1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Fitzpatrick S, Kuo JR. Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder. Cogn Emot 2021; 36:473-491. [PMID: 34931942 DOI: 10.1080/02699931.2021.2018291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.
Collapse
Affiliation(s)
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| |
Collapse
|
3
|
Kaess M, Hooley JM, Klimes-Dougan B, Koenig J, Plener PL, Reichl C, Robinson K, Schmahl C, Sicorello M, Westlund Schreiner M, Cullen KR. Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review. Neurosci Biobehav Rev 2021; 130:228-239. [PMID: 34450182 PMCID: PMC8783544 DOI: 10.1016/j.neubiorev.2021.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/17/2021] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.
Collapse
Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; 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 Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
4
|
Predicting Non-Suicidal Self-Injury in Young Adults with and without Borderline Personality Disorder: a Multilevel Approach Combining Ecological Momentary Assessment and Self-Report Measures. Psychiatr Q 2021; 92:1035-1054. [PMID: 33475912 DOI: 10.1007/s11126-020-09875-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is an increasingly prevalent phenomenon associated with many detrimental outcomes, ranging from poor academic performance to suicide attempts. Research on self-harming behaviors has identified emotion dysregulation, negative affect, and borderline pathology as strong risk factors of NSSI, whereas the potential protective effects of metacognitive skills such as decentering have not yet been explored. The current study combined ecological momentary assessment (EMA) and self-report measures to explore potential risk and protective factors of NSSI in a clinical group of Borderline Personality Disorder (BPD) patients with NSSI (N = 22), a subclinical group of college students with NSSI (N = 19), and a non-clinical healthy control group (N = 23). Participants completed self-report measures of borderline pathology, emotion dysregulation, decentering ability, and negative emotional symptoms, and they used the Sinjur App (EMA instrument) at least three times a day for 15 days to capture negative affect and NSSI in daily life. A multilevel mixed-effect regression analysis with both self-report and EMA measures was conducted to identify predictors of NSSI. The multilevel analysis showed that only momentary frustration directly predicted NSSI. Momentary guilt and anger only predicted NSSI when interacting with more stable traits of borderline pathology and negative emotional symptoms. Most importantly, greater decentering capacity protected against self-injury and attenuated the association between momentary sadness and NSSI. Findings contribute novel knowledge about NSSI, documenting the protective effects of decentering and highlighting the benefit of interventions that target metacognitive emotion regulation skills.
Collapse
|
5
|
Störkel LM, Karabatsiakis A, Hepp J, Kolassa IT, Schmahl C, Niedtfeld I. Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study. Neuropsychopharmacology 2021; 46:1357-1363. [PMID: 33398083 PMCID: PMC8134499 DOI: 10.1038/s41386-020-00914-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/29/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a prevalent and impairing behavior, affecting individuals with and without additional psychopathology. To shed further light on biological processes that precede and result from NSSI acts, we built on previous cross-sectional evidence suggesting that the endogenous opioid system, and especially β-endorphin, is involved in the psychopathology of NSSI. This is the first study assessing salivary β-endorphin in daily life in the context of NSSI acts. Fifty-one female adults with repetitive NSSI participated over a period of 15 days in an ambulatory assessment study. Salivary β-endorphin was assessed before and after engagement in NSSI, during high urge for NSSI, and on a non-NSSI day. Furthermore, NSSI specific variables such as pain ratings, as well as method, severity, and function of NSSI were assessed. We found that β-endorphin levels immediately before an NSSI act were significantly lower than directly after NSSI. However, there was no difference between β-endorphin during high urge for NSSI and post NSSI measures. We found a positive association between severity of the self-inflicted injury and β-endorphin levels, but no significant association between β-endorphin levels and subjectively experienced pain. The results of the present study indicate that it is possible to assess salivary β-endorphin in daily life in the context of NSSI. Furthermore, our results provide a first indication that NSSI acts could be associated with a momentary increase of β-endorphin, and this might reinforce NSSI engagement. More research is needed to replicate and extend our findings on peripheral β-endorphin in daily life.
Collapse
Affiliation(s)
- Lisa M Störkel
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Christian Schmahl
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| |
Collapse
|
6
|
Paret C, Niedtfeld I, Lotter T, Wunder A, Grimm S, Mennes M, Okell T, Beckmann C, Schmahl C. Single-Dose Effects of Citalopram on Neural Responses to Affective Stimuli in Borderline Personality Disorder: A Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:837-845. [PMID: 33607327 DOI: 10.1016/j.bpsc.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Psychiatric medication that has a soothing effect on limbic responses to affective stimuli could improve affective instability symptoms as observed in borderline personality disorder (BPD). The objective of this study was to investigate whether citalopram versus placebo reduces the response of the affective neural circuitry during an emotional challenge. METHODS A total of 30 female individuals with a BPD diagnosis participated in a placebo-controlled, double-blind crossover trial design. Three hours after oral drug intake, individuals with BPD viewed affective pictures while undergoing functional magnetic resonance imaging. Blood oxygen level-dependent responses to images of negative affective scenes and faces showing negative emotional expressions were assessed in regions of interest (amygdala, anterior cingulate cortex, anterior insula, dorsolateral prefrontal cortex). Blood perfusion at rest was assessed with arterial spin labeling. RESULTS The neural response to pictures showing negative affective scenes was not significantly affected by citalopram (n = 23). Citalopram significantly reduced the amygdala response to pictures of faces with negative affective expressions (n = 25, treatment difference left hemisphere: -0.06 ± 0.16, p < .05; right hemisphere: -0.06 ± 0.17, p < .05). We observed no significant effects of citalopram on the other regions. The drug did not significantly alter blood perfusion at rest. CONCLUSIONS Citalopram can alter the amygdala response to affective stimuli in BPD, which is characterized by overly responsive affective neural circuitry.
