealed that only P4 was correlated with HRV, such that higher-than-usual P4 significantly predicted lower-than-usual HRV within a given participant. In line with this, cycle phase comparisons revealed lower HRV in the mid-luteal phase (characterized by elevated P4) than in other phases. No significant main or interactive effects of E2 on HRV were found. Future female health studies should investigate individual differences in these effects and potential consequences of cyclical HRV changes on daily functioning.
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Kaess M. Childhood adversity in borderline personality disorder-a call for a more systemic approach to early intervention and prevention. Acta Psychiatr Scand 2020; 141:3-5. [PMID: 31867711 DOI: 10.1111/acps.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- M Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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