Cortical Representation of Afferent Bodily Signals in Borderline Personality Disorder: Neural Correlates and Relationship to Emotional Dysregulation
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IMPORTANCE: The ability to perceive and regulate one's own emotions has been tightly linked to the processing of afferent bodily signals (interoception). Thus, disturbed interoception might contribute to the core feature of emotional dysregulation in borderline personality disorder (BPD), as increased levels of depersonalization, body image disturbances, and reduced sensitivity to physical pain suggest poor body awareness in BPD. OBJECTIVE: To determine neural correlates of disturbed body awareness in BPD and its associations with emotional dysregulation and to explore improvements in body awareness with BPD symptom remission. DESIGN, SETTING, AND PARTICIPANTS: Case-control study performed at Heidelberg University Hospital, Heidelberg, Germany. Heartbeat evoked potentials (HEPs), an indicator of the cortical representation of afferent signals from the cardiovascular system, were investigated in 34 medication-free patients with BPD, 31 healthy volunteers, and 17 medication-free patients with BPD in remission. The HEPs were assessed using 5-minute resting-state electroencephalograms and parallel electrocardiograms. Core BPD symptoms, history of childhood traumatization, and psychiatric disorders were assessed by means of self-reports and structured interviews. To measure neural correlates of disturbed body awareness, high-resolution T1-weighted structural magnetic resonance imaging scans were collected and analyzed using voxel-based morphometry and region-of-interest-based approaches. The study was performed between 2012 and 2014, and data analysis was performed in 2014. MAIN OUTCOMES AND MEASURES: Mean HEP amplitudes in resting-state electroencephalograms and their correlation with self-reported emotional dysregulation, as well as with gray matter volume. RESULTS: Patients with BPD had significantly reduced mean HEP amplitudes compared with healthy volunteers (F1,61 = 11.32, P = .001), whereas the mean HEP amplitudes of patients with BDP in remission lie somewhere in between these 2 groups of participants (P > .05). The HEP amplitudes were negatively correlated with emotional dysregulation (R = -0.30, P = .01) and positively associated with gray matter volume in the left anterior insula (R = 0.53, P < .05) and the bilateral dorsal anterior cingulate cortex (R = 0.47, P < .05), 2 structures that have been identified as core regions for interoception. CONCLUSIONS AND RELEVANCE: The results indicate state-dependent deficits in the cortical processing of bodily signals in patients with BPD, which appear to be associated with core features of BPD. The analysis of patients with BPD in remission suggests an improvement in cortical representation of bodily signals with symptom remission. Results recommend the integration of techniques to strengthen bodily awareness in psychotherapeutic interventions of BPD.
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Reduced amplitudes of heart evoked potential (HEP) were revealed in patients with bipolar personality disorder.
“For instance, reduced amplitudes of heart evoked potential (HEP), an indicator of cortical processing of afferent bodily signals, were revealed in patients with bipolar personality disorder [50], while a reduced IAc was reported in anorexia nervosa patients [52].”
From Interoceptive Ability and Emotion Regulation in Mind–Body Interventions: An Integrative Review (2024) · cites this paper as [50]
The HEPs and BPD Symptomatology section reports significantly reduced mean HEP amplitudes compared with healthy volunteers. But the patients had borderline personality disorder (BPD), not the “bipolar personality disorder” named in the claim. The Conclusions also describe HEP amplitude as an indicator of cortical representation of bodily signals. (LLM, conf=0.88)
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Interoception primes emotional processing: multimodal evidence from neurodegeneration
Salamone, P. C., Legaz, A., Sedeño, L., Moguilner, S., Fraile-Vazquez, M., Campo, C. G., Fittipaldi, S., Yoris, A., Miranda, M., Birba, A., et al. (2021) · The Journal of Neuroscience · doi:10.1523/jneurosci.2578-20.2021 · Cited by 103 · see citing works
Sel, A., Azevedo, R. T., & Tsakiris, M. (2016) · Cerebral Cortex · doi:10.1093/cercor/bhw296 · Cited by 111 · see citing works
“…of HEPs has been consistently associated to the representation of the bodily aspects of emotional processing (Fukushima et al. 2011; Couto et al. 2014; Luft and Bhattacharya 2015; Müller et al. 2015) and self-processing (Pollatos and Schandry 2004; Canales-Johnson et al. 2015; Schulz et al. 2015).”
