Jella Voelter

Patients with borderline personality disorder (BPD) suffer from severe emotional dysregulation and disturbances in body image and self-perception. Interoception, the processing and perception of internal body signals, is closely linked to emotional processing, but it remains unclear whether BPD impairs specific interoceptive facets and how these deficits respond to treatment. We investigated two key interoceptive facets, accuracy and attention, in BPD patients and healthy controls (HC) using self-report and objective measures before (n _BPD =55,n _HC = 31) and after (n _BPD =37,n _HC = 31) four-week residential Dialectical Behavior Therapy (DBT)/a waiting interval. Interoceptive accuracy and its metacognitive awareness were evaluated using a heartbeat discrimination task, while interoceptive attention was measured through questionnaires, intensity ratings, and uni- and multivariate neural responses during a functional magnetic resonance imaging (fMRI) interoceptive attention task. Before DBT, BPD patients showed reduced self-reported interoceptive attention, which was associated with more interpersonal problems. Patients further exhibited higher similarity in activity patterns evoked by cardiac interoceptive and exteroceptive attention in the insular and dorsal anterior cingulate cortex. There were no significant group differences in behavioral or self-reported interoceptive accuracy or metacognitive awareness. However, behavioral interoceptive accuracy was impaired in BPD patients with more severe symptoms. After four-week residential DBT, self-reported interoceptive attention significantly improved, while other interoceptive facets showed no significant changes. Our findings indicate that BPD involves selective interoceptive attention disturbances, with only self-reported measures responding to treatment. These results support multifaceted assessments of interoception and the potential benefit of interoceptive attention training for all BPD patients, with additional accuracy training in more severe cases.

Background: Patients with borderline personality disorder (BPD) suffer from severe emotional dysregulation and disturbances in body image and self-perception. Interoception, the processing and perception of internal body signals, is closely linked to emotional processing, but it remains unclear whether BPD impairs specific interoceptive facets and how these deficits respond to treatment. Methods: We investigated the two key interoceptive facets, accuracy and attention, in 55 BPD patients and 31 healthy controls (HC) using self-report and objective measures before and after four-week residential Dialectical Behavior Therapy (DBT). Interoceptive accuracy and its metacognitive awareness were evaluated using a heartbeat discrimination task, while interoceptive attention was measured through questionnaires, intensity ratings, and both uni- and multivariate neural responses during a functional magnetic resonance imaging (fMRI) interoceptive attention task. Results: Before DBT, BPD patients showed reduced self-reported interoceptive attention, which was associated with more interpersonal problems. Patients further exhibited higher similarity in activity patterns evoked by cardiac interoceptive and exteroceptive attention in the insular and dorsal anterior cingulate cortex. There were no significant group differences in behavioral or self-reported interoceptive accuracy or metacognitive awareness. However, behavioral interoceptive accuracy was impaired in BPD patients with more severe symptoms. After four-week residential DBT, self-reported interoceptive attention significantly improved, while other interoceptive facets showed no significant changes. Conclusions: BPD involves disturbances in specific interoceptive facets that respond differently to treatment. Our findings support multifaceted assessments of interoception and the potential benefit of interoceptive attention training for all BPD patients, with additional accuracy training in more severe cases.

Introduction: Patients with borderline personality disorder (BPD) suffer from severe social impairments and interpersonal problems. Social touch can provide comfort and facilitate the maintenance of social bonds, and preliminary evidence indicates a negative evaluation of social touch in patients with BPD. However, the neural mechanisms underlying aberrant touch processing in BPD and its role for social impairments are still unclear. Methods: We recruited 55 BPD patients and 31 healthy controls and used functional magnetic resonance imaging to probe neural responses to slow (i.e., C-tactile [CT]-optimal; affective) and fast (i.e., CT-suboptimal; discriminative) touch before and after 4 weeks of a residential dialectical behavior therapy (DBT) program. In addition to assessing BPD symptoms and interpersonal problems, we evaluated touch allowance maps and the attitude toward social touch. Results: BPD patients showed a comprehensive negative bias toward social touch before the DBT, evident in a significantly more negative attitude toward and reduced comfort zones of social touch compared to healthy controls. Activation in the posterior insular cortex in response to CT-optimal touch was significantly reduced and correlated with the severity of interpersonal problems in BPD patients. Despite significant improvements in overall BPD symptom load, dysfunctional social touch processing persisted after 4 weeks of DBT, indicating trait-like disturbances in BPD. Conclusions: An impaired insula-mediated integration of affective and sensory components of touch may constitute a clinically relevant biological signature of the complex interpersonal problems in BPD.

Introduction: Patients with borderline personality disorder (BPD) suffer from severe social impairments and interpersonal problems. Social touch can provide comfort and facilitate the maintenance of social bonds, and preliminary evidence indicates a negative evaluation of social touch in patients with BPD. However, the neural mechanisms underlying aberrant touch processing in BPD and its role for social impairments are still unclear. Methods: We recruited 55 BPD patients and 31 healthy controls and used functional magnetic resonance imaging to probe neural responses to slow (i.e. C-tactile (CT)-optimal; affective) and fast (i.e. CT-suboptimal; discriminative) touch before and after four weeks of a residential dialectical behavior therapy (DBT) program. In addition to assessing BPD symptoms and interpersonal problems, we evaluated touch allowance maps and the attitude towards social touch. Results: BPD patients showed a comprehensive negative bias towards social touch before the DBT, evident in a significantly more negative attitude towards and reduced comfort zones of social touch compared to healthy controls. Moreover, reduced comfort zones of social touch were associated with more interpersonal problems. Activation in the posterior insular cortex in response to CT-optimal touch was significantly reduced and correlated with the severity of interpersonal problems in BPD patients. Despite significant improvements in overall BPD symptom load, dysfunctional social touch processing persisted after four weeks of DBT, indicating trait-like disturbances in BPD. Conclusions: An impaired insula-mediated integration of affective and sensory components of touch may constitute a clinically relevant biological signature of the complex interpersonal problems in BPD.