How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder?

Nadège Bourvis,David Cohen,Jean Xavier,Aveline Aouidad,Clémence Cabelguen

doi:10.3389/fpsyg.2017.02054

Abstract

Borderline personality disorder (BPD) is a severe and frequent disorder characterized by a pervasive pattern of instability affecting impulse control, emotional regulation, cognitive processing, self-image and interpersonal relationships. Patients’ personal histories are often marked by stressful or traumatic experiences, either unique or repeated. Moreover, while clinical signs of the disorder include both chronic and acute features, acute features are mostly triggered by acute stressful situations. Such features include transient cognitive distortion, intense anger, uncontrollable impulsivity, and self-harm behavior – including suicide – and contribute to the burden of the disease. In this paper, we review the various aspects (epidemiological, clinical, and physiological) contributing to the relationship between BDP and stress. In particular, we explore the statistical association between stress exposure and the emergence of BPD while taking into account other psychopathologies, such as post-traumatic stress disorder. Then, the different aspects of stress responses (namely, the phenomenological, behavioral, hormonal, neuro-vegetative and neural responses) are reviewed in BPD patients. Pathophysiological hypotheses are formulated to explain the differences in responses between BPD patients and healthy subjects and their relation to BPD symptoms. Although the pathogenesis remains uncertain, our conclusions seem to reflect a specific biological and neural pattern of altered stress perception and regulation in BPD.

Highlights

Borderline personality disorder (BPD) is a complex personality disorder which affects 2% of the adult general population
We propose a synthetic model of the response, introducing the possibility of two main profiles of acute stress response in BPD
Impulsivity is a core feature of BPD, and in contrast to other psychiatric conditions that are characterized by impulsivity, impulse control deficits in BPD occur under stressful conditions. This clinical observation was investigated experimentally in BPD, ADHD and controls (Krause-Utz et al, 2016) showing that (i) both patient groups reported higher impulsivity than controls, (ii) ADHD reported higher trait impulsivity than BPD, (iii) action-withholding deficits were significantly increased under stress compared to baseline in BPD but not in ADHD and controls, and (iv) under stress only, BPD performed significantly worse than controls in actionwithholding tasks, whereas ADHD always showed significant deficits. This experiment was conducted using a multicomponent stress task, and the results reveal the relative specificity of impulsivity states in BPD and in particular their causal and close temporal relationship to stressful situations

Summary

INTRODUCTION

Borderline personality disorder (BPD) is a complex personality disorder which affects 2% of the adult general population. Dialectical Behavioral Therapy, one of the most efficient therapy techniques in BPD (Linehan et al, 2015) has been shown to be more efficient on the ‘emotional regulation’ and ‘distress tolerance’ components than the ‘interpersonal relationships’ or ‘mindfulness parts’ (Neacsiu et al, 2014). To understand how stress and BDP relates, it is crucial to use an operational definition of stress This should take into account all possibilities from dramatic trauma to chronic neglect. Addressing the complex relations between stress and BPD is the opportunity to both tackle the issue of the etiology of the disorder, e.g., how does an early stressful environment leave its trace on the later psychological and physiological patterns of the individuals, and the issue of the treatment, e.g., how a better understanding of the process underlying the harmful. We propose a synthetic model of the response, introducing the possibility of two main profiles of acute stress response in BPD

MATERIALS AND METHODS

Findings

CONCLUSION