BackgroundVicario, C. M., Rafal, R. D., Martino, D., & Avenanti, A. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.05.008 · Cited by 103 · see citing works
I keep a close watch on this heart of mine: increased interoception in insomnia
Wei, Y., Ramautar, J. R., Colombo, M. A., Stoffers, D., Gómez-Herrero, G., van der Meijden, W. P., te Lindert, B. H. W., van der Werf, Y. D., & Van Someren, E. J. W. (2016) · Sleep · doi:10.5665/sleep.6308 · Cited by 90 · see citing works
Molavi, P., Aziziaram, S., Basharpoor, S., Atadokht, A., Nitsche, M. A., & Salehinejad, M. A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.007 · Cited by 95 · see citing works
Pang, J., Tang, X., Li, H., Hu, Q., Cui, H., Zhang, L., Li, W., Zhu, Z., Wang, J., & Li, C. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00616 · Cited by 85 · see citing works
“The HEP can be detected without direct attention or perception to the heartbeat, for example, in the resting state (22, 28, 29), during sleep (30), or when people are focused on external information (20, 31, 32), making it a valuable objective quantitative assessment tool to investigate interoception.”
Childhood Trauma Affects Stress-Related Interoceptive Accuracy
Schaan, V. K., Schulz, A., Rubel, J. A., Bernstein, M., Domes, G., Schächinger, H., & Vögele, C. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00750 · Cited by 79 · see citing works
“In line with this interpretation, reduced HEPs have been observed in individuals with borderline personality disorder (57), a disorder known to be highly associated with the experiences of traumatic events (58–60).”
BackgroundSelf-citationThe Neurobiology of Borderline Personality Disorder
Pérez-Rodríguez, M. M., Bulbena‐Cabré, A., Nia, A. B., Zipursky, G., Goodman, M. S., & New, A. S. (2018) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2018.07.012 · Cited by 79 · see citing works
Altered neural signatures of interoception in multiple sclerosis
Salamone, P., Esteves, S., Sinay, V. J., Cordero, I. R. G., Abrevaya, S., Couto, B., Adolfi, F., Martorell, M., Petroni, A., Yoris, A., et al. (2018) · Human Brain Mapping · doi:10.1002/hbm.24319 · Cited by 72 · see citing works
“Thus, following previous studies (Muller et al., 2015; Schulz et al., 2015), we focused our main analysis on HEP modulations, which provide critical information about the temporal dynamics of interoception.”
BackgroundMethodResultInfluentialAllostatic interoceptive overload in frontotemporal dementia
Birba, A., Santamaría-García, H., Prado, P., Cruzat, J., Ballesteros, A. S., Legaz, A., Fittipaldi, S., Duran-Aniotz, C., Slachevsky, A., Santibañez, R., et al. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2022.02.955 · Cited by 70 · see citing works
Yoris, A., Abrevaya, S., Esteves, S., Salamone, P., Lori, N., Martorell, M., Legaz, A., Alifano, F., Petroni, A., Sánchez, R., et al. (2018) · Human Brain Mapping · doi:10.1002/hbm.23933 · Cited by 66 · see citing works
“While similar deficits have been reported in psychiatric (Dunn et al., 2007; Khalsa et al., 2015; Muller et al., 2015; Yoris et al., 2015, 2017) and neurological (García-Cordero et al., 2016; Khalsa et al., 2009a; Ricciardi et al., 2016a,b; Terhaar et al., 2012) disorders (for a review, see Yoris…”
BackgroundInfluentialEnhanced cortical processing of cardio-afferent signals in anorexia nervosa
Lutz, A., Schulz, A., Voderholzer, U., Koch, S., Dyck, Z. V., & Vögele, C. (2019) · Clinical Neurophysiology · doi:10.1016/j.clinph.2019.06.009 · Cited by 69 · see citing works
“Mean HEP amplitudes were exported for a time window of 455 to 595 ms after the R-peak of the ECG to minimize effects of the cardiac field artifact (Gray et al., 2007; Schulz et al., 2013, 2015a, 2015b; Müller et al., 2015).”
