Skip to main content Accessibility help
×
Home

Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation

  • Annegret Krause-Utz (a1) (a2), Julia-Caroline Walther (a2), Stefanie Lis (a2), Christian Schmahl (a3) (a4) and Martin Bohus (a2)...

Abstract

Background

Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC).

Methods

57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed.

Results

Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD.

Conclusions

Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Annegret Krause-Utz, E-mail: a.d.krause@fsw.leidenuniv.nl

References

Hide All
American Psychiatric Association (APA) (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.
American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, VA: American Psychiatric Association.
Appelhans, BM, Luecken, LJ and Candland, DK (2006) Heart rate variability as an index of regulated emotional responding. Review of General Psychology 10, 229240.
Arntz, A, Stupar-Rutenfrans, S, Bloo, J, van Dyck, R and Spinhoven, P (2015) Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy. Behaviour Research and Therapy 74, 6071.
Austin, MA, Riniolo, TC and Porges, SW (2007) Borderline personality disorder and emotion regulation: insights from the Polyvagal Theory. Brain and Cognition 65, 6976.
Ball, J and Links, P (2009) Borderline personality disorder and childhood trauma: evidence for a causal relationship. Current Psychiatry Reports 11, 6368.
Barnow, S, Limberg, A, Stopsack, M, Spitzer, C, Grabe, HJ, Freyberger, HJ and Hamm, A (2012) Dissociation and emotion regulation in borderline personality disorder. Psychological Medicine 42, 783794.
Battle, CL, Shea, MT, Johnson, DM, Yen, S, Zlotnick, C, Zanarini, MC, Sanislow, CA, Skodol, AE, Gunderson, JG, Grilo, CM, McGlashan, TH and Morey, LC (2004) Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Personality Disorders 18, 193211.
Beblo, T, Pastuszak, A, Griepenstroh, J, Fernando, S, Driessen, M, Schütz, A, Rentzsch, K and Schlosser, N (2010) Self-reported emotional dysregulation but no impairment of emotional intelligence in borderline personality disorder: an explorative study. The Journal of Nervous and Mental Disease 198, 385388.
Bernstein, EM and Putnam, FW (1986) Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease 174, 727735.
Bohus, M, Kleindienst, N, Limberger, MF, Stieglitz, RD, Domsalla, M, Chapman, AL, Steil, R, Philipsen, A and Wolf, M (2009) The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. Psychopathology 42, 3239.
Bradley, NN and Lang, PJ (1994) Measuring emotion: the Self-Assessment Manikin and the Semantic Differential. Journal of Behavior Therapy and Experimental Psychiatry 25, 4959.
Cackowski, S, Neubauer, T and Kleindienst, N (2017) The impact of posttraumatic stress disorder on the symptomatology of borderline personality disorder. Borderline Personal Disord Emot Dysregul 4, 6. doi: 10.1186/s40479-017-0057-5.
Carpenter, RW and Trull, TJ (2013) Components of emotion dysregulation in borderline personality disorder: a review. Current Psychiatry Reports 15, 335.
Cavazzi, T and Becerra, R (2014) Psychophysiological research of borderline personality disorder: review and implications for biosocial theory. Europe's Journal of Psychology 10, 185203.
Chalmers, J, Quintana, D, Abbott, M and Kemp, A (2014) Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Frontiers in Psychiatry 5, 111.
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Erlbaum.
Crowell, SE, Beauchaine, TP and Linehan, MM (2009) A biosocial developmental model of borderline personality: elaborating and extending Linehan's theory. Psychological Bulletin 135, 495510.
Daros, AR, Zakzanis, KK and Ruocco, AC (2013) Facial emotion recognition in borderline personality disorder. Psychological Medicine 43, 19531963.
