Emotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory Studies

Abstract

Emotional hyperreactivity (Linehan, 1993) is the most investigated construct in borderline personality disorder (BPD). However, experimental studies revealed mixed results on the topic. Our main objective is to comprehensively summarize the results on emotional reactivity in BPD compared to healthy controls (HCs), using a meta-analytic approach, considering different emotional response systems (physiology, behavior, selfreport). We included 31 experimental studies (1,675 subjects). We observed null to small effect sizes for several physiological and behavioral outcomes. Conversely, BPD subjects revealed a moderate to large difference in valence attributed to emotional stimuli and a small difference in self-reported arousal. Significant differences in pooled effect sizes were found between self-report and physiological outcomes. Several sources of heterogeneity were explored. In general, the hyperreactivity hypothesis was not supported. Additional dysfunctional processes should be taken into consideration to understand BPD emotional responsiveness.

Altered psychophysiological correlates of risk‐taking in borderline personality disorder

“…Prior work suggests no abnormalities in resting baseline skin conductance levels in BPD. (Bortolla, Cavicchioli, Fossati, & Maffei, ).…”

Affective neural signatures do not distinguish women with emotion dysregulation from healthy controls: A mega-analysis across three task-based fMRI studies

“…Experimental settings offer higher control and better temporal resolution, but suffer from limited ecological validity, as stressors are presented outside of their natural context (assumption 2). A recent meta-analytic review found that the literature is surprisingly inconclusive concerning experimentally induced emotional reactions in BPD (Bortolla et al, 2020). While they did find moderate experimental group effects on affective self-ratings in their meta-analysis, many studies did not include a pre-measurement, potentially confounding tonic negative emotions and emotional reactivity, or only had pre- and post-task ratings, which might capture other processes than stimulus-contingent real-time responses.…”

Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

“…While assigning patients to the two therapy groups, PSA and PDT, despite the known heterogeneity of BPD patients[ 52 ], we attempted to match patients who were comparable to one another, as far as their personality structure was concerned; however, differences in the patients' personality traits were found in both therapy groups. The fact that the assigning of patients to therapy groups depended on the availability of a therapist may be seen as a legitimate point of criticism.…”

“…Our findings have descriptive value and contributed to the foundation of clinical-relevant hypotheses that might be further investigated in an experimental study design. Emotional reactivity in patients with borderline personality disorder (BPD) due to dysfunctional processes is still a concept being developed[ 52 , 57 ]. We agree that a larger sample size would have been favorable.…”