Collapse
Affiliation(s)
- Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Israel.
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Tobias Lotter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Andreas Wunder
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Simone Grimm
- MSB Medical School Berlin, Hochschule für Gesundheit und Medizin, Berlin, Germany
| | | | - Thomas Okell
- SBGneuro Ltd., Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
| |
Collapse
|
7
|
Johnson BN, Lumley MA, Cheavens JS, McKernan LC. Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders. J Psychosom Res 2020; 135:110164. [PMID: 32569851 PMCID: PMC7422088 DOI: 10.1016/j.jpsychores.2020.110164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic pain and borderline personality disorder (BPD) are commonly comorbid and jointly associated with increased symptoms of both disorders and clinical and functional impairment. Little is known, however, about specific links between these disorders. In a cross-sectional study of patients with chronic pain, we compared participants high or low on BPD symptoms on patterns of pain experience and types of child and adult traumas. METHODS Adults (N = 181) with chronic pain completed self-reports of pain severity, dimensions of pain experiencing, body coverage of pain, and clinical indicators of central sensitization (i.e., chronic hypersensitivity of the central nervous system), as well as measures of child and adult physical abuse, sexual abuse, trauma, and neglect. Participants also completed the McLean Screening Instrument for BPD. RESULTS Participants with clinically significant BPD symptoms (n = 32) reported more childhood sexual trauma, punishment, and neglect, as well as adult physical/sexual trauma, than those without elevated BPD symptoms. Among participants with clinically significant BPD symptoms, affective pain and central sensitization were elevated, potentially explained by heightened negative affect in BPD. CONCLUSION BPD symptoms are associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing (i.e., increased affective pain and central sensitization in particular). Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. Researchers and clinicians should assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
Collapse
|
8
|
Chung BY, Hensel S, Schmidinger I, Bekrater-Bodmann R, Flor H. Dissociation proneness and pain hyposensitivity in current and remitted borderline personality disorder. Eur J Pain 2020; 24:1257-1268. [PMID: 32232961 DOI: 10.1002/ejp.1567] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stress-related dissociation has been shown to negatively co-vary with pain perception in current borderline personality disorder (cBPD). While remission of the disorder (rBPD) is associated with normalized pain perception, it remains unclear whether dissociation proneness is still enhanced in this group and how this feature interacts with pain sensitivity. METHODS Twenty-five cBPD patients, 20 rBPD patients and 24 healthy controls (HC) participated in an experiment using the script-driven imagery approach. We presented a personalized stressful and neutral narrative. After listening to the scripts, dissociation and heat pain thresholds (HPT) were assessed. RESULTS Compared to HC, cBPD patients showed enhanced dissociation and exhibited significantly enhanced HPT in the neutral condition, whereas rBPD participants were in between. After listening to the stress script, both clinical groups exhibited enhanced dissociation scores. Current BPD participants responded with significantly higher HPT, whereas rBPD only showed a trend in the same direction. However, both BPD groups showed significantly increased HPT compared to the HC in the stress condition, but did not differ from each other. Dissociation proneness correlated significantly positively with pain hyposensitivity only in cBPD. CONCLUSION Dissociation proneness is enhanced in both BPD groups. This feature is clearly positively related to pain hyposensitivity in cBPD, but not in rBPD. However, the data indicate that stress causes the pain perception in rBPD to drift away from that obtained in HC. These results highlight the volatile state of BPD remission and might have important implications for the care of BPD patients in the remitted stage. SIGNIFICANCE Both current (cBPD) and remitted borderline personality disorder (rBPD) patients show enhanced proneness to dissociation. This feature is significantly linked with pain hyposensitivity in cBPD in a paradigm that induces stress using a script-driven imagery approach, whereas this connection cannot be observed in rBPD. However, in the stress compared to the neutral condition, rBPD participants also show pain hyposensitivity compared to healthy controls. This study provides new insights into the pain processing mechanisms of BPD and its remission.
