Emotional Sensitivity and the Brain in BPD

Why desensitization may worsen borderline symptoms.

Posted Jul 05, 2018

Emotional sensitivity is a prominent symptom of borderline personality disorder. A recent study1 explored how repeated exposure to negative stimuli might be differentially experienced by individuals with Borderline Personality Disorder (BPD). Emotional reactions and brain activity were compared among patients diagnosed with BPD, patients diagnosed with avoidant personality disorder, and healthy control subjects. All individuals were shown negative images intended to evoke emotions, and neutral images. A few days later the same images were shown again.

Reported emotional reactions and brain activity showed greater habituation in the other two groups; that is, the non-BPD individuals began to "get used to" the provocative images. The BPD group remained emotionally stimulated, more sensitized  to the negative images. They also exhibited more negative responses to the neutral images.

These results have implications for therapeutic interventions. Desensitization or exposure therapy is an approach used to treat some psychiatric symptoms. For example, PTSD is sometimes treated by helping the patient gradually re-experience the trauma. Phobias may be treated by gradual, increasing exposure to the feared object. The goal of this approach is to "extinguish" the symptom. This study suggests that premature re-experiencing of upsetting situations may worsen BPD symptoms, and render the patient even more sensitized. A more helpful approach may be to develop strategies to better adjust to the affective dysregulation, rather than trying to eliminate it.

References

1 Denny, B.T. et al. "Sensitization of the Neural Salience Network to Repeated Emotional Stimuli Following Initial Habituation in Patients with Borderline Personality Disorder," American Journal of Psychiatry 175:7 (July, 2018): 657-664.