Psychological and neurophysiological measures of emotion dysregulation in borderline personality disorder and posttraumatic stress disorder.

Background: Emotion dysregulation is a central feature in trauma-associated disorders such as posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, it remains unclear whether emotion dysregulation is a transdiagnostic phenomenon closely linked to childhood trauma, or if disorder-specific alterations in emotion processing exist. Following a multimethodological approach, we aimed to assess and compare the reactivity to and regulation of emotions between patients with BPD and PTSD, as well as healthy controls, and identify associations with childhood trauma.

Methods: A total of 135 women, 43 healthy controls, 43 with BPD and 49 with PTSD, took part in a multimethodological assessment of emotional reactivity and regulation. Self-report measures were used to assess childhood trauma and emotion dysregulation. Additionally, participants performed a classic emotion regulation (ER) paradigm. Subjective emotional valence ratings and neurophysiological responses (P3 and late positive potential, LPP) were measured in response to negative, positive, and neutral pictures (emotional reactivity) and during active regulation vs. passive viewing of negative pictures (ER).

Results: Regarding emotional reactivity, during the experimental paradigm both patient groups reported lower emotional valence after viewing positive or neutral pictures compared to healthy controls. Furthermore, P3 amplitudes in response to neutral pictures were reduced in both patient groups and in response to negative pictures, specifically in patients with PTSD. Regarding ER, while both patient groups self-reported significant disturbances in ER, neither valence ratings nor neurophysiological responses assessed during the ER task (P3, LPP) differed from healthy controls. Across groups, childhood trauma was related to decreased emotional valence ratings on neutral and positive pictures and higher self-reported emotion dysregulation.

Conclusions: Patients with BPD and PTSD exhibited a reduced emotional reactivity in response to positive and neutral information. Specifically, patients with PTSD demonstrated hypo-reactivity to neutral and trauma-unrelated negative stimuli, which might be due to altered attentional resource allocation following trauma. Although patients reported using adaptive ER strategies less frequently in daily life, they effectively implemented them when instructed to, highlighting important clinical and theoretical implications.