Di Simplicio, M, Costoloni, G, Western, D, Hanson, B, Taggart, P and Harmer, CJ (2012) Decreased heart rate variability during emotion regulation in subjects at risk for psychopathology. Psychological Medicine 42, 17751783.
Dixon-Gordon, KL, Chapman, AL, Lovasz, N and Walters, K (2011) Too upset to think: the interplay of borderline personality features, negative emotions, and social problem solving in the laboratory. Personality Disorders: Theory, Research, and Treatment 2, 243.
Dixon-Gordon, KL, Turner, BJ, Zachary Rosenthal, M and Chapman, AL (2017) Emotion regulation in borderline personality disorder: an experimental investigation of the effects of instructed acceptance and suppression. Behavior Therapy 48, 750764.
Domes, G, Schulze, L and Herpertz, S (2009) Emotion recognition in borderline personality disorder - a review of the literature. Journal of Personality Disorders 23, 619.
Donegan, NH, Sanislow, CA, Blumberg, HP, Fulbright, RK, Lacadie, C, Skudlarski, P, Gore, JC, Olson, IR, McGlashan, TH and Wexler, BE (2003) Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biological Psychiatry 54, 12841293.
Dyck, M, Habel, U, Slodczyk, J, Schlummer, J, Backes, V, Schneider, F and Reske, M (2009) Negative bias in fast emotion discrimination in borderline personality disorder. Psychological Medicine 39, 855864.
Ebner-Priemer, UW, Badeck, S, Beckmann, C, Wagner, A, Feige, B, Weiss, I, Lieb, K and Bohus, M (2005) Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. Journal of Psychiatric Research 39, 8592.
Ebner-Priemer, UW, Welch, SS, Grossman, P, Reisch, T, Linehan, MM and Bohus, M (2007) Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder. Psychiatry Research 150, 265275.
Ebner-Priemer, UW, Mauchnik, J, Kleindienst, N, Schmahl, C, Peper, M, Rosenthal, MZ, Flor, H and Bohus, M (2009) Emotional learning during dissociative states in borderline personality disorder. Journal of Psychiatry and Neuroscience 34, 214222.
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1997) Structured Clinical Interview for DSM-V Axis I Disorders – Clinical Version (SCID-CV). Washington, DC: American Psychiatric Press.
Fitzpatrick, S and Kuo, JR (2015) A comprehensive examination of delayed emotional recovery in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry 47, 5159.
Fitzpatrick, S and Kuo, JR (2016) The impact of stimulus arousal level on emotion regulation effectiveness in borderline personality disorder. Psychiatry Research 241, 242248.
Frías, Á and Palma, C (2015) Comorbidity between post-traumatic stress disorder and borderline personality disorder: a review. Psychopathology 48, 110.
Glenn, CR and Klonsky, ED (2009) Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders 23, 2028.
Grant, BF, Chou, SP, Goldstein, RB, Huang, B, Stinson, FS, Saha, TD, Smith, SM, Dawson, DA, Pulay, AJ, Pickering, RP and Ruan, WJ (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry 69, 533545.
Gratz, K and Roemer, L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 4154.
Gratz, KL, Tull, MT, Matusiewicz, AM, Breetz, AA, Lejuez, CW and Lejuez, CW (2013) Multimodal examination of emotion regulation difficulties as a function of co-occurring avoidant personality disorder among women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment 4, 304314.
Gross, JJ and John, OP (2003) Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology 85, 348362.
Grossman, P and Taylor, EW (2007) Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology 74, 263285.
Hagenhoff, M, Franzen, N, Gerstner, L, Koppe, G, Sammer, G, Netter, P, Gallhofer, B and Lis, S (2013) Reduced sensitivity to emotional facial expressions in borderline personality disorder: effects of emotional valence and intensity. Journal of Personality Disorders 27, 1935.