BackgroundMethodSelf-citationInteroceptive Mechanisms and Emotional Processing
Greenwood, B. M., & Garfinkel, S. N. (2024) · Annual Review of Psychology · doi:10.1146/annurev-psych-020924-125202 · Cited by 74 · see citing works
Meyer, P.-W., Müller, L. E., Zastrow, A., Schmidinger, I., Bohus, M., Herpertz, S. C., & Bertsch, K. (2016) · Journal of Neural Transmission · doi:10.1007/s00702-016-1584-8 · Cited by 64 · see citing works
“The samples of patients with the current BPD, remitted BPD, and healthy volunteers partly overlap with those presented in Müller et al. (2015), where differences in resting-state electroencephalographic and structural magnetic resonance tomography data are presented.”
ResultSelf-citationLöffler, A., Foell, J., & Bekrater‐Bodmann, R. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0890-2 · Cited by 63 · see citing works
Does stroke volume influence heartbeat evoked responses?
Buot, A., Azzalini, D., Chaumon, M., & Tallon-Baudry, C. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108165 · Cited by 46 · see citing works
Doering, S. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000724 · Cited by 55 · see citing works
“A recent study gave hints on a cortical malfunction of the processing of bodily signals in BPD (97) patients that might foster the”
BackgroundFlasbeck, V., Popkirov, S., Ebert, A., & Brüne, M. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-020-00139-1 · Cited by 54 · see citing works
“somatosensory cortex, ACC and insula in the cortical representation of cardiovascular signals [15, 18, 26, 35, 67].”
BackgroundMethodResultInfluentialThe impact of traumatic childhood experiences on interoception: disregarding one’s own body
Schmitz, M., Back, S. N., Seitz, K. I., Harbrecht, N. K., Streckert, L., Schulz, A., Herpertz, S. C., & Bertsch, K. (2023) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-023-00212-5 · Cited by 58 · see citing works
Self-citationPatron, E., Mennella, R., Benvenuti, S. M., & Thayer, J. F. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2018.12.035 · Cited by 47 · see citing works
Meulemeester, C. D., Lowyck, B., & Luyten, P. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.04.022 · Cited by 52 · see citing works
Baranauskas, M., Grabauskaitė, A., & Griškova-Bulanova, I. (2017) · Physiology & Behavior · doi:10.1016/j.physbeh.2017.07.032 · Cited by 46 · see citing works
“[29] showed that more positive HEP amplitudes at”
InfluentialBailliard, A., & Whigham, S. C. (2017) · American Journal of Occupational Therapy · doi:10.5014/ajot.2017.024497 · Cited by 45 · see citing works
Interoceptive Ability and Emotion Regulation in Mind–Body Interventions: An Integrative Review
Lazzarelli, A., Scafuto, F., Crescentini, C., Matiz, A., Orrù, G., Ciacchini, R., Alfì, G., Gemignani, A., & Conversano, C. (2024) · Behavioral Sciences · doi:10.3390/bs14111107 · Cited by 49 · see citing works
The relationship between social anxiety and heartbeat evoked potential amplitude
Judah, M. R., Shurkova, E. Y., Hager, N., White, E. J., Taylor, D. L., & Grant, D. M. (2018) · Biological Psychology · doi:10.1016/j.biopsycho.2018.09.013 · Cited by 43 · see citing works
Kritzman, L., Eidelman-Rothman, M., Keil, A., Freche, D., Sheppes, G., & Levit‐Binnun, N. (2022) · NeuroImage · doi:10.1016/j.neuroimage.2022.119133 · Cited by 40 · see citing works
“the augmented representation of cardiac activity in the brain (Müller et al., 2015), when attending the heart (Petzschner et al.”
