Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation
Open accessAbstract
BACKGROUND: Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC). METHODS: 57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed. RESULTS: Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD. CONCLUSIONS: Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.
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- Authors
- Krause-Utz, A., Walther, J.-C., Lis, S., Schmahl, C., & Bohus, M.
- Affiliations
- Leiden University (NL)
- Heidelberg University (DE)
- Western University (CA)
- Corresponding author
- Krause-Utz, Annegret
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-09-10
- Volume
- 49
- Issue
- 11
- Pages
- 1810-1821
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC6650777
- OpenAlex
- W2891926942
- Cited by
- 38
- References
- 92
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 3 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 2 · 2019: 1
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Deutsche Forschungsgemeinschaft (KFO-256)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- borderline personality disorder, post-traumatic stress disorder, dissociation, heart rate variability, cognitive reappraisal, emotion regulation, emotional dysregulation, emotional reactivity, subjective arousal, well-being, female patients, vagal tone, comorbidities
- MeSH terms
- Emotional Regulation, Adolescent, Adult, Autonomic Nervous System, Borderline Personality Disorder, Dissociative Disorders, Female, Heart Rate, Humans, Middle Aged, Pattern Recognition, Visual, Stress Disorders, Post-Traumatic, Comorbidity, Young Adult
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