Collapse
Affiliation(s)
- Boo Young Chung
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Clinic of Anesthesiology and Intensive Care Medicine, Pain Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Saskia Hensel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Ilinca Schmidinger
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI®, Aalborg University, Aalborg, Denmark
| |
Collapse
|
9
|
Möller TJ, Braun N, Thöne AK, Herrmann CS, Philipsen A. The Senses of Agency and Ownership in Patients With Borderline Personality Disorder. Front Psychiatry 2020; 11:474. [PMID: 32581864 PMCID: PMC7296131 DOI: 10.3389/fpsyt.2020.00474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
Patients with borderline personality disorder (BPD) not only experience a strong instability in their affect and interpersonal relations but also disturbances in their self-experience, including dissociation and body-alienation symptoms. It is not yet understood whether an altered sense of ownership (SoO) or sense of agency (SoA) may contribute to these disturbances. One recent hypothesis is that patients with BPD have a reduced sense of self and are therefore more likely to misattribute external objects or actions to their own self than healthy individuals. The present study followed up this hypothesis by investigating whether BPD patients have a more flexible body representation than healthy participants. More specifically, the active rubber hand illusion (aRHI) was applied to 21 patients with BPD and the same number of healthy participants. Using established subjective, electrodermal, and behavioral measures, the participants' SoO and SoA were assessed during the aRHI. The findings show self-reported evidence for higher SoO under anatomical hand congruency as compared to anatomical incongruency, but no evidence for group differences between BPD patients and healthy participants. This finding is inconsistent with previous findings of an enhanced SoO-related body plasticity in BPD patients. Regarding SoA, the findings show self-report evidence of higher SoA in BPD patients versus healthy participants, although this group difference was not evident in the implicit SoA measure (intentional binding). In summary, the present study only reveals partial evidence for a higher body plasticity in BPD patients. Instead, the observed variability in results appears better explainable by some generally elevated perceptual suggestibility of BPD individuals.
Collapse
Affiliation(s)
- Tim Julian Möller
- Berlin School of Mind and Brain, Humboldt University of Berlin, Berlin, Germany.,Experimental Psychology Lab, Department for Psychology, Faculty for Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry, Faculty for Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph S Herrmann
- Experimental Psychology Lab, Department for Psychology, Faculty for Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| |
Collapse
|
10
|
Fitzpatrick S, Zeifman R, Krantz L, McMain S, Kuo JR. Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder. Arch Suicide Res 2020; 24:102-123. [PMID: 30856367 DOI: 10.1080/13811118.2019.1586605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.
Collapse
|
11
|
Naoum J, Kleindienst N, Baumgärtner U, Willis F, Mancke F, Treede RD, Bohus M, Schmahl C. Effects of a Painful Stimulus on Stress Regulation in Male Patients With Borderline Personality Disorder: A Pilot Study. J Pers Disord 2019; 33:394-412. [PMID: 30036168 DOI: 10.1521/pedi_2018_32_351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain processing in relation to stress has so far not been investigated in male patients with borderline personality disorder (BPD). This experimental pilot study examined 17 male BPD patients and 20 male healthy controls (HCs) to assess the effects of a pain stimulus on arousal, aggression, pain (ratings), and heart rate. At baseline, BPD patients showed significantly higher arousal and aggression; however, there was no significant difference in heart rate compared to the HC group. Following stress induction, a noninvasive mechanical pain stimulus was applied. No significant differences in pain ratings or heart rates were found between the groups. For arousal, a significantly stronger decrease was revealed in the BPD group compared to the HC group (t = 2.16, p = .038). Concerning aggression, the BPD group showed a significantly greater decrease after the pain stimulus than the HC group (t = 3.25, p = .002). This data showed that nonsuicidal self-injury can reduce arousal and aggression in male BPD.
Collapse
Affiliation(s)
- Janina Naoum
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Ulf Baumgärtner
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Franziska Willis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Falk Mancke
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
12
|
Schloss N, Shabes P, Kuniss S, Willis F, Treede RD, Schmahl C, Baumgärtner U. Differential perception of sharp pain in patients with borderline personality disorder. Eur J Pain 2019; 23:1448-1463. [PMID: 31034113 DOI: 10.1002/ejp.1411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cutting is the most common method of non-suicidal self-injury (NSSI) to reduce inner tension in patients with Borderline Personality Disorder (BPD). Aim of this study was to compare pain perception induced by an incision and by application of a surrogate model for sharp mechanical pain (a non-invasive "blade") in BPD. METHODS 22 female patients and 20 healthy controls (HC) received a small incision into the volar forearm, a 7s-blade application on the same side, and non-invasive phasic stimuli (pinprick, blade, laser, tactile). Pain intensity as well as affective versus sensory components were assessed. RESULTS Incision was rated similarly by both groups (BPD: 28.6 ± 5.5 vs. HC: 33.9 ± 6.6; mean maximum pain ± SEM; p > 0.8), without significant difference for "7-s-blade" (BPD: 18.1 ± 3.8 vs. HC: 25.3 ± 3.6; mean maximum pain ± SEM; p > 0.17) or between "7-s-blade" and incision (BPD: p > 0.12; HC: p > 0.84). However, patients' intensity ratings returned significantly faster to baseline after incision (BPD: 38.9 ± 12.6 s vs. HC: 74.52 ± 11.5 s; p < 0.05), and patients evaluated "blade" and incision without any affective and with different sensory descriptors, indicating an altered evaluation of NSSI-like stimulation with qualitative in addition to quantitative differences-especially for the sharp pain component. CONCLUSIONS The reduced perception of suprathreshold nociceptive stimuli is based on a missing affective component and specific loss of the perception of "sharpness" as part of the sensory component of pain. The results further demonstrate the usefulness of the "blade" for the perception of sharpness in patients. SIGNIFICANCE Patients with Borderline Personality Disorder (BPD) who engage in non-suicidal self-injury (NSSI) report less pain in response to phasic nociceptive stimuli. In comparing an invasive pain stimulus to phasic nociceptive stimuli in BPD patients, the "blade" as non-invasive surrogate model for sharp mechanical pain in psychiatric patients is used. In contrast to healthy volunteers, BPD patients do not report significant affective ratings and specifically display a reduced sensory component for sharpness.