Herpertz, S., Schneider, I., Schmahl, C., & Bertsch, K. (2018) · Psychopathology · doi:10.1159/000488357 · Cited by 46 · see citing works
Self-citationInteroception, Stress, and Physical Symptoms in Stress-Associated Diseases
Schulz, A., Schultchen, D., & Vögele, C. (2020) · European Journal of Health Psychology · doi:10.1027/2512-8442/a000063 · Cited by 40 · see citing works
Self-citationSchmitz, M., Müller, L. E., Schulz, A., Kleindienst, N., Herpertz, S. C., & Bertsch, K. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.139 · Cited by 37 · see citing works
Self-citationKojori, E. S., Tomasi, D. G., & Volkow, N. D. (2018) · Cerebral Cortex · doi:10.1093/cercor/bhy144 · Cited by 37 · see citing works
“2017), and that lower heartbeat-evoked potentials were associated with worse emotional outcomes and personality disorders (Müller et al. 2015), we predicted that higher temporal synchrony in the amplitude fluctuations of pulse and brain resting-state networks (RSNs) would be related to more positive ratings on emotion…”
BackgroundLate heartbeat-evoked potentials are associated with survival after cardiac arrest
Schulz, A., Stammet, P., Dierolf, A. M., Vögele, C., Beyenburg, S., Werer, C., & Devaux, Y. (2018) · Resuscitation · doi:10.1016/j.resuscitation.2018.02.009 · Cited by 32 · see citing works
Dynamic neurocognitive changes in interoception after heart transplant
Salamone, P., Sedeño, L., Legaz, A., Bekinschtein, T. A., Martorell, M., Adolfi, F., Fraile-Vazquez, M., Arriagada, N. R., Favaloro, L. E., Peradejordi, M. A., et al. (2020) · Brain Communications · doi:10.1093/braincomms/fcaa095 · Cited by 34 · see citing works
Schnell, K., & Herpertz, S. (2018) · Journal of Personality Disorders · doi:10.1521/pedi.2018.32.supp.12 · Cited by 32 · see citing works
Self-citationAmbrosini, E., Finotti, G., Azevedo, R. T., Manos Tsakiris, A., & Ferri, F. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.03.006 · Cited by 30 · see citing works
Schulz, A., Rost, S., Flasinski, T., Dierolf, A. M., Lutz, A., Münch, E. E., Mertens, V., Witthöft, M., & Vögele, C. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110223 · Cited by 30 · see citing works
Self-citationNeural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy–A Review
Iskric, A., & Barkley-Levenson, E. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.772081 · Cited by 25 · see citing works
Schulz, A., Vögele, C., Bertsch, K., Bernard, S., Münch, E. E., Hansen, G., Naumann, E., & Schächinger, H. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.08.005 · Cited by 25 · see citing works
Self-citationTaking charge of one's feelings: Sense of power and affect regulation
Leach, S., & Weick, M. (2020) · Personality and Individual Differences · doi:10.1016/j.paid.2020.109958 · Cited by 28 · see citing works
Neurobiology of Criterion A: self and interpersonal personality functioning
Herpertz, S. C., Bertsch, K., & Jeung, H. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.08.032 · Cited by 28 · see citing works
Self-citationBack, S. N., & Bertsch, K. (2020) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-020-00217-2 · Cited by 27 · see citing works
Self-citationXi, C., Liu, Z., Yang, J., Zhang, W., Deng, M., Pan, Y., Cheng, Y., & Pu, W. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.04.033 · Cited by 26 · see citing works
Heartbeat Induces a Cortical Theta-Synchronized Network in the Resting State
Kim, J., & Jeong, B. (2019) · eNeuro · doi:10.1523/eneuro.0200-19.2019 · Cited by 26 · see citing works
“Finally, cardiac interoceptive processing has been suggested to be closely related to an affective state of an individual (Terhaar et al., 2012; Müller et al., 2015).”
