Borderline Personality Disorder (BPD)

Question 1

In which cluster is BPD?

Answer 1

In Cluster B. Together with narcissistic personality disorder, histrionic, and antisocial.

Question 2

What characterizes BPD according to the DSM-V?

Answer 2

BPD is characterized through:
- intense & unstable emotions and mood
- impulsive behavior
- Specific thinking patterns: over-simplified, black-and white thinking, all-or-nothing thinking,…
- unstable sense of self
- often radical impulsive life changes regarding career or relationships
- misinterpretation of actions/motivations of others
- switching between devaluating (=Abwertung) and idealization
- functional impairment: difficulties to maintain relationships, Self-fulling prophecy (= the physical outcome of a situation being influenced by our thinking, either positively or negatively)

Question 3

What showed the Rubber Hand Illusion Study (Bodmann et al., 2016) in BPD patients, remitted BPD and healthy controls?

Answer 3

• Current BPD patients showed a strong experience of ownership of the rubber hand
  => BPD patients who experience more dissociation symptoms, also experience stronger illusions
  (through the link to dissociation, the bottom-up integration deficit is unlikely (how youre susceptible to the rubber hand illusion)
• whereas remitted BPD showed less feelings of ownership
• and HC showed the lowest feeling of ownership of the rubber hand
  => significant difference between current BPD and HC

Question 4

Which aspects of BPD were tested with the rubber hand illusion?

Answer 4

Identity disturbance and dissociation

Question 5

In what other psychiatric disorders showed the rubber hand illusion a higher susceptibility in patients?

Answer 5

Schizophrenia, eating disorders, BPD
-> all of these disorders are also characterized by dissociation and an unstable self

Question 6

What is the first form of emotion regulation?

Answer 6

touch (tactile stimuli)

Question 7

What did the Study “The skin as a social organ” (Morrison et al., 2003) show?

Answer 7

• It showed that the skin is the most social organ
• touch is the first form of emotion regulation (even prenatal)
  -> if a mother puts her hand on her belly the baby starts to make more outward movements
  -> that is not happening with the hand of a foreigner (even baby tends to more self-touch then)

Question 8

Explain the James-Lange-Theory of emotion.

Answer 8

Basic idea: you perceive a stimulus (eg.: bear) -> body starts reacting (eg.:arousal, heart pounding) -> experience of emotion (eg.: fear)
=> eg. Panic attacks: show a misunderstanding of bodily sensations leading to anxiety

Question 9

Explain some aspects of touch throughout the life.

Answer 9

Prenatal: first emotion regulation, touch experiences with mother dominantly
Newborns: need to learn how to express and regulation their emotions, bonding with caregivers through touch-> eg.: crying leads to a higher level of cortisol which can be decrease through touch
Early childhood: learning how to use touch to communicate, imitation of parents and others + a lot of games involve touch
Throughout the lifespan: in adolescence more touch with peer group (not parents that much anymore), used to share happiness and love (eg.), + also old people still engage into sexuality

Question 10

What is important to regulate our emotions?

Answer 10

An individual needs to be able to perceive and interpret emotions, bodily sensations (stimuli) correctly.

Question 11

What is the difference between feeling and sensing?

Answer 11

Sensing (fast nerve fibers): functional touch
- Fast touch, pokes, pinpricks, pressure, vibration, gives information about the spatial location
- mainly processed in the somatosensory cortex
Feeling (slow nerve fibers): affective social touch
- deep pain, temperature, pleasant touch
- processed also in the somatosensory cortex BUT also in the insular cortex

Question 12

What is affective touch and how does it work?

Answer 12

• Slow stroking activates C-tactile fibers (CT) (receptors)
• this leads to direct communication with the insula
• there happens the social/emotional evaluation of the touch
• affective touch is experienced more pleasant than non-affective touch
• but the touch provider and the context matter a lot

Question 13

What beneficial effects have affective touch?

Answer 13

• reduces physical and mental pain -> increases well-being
• acts as a social buffer to stress and anxiety

Question 14

Explain and describe the study “Slow brushing decreases heat pain in humans”.

Answer 14

• Participants got a painful stimulus in their hand
• Probands who where simultaniously in a slow stroking way reduced experience less pain, they could also endure pain for longer
• Highes effect when people were touched by their partner and not by the researcher

Question 15

Explain and describe the study “Parental touch reduces social vigilance in children”.

Answer 15

• children with and without social anxiety were included
• First condition: parents wished good luck and said that they will wait in the room next door and touched the child very briefly on the shoulder
• Second condition: parents said the same things like first condition, but they did not touch the children
  => Touch by their Parents gave them the idea of more social confidence, save social envrionemtn that can be explored
  BUT: this effect only occurred in young children (before puberty) -> touch experience differs depending on age

Question 16

What did the brush study showed in BPD, trauma and healthy controls?

Answer 16

○ Results:
- Controls experienced being slowly stroked as highly pleasant (on TPT scale)
- BPD experienced less pleasure by being touched than the healthy controls (significantly lower)
- Trauma participants rate significantly lower than the healthy controls and the BPD participants on the TPT scale
- No differences in the fast stroking condition between the groups
- BUT: comparing each group in the slow and in the fast stroking condition
- Significant difference in the healthy controls: they experience more pleasure in the slow touch condition
Also significant difference in BPD patients: they experience more pleasure in the slow touch condition
- No difference for the trauma group -> they dont distingusih in terms of pleasantness between the two stroking conditions
=> the CT system of the control and the BPD group is (more or less) still functioning
=> nature of the trauma may explain the difference

Question 17

How is emotion regulation and touch associated?

Answer 17

The more participants dislike (the affective, slow) touch, the more emotion regulation problems were reported.

Question 18

Can touch be beneficial even if somebody doesn’t like it to be touched?

Answer 18

It actually is still beneficial, but that doesn’t mean that somebody should be touched without their will. Thus, it can be expected that the CT system still works in individuals with BPD, although they don’t experience touch as pleasant.
-> Study showed that feeling of social exclusion are decreasing due to affective touch in individuals with personality disorders

Question 19

What is a PAR reflex and how is it connected to measuring the pleasantness of touch?

Answer 19

The PAR reflex is a small muscle behind the ear, that normally becomes only active when there is like a ticking noise. Previous studies found that this reflex is activated due to seeing rewarding stimuli. Thus, this could be a chance for objective measure of pleasantness of touch in individuals.

Question 20

What can be clinical implications from the recent findings regarding touch?

Answer 20

Touch experiences should be talked about during the clinical intake. Thus, therapist could help with communicating touch needs and boundaries in their own social network.