Hautzinger, M, Keller, F and Kühner, C (2009) Beck-Depressions-Inventar (BDI-II), 2nd Edn. Frankfurt: Pearson Assessment.
Kemp, AH and Quintana, DS (2013) The relationship between mental and physical health: insights from the study of heart rate variability. International Journal of Psychophysiology 89, 288296.
Kemp, AH, Quintana, DS, Felmingham, KL, Matthews, S and Jelinek, HF (2012) Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS ONE 7, e30777.
Kleindienst, N, Priebe, K, Görg, N, Dyer, A, Steil, R, Lyssenko, L, Winter, D, Schmahl, C and Bohus, M (2016) State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. European Journal of Psychotraumatology 7, 30375.
Koenig, J, Kemp, AH, Beauchaine, TP, Thayer, JF and Kaess, M (2016 a). Depression and resting state heart rate variability in children and adolescents - A systematic review and meta-analysis. Clinical Psychology Review 46, 136150.
Koenig, J, Kemp, AH, Feeling, NR, Thayer, JF and Kaess, M (2016 b). Resting state vagal tone in borderline personality disorder: a meta-analysis. Progress in Neuropsychopharmacology & Biological Psychiatry 64, 1826.
Koenigsberg, HW, Fan, J, Ochsner, KN, Liu, X, Guise, KG, Pizzarello, S, Dorantes, C, Guerreri, S, Tecuta, L, Goodman, M, New, A and Siever, LJ (2009) Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biological Psychiatry 66, 854863.
Krause-Utz, A, Winter, D, Niedtfeld, I and Schmahl, C (2014) The latest neuroimaging findings in borderline personality disorder. Current Psychiatry Reports 16, 438.
Krause-Utz, A, Frost, R, Winter, D and Elzinga, BM (2017) Dissociation and alterations in brain function and structure: implications for borderline personality disorder. Current Psychiatry Reports 19, 6.
Krause-Utz, A, Winter, D, Schriner, F, Chiu, CD, Lis, S, Spinhoven, P, Bohus, M, Schmahl, C and Elzinga, BM (2018) Reduced amygdala reactivity and impaired working memory during dissociation in borderline personality disorder. European Archives of Psychiatry and Clinical Neuroscience 268, 401415.
Kuo, JR and Linehan, MM (2009) Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology 118, 531544.
Kuo, JR, Fitzpatrick, S, Metcalfe, RK and Mcmain, S (2016) A multi-method laboratory investigation of emotional reactivity and emotion regulation abilities in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry 50, 5260.
Lang, PJ, Bradley, MM and Cuthbert, BN (2008) International affective picture system (IAPS). In Affective Ratings of Pictures and Instruction Manual. Technical Report A-8. Gainesville, FL: University of Florida.
Lanius, RA, Vermetten, E, Loewenstein, RJ, Brand, B, Schmahl, C, Bremner, JD and Spiegel, D (2010) Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry 167, 640647.
Laux, L, Glanzmann, P, Schaffner, P and Spielberger, CD (1981) State-Trait Anxiety Inventory (Spielberger, C.D., Gorsuch, R.L., Lushene, R.E., 1970) - German version. Beltz: Weinheim.
Lehrl, S (1989) Mehrfachwahl-Wortschatz-Intelligenztest: MWT-B (2., überarb. Aufl. ed.). Perimed-Fachbuch-Verl.-Ges.: Erlangen.
Liao, D, Carnethon, M, Evans, GW, Cascio, WE and Heiss, G (2002) Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes 51, 35243531.
Lieb, K, Zanarini, MC, Schmahl, C, Linehan, MM and Bohus, M (2004) Borderline personality disorder. The Lancet 364, 453461.
Loranger, AW (1999) International Personality Disorder Examination (IPDE): DSM-IV and ICD-10 Modules. Odessa, FL: Psychological Assessment Resources.
Malik, M (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Annals of Noninvasive Electrocardiology 1, 151181.
Metcalfe, RK, Fitzpatrick, S and Kuo, JR (2015) A laboratory examination of emotion regulation skill strengthening in borderline personality disorder. Personality Disorders 8, 237246.
