Oxytocin Normalizes Approach–Avoidance Behavior in Women With Borderline Personality Disorder

Abstract

Background: Interpersonal deficits are a core symptom of borderline personality disorder (BPD), which could be related to increased social threat sensitivity and a tendency to approach rather than avoid interpersonal threats. The neuropeptide oxytocin has been shown to reduce threat sensitivity in patients with BPD and to modify approach-avoidance behavior in healthy volunteers.Methods: In a randomized, double-blind placebo-controlled between-subject design, 53 unmedicated women with BPD and 61 healthy women participated in an approach-avoidance task 75 min after intranasal substance administration (24 IU of oxytocin or placebo). The task assesses automatic approach-avoidance tendencies in reaction to facial expressions of happiness and anger.Results: While healthy participants responded faster to happy than angry faces, the opposite response pattern, that is, faster reactions to angry than happy faces, was found in patients with BPD. In the oxytocin condition, the "congruency effect" (i.e., faster avoidance of facial anger and approach of facial happiness vice versa) was increased in both groups. Notably, patients with BPD exhibited a congruency effect toward angry faces in the oxytocin but not in the placebo condition.Conclusions: This is the second report of deficient fast, automatic avoidance responses in terms of approach behavior toward interpersonal threat cues in patients with BPD. Intranasally administered oxytocin was found to strengthen avoidance behavior to social threat cues and, thus, to normalize fast action tendencies in BPD. Together with the previously reported oxytocinergic reduction of social threat hypersensitivity, these results suggest beneficial effects of oxytocin on interpersonal dysfunctioning in BPD.

Approach and Avoidance Behavior in Female Patients With Borderline Personality Disorder

“…No differential effect occurred for angry faces, which is in line with previous findings (Kobeleva et al, 2014;Schneider et al, 2020), although one study found less pronounced approachavoidance behavior in anger-prone women with BPD (Bertsch et al, 2018). Our results are coherent with the idea that psychophysiological reactions to negative effects appear to be intact in BPD (Herpertz et al, 1999;Kuo and Linehan, 2009;Dukalski et al, 2017).…”

“…This AAT variant revealed no significant difference between patients with BPD and healthy controls. In contrast, Bertsch et al (2018) observed a highly avoidant reaction to angry stimuli, while another study failed to replicate this finding (Schneider et al, 2020), However, Schneider et al (2020 found that approach and avoidance were modulated by oxytocin administration, whereby oxytocin accelerated the avoidant response to angry faces relative to the approach condition toward happy facial expressions in patients with BPD. In another study, no impact of temperamental differences among BPD subtypes on AAT performance was found.…”

The Role of Impairments in Self–Other Distinction in Borderline Personality Disorder: A Narrative Review of Recent Evidence

“…Impairments in the attachment system in BPD, as evidenced by high reports of attachment insecurity (Agrawal et al, 2004) and dysfunction of the oxytocin system (Carrasco et al, 2020), may leave BPD patients without a "filter" to allow them to decide which interactions are safe and rewarding to tune into. Indeed, the administration of intranasal oxytocin was found to normalize approach motivation (Domes et al, 2019) and approach-avoidance behaviour (Schneider et al, 2020) in response to socio-emotional cues in individuals with BPD. However, this increased motivation may not translate into improved social alignment, as the administration of oxytocin has also been found to reduce behavioural synchrony in BPD (Ramseyer et al, 2020).…”

Childhood Maltreatment Alters the Neural Processing of Chemosensory Stress Signals

“…Mechanistically, a stronger effect of OXT on threatspecific amygdala activation in individuals with a history of CM appears to be rooted in a reinstated top-down regulatory function of the mOFC over the amygdala, thereby emulating a more normative response to social olfactory threat cues in individuals with a history of CM (16)(17)(18)(19)76). Evidence corroborating this interpretation comes from studies demonstrating that OXT reduces threat hypersensitivity in women with Borderline Personality Disorder (90,91) which is frequently associated with CM. Likewise, OXT enhanced the stress-buffering effects of social support in women with more severe CM exposure (51).…”