Collapse
Affiliation(s)
- Natalie Schloss
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Polina Shabes
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Franziska Willis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany.,Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| |
Collapse
|
13
|
Abstract
The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings.
Collapse
|
14
|
Krantz LH, McMain S, Kuo JR. The unique contribution of acceptance without judgment in predicting nonsuicidal self-injury after 20-weeks of dialectical behaviour therapy group skills training. Behav Res Ther 2018. [PMID: 29529508 DOI: 10.1016/j.brat.2018.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The current research tested whether four dimensions of mindfulness - acceptance without judgment, observing, describing and acting with awareness - predicted frequency of nonsuicidal self-injury (NSSI) and mediate the relationship with NSSI outcomes during 20-weeks of Dialectical Behaviour Therapy (DBT) skills training for borderline personality disorder (BPD). Eighty-four self-harming individuals with BPD were randomized to either DBT skills training or to a waitlist control group. A series of regressions revealed no relationship between dimensions of mindfulness and NSSI at baseline. There was a significant effect of DBT skills training on NSSI. As well, mediation analysis indicated that acceptance without judgment, specifically, mediated the relation between DBT skills training and change in frequency of NSSI.
Collapse
Affiliation(s)
- Lillian H Krantz
- Ryerson University, Department of Psychology, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada.
| | - Shelley McMain
- Centre for Addiction and Mental Health, Canada; University of Toronto, Department of Psychiatry, Canada.
| | - Janice R Kuo
- Ryerson University, Department of Psychology, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada.
| |
Collapse
|
15
|
Niedtfeld I, Schmitt R, Winter D, Bohus M, Schmahl C, Herpertz SC. Pain-mediated affect regulation is reduced after dialectical behavior therapy in borderline personality disorder: a longitudinal fMRI study. Soc Cogn Affect Neurosci 2018; 12:739-747. [PMID: 28119507 PMCID: PMC5460047 DOI: 10.1093/scan/nsw183] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 12/12/2016] [Indexed: 12/03/2022] Open
Abstract
Borderline Personality Disorder (BPD) is characterized by affective instability, but self-injurious behavior appears to have an emotion-regulating effect. We investigated whether pain-mediated affect regulation can be altered at the neural level by residential Dialectical Behavior Therapy (DBT), providing adaptive emotion regulation techniques. Likewise, we investigated whether pain thresholds or the appraisal of pain change after psychotherapy. We investigated 28 patients with BPD undergoing DBT (self-referral), 15 patients with treatment as usual and 23 healthy control subjects at two time points 12 weeks apart. We conducted an fMRI experiment eliciting negative emotions with picture stimuli and induced heat pain to investigate the role of pain in emotion regulation. Additionally, we assessed heat and cold pain thresholds. At first measurement, patients with BPD showed amygdala deactivation in response to painful stimulation, as well as altered connectivity between left amygdala and dorsal anterior cingulate cortex. These effects were reduced after DBT, as compared with patients with treatment as usual. Pain thresholds did not differ between the patient groups. We replicated the role of pain as a means of affect regulation in BPD, indicated by increased amygdala coupling. For the first time, we could demonstrate that pain-mediated affect regulation can be changed by DBT.
Collapse
Affiliation(s)
- Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Ruth Schmitt
- Department of General Psychiatry, Medical Faculty Heidelberg, Heidelberg University, Germany
| | - Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Medical Faculty Heidelberg, Heidelberg University, Germany
| |
Collapse
|
16
|
Willis F, Kuniss S, Kleindienst N, Lis S, Naoum J, Jungkunz M, Neukel C, Bohus M, Treede R, Baumgärtner U, Schmahl C. Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain Behav 2018; 8:e00909. [PMID: 29484266 PMCID: PMC5822574 DOI: 10.1002/brb3.909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022] Open
Abstract
Objective Patients with borderline personality disorder (BPD) use nonsuicidal self-injury (NSSI) to cope with states of elevated inner tension. It is unclear to what extent remitted BPD patients experience these states and whether the experience of pain still regulates emotion. The purpose of this study was the investigation of baseline stress levels, stress reactivity, and pain-mediated stress regulation in remitted BPD patients. Method Subjective and objective stress parameters were assessed in 30 remitted BPD patients, 30 current BPD patients, and 30 healthy controls. After stress induction, a non-nociceptive tactile stimulus, a tissue-injuring, or a noninvasive pain stimulus was applied to the right volar forearm. Results Baseline stress levels of remitted BPD patients lie in between the stress levels of current BPD patients and healthy controls. Urge for NSSI increased significantly more in current than remitted BPD patients. The experience of pain led to a greater decrease of arousal in current compared to remitted BPD patients and healthy controls. Conclusions States of increased tension still seem to appear in remitted BPD patients. The role of pain-mediated stress regulation appears to be reduced in remitted patients.