Bekrater‐Bodmann, R., Azevedo, R. T., Ainley, V., & Manos Tsakiris, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.562016 · Cited by 25 · see citing works
Schmitz, M., Bertsch, K., Löffler, A., Steinmann, S., Herpertz, S. C., & Bekrater‐Bodmann, R. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00157-7 · Cited by 24 · see citing works
“The convergence between objective performance in interoceptive tasks and higher-order representations of one’s own interoceptive abilities [66] could be used as more objective indicators of body connection and help to shed light on the inconsistent effects of previous studies [19, 67].”
BackgroundSelf-citationInduced illusory body ownership in borderline personality disorder
Neustadter, E. S., Fineberg, S. K., Leavitt, J., Carr, M. M., & Corlett, P. R. (2019) · Neuroscience of Consciousness · doi:10.1093/nc/niz017 · Cited by 24 · see citing works
“Importantly, the ACC and the insular cortex have been identified as central structures for interoception (Müller et al. 2015).”
BackgroundSchneider, I., Bertsch, K., Hidalgo, N. A. I., Müller, L. E., Schmahl, C. G., & Herpertz, S. C. (2017) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-017-0841-7 · Cited by 23 · see citing works
“[11], who analyzed the cortical processing of afferent signals using heartbeat evoked potentials (HEPs) and its association with emotional dysregulation.”
Self-citationSchmitz, M., Müller, L. E., Seitz, K. I., Schulz, A., Steinmann, S., Herpertz, S. C., & Bertsch, K. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1987686 · Cited by 22 · see citing works
“Whereas statistical power was adequate for detecting medium group differences and medium-sized correlations in the two samples, the obtained group difference between PTSD and HC for mean HEP amplitudes was smaller than expected on the basis of previously reported medium effect sizes in similar studies with clinical an…”
BackgroundResultInfluentialSelf-citationModulation of heartbeat-evoked potential and cardiac cycle effect by auditory stimuli
Tanaka, Y., Ito, Y., Terasawa, Y., & Umeda, S. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108637 · Cited by 25 · see citing works
Kim, J., Park, H.-D., Kim, K. W., Shin, D. W., Lim, S., Kwon, H., Kim, M.-Y., Kim, K., & Jeong, B. (2019) · Scientific Reports · doi:10.1038/s41598-018-36498-7 · Cited by 22 · see citing works
Bourvis, N., Aouidad, A., Spodenkiewicz, M., Palestra, G., Aigrain, J., Baptista, A., Benoliel, J. J., Chétouani, M., & Cohen, D. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110095 · Cited by 22 · see citing works
“evoked potentials at the neurophysiological level in BPD patients, indicating an alteration of interoceptive processing (Müller et al., 2015).”
BackgroundWhole‐brain microstructural white matter alterations in borderline personality disorder patients
Quattrini, G., Marizzoni, M., Magni, L. R., Magnaldi, S., Lanfredi, M., Rossi, G., Frisoni, G. B., Pievani, M., & Rossi, R. (2019) · Personality and Mental Health · doi:10.1002/pmh.1441 · Cited by 21 · see citing works
Psychological stress, the central nervous system and arrhythmias
Lambiase, P. D., Garfinkel, S. N., & Taggart, P. I. (2023) · QJM · doi:10.1093/qjmed/hcad144 · Cited by 24 · see citing works
“8 High-resolution functional neuroimaging combined with physiological recordings during emotional processing reveals the central representation of cardiac signal in the posterior insula.”
BackgroundKamp, S., Schulz, A., Forester, G., & Domes, G. (2021) · Brain Research · doi:10.1016/j.brainres.2020.147238 · Cited by 20 · see citing works
Self-citationInteroception Dysfunction Contributes to the Negative Emotional Bias in Major Depressive Disorder
Zhou, H., Zou, H., Dai, Z., Zhao, S., Hua, L., Xia, Y., Han, Y., Yan, R., Tang, H., Huang, Y., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.874859 · Cited by 20 · see citing works
Schulz, A., Dierolf, A. M., Lutz, A., Voderholzer, U., Koch, S., Bach, M., Asenstorfer, C., Michaux, G., Mertens, V., & Vögele, C. (2022) · Psychiatry Research Communications · doi:10.1016/j.psycom.2022.100052 · Cited by 20 · see citing works
Self-citationFlasbeck, V., Jungilligens, J., Lemke, I., Beckers, J., Öztürk, H., Wellmer, J., Seliger, C., Juckel, G., & Popkirov, S. (2024) · BMJ Neurology Open · doi:10.1136/bmjno-2024-000665 · Cited by 20 · see citing works
“26 Specifically, in a region- of-interest analysis, positive correlations were found between the HEP amplitude and the left anterior insula and bilateral dorsal anterior cingulate cortex.”
