Borderline Personality Disorder and Autonomic Dysregulation – Preliminary Findings David Eddie
[email protected]
Borderline personality disorder:
Overview
1. Frantic efforts to avoid real or imagined abandonment. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging. 5. Recurrent suicidal behavior, gestures, or threats, or NSSI. 6. Affective instability due to a marked reactivity of mood. 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger. 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. ✻ Hyper-arousal after emotional challenge/stress
+ slow return to affective baseline.
Overview o
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Cognitive components of BPD affect dysregulation have been well investigated; psychophysiological processes remain poorly understood. Knowledge gap may be limiting progress in the treatment of BPD because emotion regulation is mediated by both cognitive and physiological processes coordinated by the the central autonomic network (CAN).
CAN Structures, courtesy Cleveland Clinic
Sympathetic
Central Autonomic Network
CAN
Parasympathetic
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Efferent stream: messages from the brain to the heart
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Afferent stream: messages from the body to the brain
Overview o
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CAN control of physiological processes via the autonomic nervous system (ANS) supports adaptability to changing environmental and internal demands. Inflexibility or instability may result in emotional arousal being maintained longer than is optimal, leading to negative psychosocial consequences. This study examined whether a loss of flexibility in such processes is associated with emotion dysregulation in BPD.
Measuring CAN Activation
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Because CAN affects regulatory actions via the cardiovascular system, indices of neurocardiac processes provide reliable measures of dynamic emotion regulation processes.
Measuring CAN Activation
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Heart rate variability (HRV) reflects fine-grained, moment-tomoment changes initiated by the CAN in response to environmental and interoceptive stimuli.
Measuring CAN Activation o
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Heart rate (HR), blood pressure (BP), and skin conductance response (SCR) also help characterize sympathetic and parasympathetic activation. Also important markers of neurovisceral integration and an individual’s ability to self-regulate affect.
Baroreflex o
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Feedback mechanism in the body that helps regulate blood pressure (BP) and heart rate (HR). Baroreflex supports cardiovascular flexibility/ adaptability. Implicated in affect regulation and stress resilience.
Study Aims 1) Assess psychophysiological differences between individuals with BPD and healthy controls, at rest (i.e., baseline). Hypothesis Participants with BPD predicted to show lower neurocardiovascular flexibility (i.e., lower HRV), and greater sympathetic activation (i.e., greater SCR).
Study Aims 2) Assess psychophysiological differences between individuals with BPD and healthy controls during exposure to BPD relevant pictures (i.e., stimuli reactivity). Hypothesis Participants with BPD predicted to report greater subjective arousal; both groups expected to show increased sympathetic activation (i.e., increased HR & SCR), and parasympathetic withdrawal (i.e., decreased HRV).
Study Aims 3) Assess psychophysiological differences between individuals with BPD and healthy controls during recovery from exposure to BPD relevant pictures (i.e., stimuli exposure recovery). Hypothesis BPD group predicted to show continued sympathetic activation and parasympathetic withdrawal; control group expected to return to pre-challenge psychophysiological baseline.
Participants
Methods
BPD Group o
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14 participants with BPD recruited from DBT-RU, and 8 from other local DBT providers (n= 22). BPD participants met DSM-IV-TR criteria for BPD. Co-occurring psychopathology was allowed for BPD participants.
Participants
Methods
Control Group o
22 healthy controls recruited from New Brunswick area.
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Sex and age matched to BPD group.
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Any DSM-IV-TR disorder diagnosis exclusionary for control participants. Ø
Serious medical or neurological conditions, active psychosis and medications directly affecting the cardiovascular system exclusionary for both groups.
Psychosocial Measures
Methods
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Current BPD symptomology (Borderline Symptom List 23)
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Substance use (CNL questionnaire)
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Anxiety (State-Trait Anxiety Inventory – Form Y)
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Depression (Beck Depression Inventory)
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Psychological/affective flexibility (Acceptance and Action Questionnaire II; Difficulties in Emotion Regulation Scale)
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Positive & negative affect (Positive and Negative Affect Schedule)
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Dissociative tendencies (Dissociative Experiences Scale-II)
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Exercise (in house questionnaire)
Methods Experimental Tasks
Task A
Task B
Task C
Vanilla Task (Baseline)
Emotionally Evocative Stimulus (Stimulus reactivity)
Naturalistic Recovery Period (Stimulus recovery)
Stimuli o
Methods
Subset from the International Affective Picture System (IAPS) developed for BPD Stimulus-reactivity paradigms. e.g., fear of abandonment, interpersonal conflict, self-harm, intense anger (Sloan et al., 2010).
Psychophysiological Assessment o
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Methods
Continuous recordings of ECG, respiration, and SC taken with Powerlab Acquisition system (ADInstruments, Colorado Springs, CO), and BP from Finometer MIDI (Finapres, Amsterdam). Data were exported to WinCPRS software (Absolute Aliens Oy, Turku, Finland) for analyses and calculation of time and frequency domain indices.
Selected Indices
Methods
HR (mean heart rate; beats per minute) SDNN (standard deviation of normal-to-normal intervals) RMSSD (root of the mean squared differences of successive normal-to-normal intervals) pNN50 (% normal-to-normal adjacent intervals greater than 50ms) HF HRV (high frequency HRV) LF HRV (low frequency HRV) Systolic BP (mean systolic BP) SCR (skin conductance response)
Analysis o
Distributional characteristics were assessed… normality, kurtosis, skew & influential outliers
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All indices logarithmically transformed, except HR, pNN50 and BP measures.
Analysis
A Priori Hypothesis Testing o
Repeated measures mixed model examined the effect of group (BPD vs. control), experimental task (time), and their interaction on physiological indices. Task A
Task B
Task C
BPD (n= 22)
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Control (n= 22)
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X
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Test-wise alpha set at p
