Abstract
BackgroundPrevious eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD). From an etiological point of view, such interpersonal threat hypersensitivity might be explained by a biological vulnerability along with a history of early life adversities. The objective of the current study was to investigate interpersonal threat hypersensitivity and its association with adverse childhood experiences (ACE) in patients with BPD employing eye-tracking technology.MethodsWe examined a sample of 46 unmedicated, adult female patients with BPD and 25 healthy female volunteers, matched on age and intelligence, with a well-established emotion classification paradigm with angry, fearful, happy, and neutral facial expressions. ACE were assessed retrospectively with the Childhood Trauma Questionnaire.ResultsPatients as compared to healthy volunteers reflexively directed their gaze more quickly towards the eyes of emotional and neutral faces and did not adapt their fixation patterns according to the facial expression presented. Misclassifying emotional and neutral faces as angry correlated positively with the patients’ self-reported ACE.ConclusionsBuilding on and extending earlier findings, our results are likely to suggest a visual hypervigilance towards the eyes of emotional and neutral facial expressions and a childhood trauma-related anger bias in patients with BPD. Given the lack of a clinical control group, the question whether these findings are specific for BPD has to remain open. Thus, further research is needed to elucidate the specificity of altered visual attention allocation and the role of ACE in anger recognition in patients with BPD.
Highlights
Previous eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD)
Hypothesis 1 To test our first hypothesis, proposing that patients with BPD would misclassify facial expressions more often as angry compared to healthy volunteers, we analyzed proportion of correct responses and types of errors
Healthy volunteers were significantly more accurate in classifying happy compared to fearful faces (p < .01) as well as neutral compared to angry (p < .01) and fearful faces (p < .01), while this was not shown for patients with BPD
Summary
Previous eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD). The objective of the current study was to investigate interpersonal threat hypersensitivity and its association with adverse childhood experiences (ACE) in patients with BPD employing eye-tracking technology. Adverse childhood experiences (ACE) are seen as playing a significant role in the etiology of interpersonal threat hypersensitivity in BPD. Following Linehan’s biosocial model [22], interpersonal threat hypersensitivity in BPD may emerge from an interplay between biological vulnerabilities and the exposure to such traumatic childhood experiences [1]. Studies suggest that the more patients with BPD report ACE, the more they show a tendency to judge faces as less approachable [23], a heightened vigilance [24], and avoidant reactions towards angry faces [25], but the evidence remains somewhat inconclusive (cf [17, 26])
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