Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.

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Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder.

An investigation of heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) indices using data obtained from Doppler radar cardiopulmonary remote sensing is presented in this paper. High accuracy in extracting the HRV and RSA indices was achieved using a direct-conversion quadrature radar system with linear demodulation method. This method was validated using data obtained from 12 human subjects in seated and supine positions. For supine position measurements, all standard deviation of normal beat-to-beat interval indices from Doppler radar and electrocardiogram reference differed less than plusmn9 ms of each other, while all the root mean square of differences of successive normal beat-to-beat interval indices differed less than plusmn76 ms. The measurements from subjects in seated and supine positions with normal RSA demonstrated that the results from radar correlated well with both respiratory piezoresistor chest belts. Higher level of HRV and RSA was detected in seated position, as expected.

Assessment of Heart Rate Variability and Respiratory Sinus Arrhythmia via Doppler Radar

Borderline personality disorder (BPD) is characterized by enduring psychological distress and affective dysregulation. Several models have linked both phenomena, but are lacking empirical support. To investigate the relation between psychological distress and components of affective dysregulation (especially inability to label emotions, conflictive emotions, and physiological hyperarousal), we repeatedly assessed these components using a 24-hour ambulatory monitoring approach in a group of 50 BPD patients and 50 healthy controls. Hierarchical linear model analyses identified a clear relation between inability to label emotions and distress in the BPD group (p = 0.0009) but not across all subjects (p = 0.6492). Conflictive emotions were related to psychological distress in both groups (p < 0.0001). This relation is, however, most pertinent to the BPD group who experienced conflicting emotions more frequently. Physiological arousal (heart rate) was related to distress in both groups. Our empirical findings emphasize training in labeling emotions and distress tolerance interventions in treatment for BPD.

Distress and affective dysregulation in patients with borderline personality disorder: a psychophysiological ambulatory monitoring study

Aims: Schizophrenia patients have a mortality rate two to three-fold higher than that of the general population. Despite the disorder's widespread recognition, how and to what extent autonomic nervous system (ANS) activity contributes to schizophrenia remains inconclusive. The aim of the present study, therefore, was to determine the extent of ANS activity depression with respect to healthy, well-matched control subjects and the severity of psychiatric disorders as determined using the Global Assessment of Functioning (GAF) scale among schizophrenia patients with special reference to antipsychotic dose.



Methods:  This study included 71 schizophrenia patients and 72 healthy controls. ANS activity was assessed by means of heart rate variability power spectral analysis.



Results:  ANS-related spectral parameters were three–four-fold lower in the patients compared to the control group (P < 0.01). Furthermore, when the patients without cardiovascular complications were classified according to GAF score, overall ANS (P = 0.033) and parasympathetic nervous system (PNS) activity (P = 0.025) were significantly reduced in the low-GAF as compared to the high-GAF group. Partial correlation analyses demonstrated that ANS activity was significantly correlated with GAF score while statistically eliminating the effects of age, gender, body mass index, antipsychotic dose, and lipid profiles of the patient population.



Conclusion:  The significantly lower ANS activity in the low-GAF group suggests that such autonomic functional depression could be associated with the severity of schizophrenia. The present data further imply that schizophrenia patients with more depressed overall ANS and PNS activity might encounter increasing risks for cardiovascular events such as sudden death.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1819.2009.01983.x

Autonomic nervous system activity and psychiatric severity in schizophrenia.

According to Linehan's biosocial model, the core characteristic of borderline personality disorder (BPD) is emotional dysregulation. In the present study, we investigated two components of this model: baseline emotional intensity and emotional reactivity. A total of 60 women, 30 with BPD diagnosis and 30 age and sex-matched healthy subjects (HCs), participated in two experiments. In the first experiment, we evaluated emotional responses to six films designed to elicit discrete emotions (anger, fear, sadness, disgust, amusement and neutral). The second experiment evaluated emotional reactions to three emotion-eliciting films containing BPD-specific content (sexual abuse, emotional dependence and abandonment/separation). Skin conductance level, heart rate, and subjective emotional response were recorded for each film. Although self-reported data indicated that negative emotions at baseline were stronger in the BPD group, physiological measures showed no differences between the groups. Physiological results should be interpreted with caution since most BPD participants were under pharmacological treatment. BPD subjects presented no subjective heightened reactivity to most of the discrete emotion-eliciting films. Subjective responses to amusement and “BPD-specific content” films revealed significant between-group differences. These findings suggest that the main characteristic of BPD might be negative emotional intensity rather than heightened emotional reactivity.

Physiological and self-assessed emotional responses to emotion-eliciting films in borderline personality disorder.

The aim of this study was to evaluate the effects of combination psychotropic drug treatment on heart rate variability (HRV), which was mainly controlled by the parasympathetic nervous system. Mean R–R intervals (mRR) and coefficient of variation (CV), an index of HRV, were studied in 22 psychiatric patients and 21 age- and sex-matched healthy controls. Next, in the patient group focusing on both anticholinergic and antidopaminergic properties, combination psychotropic drug daily doses were converted into biperiden milligram equivalents (BPDeq) and chlorpromazine milligram equivalents (CPZeq), respectively. The relationship between mRR and CV and these equivalent dosages was examined. A significant reduction in both mRR (P < 0.05) and CV (P < 0.05) was found in the patient group. In addition, significant negative correlations were observed between the dose of BPDeq and mRR (P < 0.05), and between the dose of BPDeq and CV (P < 0.005). In contrast, no significant correlations were observed between the dose of CPZeq and either parameter. These findings suggest that the effects of combination psychotropic drug treatment on HRV are mainly due to their anticholinergic properties. Therefore, CV is a useful indicator to assess the parasympathetic activity of psychiatric patients under combination psychotropic drug treatment.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1440-1819.2001.00873.x

Michiharu Sekiya

Papers

Effects of combination psychotropic drug treatment on heart rate variability in psychiatric patients