Collapse
Affiliation(s)
- Franziska Willis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Janina Naoum
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Martin Jungkunz
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Corinne Neukel
- Department of Psychosocial MedicineUniversity of HeidelbergHeidelbergGermany
| | - Martin Bohus
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Faculty of HealthUniversity of AntwerpAntwerpBelgium
| | - Rolf‐Detlef Treede
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonONCanada
| |
Collapse
|
17
|
Stoffels M, Nijs M, Spinhoven P, Mesbah R, Hagenaars MA. Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls. J Behav Ther Exp Psychiatry 2017; 57:6-13. [PMID: 28235636 DOI: 10.1016/j.jbtep.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 01/15/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Exaggerated emotional reactivity is supposed to be essential in the etiology of borderline personality disorder (BPD). More specifically, models of defensive behavior would predict reduced freezing behavior -indicated by fear bradycardia-in response to threat. This study examined automatic fear bradycardia responses in BPD versus healthy controls and the role of emotion dysregulation, more specifically tendencies to avoid emotions. METHODS Patients with BPD (n = 23) and healthy controls (n = 18) completed questionnaires and then watched neutral, pleasant and unpleasant pictures while heart rate was assessed. RESULTS Emotion avoidance interacted with group: it was associated with distinct autonomic responses in healthy controls but not in BPD patients. Controls with lower emotion avoidance tendencies showed bradycardia in response to unpleasant pictures, while controls with higher emotion avoidance tendencies did not. BPD patients showed no bradycardia, irrespective of their emotion avoidance tendencies. LIMITATIONS This study is limited by a small sample size. Comorbidity or medication intake were not controlled for. CONCLUSIONS The results may suggest impaired automatic defense responses in BPD. Further understanding of the regulation of distress and defense responses might improve BPD treatment.
Collapse
Affiliation(s)
- Malou Stoffels
- Amstel Academy, VU Medical Centre, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maurits Nijs
- Netherlands Psychiatric Association, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Rahele Mesbah
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; PsyQ, Lijnbaan 4, 2512 VA Den Haag, The Netherlands
| | - Muriel A Hagenaars
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| |
Collapse
|
18
|
The role of nociceptive input and tissue injury on stress regulation in borderline personality disorder. Pain 2017; 158:479-487. [PMID: 27941497 DOI: 10.1097/j.pain.0000000000000787] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 60% to 90% of patients with borderline personality disorder (BPD) show nonsuicidal self-injurious behavior (NSSI) with cutting being the most frequently applied method. One of NSSI's functions is to reduce aversive tension. Previous studies have found a tension-reducing effect of painful tissue injury by an incision. It is still unclear whether this effect is based on the effect of tissue injury or the effect of pain experience, or both. The aim of this study was to determine whether tissue injury leads to a stronger stress reduction than a sole pain stimulus in patients with BPD. After stress induction, 57 BPD patients and 60 healthy controls (HCs) received either an incision or a non-tissue-injuring mechanical nociceptive stimulus ("blade") typically perceived as painful or a non-nociceptive tactile sham stimulus (blunt end of scalpel). Participants were unaware of which procedure was applied. For stress assessment, subjective and objective parameters were measured. As immediate response to the stimulus application, we found greater stress reduction after both painful stimuli (incision and blade) in BPD patients but no difference in stress decrease between the tissue-injuring incision and the non-tissue-injuring pain stimulus (blade). Compared with HCs, incision and blade were followed by greater immediate decrease of arousal in BPD patients. Our findings confirm that among BPD patients, the nociceptive input leads to stress reduction. In contrast, the impact of tissue damage on stress reduction was relatively small. In addition, the results suggest that painful stimuli lead to a greater stress reduction in BPD patients compared with HCs.
Collapse
|
19
|
Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S. Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2017; 27:425-438. [PMID: 29527105 PMCID: PMC5842953 DOI: 10.1037/int0000044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.