BackgroundInteroception and pain: body–mind integration, rupture, and repair
Garfinkel, S. N., & Eccleston, C. (2025) · Pain · doi:10.1097/j.pain.0000000000003515 · Cited by 21 · see citing works
“37 Thus, markers of body-brain integration, such as the heartbeat-evoked potential, can offer dispositional insights into the nature (and efficiency) of how the brain processes interoceptive signals, with implications for the regulation of internal states.”
Heartbeat evoked potentials (HEP) capture brain activity affecting subsequent heartbeat
Baranauskas, M., Grabauskaitė, A., Griškova-Bulanova, I., Lataitytė-Šimkevičienė, B., & Stanikūnas, R. (2021) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2021.102731 · Cited by 18 · see citing works
Vicario, C. M., Kuran, K. A., & Urgesi, C. (2019) · Psychological Research · doi:10.1007/s00426-017-0934-y · Cited by 17 · see citing works
“This is true for Parkinson’s disease (Ricciardi et al., 2016), Schizophrenia (Ardizzi et al., 2016), Borderline Personality Disorders (Müller et al., 2015), and Depression (Simmons et al., 2016).”
BackgroundAllostatic-interoceptive anticipation of social rejection
Migeot, J., Hesse, E., Fittipaldi, S., Mejía, J., Fraile, M., García, A. M., García, M. D. C., Ortega, R., Lawlor, B., Lopez, V., et al. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.120200 · Cited by 15 · see citing works
“Because HEP is a negative deflection mainly reflected in central and frontal electrodes around 200-600 ms post R waveform onset (peak) (Garcia-Cordero et al., 2016; Muller et al., 2015; Pollatos et al., 2016; Pollatos and Schandry, 2004), we assessed modulations in frontocentral electrodes (26 electrodes: Fp1, AF7, AF…”
MethodBilleci, L., Faraguna, U., Santarcangelo, E. L., D’Ascanio, P., Varanini, M., & Sebastiani, L. (2021) · Brain Sciences · doi:10.3390/brainsci11081089 · Cited by 15 · see citing works
“This is the first report of association between HEP amplitude during sleep and interoceptive sensitivity, which had been already observed during wakefulness in resting [11] and task conditions [27,85–87].”
BackgroundThe Heart, the Brain, and the Regulation of Emotion
Garfinkel, S. N., Eccles, J., & Critchley, H. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.1493 · Cited by 16 · see citing works
Sleep-Dependent Directional Interactions of the Central Nervous System-Cardiorespiratory Network
Yang, J., Pan, Y., Wang, T., Zhang, X., Wen, J., & Luo, Y. (2020) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2020.3009950 · Cited by 15 · see citing works
Aberrant heartbeat-evoked potential in schizophrenia
Koreki, A., Ogyu, K., Miyazaki, T., Takenouchi, K., Matsushita, K., Honda, S., Koizumi, T., Onaya, M., Uchida, H., Mimura, M., et al. (2024) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2024.110969 · Cited by 16 · see citing works
The Self–Other Distinction in Psychopathology: Recent Developments from a Mentalizing Perspective
Luyten, P., Meulemeester, C. D., & Fonagy, P. (2021) · Springer eBooks · doi:10.1007/978-3-030-51890-5_34 · Cited by 16 · see citing works
Computational Psychiatry in Borderline Personality Disorder
Fineberg, S. K., Stahl, D. S., & Corlett, P. R. (2017) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-017-0104-y · Cited by 14 · see citing works
“Reference 68 (Muller et al. 2015): The researchers examined the neural signal (in EEG) that reports on individuals’ heartbeats.”
