Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit
Open accessAbstract
The last two decades have seen a strong rise in empirical research in the mechanisms of emotion dysregulation in borderline personality disorder. Major findings comprise structural as well as functional alterations of brain regions involved in emotion processing, such as amygdala, insula, and prefrontal regions. In addition, more specific mechanisms of disturbed emotion regulation, e.g. related to pain and dissociation, have been identified. Most recently, social interaction problems and their underlying neurobiological mechanisms, e.g. disturbed trust or hypersensitivity to social rejection, have become a major focus of BPD research. This article covers the current state of knowledge and related relevant research goals. The first part presents a review of the literature. The second part delineates important open questions to be addressed in future studies. The third part describes the research agenda for a large German center grant focusing on mechanisms of emotion dysregulation in BPD.
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Transdiagnostically, heightened dissociative symptoms are associated with increased pain threshold and reduced pain perception (related to self-harm behaviours).
“increased pain threshold, reduced pain perception (related to self-harm behaviours) (Bekrater-Bodmann et al., 2015;Ludascher et al., 2007;Schmahl et al., 2014)”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Schmahl et al., 2014
The ‘Phenomenology of emotion processing in BPD’ section says that dissociative symptoms are related to hypoalgesia and that self-injury can stop dissociative states. The ‘Pain processing and dissociation’ section also reports reduced pain sensitivity in BPD patients. These passages support the association and its connection to self-harm in BPD, but not the claim that it holds transdiagnostically. (LLM, conf=0.85)
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“Consequently, increasing emotional awareness and emotion acceptance is currently seen as an important mode of action in psychotherapy in general and in BPD [44].”
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Self-citationThe Rupture and Repair of Cooperation in Borderline Personality Disorder
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Brain Mechanisms Underlying Reactive Aggression in Borderline Personality Disorder—Sex Matters
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Borderline Personality Disorder Features and Sensitivity to Injustice.
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Self-citationBertsch, K., Back, S. N., Flechsenhar, A., Neukel, C., Krauch, M., Spieß, K., Panizza, A., & Herpertz, S. C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.695062 · Cited by 11 · see citing works
Self-citationWillis, F. M., Kuniss, S., Kleindienst, N., Lis, S., Naoum, J., Jungkunz, M., Neukel, C., Bohus, M., Treede, R., Baumgärtner, U., et al. (2018) · Brain and Behavior · doi:10.1002/brb3.909 · Cited by 11 · see citing works
Self-citationGescher, D. M., Schanze, D., Vavra, P., Wolff, P., Zimmer‐Bensch, G., Zenker, M., Frodl, T., & Schmahl, C. G. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02628-z · Cited by 10 · see citing works
Self-citationEvidence for a shared genetic contribution to loneliness and borderline personality disorder
Schulze, A., Streit, F., Zillich, L., Awasthi, S., Hall, A. S. M., Jungkunz, M., Kleindienst, N., Frank, J., Schwarze, C. E., Dahmen, N., et al. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02705-x · Cited by 10 · see citing works
Self-citationHonecker, H., Bertsch, K., Spieß, K., Krauch, M., Kleindienst, N., Herpertz, S. C., & Neukel, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.689267 · Cited by 10 · see citing works
Self-citationCognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder
Hillmann, K., Neukel, C., Krauch, M., Spohn, A., Schnell, K., Herpertz, S. C., & Bertsch, K. (2021) · Journal of Personality Disorders · doi:10.1521/pedi.2021.35.5.672 · Cited by 10 · see citing works
Self-citationKulakova, E., Graumann, L., An, B.-C., Deuter, C., Wolf, O. T., Roepke, S., Otte, C., & Wingenfeld, K. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01678-8 · Cited by 8 · see citing works
