Neurobiological Mechanisms Mediating Emotion Dysregulation as Targets of Change in Borderline Personality Disorder

Herpertz, Sabine C.; Schneider, Isabella; Schmahl, Christian; Bertsch, Katja

doi:10.1159/000488357

Cited by 33 publications

(22 citation statements)

References 35 publications

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“…Impaired facial affect recognition and emotional regulation deficits are observed in individuals with borderline PD 202,203 .…”

Section: Cognitive and Emotional Processing Abnormalitiesmentioning

confidence: 99%

“…Impaired facial affect recognition and emotional regulation deficits are observed in individuals with borderline PD 202,203 . The evidence concerning narcissistic and paranoid PDs (respectively, difficulties in emotional empathy and regulation 204 , and hypervigilance and stress reactivity 205 ) has come from symptom, descriptive and trait checklists, rather than behavioral task performance.…”

Section: Validity Evidencementioning

confidence: 99%

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Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

et al. 2021

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The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within disorders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

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“…Impaired facial affect recognition and emotional regulation deficits are observed in individuals with borderline PD 202,203 .…”

Section: Cognitive and Emotional Processing Abnormalitiesmentioning

confidence: 99%

Section: Validity Evidencementioning

confidence: 99%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

et al. 2021

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“…The constant development of neuroimaging methods and analytical techniques has increased knowledge about possible neurobiological underpinnings. Disturbances in corticolimbic circuitry involving the amygdala, hippocampus, insula, anterior cingulate, orbitofrontal cortex, and medial prefrontal cortex have been associated with problems in emotion regulation, interpersonal disturbances, and disturbed identity [101,102].…”

Section: Neuroimaging Studies On Dissociation In Bpdmentioning

confidence: 99%

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

Krause-Utz

Frost

Chatzaki

et al. 2021

Curr Psychiatry Rep

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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.

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“…Affective instability in BPD is supposed to arise from high sensitivity of neural systems involved in the generation of an emotional state, in combination with a severe emotion regulation deficit (Koenigsberg, 2010;Putnam and Silk, 2005). Increased amygdala activation has been interpreted as impairment in top-down control of the prefrontal cortex and may therefore contribute to affective instability (Dillon and Pizzagalli, 2007;Herpertz et al, 2018;Schulze et al, 2016). Amygdala neurofeedback training might be specifically suited to target the neural mechanisms of affective instability in precision psychiatry, although more research is needed for corroboration.…”

Section: Discussionmentioning

confidence: 99%

Improved emotion regulation after neurofeedback. A single-arm trial in patients with borderline personality disorder

Zaehringer¹,

Santangelo²,

Kleindienst³

et al. 2019

Preprint

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Real-time functional magnetic resonance imaging neurofeedback training of amygdala hemodynamic activity directly targets a neurobiological mechanism, which contributes to emotion regulation problems in borderline personality disorder (BPD). However, it remains unknown which outcome measures are suited to assess changes in emotion regulation and affective instability associated with amygdala down-regulation in a clinical trial. The current study directly addresses this question. 24 female patients with a DSM-IV BPD diagnosis underwent a four-session amygdala neurofeedback training. Before and after the training as well as at a six weeks follow-up, participants completed measures of emotion dysregulation and affective instability at diverse levels of analysis (verbal report, clinical interview, ecological momentary assessment, emotion-modulated startle, heart rate variability and fMRI). Participants were able to down-regulate their amygdala BOLD response with neurofeedback. There was a decrease of BPD symptoms as assessed with the Zanarini rating Scale for BPD (ZAN-BPD). Patients also indicated less affective instability, indicated by lower hour-to-hour variability in negative affect and inner tension in daily life. After training, patients showed decreased emotion-modulated startle to negative pictures. Overall, we observed changes in emotion regulation and affective instability on several systems levels, including behavior and verbal report. Conclusions are limited due to the lack of a control group. In a next step, a randomized controlled trial (RCT) is needed to confirm effectiveness of the training.

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Neurobiological Mechanisms Mediating Emotion Dysregulation as Targets of Change in Borderline Personality Disorder

Cited by 33 publications

References 35 publications

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

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

Improved emotion regulation after neurofeedback. A single-arm trial in patients with borderline personality disorder

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