Exploring the role of interoception in autobiographical memory recollection
Messina, A., Basilico, S., Bottini, G., & Salvato, G. (2022) · Consciousness and Cognition · doi:10.1016/j.concog.2022.103358 · Cited by 13 · see citing works
Mapping human brain topography to heart rhythms: an SEEG study
Wang, X., Yang, H., Cheng, Y., Liu, S., Jin, G., Qiao, Z., Qi, L., Wang, S., Ge, J., Hu, D., et al. (2025) · Cardiovascular Research · doi:10.1093/cvr/cvaf099 · Cited by 12 · see citing works
Timing of Modulation of Corticospinal Excitability by Heartbeat Differs with Interoceptive Accuracy
Otsuru, N., Miyaguchi, S., Kojima, S., Yamashiro, K., Sato, D., Yokota, H., Saito, K., Inukai, Y., & Onishi, H. (2020) · Neuroscience · doi:10.1016/j.neuroscience.2020.03.014 · Cited by 11 · see citing works
Dissociative Symptoms and Interoceptive Integration
Woelk, S. P., & Garfinkel, S. N. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_480 · Cited by 11 · see citing works
Heartbeat evoked potentials reflect interoceptive awareness during an emotional situation
Tanaka, Y., Ito, Y., Shibata, M., Terasawa, Y., & Umeda, S. (2025) · Scientific Reports · doi:10.1038/s41598-025-92854-4 · Cited by 12 · see citing works
Baptista, A., Cohen, D., Jacquet, P. O., & Chambon, V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.707091 · Cited by 11 · see citing works
“…of interoception in BPD: one study found that interoceptive performance was not altered in BPD (47), while another provided neurophysiological evidence of a deficit in cortical representation of interoceptive afferences (i.e., heartbeat-evoked potentials) in BPD (48) [see (46) for a review].”
The Neurophysiology of Interoceptive Disruptions in Trauma-Exposed Populations
Fani, N., Fulton, T. M., & Botzanowski, B. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_469 · Cited by 11 · see citing works
Alterations of Heartbeat Evoked Magnetic Fields Induced by Sounds of Disgust
Kato, Y., Takei, Y., Umeda, S., Mimura, M., & Fukuda, M. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00683 · Cited by 10 · see citing works
“org 2 including depression (41), depersonalization (42), and borderline personality disorder (43).”
BackgroundColl, M., Hobson, H., & Murphy, J. (2020) · doi:10.31234/osf.io/g2zhc · Cited by 10 · see citing works
Elevated EEG heartbeat-evoked potentials in adolescents with more ADHD symptoms
Rapp, L., Mai‐Lippold, S. A., Georgiou, E., & Pollatos, O. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108698 · Cited by 9 · see citing works
Interoception and Mental Health
Khalsa, S. S., & Verdonk, C. (2024) · Springer eBooks · doi:10.1007/978-3-031-68521-7_9 · Cited by 9 · see citing works
Zhou, H., Xiong, T., Dai, Z., Zou, H., Wang, X., Tang, H., Huang, Y., Sun, H., You, W., Yao, Z., et al. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01628-4 · Cited by 9 · see citing works
“…heart is involved in higher-order cognitive processes, and disturbances in brain–heart interactions are related to cognitive and affective dysfunction found in many mental disorders, such as anxiety disorder [37], nightmare disorder [58], borderline personality disorder [39] and depression [59].”
