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Emotional Responsiveness in Borderline Personality Disorder

The Role of Basal Hyperarousal and Self-Reported Emotional Regulation

Bortolla, Roberta, PhD*; Roder, Emanuela; Ramella, Pietro*; Fossati, Andrea*; Maffei, Cesare*†

The Journal of Nervous and Mental Disease: March 2019 - Volume 207 - Issue 3 - p 175–183
doi: 10.1097/NMD.0000000000000939
Original Articles

The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.

*Vita-Salute San Raffaele University; and

San Raffaele Hospital, Milan, Italy.

Send reprint requests to Cesare Maffei, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele-Turro, via Stamira d'Ancona, 20, 20127, Milan, Italy. E-mail:

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