Flasbeck Vera, Popkirov Stoyan, Ebert Andreas, Brüne Martin
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.
University Hospital Knappschaftskrankenhaus Bochum, Department of Neurology, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany.
Borderline Personal Disord Emot Dysregul. 2020 Oct 22;7:24. doi: 10.1186/s40479-020-00139-1. eCollection 2020.
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.
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.
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.
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.
边缘型人格障碍（BPD）患者在情绪觉察（述情障碍）方面存在困难，且常出现分离症状，这可能反映出其在本体感受觉察方面存在更广泛的缺陷。目前尚不清楚这是否与本体感受的皮质处理改变有关。
我们利用一种本体感受的电生理标志物，即心跳诱发电位（HEP），并研究了其与自主神经系统（ANS）功能的心电图相关指标（心率变异性），以及与BPD患者述情障碍、分离和边缘症状严重程度的自我报告测量值之间的关系。
与健康对照组相比，BPD患者额叶电极上的HEP波幅更高。BPD患者的交感ANS活动比对照组更强。在所有组中，HEP波幅与中央电极上的副交感神经活动相关，且与额叶电极上的述情障碍相关。
这些发现支持了这样一种观点，即BPD患者在情绪觉察方面的困难反映在额叶本体感受电生理标志物的改变上。因此，情绪觉察可被理解为本体感受和外感受性注意之间调节失败。未来的研究可能旨在调查改变的本体感受及其电生理相关指标是否可通过治疗干预得到改善。
