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Cortical Representation of Afferent Bodily Signals in Borderline Personality Disorder: Neural Correlates and Relationship to Emotional Dysregulation
Open accessAbstract
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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“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]
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“Mean HR and high-frequency normalized units (HF n.u.) were calculated as an indicator of bodily signal strength/cardiac activation, reflecting the most basic level of interoceptive signal processing (Forkmann et al., 2016; Müller et al., 2015; Schulz et al., 2020).”
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“Resting state studies have shown that HEP amplitudes can be lower in clinical groups, for example, in individuals with borderline personality disorder compared to healthy controls (Müller et al., 2015; Schmitz et al., 2020).”
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“CFA by using the time window of 455-595 ms after each R peak for the statistical analyses of HEPs; this time window is known to have a minimal influence on CFA and, thus, has been used in many previous studies (Gray et al., 2007; Müller et al., 2015; Schulz et al., 2015).”
BackgroundMethodInfluentialAtrial Fibrillation as a Disorder of Heart-Brain Communication
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“For example, the sensitivity of cardiac interoception, measured according to the accuracy of performance in the heartbeat detection task, has been related not only to the intensity of emotional feelings [12–14] but also to pathological conditions such as borderline personality disorder [15].”
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“These fronto-centro-parietal regions have been identified as reliable generators of the HEP, and alterations in HEP amplitudes within these regions are closely linked to interoceptive dysfunction across a broad range of clinical populations [13, 14, 35].”
Sound propagation and quantum-limited damping in an ultracold two-dimensional Fermi gas
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InfluentialGuerriero, G., Ruocco, A. C., Carlsen, H. K., Daros, A. R., Kosara, D., & Steingrímsson, S. (2026) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-026-00367-x
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Metadata
- 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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