Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

Abstract

Purpose of Review The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. Recent Findings Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. Summary There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.

Arousal Temporally Precedes Dissociation in Patients with Borderline Personality Disorder: A Preliminary Experience Sampling Study

“…In line with this reasoning, correlational studies link self-reports of childhood abuse and neglect (which is highly prevalent in patients with BPD) to levels of dissociation (see Vonderlin et al, 2018 for a meta-analysis).). Although there has been extensive research into internal and external triggers of dissociative states (see Lynn et al, 2019 for a review), from an empirical perspective little is known about the psychological states that precede and follow dissociations (i.e., the temporal dynamics of dissociative states), especially outside the lab (see Krause-Utz et al, 2021 for a review). Researchers (Linehan, 1993;van der Kolk, 1987) have hypothesized that changes in distress play a key role at the onset of dissociations, whereas distress has been shown to relate to components of affective dysregulation including physiological hyperarousal in patients with BPD (also see Ebner-Priemer et al, 2008).…”

Dissociation, trauma, and borderline personality disorder

“…The effects of dissociation on psychosocial functioning may depend on the larger psychopathological context, e.g., emotional dysregulation and identity problems [ 47 , 48 ]. In BPD, stress-related dissociation is a core symptom, closely linked to other features of the disorder [ 1 , 49 ].…”

Case Report: Anomalous Experience in a Dissociative Identity and Borderline Personality Disorder

“…Dissociative disorders seem to arise because of the transaction between genetic factors, which determine an individual's biological vulnerability and environmental condition ( 5 ). Among the latter, the socio-cognitive model highlights the importance of social-cultural self-oneness as the cause of deterioration of chronological, biographical, and perceptive unity ( 1 , 2 , 4 ), while the trauma model, which has received more support and was studied more, underlies the role of traumatic life experiences ( 6 , 7 ). Very recently, aligned with the transdiagnostic model, it was proposed that dissociation can be understood as failures of normally adaptive systems and functions ( 8 ).…”