Abstract
Difficulty regulating emotion is a cardinal feature of borderline personality disorder (BPD), yet little is known about the automatic psychophysiological processes involved in this phenotype. Inconsistent findings have emerged from studies that employed limited assessments (e.g., heart rate variability, skin conductance) of autonomic nervous system response to emotional contexts, and compared groups based on the presence or absence of BPD as a categorical diagnosis. This exploratory study assessed a comprehensive set of autonomic nervous system processes in 44 individuals (22 with BPD) at rest, in response to emotionally evocative stimuli, and during a subsequent recovery period. BPD was characterized with a dimensional measure of BPD symptom severity, as a well by categorical diagnosis. At baseline and across experimental tasks, higher heart rate was observed in those diagnosed with BPD compared to controls, and in those expressing greater BPD symptom severity. These effects, however, were fully mediated by differences in physical exercise. In contrast, during recovery from emotional activation, greater symptom severity predicted consistently higher levels of multiple sympathetic and parasympathetic processes compared to lower symptom severity. Overall, these findings suggest that the heart rate elevations sometimes observed in those diagnosed with BPD may be associated with individual and group differences in levels of physical exercise. Results further indicate that adaptive psychophysiological recovery responses following emotional challenge may be disrupted in proportion to BPD symptom severity, independently of exercise. Results highlight the utility of considering lifestyle factors and symptom severity in studies of emotional activation and regulation processes in BPD.
Highlights
Borderline personality disorder (BPD) is characterized by intense and rapidly shifting emotional states, and difficulty regulating emotion [1,2,3]
The present investigation sought to inform future research aimed at better understanding the autonomic nervous system processes contributing to emotion activation and recovery in borderline personality disorder (BPD) by comprehensively assessing psychophysiology at rest, during emotional challenge, and during recovery, with special consideration given to the potential influence of BPD symptom severity and physical exercise
It is possible that previously observed differences in heart rate (HR) between those diagnosed with BPD and controls may have been a function of lifestylerelated behaviors such as exercise engagement, rather than an intrinsic disorder-related difference in resting state arousal
Summary
Borderline personality disorder (BPD) is characterized by intense and rapidly shifting emotional states, and difficulty regulating emotion [1,2,3]. The dynamic regulation of arterial tone in response to vascular tone baroreflex demand is necessary for appropriate hemodynamic perfusion of the brain and organs [68] These psychophysiological processes were assessed in three contexts to capture central autonomic activation across multiple states: at resting baseline while engaged in a standardized low cognitive demand task, during exposure to BPD-related emotional picture cues, and during a naturalistic post-perturbation recovery period. During the recovery period following emotional challenge, continuing higher levels of HR and SC were expected in the BPD group compared to controls, based on the pronounced and sustained negative emotional states that individuals with BPD are thought to experience after perturbation [e.g., [26, 27]] These hypotheses were examined dimensionally to determine whether heterogeneity in BPD symptom severity is related to psychophysiological regulation, regardless of participant’s diagnostic status. Examination of processes involved in neurocardiac feedback between the brain and body in the service of emotion responding such as baroreflex sensitivity, cardiodynamic measures, and arterial tone [5, 71], were exploratory as, to our knowledge, they have not been studied in relation to BPD
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