Severity of childhood maltreatment predicts reaction times and heart rate variability during an emotional working memory task in borderline personality disorder.

Background: Difficulties in emotion regulation are a core symptom of borderline personality disorder (BPD) and often interfere with cognitive functions, such as working memory (WM). Traumatic childhood experiences, including severe maltreatment, can contribute to emotion dysregulation, possibly mediated by changes in high-frequency heart rate variability (HF-HRV). However, it is not yet entirely understood if HF-HRV alterations underlie impaired WM during emotional distraction in BPD and if this is related to traumatic childhood experiences and to comorbid post-traumatic stress disorder (PTSD). Objective: Our aim was to investigate performance (reaction times, RTs) and HF-HRV during an emotional working memory task (EWMT) in relation to childhood maltreatment severity and comorbid PTSD in BPD. Method: Eighty-one women (n = 28 healthy controls (HC) and n = 53 BPD patients of which n = 18 had comorbid PTSD) performed an adapted Sternberg item recognition WM task with neutral and negative social cues (interpersonal scenes from the International Affective Picture System (IAPS), and neutral, fearful, and angry faces) as distractors. Dependent variables were RTs of correct trials and HF-HRV. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. Results: Compared to healthy participants, patients with BPD showed prolonged RTs across all distractor conditions with social cues, regardless of their emotional valence. Patients with BPD, especially those with PTSD, demonstrated reduced HF-HRV both at rest and during EWMT. Severity of childhood maltreatment predicted longer RTs and lower HF-HRV during the EWMT. Conclusions: Findings suggest that adverse childhood experiences accelerate difficulties in shifting attention away from social information and that these are more pronounced in individuals with BPD. Reduced HF-HRV (low parasympathetic-tonus) may be an important psychophysiological mechanism underlying impaired WM in the presence of distracting social cues in patients with BPD, especially in those with comorbid PTSD. HIGHLIGHTS: This study provides evidence that childhood maltreatment experiences are associated with hypersensitivity to social information and reduced high-frequency heart rate variability during a working memory task in borderline personality disorder.

Antecedentes: las dificultades en la regulación emocional es un síntoma central del trastorno límite de la personalidad (TLP) y, a menudo, interfieren con las funciones cognitivas, como la memoria de trabajo (MT). Las experiencias traumáticas de la infancia, incluido el maltrato grave, pueden contribuir a la desregulación emocional, posiblemente mediada por cambios en la variabilidad de la frecuencia cardíaca de alta frecuencia (VFC-AF). Sin embargo, aún no se comprende del todo si las alteraciones de VFC-AF subyacen a la alteración de la MT durante la distracción emocional en el TLP y si esto está relacionado con experiencias traumáticas de la infancia y con el trastorno de estrés postraumático (TEPT) comórbido.Objetivo: Nuestro objetivo fue investigar el rendimiento (tiempos de reacción, TR) y VFC-AF durante una tarea de memoria de trabajo emocional (MTE) en relación con la gravedad del maltrato infantil y el TEPT comórbido en el TLP.Método: Ochenta y una mujeres (n=28 controles sanos (CS) y n=53 pacientes con TLP, de las cuales n=18 tenían TEPT comórbido) realizaron una tarea de MT de reconocimiento de elementos de Sternberg adaptada con señales sociales neutras y negativas (escenas interpersonales del Sistema internacional de imágenes afectivas (IAPS por sus siglas en ingles) y rostros neutrales, temerosos y enojados) como distractores. Las variables dependientes fueron TR de ensayos correctos y VFC-AF. El maltrato infantil se evaluó con el Cuestionario de Trauma Infantil.Resultados: En comparación con las participantes sanas, las pacientes con TLP mostraron TR prolongados en todas las condiciones de distracción con señales sociales, independientemente de su valencia emocional. Los pacientes con TLP, especialmente aquellos con TEPT, demostraron una reducción de VFC-AF tanto en reposo como durante MTE. La gravedad del maltrato infantil predijo TR más largos y VFC-AF más bajo durante el MTE.Conclusiones: Los resultados sugieren que las experiencias infantiles adversas refuerzan las dificultades para desviar la atención de la información social y que estas son más pronunciadas en las personas con TLP. La VFC-AF reducida (tono parasimpático bajo) puede ser un mecanismo psicofisiológico importante subyacente a la MT alterada en presencia de señales sociales que distraen en pacientes con TLP, especialmente en aquellos con TEPT comórbido.

Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation.

BACKGROUND: Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC). METHODS: 57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed. RESULTS: Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD. CONCLUSIONS: Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.