Collapse
Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Science, 135 Hicks Way, Amherst, MA 01002
| | - Jessica R Peters
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
| | - Eric A Fertuck
- The City College of New York, The City University of New York, 160 Convent Avenue, North Academic Center, Room 7/239, New York, NY 10031
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032
| | - Shirley Yen
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
| |
Collapse
|
20
|
The role of seeing blood in non-suicidal self-injury in female patients with borderline personality disorder. Psychiatry Res 2016; 246:676-682. [PMID: 27829508 DOI: 10.1016/j.psychres.2016.10.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/18/2016] [Accepted: 10/30/2016] [Indexed: 11/24/2022]
Abstract
Patients with Borderline Personality Disorder (BPD) often engage in non-suicidal self-injury (NSSI), to reduce arousal levels under stress. However, the importance of seeing blood for the effect of NSSI is yet unknown. The present pilot study examined 20 female BPD patients and 20 healthy controls (HC) to assess the role of seeing blood on arousal, pain, urge for NSSI (ratings) and heart rate (continuously measured). Participants completed two sessions consisting of stress induction (forced mental arithmetics with white noise), followed by a seven second non-invasive pain stimulus with a blade to the volar forearm. At one session, only the painful blade stimulus was applied, at the other, artificial blood was added. For arousal, a significantly stronger decrease was revealed in the BPD than in the HC group, however with no significant effects between blood and non-blood conditions. Concerning urge for NSSI, the BPD showed a significantly greater decrease in blood condition over time than the HC group. Interestingly, heart rate decreased stronger over time in the HC group during the blood condition than in BPD. For tension relief by non-damaging mechanical painful stimulus the addition of visible blood showed neither subjective (arousal, urge for NSSI), nor objective (heart rate) advantages.
Collapse
|
21
|
Paret C, Hoesterey S, Kleindienst N, Schmahl C. Associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder. Psychiatry Res 2016; 244:194-201. [PMID: 27491014 DOI: 10.1016/j.psychres.2016.07.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
Those with borderline personality disorder (BPD) display altered evaluations regarding reward and punishment compared to others. The processing of rewards is basal for operant conditioning. However, studies addressing operant conditioning in BPD patients are rare. In the current study, an operant conditioning task combining learning acquisition and reversal was used. BPD patients and matched healthy controls (HCs) were exposed to aversive and neutral stimuli to assess the influence of emotion on learning. Picture content, dissociation, aversive tension and symptom severity were rated. Error rates were measured. Results showed no group interactions between aversive versus neutral scenes. The higher emotional arousal, dissociation and tension, the worse the acquisition, but not reversal, scores were for BPD patients. Scores from the Borderline Symptom List were associated with more errors in the reversal, but not the acquisition phase. The results are preliminary evidence for impaired acquisition learning due to increased emotional arousal, dissociation and tension in BPD patients. A failure to process punishment in the reversal phase was associated with symptom severity and may be related to neuropsychological dysfunctioning involving the ventromedial prefrontal cortex. Conclusions are limited due to the correlational study design and the small sample size.
Collapse
Affiliation(s)
- Christian Paret
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany.
| | - Steffen Hoesterey
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| |
Collapse
|
22
|
Hasking P, Whitlock J, Voon D, Rose A. A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure. Cogn Emot 2016; 31:1543-1556. [DOI: 10.1080/02699931.2016.1241219] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Penelope Hasking
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Janis Whitlock
- College of Human Ecology, Cornell University, New York, NY, USA
| | - David Voon
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Alyssa Rose
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| |
Collapse
|
23
|
Fitzpatrick S, Khoury JE, Kuo JR. Examining the relationship between emotion regulation deficits and borderline personality disorder features: A daily diary study. COUNSELLING PSYCHOLOGY QUARTERLY 2016. [DOI: 10.1080/09515070.2016.1211509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Janice R. Kuo
- Department of Psychology, Ryerson University, Toronto, Canada
| |
Collapse
|
24
|
Fitzpatrick S, Kuo JR. The impact of stimulus arousal level on emotion regulation effectiveness in borderline personality disorder. Psychiatry Res 2016; 241:242-8. [PMID: 27203152 DOI: 10.1016/j.psychres.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
Abstract
Basic emotion theory suggests that the effectiveness of different emotion regulation strategies vary with the intensity of the emotionally-salient stimulus. Although findings from studies using healthy samples are concordant with what is proposed by theory, it is unclear whether these relationships hold true among individuals with borderline personality disorder (BPD). Twenty-five individuals with BPD and 30 HCs were exposed to negative images of varying levels of emotional arousal and were instructed to either react as they normally would, distract, or use mindful awareness. Self-reported negativity ratings, heart rate, and skin conductance level (SCL) were monitored throughout. SCL data indicated that increases in image arousal resulted in larger reductions in SCL when distracting but not when implementing mindful awareness. Self-report data suggested that, in HCs, the effectiveness of mindful awareness decreased to a greater extent than distraction when image arousal increased. These findings are consistent with basic emotion research and suggest that some forms of emotion regulation (distraction) are more suited to high emotion arousal contexts than others (mindful awareness) and that, compared with HCs, individuals with BPD may be more resilient to the deteriorating effectiveness of mindful awareness with respect to increasing emotional arousal.
