Attentional Bias for Emotional Stimuli in Borderline Personality Disorder: A Meta-Analysis

Abstract

Background: In borderline personality disorder (BPD), attentional bias (AB) to emotional stimuli may be a core component in disorder pathogenesis and maintenance. Sampling: 11 emotional Stroop task (EST) studies with 244 BPD patients, 255 nonpatients (NPs) and 95 clinical controls and 4 visual dot-probe task (VDPT) studies with 151 BPD patients or subjects with BPD features and 62 NPs were included. Methods: We conducted two separate meta-analyses for AB in BPD. One meta-analysis focused on the EST for generally negative and BPD-specific/personally relevant negative words. The other meta-analysis concentrated on the VDPT for negative and positive facial stimuli. Results: There is evidence for an AB towards generally negative emotional words compared to NPs (standardized mean difference, SMD = 0.311) and to other psychiatric disorders (SMD = 0.374) in the EST studies. Regarding BPD-specific/personally relevant negative words, BPD patients reveal an even stronger AB than NPs (SMD = 0.454). The VDPT studies indicate a tendency towards an AB to positive facial stimuli but not negative stimuli in BPD patients compared to NPs. Conclusions: The findings rather reflect an AB in BPD to generally negative and BPD-specific/personally relevant negative words rather than an AB in BPD towards facial stimuli, and/or a biased allocation of covert attentional resources to negative emotional stimuli in BPD and not a bias in focus of visual attention. Further research regarding the role of childhood traumatization and comorbid anxiety disorders may improve the understanding of these underlying processes.

Impulse control under emotion processing: an fMRI investigation in borderline personality disorder compared to non-patients and cluster-C personality disorder patients

“…Subsequently, continuous reorientation and/or slowed disengagement might interfere with cognitive resources required to disengage attention from sensory salient but behaviorally irrelevant stimuli. This is in line with behavioral studies, reporting on biased attention towards emotional stimuli in BPD (Arntz et al 2000;von Ceumern-Lindenstjerna et al 2010;Kaiser et al 2016;Bertsch et al 2017). Additional evidence is provided by previous fMRI studies using attention tasks, i.e.…”

Borderline personality disorder and emotion dysregulation

“…Some research indicating that people with BPD are particularly prone to rumination, for example, suggests difficulty disengaging from emotional events (Abela, Payne, & Moussaly, 2003; Smith, Grandin, Alloy, & Abramson, 2006), and the cascade model of BPD posits that NSSI is particularly likely when rumination has amplified negative emotional experiences to an intolerable level (Selby & Joiner, 2009). Findings from some studies have suggested the presence of an attentional bias toward negative and BPD-related stimuli (words; Kaiser, Jacobs, Domes, & Arntz, 2017); this possible bias may amplify emotional responding and disrupt the ability of persons with BPD to disengage or distance themselves from emotional events. The findings on attentional biases in BPD, however, are complex, sometimes inconsistent, and may depend on the laboratory paradigms and stimuli used (Kaiser et al, 2017).…”

“…Findings from some studies have suggested the presence of an attentional bias toward negative and BPD-related stimuli (words; Kaiser, Jacobs, Domes, & Arntz, 2017); this possible bias may amplify emotional responding and disrupt the ability of persons with BPD to disengage or distance themselves from emotional events. The findings on attentional biases in BPD, however, are complex, sometimes inconsistent, and may depend on the laboratory paradigms and stimuli used (Kaiser et al, 2017).…”

A comprehensive evaluation of emotional responsiveness in borderline personality disorder: a support for hypersensitivity hypothesis

“…Further operationalization included a faster orientation towards negative emotional faces. A meta-analysis conducted by Kaiser and colleagues [14] partially supported Linehan’s hypersensitivity hypothesis by revealing negative attentional bias for BPD schema congruent words and moderate attentional bias for positive emotional faces. Moreover, a recent work from Kaiser and colleagues [15] extended the previous findings [14] showing that BPD attentional bias was enhanced for threating information.…”