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Strengthening bodily awareness may be significant aspect of borderline personality disorder psychotherapy

Study findings in JAMA Psychiatry indicate state-dependent deficits in cortical processing of bodily signal patterns among individuals with borderline personality disorder and suggest that techniques to improve bodily awareness be integrated into psychotherapeutic interventions.

“Since the James-Lange theory, the ability to perceive and regulate emotions has been tightly linked to the perception of afferent bodily signals (interoception). This has been confirmed by results indicating a positive relationship between interoceptive awareness and the ability to perceive one’s own emotions and altered processing of interoceptive signals in mental disorders characterized by emotional dysregulation, such as major depression or depersonalization,” Laura E. Müller, MSc, of the University of Heidelberg, Germany, and colleagues wrote.

To identify neural correlates of disturbed body awareness and its associations with emotional dysregulation in borderline personality disorder, researchers investigated heartbeat-evoked potentials (HEPs) among 34 medication-free individuals with borderline personality disorder, 31 healthy volunteers and 17 medication-free individuals with borderline personality disorder in remission. HEPs were assessed via 5-minute resting-state electroencephalograms and parallel electrocardiograms. Self-reports and structured interviews determined core borderline personality disorder symptoms, history of childhood traumatization and psychiatric disorders. High-resolution T1-weighted structural MRI scans measured neural correlates of disturbed body awareness.

Individuals with borderline personality disorder had significantly reduced mean HEP amplitudes compared with healthy individuals (P = .001). Mean HEP amplitudes of individuals with borderline personality disorder in remission were in between those of individuals with borderline personality disorder and healthy individuals (P > .05).

HEP amplitudes negatively correlated with emotional dysregulation (P = .01) and positively associated with grey matter volume in the left anterior insula (P < .05) and the bilateral dorsal anterior cingulate cortex (P < .05).

“The innovative work of Müller and colleagues highlights the fundamental relevance of interoceptive signaling to a personality disorder characterized by emotional instability. The research also coincides with a new understanding of interoceptive processing and with refinements to the measurement of interoceptive ability from heartbeat detection tests,” Sarah N. Garfinkel, PhD, of the University of Sussex, Brighton, England, and colleagues wrote in an accompanying editorial. “This is an exciting and timely area of research. Interoceptive processes are increasingly considered within affective neuroscience and consciousness research as fundamental influences on human psychology… Comprehensive accounts of psychopathological mechanisms must consider interoception, yet, presently, this knowledge base is limited.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.