Collapse
Affiliation(s)
- Skye Fitzpatrick
- Ryerson University, Department of Psychology, Toronto, Ontario, Canada
| | - Janice R Kuo
- Ryerson University, Department of Psychology, Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Winter D. Attention to emotional stimuli in borderline personality disorder - a review of the influence of dissociation, self-reference, and psychotherapeutic interventions. Borderline Personal Disord Emot Dysregul 2016; 3:11. [PMID: 27713819 PMCID: PMC5050674 DOI: 10.1186/s40479-016-0047-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
Interactions between attention and processing of emotional stimuli shed light on both sensitivity to emotional stimuli as well as emotion dysregulation. Both of the latter processes have been proposed as central characteristics of altered emotion processing in those with borderline personality disorder (BPD). This review first summarizes the conflicting behavioural, psychophysiological and neuroimaging evidence for the hypothesis that emotional dysregulation should be reflected by higher distractibility through emotional stimuli in those with BPD. Dissociation, self-reference, as well as symptom severity modulated by psychotherapeutic interventions are proposed to help clarify divergent findings. Data suggest an association of dissociation with impaired task continuation during the presentation of interfering emotional and neutral stimuli, as well as high recruitment of neuronal attention networks together with a blunted emotional response. Considering self-reference, evidence suggests that negative rather than positive information may be more self-relevant to those with BPD. This may be due to a negative self-concept and self-evaluation. Social or trauma-relevant information attracts more attention from individuals with BPD and thus suggests higher self-relevance. After psychotherapeutic interventions, initial evidence may indicate normalization of the way attention and emotional stimuli interact in BPD. When studying attention-emotion interactions in BPD, methodological heterogeneities regarding sample, task, and stimulus characteristics need to be considered. When doing so, dissociation, self-reference, and psychotherapeutic interventions offer promising targets for future studies on attention-emotion interactions in those with BPD. This could promote a deeper insight into the affected individuals' struggle with emotions.
Collapse
Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| |
Collapse
|
26
|
Shabes P, Schloss N, Magerl W, Schmahl C, Treede RD, Baumgärtner U. A novel human surrogate model of noninjurious sharp mechanical pain. Pain 2016; 157:214-224. [DOI: 10.1097/j.pain.0000000000000352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Reitz S, Kluetsch R, Niedtfeld I, Knorz T, Lis S, Paret C, Kirsch P, Meyer-Lindenberg A, Treede RD, Baumgärtner U, Bohus M, Schmahl C. Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour. Br J Psychiatry 2015; 207:165-72. [PMID: 25906795 DOI: 10.1192/bjp.bp.114.153379] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress. AIMS Investigation of neurobiological mechanisms of NSSI in borderline personality disorder. METHOD In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed. RESULTS We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group. CONCLUSIONS Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.
Collapse
Affiliation(s)
- Sarah Reitz
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rosemarie Kluetsch
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Teresa Knorz
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Paret
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Peter Kirsch
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Ulf Baumgärtner
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| |
Collapse
|
28
|
Schmahl C, Stiglmayr C. Dialektisch-behaviorale Therapie nichtsuizidalen selbstverletzenden Verhaltens. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
29
|
Non-suicidal self-injury during an exposure-based treatment in patients with posttraumatic stress disorder and borderline features. Behav Res Ther 2014; 61:136-41. [PMID: 25193004 DOI: 10.1016/j.brat.2014.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/06/2014] [Accepted: 08/11/2014] [Indexed: 11/21/2022]
Abstract
Patients with posttraumatic stress disorder (PTSD) and features of borderline personality disorder (BPD) often show non-suicidal self-injury (NSSI). However, patients with on-going NSSI are mostly excluded from PTSD treatments and NSSI during PTSD treatment has rarely been investigated. The aim of the present study was to evaluate the course of NSSI during an exposure-based PTSD treatment. This study focused on a subset (n = 34) of data from a randomised controlled trial that tested the efficacy of a residential PTSD programme (DBT-PTSD) in comparison to a treatment-as-usual wait-list. In this subset we compared a) NSSI during treatment between participants who had or had not engaged in NSSI pre-treatment and b) NSSI between treatment weeks that included exposure interventions vs. those that did not. We further compared the outcome between participants with vs. without NSSI at pre-treatment. At pre-treatment, 62% participants reported on-going NSSI. During treatment, the percentage of participants carrying out NSSI decreased to 38% (p = 0.003). The rates of NSSI were similar in treatment weeks with exposure compared to weeks without. Similar results were observed for the frequency of NSSI. At the end of treatment, participants showed comparable improvement in PTSD symptoms regardless of whether or not they had exhibited NSSI beforehand.
Collapse
|
30
|
Kolar DR, Bürger A, Hammerle F, Jenetzky E. Aversive tension of adolescents with anorexia nervosa in daily course: a case-controlled and smartphone-based ambulatory monitoring trial. BMJ Open 2014; 4:e004703. [PMID: 24760350 PMCID: PMC4010818 DOI: 10.1136/bmjopen-2013-004703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that patients with anorexia nervosa suffer from aversive tension as well. Furthermore the usability of a smartphone application for ambulatory monitoring purposes has not been sufficiently explored. METHODS AND ANALYSIS We compare the mean and maximum self-reported aversive tension in 20 female adolescents (12-19 years) with anorexia nervosa in outpatient treatment with 20 healthy controls. They are required to answer hourly, over a 2-day period, that is, about 30 times, four short questions on their smartphone, which ensures prompt documentation without any recall bias. At the close out, the participants give a structured usability feedback on the application and the procedure. ETHICS AND DISSEMINATION The achieved result of this trial has direct relevance for efficient therapy strategies and is a prerequisite for trials regarding dialectical behaviour therapy in anorexia nervosa. The results will be disseminated through peer-review publications. The ethics committee of the regional medical association in Mainz, Germany approved the study protocol under the reference number 837.177.13. TRIAL REGISTRATION NUMBER The trial is registered at the German clinical trials registration under the reference number DRKS00005228.