Meyer, PW, Müller, LE, Zastrow, A, Schmidinger, I, Bohus, M, Herpertz, SC and Bertsch, K (2016) Heart rate variability in patients with post-traumatic stress disorder or borderline personality disorder: relationship to early life maltreatment. Journal of Neural Transmission 23, 11071118.
Ochsner, KN, Bunge, SA, Gross, JJ and Gabrieli, JD (2002) Rethinking feelings: an FMRI study of the cognitive regulation of emotion. Journal of Cognitive Neuroscience 14, 12151229.
Pagura, J, Stein, MB, Bolton, JM, Cox, BJ, Grant, B and Sareen, J (2010) Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research 44, 11901198.
Parati, G, Saul, JP, Di Rienzo, M and Mancia, G (1995) Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation. A critical appraisal. Hypertension 25, 12761286.
Paret, C, Kluetsch, R, Zaehringer, J, Ruf, M, Demirakca, T, Bohus, M, Ende, G and Schmahl, C (2016) Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. Social Cognitive and Affective Neuroscience 11, 952960.
Pechtel, P and Pizzagalli, D (2011) Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology 214, 5570.
Reitz, S, Kluetsch, R, Niedtfeld, I, Knorz, T, Lis, S, Paret, C, Kirsch, P, Meyer-Lindenberg, A, Treede, RD, Baumgärtner, U, Bohus, M and Schmahl, C (2015) Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour. The British Journal of Psychiatry 207, 165172.
Rosenthal, MZ, Gratz, KL, Kosson, DS, Cheavens, JS, Lejuez, CW and Lynch, TR (2008) Borderline personality disorder and emotional responding: a review of the research literature. Clinical Psychology Reviews 28, 7591.
Rüsch, N, Weber, M, Il'yasov, KA, Lieb, K, Ebert, D, Hennig, J and van Elst, LT (2007) Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. NeuroImage 35, 738747.
Salsman, NL and Linehan, MM (2012) An investigation of the relationships among negative affect, difficulties in emotion regulation, and features of borderline personality disorder. Journal of Psychopathology and Behavioral Assessment 34, 260267.
Sammito, S, Thielmann, B, Zimmermann, P and Böckelmann, I (2015) Influence of post-traumatic stress disorder on heart rate variability as marker of the autonomic nervous system—a systematic review. Fortschritte der Neurologie Psychiatrie 83, 3037. [Article in German].
Santangelo, PS, Reinhard, I, Koudela-Hamila, S, Bohus, M, Holtmann, J, Eid, M and Ebner-Priemer, UW (2017) The temporal interplay of self-esteem instability and affective instability in Borderline Personality Disorder patients’ everyday life. Journal of Abnormal Psychology 126, 10571065.
Scheiderer, EM, Wood, PK and Trull, TJ (2015) The comorbidity of borderline personality disorder and posttraumatic stress disorder: revisiting the prevalence and associations in a general population sample. Borderline Personality Disorder and Emotion Dysregulation 2, 11.
Schmahl, C, Herpertz, SC, Bertsch, K, Ende, G, Flor, H, Kirsch, P, Lis, S, Meyer-Lindenberg, A, Rietschel, M, Schneider, M, Spanagel, R, Treede, RD and Bohus, M (2014) Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of the art and research agenda of the German Clinical Research Unit. Borderline Personality Disorder and Emotion Dysregulation 1, 12.
Schmitt, R, Winter, D, Niedtfeld, I, Herpertz, SC and Schmahl, C (2016) Effects of psychotherapy on neuronal correlates of reappraisal in female patients with borderline personality disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 1, 548557.
Schulze, L, Domes, G, Krüger, A, Berger, C, Fleischer, M, Prehn, K, Schmahl, C, Grossmann, A, Hauenstein, K and Herpertz, SC (2011) Neuronal correlates of cognitive reappraisal in borderline patients with affective instability. Biological Psychiatry 69, 564573.
Schulze, L, Schmahl, C and Niedtfeld, I (2016) Neural correlates of disturbed emotion processing in borderline personality disorder: a multimodal meta-analysis. Biological Psychiatry 79, 97106.