Mai‐Lippold, S. A., Dettlinger, C. M., Khalsa, S. S., & Pollatos, O. (2020) · European Journal of Health Psychology · doi:10.1027/2512-8442/a000061 · Cited by 9 · see citing works
Bertsch, K., & Herpertz, S. C. (2021) · Der Nervenarzt · doi:10.1007/s00115-021-01133-w · Cited by 8 · see citing works
Self-citationCoates, D., Lewis, S. P., & Burge-Ferrow, G. (2025) · Psychotherapy and Counselling Journal of Australia · doi:10.59158/001c.146359 · Cited by 7 · see citing works
Steinfath, T. P., Azanova, M., Kapralov, N., Loesche, T., Enk, L., Nikulin, V. V., & Villringer, A. (2026) · Psychophysiology · doi:10.1111/psyp.70297 · Cited by 6 · see citing works
“Another common strategy is to choose a time window of approximately 455-595 ms post-R-peak (Gray et al., 2007; Lutz et al., 2019; Müller et al., 2015; Rapp et al., 2023; Schmitz et al., 2020, 2021; Schulz et al., 2013), following Dirlich et al. (1997), who demonstrated the minimal influence of the…”
My body, your emotions: Viscerosomatic modulation of facial expression discrimination
Chick, C. F., Rounds, J. D., Hill, A. B., & Anderson, A. K. (2020) · Biological Psychology · doi:10.1016/j.biopsycho.2019.107779 · Cited by 6 · see citing works
Impaired interoception in Colombian victims of armed conflict with PTSD: a preliminary HEP study
Herrera, E., Gutiérrez-Sterling, D., Barrera-Ocampo, A. A., Jaramillo, J. O., Santamaría‐García, H. A., & Birba, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1567574 · Cited by 5 · see citing works
Changes in heartbeat-evoked potentials reflect changes in blood pressure
Plantard, A., Séry, R., Pichot, V., & Chouchou, F. (2025) · Journal of Neurophysiology · doi:10.1152/jn.00118.2025 · Cited by 5 · see citing works
Cognitive Processes Supporting Interoception and the Influence of Activation States
Schulz, A., & Vögele, C. (2024) · Springer eBooks · doi:10.1007/978-3-031-68521-7_7 · Cited by 6 · see citing works
Self-citationBrain State Relays Self-Processing and Heartbeat-Evoked Cortical Responses
Huang, Y., Xie, M., Liu, Y., Zhang, X., Jiang, L., Bao, H., Qin, P., & Han, J. (2023) · Brain Sciences · doi:10.3390/brainsci13050832 · Cited by 5 · see citing works
“For patients with BPD, mean HEP amplitude between 455 and 595 ms was found to be negatively correlated with emotional dysregulation (Pearsons r = − 0.30) [56].”
BackgroundInfluentialUnderstanding Anxiety in Borderline Personality Disorder
Bulbena-Cabré, A., Pérez-Rodríguez, M., Porges, S., Bulbena, A., & Goodman, M. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0122-0 · Cited by 5 · see citing works
Interoceptive Approaches to Embodiment Research
Schulz, A., & Vögele, C. (2021) · Springer eBooks · doi:10.1007/978-3-030-78471-3_4 · Cited by 5 · see citing works
Self-citation
- Authors
- Müller, L. E., Schulz, A., Andermann, M., Gäbel, A., Gescher, D. M., Spohn, A., Herpertz, S. C., & Bertsch, K.
- Affiliations
- Heidelberg University (DE)
- University of Luxembourg (LU)
- Corresponding author
- Bertsch, Katja
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2015-11-01
- Volume
- 72
- Issue
- 11
- Pages
- 1077
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2096930850
- Cited by
- 141
- References
- 84
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 12 · 2023: 7 · 2022: 7 · 2021: 18 · 2020: 18 · 2019: 12 · 2018: 13 · 2017: 15 · 2016: 6 · 2015: 1
- FWCI
- 14.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Open Repository and Bibliography (University of Luxembourg) (submittedVersion, cc-by-nc-sa)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- borderline personality disorder, interoception, body awareness, emotional dysregulation, heartbeat-evoked potentials, heart rate variability, anterior insula, dorsal anterior cingulate cortex, gray matter volume, symptom remission, childhood trauma, resting-state EEG, body image disturbance, depersonalization, pain sensitivity, emotion regulation, neuroplasticity
- MeSH terms
- Adult, Afferent Pathways, Borderline Personality Disorder, Cerebral Cortex, Electrocardiography, Electroencephalography, Emotions, Evoked Potentials, Female, Heart Rate, Humans, Magnetic Resonance Imaging, Male, Case-Control Studies, Young Adult, Interoception
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