The Modulating Role of Self-Referential Stimuli and Processes in the Effect of Stress and Negative Emotion on Inhibition Processes in Borderline Personality Disorder: Proposition of a Model to Integrate the Self-Concept and Inhibition Processes.

Jean Gagnon,Joséphine Aldebert,Gasser Saleh,Wan Kim

doi:10.3390/brainsci9040077

Abstract

Impulsivity is an important clinical and diagnostic feature of borderline personality disorder (BPD). Even though it has been reported that BPD individuals’ inhibition performance is significantly reduced in the context of negative emotion or stress, this literature shows mixed results, raising questions about the possible role played by other factors. Winter (2016) proposed that negative emotion stimuli can be more disruptive for BPD individuals’ attention control performance because they induce higher distractibility self-referential processes. This article aimed to systematically review the literature regarding the effect of stress and negative emotions on three main inhibition processes—prepotent response inhibition, resistance to distractor interference, and resistance to proactive interference—in BPD and to verify the putative modulating role of self-referential stimuli and processes on these inhibition processes. All English and French experimental studies published until August 2018 were searched in PsychINFO and PubMED databases. The following keywords were used: “borderline* AND inhibit* OR interference* OR forget* OR task* AND emotion* OR stress* OR affect*”. A total of 1215 articles were included in the study. After full text revision, twenty-six papers were selected for review. The results of this review indicate that when stimuli or procedures involve self-reference stimuli or processes, BPD individuals’ performance seems to be more disrupted in all three inhibition processes. A model based on Winter’s and Kernberg’s models is proposed with the aim of integrating the self-concept with inhibition processes in BPD.

Highlights

In the last two decades, a growing interest has emerged in the use of behavioral tasks for studying the neuropsychological mechanisms associated with impulsive behaviors in order to clarify the nature of borderline personality disorder (BPD)’s impulsivity
Our literature review resulted in 26 studies that measured at least one of the inhibition processes among BPD participants in a negative emotional or stressful context
The second aim of our study was to verify if self-referential stimuli or processes were able to impact on BPD individuals’ inhibition performance during stress and negative emotional contexts or stimuli, and if this impact was similar across inhibition processes

Summary

Introduction

Impulsivity is a major diagnostic criterion and manifests itself in various high-risk behaviors, such as substance use, unprotected sex, reckless driving, temper outbursts, binge eating, and suicidal or self-damaging acts [1]. These behaviors have several consequences involving an undermining of their relationships, occupational functioning, and overall stability, but can lead to serious legal and health problems as well as a risk of death. The delay discounting principle refers to the fact that the value of a reward is discounted as a function of the delay before receiving it According to this principle, impulsive individuals prefer smaller immediate rewards over larger delayed rewards. Several studies have shown that BPD patients showed less advantageous choices on the Iowa Gambling task than did the healthy comparison subjects [7,8]

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