Sierra, M and Berrios, GE (1998) Depersonalization: neurobiological perspectives. Biological Psychiatry 44, 898908.
Sieswerda, SH, Arntz, AR, Mertens, I and Vertommen, S (2007) Hypervigilance in patients with borderline personality disorder: specificity, automaticity, and predictors. Behaviour Research and Therapy 45, 10111024.
Stiglmayr, CE, Ebner-Priemer, UW, Bretz, J, Behm, R, Mohse, M, Lammers, CH, Anghelescu, IG, Schmahl, C, Schlotz, W, Kleindienst, N and Bohus, M (2008) Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatrica Scandinavica 117, 139147.
Stiglmayr, C, Schmahl, C, Bremner, JD, Bohus, M and Ebner-Priemer, U (2009) Development and psychometric characteristics of the DSS-4 as a short instrument to assess dissociative experience during neuropsychological experiments. Psychopathology 42, 370374.
Svaldi, J, Dorn, C, Matthies, S and Philipsen, A (2012) Effects of suppression and acceptance of sadness on the urge for non-suicidal self-injury and self-punishment. Psychiatry Research 200, 404416.
Tarvainen, MP, Niskanen, JP, Lipponen, JA, Ranta-aho, PO and Karjalainen, PA (2014) Kubios HRV – Heart rate variability analysis software. Computer Methods and Programs in Biomedicine 113, 210220.
Thayer, JF, Åhs, F, Fredrikson, M, Sollers, JJ and Wager, TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neuroscience and Biobehavioral Reviews 36, 747756.
Thome, J, Liebke, L, Bungert, M, Schmahl, C, Domes, G, Bohus, M and Lis, S (2015) Confidence in facial emotion recognition in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment 7, 159168.
Unoka, Z, Fogd, D, Füzy, M and Csukly, G (2011) Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder. Psychiatry Research 189, 419425.
van Zutphen, L, Siep, N, Jacob, GA, Goebel, R and Arntz, A (2015) Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: a critical review of fMRI studies. Neuroscience and Biobehavioural Reviews 51, 6476.
Verkuil, B, Brosschot, JF, Marques, AH, Kampschroer, K, Sternberg, EM and Thayer, JF (2015) Gender differences in the impact of daily sadness on 24-h heart rate variability. Psychophysiology 52, 16821688.
Verkuil, B, Brosschot, J, Tollenaar, M, Lane, R and Thayer, J (2016) Prolonged non-metabolic heart rate variability reduction as a physiological marker of psychological stress in daily life. Annals of Behavioural Medicine 50, 704714.
Weinberg, A, Klonsky, ED and Hajcak, G (2009) Autonomic impairment in borderline personality disorder: a laboratory investigation. Brain and Cognition 71, 279286.
Westphal, M, Olfson, M, Bravova, M, Gameroff, MJ, Gross, R, Wickramaratne, P, Pilowsky, DJ, Neugebauer, R, Shea, S, Lantigua, R, Weissman, M and Neria, Y (2013) Borderline personality disorder, exposure to interpersonal trauma, and psychiatric comorbidity in urban primary care patients. Psychiatry 76, 365380.
Williams, DP, Cash, C, Rankin, C, Bernardi, A, Koenig, J and Thayer, JF (2015) Resting heart rate variability predicts self reported difficulties in emotion regulation: a focus on different facets of emotion regulation. Frontiers in Psychology 6, 18.
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A and Reynolds, V (1998) Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry 39, 296302.
Zilverstand, A, Parvaz, MA and Goldstein, RZ (2017) Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review. NeuroImage 151, 105116.
Zimmerman, M and Mattia, JI (1999) Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry 40, 245252.

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Krause-Utz et al. supplementary material
Krause-Utz et al. supplementary material 1

 Unknown (258 KB)
258 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed