• DSM 5 – Pathological personality traits in: negative affectivity – Anxiousness::Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses;   

    What We Knows

                We now move into the field of anxiety and how it relates to BPD traits. The first concern in this area is related to how we react to interpersonal stresses. The dominant factor here is our response to perceptions of rejection. Von Ceumen-Lindenstjerna and others[1] looked at the responses of 30 adolescent female BPD patients, 29 patients with mixed diagnosis, and 30 healthy controls while viewing emotional faces using a visual dot probe task. This study indicated that BPD may be linked to an inability to disengage attention from negative facial expressions when in a negative mood. Burkland and others [2] looked at neural responses to visual representations of disapproval, anger and disgust using an fMRI. In all cases there was activation of the amygdala. Individuals with rejection sensitivity (BPD) exhibited greater dorsal anterior cingulate cortex activity in response to disapproving facial expressions, but not in response to anger or disgust.                    

                So what do these two studies tell us in plain English. First or all let’s remember that these are traits and not pathological disorders. That means that these are biological brain tendencies to react to our environment is specific ways. The main conclusion is that we tend to be sensitive and over vigilant in responses to the visual clues we read from others. This includes body language and facial expression. Secondly, we seem to be searching specifically for signs of rejection. The third conclusion is that these images seem to be processed by a combination of the amygdala and the dorsal anterior cingulate. Now we know that the amygdala is our general emotional response mechanism involving our sympathetic system, but what about the dorsal anterior cingulate?

                The dorsal anterior cingulate appears to be part of the prefrontal cortex that is involved in cognitive functions, such as empathy, impulse control, emotion, and decision-making. Some areas are particularly activated in tasks involving visual attention. It would appear then that we are wired to be more attentive or sensitive to processing visual information especially when it involves social relationships. It would also appear that we are specifically wired to look for signs of rejection. This appears to be a combination then of physical or neurological predisposition to visual cues combined with learned experiences of rejection.

               The key here again is that we are wired this way. Rather than rewiring and refiring and rewiring as a cognitive process, which seems to be a dead end issue, we should look more towards just taking in the information and accepting it, thereby blocking or not allowing the information to proceed on to the amygdala and the activation of the sympathetic system. In other words, when our dorsal anterior cingulate is sending us a message that it might be seeing signs of rejection, we simply accept that information and not allow the brain to pass it on to the amygdala to try to motivate us to react and respond.

             This is the difference between an impairment and a trait. If the case of an impairment we are unable to control our response but in the case of a trait we have tendencies to react but we are in control and can choose how to respond. The very act of choosing completes the circuit with no emotional response and allows us to move on. We simply acknowledge and accept and make a conscious decision to ignore these signs. We thereby complete the circuit by making a decision to not respond. We take a deep breath  and move on.

     

    [1] Von Ceumen-Lindenstjerna, I-A; Brunner, R; Parzer, P.; Mundt, C.; Fiedler P. and Resch, F.. Attentional Bias in Later Stages of Emotional Information Processing in Female Adolescents with Borderline Personality Disorder. Psychopathology; 2010

    [2] Burkland, Lisa J.; Eisenberger, Naomi I.; and Lieberman, Matthew d. The face of rejection: Rejection sensitivity moderates dorsal anterior cingulate activity to disapproving facial expressions. Social Neuroscience, 2007.