Evaluation of the own body in women with current and remitted borderline personality disorder: evidence for long-lasting effects of childhood sexual abuse

Attachment and body representations in adolescents with personality disorder

BACKGROUND

Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated.

METHOD

A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror.

RESULTS

The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR).

CONCLUSION

Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.

Out of touch? How trauma shapes the experience of social touch - Neural and endocrine pathways

Trauma can shape the way an individual experiences the world and interacts with other people. Touch is a key component of social interactions, but surprisingly little is known about how trauma exposure influences the processing of social touch. In this review, we examine possible neurobiological pathways through which trauma can influence touch processing and lead to touch aversion and avoidance in trauma-exposed individuals. Emerging evidence indicates that trauma may affect sensory touch thresholds by modulating activity in the primary sensory cortex and posterior insula. Disturbances in multisensory integration and oxytocin reactivity combined with diminished reward-related and anxiolytic responses may induce a bias towards negative appraisal of touch contexts. Furthermore, hippocampus deactivation during social touch may reflect a dissociative state. These changes depend not only on the type and severity of the trauma but also on the features of the touch. We hypothesise that disrupted touch processing may impair social interactions and confer elevated risk for future stress-related disorders.

Stress and reward in the maternal brain of mothers with borderline personality disorder: a script-based fMRI study

Borderline personality disorder (BPD) is associated with altered neural activity in regions of salience and emotion regulation. An exaggerated sensitization to emotionally salient situations, increased experience of emotions, and dysfunctional regulative abilities could be reasons for increased distress also during parenting. Mothers with BPD tend to have less reciprocal mother-child interactions (MCI) and reveal altered cortisol and oxytocin reactivity in the interaction with their child, which could indicate altered processing of stress and reward. Here, we studied underlying neural mechanisms of disrupted MCI in BPD. Twenty-five mothers with BPD and 28 healthy mothers participated in a script-driven imagery functional magnetic resonance imaging (fMRI)-paradigm. Scripts described stressful or rewarding MCI with the own child, or situations in which the mother was alone. Mothers with BPD showed larger activities in the bilateral insula and anterior cingulate cortex (ACC) compared to healthy mothers during the imagination of MCI and non-MCI. Already in the precursory phase while listening to the scripts, a similar pattern emerged with stronger activity in the left anterior insula (AINS), but not in the ACC. This AINS activity correlated negatively with the quality of real-life MCI for mothers with BPD. Mothers with BPD reported lower affect and higher arousal. An exaggerated sensitization to different, emotionally salient situations together with dysfunctional emotion regulation abilities, as reflected by increased insula and ACC activity, might hinder sensitive maternal behavior in mothers with BPD. These results underline the importance for psychotherapeutic interventions to improve emotional hyperarousal and emotion regulation in patients with BPD, especially in affected mothers caring for young children.

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation

BACKGROUND

Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including abnormal evaluation of nociceptive input. However, whether or not perceptual alterations are present for its positive counterpart, i.e. pleasant touch (PT), has not yet been examined.

METHODS

In the present study, we applied standardized PT stimuli to the hands of 25 patients with BPD and 25 healthy controls (HC) and compared their perception. We used the affect-modulated acoustic startle response as a physiological correlate of affective processing. We further explored the effect of PT stimulation on dissociative experiences in BPD.

RESULTS

Compared to HC, BPD perceived PT as less pleasant and less intense. The effect on perceived valence of touch was large even after controlling for the effect of reduced perceived intensity of touch (ƞ² = .29). We further found qualitative alterations in touch perception in BPD, who rated the touch as significantly rougher and firmer compared to HC. There was a positive correlation between perceived valence of touch and changes in dissociative experiences in terms of body ownership of the stimulated body part from pre to post stimulation, suggesting that a more negative evaluation of touch is associated with an increase in body-related dissociative experiences, while a positive perception of touch might be related to a reduction of these dissociative experiences.

CONCLUSIONS

Our results confirm BPD-associated disturbances in the processing of affective somatosensory stimuli and indicate that not only pain perception but also pleasant touch perception is diminished in BPD. We discuss the role of altered touch perception for BPD psychopathology and its potential role for new treatment approaches.

Body Image in Borderline Personality Disorder: A Systematic Review of the Emerging Empirical Literature

As an element of distorted self-image, body image disturbances may be relevant to borderline personality disorder (BPD). Therefore, this systematic review aims to critically discuss and summarize empirical findings in this matter. Based on the available theoretical models, three body image components were identified: (a) perception, (b) affect and cognition, and (c) general body dissatisfaction. We conducted a systematic search of the empirical literature published in English in the MEDLINE, PsycINFO, and Scopus databases until June 2021 using a priori eligibility criteria (BPD; BPD symptoms or features in nonclinical groups; quasipsychotic or psychotic symptoms were not considered). We included k = 10 records meeting the criteria. Compared with other analyzed groups, individuals diagnosed with BPD obtained higher scores in the three components of body image disturbances. The issue of body image in BPD is relatively understudied, although current research findings clearly indicate disturbances in all of the abovementioned body image components in individuals with BPD or significant relationships of these components with BPD traits or symptoms both in clinical and nonclinical samples. Eventually, possible practical implications and future research directions are also discussed.

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

PURPOSE OF REVIEW

The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD.

RECENT FINDINGS

Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.