Abstract
BackgroundPatients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown.MethodsWe utilized an electrophysiological marker of interoception, i.e. heartbeat-evoked potentials (HEP), and examined its relationship with electrocardiographic correlates of autonomic nervous system (ANS) functioning (heart rate variability), and with self-report measures of alexithymia, dissociation and borderline symptom severity in patients with BPD.ResultsIndividuals with BPD had higher HEP amplitudes over frontal electrodes compared to healthy controls. Sympathetic ANS activity was greater in BPD patients than in controls. Across groups, HEP amplitudes were associated with parasympathetic activity over central electrodes and correlated with alexithymia over frontal electrodes.ConclusionsThese findings support the idea that difficulties in emotional awareness in BPD are reflected in altered frontal electrophysiological markers of interception. Therefore, emotional awareness can be understood as failures of modulation between interoceptive and exteroceptive attention. Future research may aim to investigate whether altered interoception and its electrophysiological correlates are malleable by therapeutic intervention.
Highlights
Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness, and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness
One promising approach to measure interoception has utilized heartbeat-evoked potentials (HEP) representing event-related potentials (ERPs) over scalp electrodes that are time-locked to the R-wave of the electrocardiogram (ECG)
The association of HEPs with awareness was reported to be more prominent over frontocentral electrodes compared to parietal brain regions [15, 18, 19] That is, cardiac afferent signals seem to be processed by frontocentral brain regions via feed-forward signals from the insular region, the anterior cingulate cortex and the somatosensory cortices [20,21,22]
Summary
Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown. The association of HEPs with awareness was reported to be more prominent over frontocentral electrodes compared to parietal brain regions [15, 18, 19] That is, cardiac afferent signals seem to be processed by frontocentral brain regions via feed-forward signals from the insular region, the anterior cingulate cortex and the somatosensory cortices [20,21,22]. In line with the SMH, interoception (and HEPs) has been linked to emotional awareness [11, 23,24,25,26,27] and to autonomic nervous system (ANS) functioning as revealed by heartrate variability [28, 29]
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