The Modulating Role of Self-Referential Stimuli and Processes in the Effect of Stress and Negative Emotion on Inhibition Processes in Borderline Personality Disorder: Proposition of a Model to Integrate the Self-Concept and Inhibition Processes

Abstract

Impulsivity is an important clinical and diagnostic feature of borderline personality disorder (BPD). Even though it has been reported that BPD individuals’ inhibition performance is significantly reduced in the context of negative emotion or stress, this literature shows mixed results, raising questions about the possible role played by other factors. Winter (2016) proposed that negative emotion stimuli can be more disruptive for BPD individuals’ attention control performance because they induce higher distractibility self-referential processes. This article aimed to systematically review the literature regarding the effect of stress and negative emotions on three main inhibition processes—prepotent response inhibition, resistance to distractor interference, and resistance to proactive interference—in BPD and to verify the putative modulating role of self-referential stimuli and processes on these inhibition processes. All English and French experimental studies published until August 2018 were searched in PsychINFO and PubMED databases. The following keywords were used: “borderline* AND inhibit* OR interference* OR forget* OR task* AND emotion* OR stress* OR affect*”. A total of 1215 articles were included in the study. After full text revision, twenty-six papers were selected for review. The results of this review indicate that when stimuli or procedures involve self-reference stimuli or processes, BPD individuals’ performance seems to be more disrupted in all three inhibition processes. A model based on Winter’s and Kernberg’s models is proposed with the aim of integrating the self-concept with inhibition processes in BPD.

Is Splitting Related to Resistance to Proactive Interference? A Process-Oriented Study of Kernberg’s Conceptualization of Splitting

“…From the results obtained, it is possible to formulate new hypotheses that could be investigated in future experiments. First, the results of the present study clarify the links that were expected in Gagnon and collaborators’ model [28] between splitting and RPI by suggesting that those relationships cannot be seen in the same way for positive and negative object relations. Furthermore, by clarifying the relationships between splitting and the PI index with negative words, it is possible to propose some hypotheses regarding the neurobiological correlates of splitting.…”

“…In general, studies of inhibition processes have reported that inhibition performance among BPD individuals is significantly reduced, especially when presented with negative emotional stimuli or self-referential material that contains themes specific to BPD, such as abandonment [28]. To explain the particular effect of emotional stimuli on the three inhibition processes of BPD individuals, Gagnon and colleagues [28] proposed a model adapted from certain propositions of Kernberg's theory. Here, the BPD self-concept belongs to long-term memory and is composed of split representations of self and other that will likely produce intense emotional responses and consequently disrupt the process of resistance to distractor interference and prepotent Psychopathology 2022;55:345-361 DOI: 10.1159/000525006 response inhibition.…”

“…Evidence of these three processes of inhibition has been empirically shown by factorial studies on a range of inhibition tasks [ 27 ]. In general, studies of inhibition processes have reported that inhibition performance among BPD individuals is significantly reduced, especially when presented with negative emotional stimuli or self-referential material that contains themes specific to BPD, such as abandonment [ 28 ]. To explain the particular effect of emotional stimuli on the three inhibition processes of BPD individuals, Gagnon and colleagues [ 28 ] proposed a model adapted from certain propositions of Kernberg's theory.…”