Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Institute for Health and Behaviour, Integrative Research Unit on Social and Individual Development, University of Luxembourg, Walferdange, Luxembourg.
JAMA Psychiatry. 2015 Nov;72(11):1077-86. doi: 10.1001/jamapsychiatry.2015.1252.
The ability to perceive and regulate one's own emotions has been tightly linked to the processing of afferent bodily signals (interoception). Thus, disturbed interoception might contribute to the core feature of emotional dysregulation in borderline personality disorder (BPD), as increased levels of depersonalization, body image disturbances, and reduced sensitivity to physical pain suggest poor body awareness in BPD.
To determine neural correlates of disturbed body awareness in BPD and its associations with emotional dysregulation and to explore improvements in body awareness with BPD symptom remission.
DESIGN, SETTING, AND PARTICIPANTS: Case-control study performed at Heidelberg University Hospital, Heidelberg, Germany. Heartbeat evoked potentials (HEPs), an indicator of the cortical representation of afferent signals from the cardiovascular system, were investigated in 34 medication-free patients with BPD, 31 healthy volunteers, and 17 medication-free patients with BPD in remission. The HEPs were assessed using 5-minute resting-state electroencephalograms and parallel electrocardiograms. Core BPD symptoms, history of childhood traumatization, and psychiatric disorders were assessed by means of self-reports and structured interviews. To measure neural correlates of disturbed body awareness, high-resolution T1-weighted structural magnetic resonance imaging scans were collected and analyzed using voxel-based morphometry and region-of-interest-based approaches. The study was performed between 2012 and 2014, and data analysis was performed in 2014.
Mean HEP amplitudes in resting-state electroencephalograms and their correlation with self-reported emotional dysregulation, as well as with gray matter volume.
Patients with BPD had significantly reduced mean HEP amplitudes compared with healthy volunteers (F1,61 = 11.32, P = .001), whereas the mean HEP amplitudes of patients with BDP in remission lie somewhere in between these 2 groups of participants (P > .05). The HEP amplitudes were negatively correlated with emotional dysregulation (R = -0.30, P = .01) and positively associated with gray matter volume in the left anterior insula (R = 0.53, P < .05) and the bilateral dorsal anterior cingulate cortex (R = 0.47, P < .05), 2 structures that have been identified as core regions for interoception.
The results indicate state-dependent deficits in the cortical processing of bodily signals in patients with BPD, which appear to be associated with core features of BPD. The analysis of patients with BPD in remission suggests an improvement in cortical representation of bodily signals with symptom remission. Results recommend the integration of techniques to strengthen bodily awareness in psychotherapeutic interventions of BPD.
感知和调节自己情绪的能力与对传入身体信号的处理（内感受）密切相关。因此，内感受障碍可能是边缘型人格障碍（BPD）中情绪调节障碍的核心特征之一，因为去人格化、身体意象障碍和对身体疼痛的敏感性降低表明 BPD 患者的身体意识较差。
确定 BPD 中身体意识障碍的神经相关性及其与情绪调节障碍的关系，并探讨 BPD 症状缓解时身体意识的改善。
设计、地点和参与者：在德国海德堡大学医院进行的病例对照研究。使用 34 名未服用药物的 BPD 患者、31 名健康志愿者和 17 名未服用药物的 BPD 缓解患者的静息状态脑电图和并行心电图记录心率诱发电位（HEPs），这是心血管系统传入信号皮质代表的一个指标。使用 5 分钟的静息状态脑电图和并行心电图进行 HEPs 评估。核心 BPD 症状、儿童期创伤史和精神障碍通过自我报告和结构访谈进行评估。为了测量身体意识障碍的神经相关性，采集高分辨率 T1 加权结构磁共振成像扫描并使用基于体素形态测量和基于感兴趣区域的方法进行分析。该研究于 2012 年至 2014 年进行，数据分析于 2014 年进行。
静息状态脑电图中 HEPs 的平均振幅及其与自我报告的情绪调节障碍的相关性，以及与灰质体积的相关性。
与健康志愿者相比，BPD 患者的 HEPs 平均振幅显著降低（F1,61=11.32，P=0.001），而 BPD 缓解患者的 HEPs 平均振幅介于这两组参与者之间（P>.05）。HEPs 振幅与情绪调节障碍呈负相关（R=-0.30，P=0.01），与左侧前岛叶（R=0.53，P<.05）和双侧背侧前扣带皮层（R=0.47，P<.05）的灰质体积呈正相关，这两个区域被确定为内感受的核心区域。
研究结果表明，BPD 患者的身体信号皮质处理存在状态依赖性缺陷，这似乎与 BPD 的核心特征有关。对缓解期 BPD 患者的分析表明，随着症状缓解，身体信号的皮质代表得到改善。结果建议在 BPD 的心理治疗干预中整合增强身体意识的技术。