Paret, C., Niedtfeld, I., Lotter, T., Wunder, A., Grimm, S., Mennes, M., Okell, T. W., Beckmann, C. F., & Schmahl, C. G. (2021) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2021.02.002 · Cited by 10 · see citing works
Self-citationBrück, C., Derstroff, S., Jacob, H., Wolf‐Arehult, M., Wekenmann, S., & Wildgruber, D. (2016) · Journal of Personality Disorders · doi:10.1521/pedi_2016_30_245 · Cited by 9 · see citing works
Bocchio‐Chiavetto, L., Tardito, D., Galbiati, C., Ferrari, C., Lanfredi, M., Pedrini, L., Carcione, A., Riccardi, I., Nicolò, G., Rossi, R., et al. (2025) · Psychological Medicine · doi:10.1017/s003329172500042x · Cited by 8 · see citing works
EEG-vigilance regulation in Borderline Personality Disorder
Kramer, L., Sander, C., Bertsch, K., Gescher, D. M., Cackowski, S., Hegerl, U., & Herpertz, S. C. (2019) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2019.02.007 · Cited by 8 · see citing works
Self-citationAndermann, M., Hidalgo, N. A. I., Rupp, A., Schmahl, C. G., Herpertz, S. C., & Bertsch, K. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01434-4 · Cited by 8 · see citing works
Self-citationTonarely, N. A., Sherman, J. A., Grossman, R. A., & Ehrenreich-May, J. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1805821 · Cited by 7 · see citing works
Impathy and Emotion Recognition: How Attachment Shapes Self- and Other-Focused Emotion Processing
Eilert, D. W., de Punder, K., Maerz, J., Dose, J., Gander, M., Mensah, P., Neubrand, S., Hinterhoelzl, J., & Buchheim, A. (2025) · Brain Sciences · doi:10.3390/brainsci15050516 · Cited by 7 · see citing works
fMRI neurofeedback for disorders of emotion regulation
Young, K. D., Fine, N. B., & Hendler, T. (2021) · fMRI Neurofeedback · doi:10.1016/b978-0-12-822421-2.00014-4 · Cited by 5 · see citing works
Biermann, M., Schulze, A., Unterseher, F., Hamm, M., Atanasova, K., Stahlberg, D., & Lis, S. (2022) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-022-00193-x · Cited by 7 · see citing works
Self-citationCognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder
Hillmann, K., Neukel, C., Krauch, M., Spohn, A., Schnell, K., Herpertz, S. C., & Bertsch, K. (2020) · Journal of Personality Disorders · doi:10.1521/pedi_2020_34_490 · Cited by 7 · see citing works
Self-citationWang, Y., Guo, J.-N., Yin, X., Zhang, Q., Dong, L.-Y., Wang, K., & Wang, Y. (2021) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2021.1886314 · Cited by 7 · see citing works
Robinson, K., Cornes, J., Karl, J. A., Wilson, M., & Grimshaw, G. M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.07.129 · Cited by 6 · see citing works
Bohus, M. (2018) · Springer eBooks · doi:10.1007/978-3-662-54909-4_25 · Cited by 5 · see citing works
Self-citationBiermann, M., Schulze, A., Vonderlin, R., Bohus, M., Lyssenko, L., & Lis, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1082785 · Cited by 5 · see citing works
Self-citationNaoum, J., Kleindienst, N., Baumgärtner, U., Willis, F. M., Mancke, F., Treede, R., Bohus, M., & Schmahl, C. G. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_351 · Cited by 5 · see citing works
Self-citation
- Authors
- Schmahl, C., Herpertz, S. C., Bertsch, K., Ende, G., Flor, H., Kirsch, P., Lis, S., Meyer-Lindenberg, A., Rietschel, M., Schneider, M., Spanagel, R., Treede, R.-D., & Bohus, M.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Schmahl, Christian
- ORCID
- Venue
- Borderline Personality Disorder and Emotion Dysregulation
- Published
- 2014
- Volume
- 1
- Issue
- 1
- Pages
- 12
- ISSN
- 2051-6673 (ISSN-L)
- PMC
- PMC4579501
- OpenAlex
- W2108334765
- Cited by
- 168
- References
- 212
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 3 · 2023: 11 · 2022: 13 · 2021: 23 · 2020: 19 · 2019: 13 · 2018: 14 · 2017: 12 · 2016: 18 · 2015: 14 · 2014: 1
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Borderline Personality Disorder and Emotion Dysregulation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- heiDOK (Heidelberg University) (acceptedVersion, other-oa)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- borderline personality disorder, emotional dysregulation, emotional processing, social interaction, amygdala, insula, prefrontal cortex, pain, dissociation, trust, rejection sensitivity, neurobiological mechanisms, research agenda
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