Altered interoception in patients with borderline personality disorder: a study using heartbeat-evoked potentials
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RESEARCH ARTICLE
Open Access
Altered interoception in patients with borderline personality disorder: a study using heartbeat-evoked potentials Vera Flasbeck1*, Stoyan Popkirov2, Andreas Ebert1 and Martin Brüne1
Abstract Background: Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown. Methods: We utilized an electrophysiological marker of interoception, i.e. heartbeat-evoked potentials (HEP), and examined its relationship with electrocardiographic correlates of autonomic nervous system (ANS) functioning (heart rate variability), and with self-report measures of alexithymia, dissociation and borderline symptom severity in patients with BPD. Results: Individuals with BPD had higher HEP amplitudes over frontal electrodes compared to healthy controls. Sympathetic ANS activity was greater in BPD patients than in controls. Across groups, HEP amplitudes were associated with parasympathetic activity over central electrodes and correlated with alexithymia over frontal electrodes. Conclusions: These findings support the idea that difficulties in emotional awareness in BPD are reflected in altered frontal electrophysiological markers of interception. Therefore, emotional awareness can be understood as failures of modulation between interoceptive and exteroceptive attention. Future research may aim to investigate whether altered interoception and its electrophysiological correlates are malleable by therapeutic intervention. Keywords: Interoception, Heartbeat-evoked potentials, Autonomic nervous system, Borderline personality disorder, Alexithymia, Dissociation
Background Borderline personality disorder (BPD) is characterized by self-injurious and risk-taking behavior, deficits in emotion regulation and poor impulse control, fragile selfimages, unstable relationships and intensive fear of being abandoned [1]. Moreover, many patients with BPD have difficulties in identifying and describing their own * Correspondence: [email protected] 1 LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Alexandrinenstr. 1, D-44791 Bochum, Germany Full list of author information is available at the end of the article
feelings, referred to as alexithymia [2–5]. BPD is also frequently associated with trauma-related dissociative symptoms [6, 7]. Both, alexithymia and dissociation can be conceptualized as dysfunctional interoception [8]. Indeed, the perception of internal bodily signals and emotional awareness are physiologically closely related [9, 10], integrated in a conceptual framework referred to as the “Somatic Marker Hypothesis” (SMH [11];). In addition, there is also evidence for an association of dissociation and alexithymia in BPD [12, 13]. Int
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