Emotional Vulnerability in Borderline Personality Disorder Is Cue Specific and Modulated by Traumatization
Abstract
Background A general emotional vulnerability (intense, easily triggered affective reactions) is considered a core symptom in borderline personality disorder (BPD), but evidence from psychophysiological studies for this hypothesis is not very consistent. Given the high comorbidity of posttraumatic stress disorder (PTSD) in BPD patients, current comorbid PTSD might also modulate emotional reactivity. In the present study using a script-driven imagery paradigm, idiographic aversive, disorder-specific (scenes about rejection and abandonment), and standard unpleasant, neutral, and pleasant scripts were presented to investigate emotional reactivity in patients with BPD. Methods Forty nonmedicated BPD patients and 32 healthy control subjects first read and then imagined the scripts. Acoustic startle probes were presented during reading and imagery and the eye-blink responses, as well as changes in heart rate and skin conductance level were recorded. Results Imagery of disorder-specific scripts resulted in a clear potentiation of the startle responses and increased autonomic arousal in BPD patients but not in control subjects. Borderline personality disorder patients with current comorbid PTSD (n = 26 out of 40) showed attenuated startle potentiation during aversive imagery that was not the case in BPD patients without current PTSD. This effect was most pronounced in BPD patients with severe PTSD. Conclusions Scenes about rejection and abandonment are specifically able to activate defensive response mobilization in BPD patients. These findings suggest that BPD patients are not more physiologically reactive to emotional cues in general but show increased emotional vulnerability if borderline-specific schemas are activated. Moreover, emotional reactivity is attenuated in BPD patients with PTSD.
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A subset of traumatized individuals (approximately one third) do not show hyperreactivity to threat cues.
“Yet, a subset of traumatized individuals (approximately one third) do not show such hyperreactivity to threat cues.”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Limberg et al., 2011
Other studies found autonomic responses in PTSD patients to be either physiologically similar to controls or reduced from baseline.
“Other studies found autonomic responses in PTSD patients to be either physiologically similar to controls or reduced from baseline (Cuthbert et al., 2003; D'Andrea et al., 2013; Limberg et al., 2011; McTeague & Lang, 2012).”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Limberg et al., 2011
Cites
Measuring emotion: The self-assessment manikin and the semantic differential
Bradley, M. M., & Lang, P. J. (1994) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(94)90063-9 · Cited by 9,538 · see citing works
McGlashan, T. H., Grilo, C. M., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., Zanarini, M. C., & Stout, R. L. (2000) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2000.102004256.x · Cited by 542 · see citing works
Borderline personality disorder and childhood trauma: Evidence for a causal relationship
Ball, J. S., & Links, P. S. (2009) · Current Psychiatry Reports · doi:10.1007/s11920-009-0010-4 · Cited by 320 · see citing works
Kuo, J. R., & Linehan, M. M. (2009) · Journal of Abnormal Psychology · doi:10.1037/a0016392 · Cited by 288 · see citing works
Fearful Imagery in Social Phobia: Generalization, Comorbidity, and Physiological Reactivity
McTeague, L. M., Lang, P. J., Laplante, M.-C., Cuthbert, B. N., Strauss, C. C., & Bradley, M. M. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.09.023 · Cited by 169 · see citing works
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Goodman, M., Carpenter, D., Tang, C. Y., Goldstein, K. E., Avedon, J., Fernandez, N., Mascitelli, K. A., Blair, N. J., New, A. S., Triebwasser, J., et al. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.06.020 · Cited by 198 · see citing works
Potentiated amygdala response to repeated emotional pictures in borderline personality disorder
Hazlett, E. A., Zhang, J., New, A. S., Zelmanova, Y., Goldstein, K. E., Haznedar, M. M., Meyerson, D., Goodman, M., Siever, L. J., & Chu, K.-W. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2012.03.027 · Cited by 186 · see citing works
Social cognition in borderline personality disorder
Roepke, S., Vater, A., Preißler, S., Heekeren, H. R., & Dziobek, I. (2013) · Frontiers in Neuroscience · doi:10.3389/fnins.2012.00195 · Cited by 184 · see citing works
Comorbidity between Post-Traumatic Stress Disorder and Borderline Personality Disorder: A Review
Frías, Á., & Palma, C. (2015) · Psychopathology · doi:10.1159/000363145 · Cited by 114 · see citing works
EEG asymmetry in borderline personality disorder and depression following rejection.
Beeney, J. E., Levy, K. N., Gatzke-Kopp, L. M., & Hallquist, M. N. (2014) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/per0000032 · Cited by 93 · see citing works
Scheiderer, E. M., Wood, P. K., & Trull, T. J. (2015) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-015-0032-y · Cited by 90 · see citing works
Beutler, S., Mertens, Y. L., Ladner, L., Schellong, J., Croy, I., & Daniels, J. K. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2132599 · Cited by 64 · see citing works
“logically similar to controls or reduced from baseline (Cuthbert et al., 2003; D’Andrea et al., 2013; Limberg et al., 2011; McTeague & Lang, 2012).”
ResultJowett, S., Karatzias, T., & Albert, I. (2020) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12248 · Cited by 55 · see citing works
Scherpiet, S., Brühl, A. B., Opialla, S., Roth, L., Jäncke, L., & Herwig, U. (2014) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-013-0444-x · Cited by 46 · see citing works
del Río-Casanova, L., González, A., Páramo, M., Van Dijke, A., & Brenlla, J. (2016) · Reviews in the Neurosciences · doi:10.1515/revneuro-2015-0045 · Cited by 32 · see citing works
Hazlett, E. A., Blair, N. J., Fernandez, N., Mascitelli, K., Perez‐Rodriguez, M. M., New, A. S., Goetz, R. R., & Goodman, M. (2016) · Psychophysiology · doi:10.1111/psyp.12698 · Cited by 20 · see citing works
Anhedonia in trauma related disorders: the good, the bad, and the shut-down
DePierro, J. M., D’Andrea, W., & Frewen, P. (2014) · Anhedonia: A Comprehensive Handbook Volume II · doi:10.1007/978-94-017-8610-2_7 · Cited by 7 · see citing works
- Authors
- Limberg, A., Barnow, S., Freyberger, H. J., & Hamm, A. O.
- Affiliations
- Universität Greifswald (DE)
- Heidelberg University (DE)
- Corresponding author
- Limberg, Anke
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 69
- Issue
- 6
- Pages
- 574-582
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2091004296
- Cited by
- 136
- References
- 5
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 7 · 2022: 9 · 2021: 16 · 2020: 9 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 11 · 2015: 14 · 2014: 15 · 2013: 12 · 2012: 14
- FWCI
- 15.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Bildung und Forschung
- Deutsche Forschungsgemeinschaft (BA 2172/3-1)
- 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 › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- borderline personality disorder, emotional vulnerability, emotional reactivity, post-traumatic stress disorder, PTSD comorbidity, script-driven imagery, skin conductance, heart rate, autonomic arousal, emotional schemas
- MeSH terms
- Adult, Affective Symptoms, Borderline Personality Disorder, Cues, Female, Galvanic Skin Response, Heart Rate, Humans, Imagination, Judgment, Male, Psychophysics, Reflex, Startle, Stress Disorders, Post-Traumatic, Young Adult
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