An eye-tracking study of interpersonal threat sensitivity and adverse childhood experiences in borderline personality disorder

Abstract

Background Previous eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD). From an etiological point of view, such interpersonal threat hypersensitivity might be explained by a biological vulnerability along with a history of early life adversities. The objective of the current study was to investigate interpersonal threat hypersensitivity and its association with adverse childhood experiences (ACE) in patients with BPD employing eye-tracking technology. Methods We examined a sample of 46 unmedicated, adult female patients with BPD and 25 healthy female volunteers, matched on age and intelligence, with a well-established emotion classification paradigm with angry, fearful, happy, and neutral facial expressions. ACE were assessed retrospectively with the Childhood Trauma Questionnaire. Results Patients as compared to healthy volunteers reflexively directed their gaze more quickly towards the eyes of emotional and neutral faces and did not adapt their fixation patterns according to the facial expression presented. Misclassifying emotional and neutral faces as angry correlated positively with the patients’ self-reported ACE. Conclusions Building on and extending earlier findings, our results are likely to suggest a visual hypervigilance towards the eyes of emotional and neutral facial expressions and a childhood trauma-related anger bias in patients with BPD. Given the lack of a clinical control group, the question whether these findings are specific for BPD has to remain open. Thus, further research is needed to elucidate the specificity of altered visual attention allocation and the role of ACE in anger recognition in patients with BPD.

Saccadic eye movements are deployed faster for salient facial stimuli, but are relatively indifferent to their emotional content

“…In a more straightforward free-viewing, or 'fast capture' task, observers were simply required to look toward the location of a face target shown for 20 ms, and Bannerman et al [13] showed that saccadic responses were faster when the face was fearful versus neutral, but did not differ compared to response times for happy faces. Opposing findings, however, were observed in a different study by Seitz et al [21] also employing a 'fast capture' task for 150 ms presentations of neutral, angry, fearful and happy faces. Initial saccades towards the eyes (as opposed to mouth) of faces were deployed faster for fearful compared to happy faces, though notably response times did not differ between fear and angry or neutral counterparts [21].…”

“…Opposing findings, however, were observed in a different study by Seitz et al [21] also employing a 'fast capture' task for 150 ms presentations of neutral, angry, fearful and happy faces. Initial saccades towards the eyes (as opposed to mouth) of faces were deployed faster for fearful compared to happy faces, though notably response times did not differ between fear and angry or neutral counterparts [21]. Together these findings emphasise the need for further replication, particularly for clarifying the effects of face presentation duration and task-type on saccadic responses to emotional facial stimuli.…”

“…Bannerman and colleagues [12,13]suggest that for longer face durations (500 ms and above), manual rather than saccadic responses are the preferred response mode, and that saccadic responses are more appropriately explored using very short stimulus presentations, below 200 ms. Despite this, Seitz and colleagues [21], for example, showed that the eyes of fearful faces were located faster compared to happy faces when available for 150 ms, but not compared to neutral or angry faces, showing that biases for detecting threat-relevant information in fear expressions is possible in a simple localisation task, even at 150 ms durations. Similarly, fearful face precues shown for both 100 and 500 ms have also been shown to have no effect on search efficiency, [31], while other instances evidence improved search efficiency following exposure to fearful faces for 500 as opposed to 100 ms [32].…”

“…These responses are therefore considered to be reliable measures of perceptual biases because they capture implicit and automatic behavioural responses in a way that mimics natural viewing, or in other words, they can capture eye movements towards faces as soon as they appear in the visual field, without the need to perform a calculated manual response. Despite this, compared to the wider literature on biases for detecting and responding to fear expressions there are relatively few studies that employ saccadic latency [6,[11][12][13]21], and their findings are not always consistent. It can also be difficult to reconcile their findings because these studies use a variety of observer tasks, and so pursue biases for fear expressions in various contexts.…”

Stimulating research on childhood adversities, borderline personality disorder, and complex post-traumatic stress disorder

“…Research articles, included in this special issue, shed more light on the consequences of childhood adversities. Seitz and colleagues [21] used eye-tracking to investigate hypersensitivity to negative, potentially threatening interpersonal cues in BPD and its association with adverse childhood experiences. Findings point towards a childhood trauma-related anger bias and a visual hypervigilance towards the eyes of facial expressions in patients with BPD.…”