Collapse
Affiliation(s)
- David Raphael Kolar
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Arne Bürger
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Ekkehart Jenetzky
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
31
|
Schmahl C, Herpertz SC, Bertsch K, Ende G, Flor H, Kirsch P, Lis S, Meyer-Lindenberg A, Rietschel M, Schneider M, Spanagel R, Treede RD, Bohus M. Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit. Borderline Personal Disord Emot Dysregul 2014; 1:12. [PMID: 26401296 PMCID: PMC4579501 DOI: 10.1186/2051-6673-1-12] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/22/2014] [Indexed: 12/15/2022] Open
Abstract
The last two decades have seen a strong rise in empirical research in the mechanisms of emotion dysregulation in borderline personality disorder. Major findings comprise structural as well as functional alterations of brain regions involved in emotion processing, such as amygdala, insula, and prefrontal regions. In addition, more specific mechanisms of disturbed emotion regulation, e.g. related to pain and dissociation, have been identified. Most recently, social interaction problems and their underlying neurobiological mechanisms, e.g. disturbed trust or hypersensitivity to social rejection, have become a major focus of BPD research. This article covers the current state of knowledge and related relevant research goals. The first part presents a review of the literature. The second part delineates important open questions to be addressed in future studies. The third part describes the research agenda for a large German center grant focusing on mechanisms of emotion dysregulation in BPD.
Collapse
Affiliation(s)
- Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, Medical Faculty Heidelberg / Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center of Psychosocial Medicine, Medical Faculty Heidelberg / Heidelberg University, Heidelberg, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Institute of Neuropsychology and Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Miriam Schneider
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| |
Collapse
|
32
|
Winter D, Elzinga B, Schmahl C. Emotions and memory in borderline personality disorder. Psychopathology 2014; 47:71-85. [PMID: 24355827 DOI: 10.1159/000356360] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 10/06/2013] [Indexed: 11/19/2022]
Abstract
Memory processes such as encoding, storage, and retrieval of information are influenced by emotional content. Because patients with borderline personality disorder (BPD) are particularly susceptible to emotional information, it is relevant to understand whether such memory processes are altered in this patient group. This systematic literature review collects current evidence on this issue. Research suggests that emotional information interferes more strongly with information processing and learning in BPD patients than in healthy controls. In general, BPD patients do not seem to differ from healthy control subjects in their ability to memorize emotional information, but they tend to have specific difficulties forgetting negative information. Also, BPD patients seem to recall autobiographical, particularly negative events with stronger arousal than healthy controls, while BPD patients also show specific temporo-prefrontal alterations in neural correlates. No substantial evidence was found that the current affective state influences learning and memory in BPD patients any differently than in healthy control subjects. In general, a depressive mood seems to both deteriorate and negatively bias information processing and memories, while there is evidence that dissociative symptoms impair learning and memory independently of stimulus valence. This review discusses methodological challenges of studies on memory and emotions in BPD and makes suggestions for future research and clinical implications.
Collapse
Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | | |
Collapse
|
33
|
McKenzie KC, Gross JJ. Nonsuicidal self-injury: an emotion regulation perspective. Psychopathology 2014; 47:207-19. [PMID: 24526099 DOI: 10.1159/000358097] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is widely thought to serve an emotion-regulatory function. METHOD The focus of the present paper is to provide a conceptual framework for understanding how NSSI might modify a person's emotions. RESULTS Drawing upon the process model of emotion regulation, we argue that 5 families of emotion regulation strategies may be engaged by NSSI. Individuals may engage in NSSI as an alternative to more distressing situations. They also may use NSSI to modify their social environment. Individuals may shift their attention away from unpleasant emotions or thoughts via NSSI. NSSI may change cognitions about the self via self-punishment or transformation of the self from higher-order to lower-order awareness. NSSI may also bring about various physiological effects, such as changes in endogenous opioids or parasympathetic nervous system activation, as a way of modulating emotional responses. CONCLUSION Simply labeling NSSI as 'emotion regulatory' does not tell us precisely what is going on. This is because at any given moment, NSSI can serve to regulate emotions in many different ways. One key challenge is to clarify the precise functions NSSI may be serving for a given individual in a particular context.
Collapse
|
34
|
McMain S, Links PS, Guimond T, Wnuk S, Eynan R, Bergmans Y, Warwar S. An exploratory study of the relationship between changes in emotion and cognitive processes and treatment outcome in borderline personality disorder. Psychother Res 2013; 23:658-73. [DOI: 10.1080/10503307.2013.838653] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|