Exaggerated Affect-Modulated Startle During Unpleasant Stimuli in Borderline Personality Disorder

Department of Psychology, Eastern Washington University, Чини, Washington, United States
Biological Psychiatry (Impact Factor: 10.26). 09/2007; 62(3):250-5. DOI: 10.1016/j.biopsych.2006.10.028
Source: PubMed


Excessive emotional responding is considered to be a hallmark of borderline personality disorder (BPD). The affect-modulated startle response is a reliable indicator of emotional processing of stimuli. The aim of this study was to examine emotional processing in BPD patients (n = 27) and healthy control subjects (n = 21).
Participants viewed an intermixed series of unpleasant, borderline-salient (e.g., "hate"), and neutral (e.g., "view") words and were instructed to think about the meaning of the word for them personally while eyeblink responses were assessed.
The BPD patients exhibited larger startle eyeblink during unpleasant but not neutral words, indicating exaggerated physiological affect. This finding remained significant when we controlled for comorbid diagnoses, including generalized anxiety disorder and post-traumatic stress disorder. Greater symptom severity was associated with greater affective-startle difference scores (unpleasant-neutral).
Consistent with the symptom of affective dysregulation, these results suggest an abnormality in the processing of unpleasant emotional stimuli by BPD patients.

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Available from: Michael Minzenberg, Oct 05, 2015
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    • "In line with this, BPD patients, when compared with healthy controls, showed an enhanced reactivity of heart rate (Ebner- Priemer et al., 2007) and skin conductance (Barnow et al., 2012), more slow wave activity in resting electroencephalography (Snyder & Pitts, 1984), and augmented potentiation of the startle response (Ebner-Priemer et al., 2005; Hazlett et al., 2007). Compared with clinical controls, BPD patients demonstrated diminished P300 amplitude in a 2-tone discrimination task (Blackwood, St Clair, & Kutcher, 1986). "
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    ABSTRACT: This article proposes a multidimensional model of aggression in borderline personality disorder (BPD) from the perspective of the biobehavioral dimensions of affective dysregulation, impulsivity, threat hypersensitivity, and empathic functioning. It summarizes data from studies that investigated these biobehavioral dimensions using self-reports, behavioral tasks, neuroimaging, neurochemistry as well as psychophysiology, and identifies the following alterations: (a) affective dysregulation associated with prefrontal-limbic imbalance, enhanced heart rate reactivity, skin conductance, and startle response; (b) impulsivity also associated with prefrontal-limbic imbalance, central serotonergic dysfunction, more electroencephalographic slow wave activity, and reduced P300 amplitude in a 2-tone discrimination task; (c) threat hypersensitivity associated with enhanced perception of anger in ambiguous facial expressions, greater speed and number of reflexive eye movements to angry eyes (shown to be compensated by exogenous oxytocin), enhanced P100 amplitude in response to blends of happy versus angry facial expressions, and prefrontal-limbic imbalance; (d) reduced cognitive empathy associated with reduced activity in the superior temporal sulcus/gyrus and preliminary findings of lower oxytocinergic and higher vasopressinergic activity; and (e) reduced self-other differentiation associated with greater emotional simulation and hyperactivation of the somatosensory cortex. These biobehavioral dimensions can be nicely linked to conceptual terms of the alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model of BPD, and thus to a multidimensional rather than a traditional categorical approach. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 07/2015; 6(3):278-291. DOI:10.1037/per0000098 · 3.54 Impact Factor
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    • "The findings of some studies were dependent on the stimuli and revealed effects for BPD-specific stimuli but not for neutral stimuli (Hazlett et al., 2007; Limberg, Barnow, Freyberger, & Hamm, 2011) or effects of specific emotions such as fear but not anger (Minzenberg, Fan, New, Tang, & Siever, 2007). Additionally, a dissociation between physiological measures and subjective reports has been reported (Hazlett et al., 2007; Herpertz et al., 2001; Koenigsberg et al., 2009; Limberg et al., 2011). The findings of psychophysiological studies that have used standardized film clips are also mixed; some of these studies have reported higher baseline values and unchanged reactivity (Kuo & Linehan, 2009), whereas other studies have reported the opposite pattern (Austin, Riniolo, & Porges, 2007). "
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    ABSTRACT: Although emotion dysregulation has consistently been conceptualized as a core problem of borderline personality disorder (BPD), a comprehensive, and empirically and ecologically validated model that captures the exact types of dysregulation remains absent. In the present article, we combine insights from basic affective science and the biosocial theory of BPD to present a theoretical model that captures the most fundamental affective dynamical processes that underlie BPD and stipulates that individuals with BPD are characterized by more negative affective homebases, higher levels of affective variability, and lower levels of attractor strength or return to baseline. Next, we empirically validate this proposal by statistically modeling data from three electronic diary studies on emotional responses to personally relevant stimuli in personally relevant environments that were collected both from patients with BPD (N = 50, 42, and 43) and from healthy subjects (N = 50, 24, and 28). The results regarding negative affective homebases and heightened affective variabilities consistently confirmed our hypotheses across all three datasets. The findings regarding attractor strengths (i.e., return to baseline) were less consistent and of smaller magnitude. The transdiagnostic nature of our approach may help to elucidate the common and distinctive mechanisms that underlie several different disorders that are characterized by affective dysregulation. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Abnormal Psychology 01/2015; 124(1). DOI:10.1037/abn0000021 · 4.86 Impact Factor
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    • "Additionally, our emotional task was a " passive viewing task " which means that we did not examine " active " emotion regulation, per se which might be considered a study limitation by some. However, given our prior work indicating that BPD patients evince a mismatch between their psychophysiological and self-report measures of emotion/valence (Hazlett et al., 2007, 2012), it could be argued that asking BPD participants whether they successfully regulated their emotions (i.e. using self-report) during a task involves a participant bias or demand characteristic which is a confound. Nevertheless, additional research is needed given recent research showing skill acquisition is critical to DBT treatment efficacy . "
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    ABSTRACT: Objective: Siever and Davis' (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods: Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results: fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion: These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity-part of the disturbed neural circuitry underlying emotional dysregulation in BPD. Future work includes examining how DBT-induced amygdala changes interact with frontal-lobe regions implicated in emotion regulation.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.020 · 3.96 Impact Factor
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