Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Sự thay đổi cảm nhận nội thể ở bệnh nhân rối loạn nhân cách biên giới: một nghiên cứu sử dụng tiềm năng đến từ nhịp tim
Tóm tắt
Bệnh nhân mắc rối loạn nhân cách biên giới (BPD) gặp khó khăn trong việc nhận biết cảm xúc (alexithymia) và thường phát triển các triệu chứng phân ly, điều này có thể phản ánh những thiếu sót rộng hơn trong nhận thức nội tại. Hiện tại, chưa rõ liệu sự thay đổi này có liên quan đến sự thay đổi trong xử lý vỏ não đối với cảm nhận nội tại hay không. Chúng tôi đã sử dụng một dấu hiệu điện sinh lý của cảm nhận nội tại, cụ thể là tiềm năng đến từ nhịp tim (HEP), và kiểm tra mối quan hệ của nó với các chỉ số điện tâm đồ liên quan đến chức năng của hệ thần kinh tự chủ (ANS) (biến thiên nhịp tim), cũng như với các thang đo tự báo về alexithymia, phân ly và mức độ nghiêm trọng của triệu chứng rối loạn nhân cách biên giới ở bệnh nhân BPD. Các cá nhân mắc BPD có biên độ HEP cao hơn ở các điện cực trán so với nhóm đối chứng là khỏe mạnh. Hoạt động ANS giao cảm cao hơn ở bệnh nhân BPD so với nhóm đối chứng. Qua các nhóm, biên độ HEP có mối liên hệ với hoạt động phó giao cảm ở các điện cực trung tâm và tương quan với alexithymia ở các điện cực trán. Những phát hiện này hỗ trợ ý tưởng rằng những khó khăn trong việc nhận biết cảm xúc ở BPD được phản ánh qua các dấu hiệu điện sinh lý thay đổi ở vùng trán của cảm nhận nội tại. Do đó, việc nhận biết cảm xúc có thể được hiểu như là sự thất bại trong điều chỉnh giữa sự chú ý nội tại và sự chú ý ngoại tại. Các nghiên cứu trong tương lai có thể nhằm mục đích điều tra liệu cảm nhận nội tại thay đổi và các liên hệ điện sinh lý của nó có thể thay đổi thông qua can thiệp trị liệu hay không.
Từ khóa
#rối loạn nhân cách biên giới #cảm nhận nội tại #điện sinh lý #tiềm năng đến từ nhịp tim #alexithymiaTài liệu tham khảo
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American psychiatric pub; 2013.
Domes G, Grabe HJ, Czieschnek D, Heinrichs M, Herpertz SC. Alexithymic traits and facial emotion recognition in borderline personality disorder. Psychother Psychosom. 2011;80(6):383. https://doi.org/10.1159/000325828.
Flasbeck V, Popkirov S, Brüne M. Frontal EEG asymmetry in borderline personality disorder is associated with alexithymia. Borderline Pers Disord Emotion Dysregulation. 2017;4(1):20. https://doi.org/10.1186/s40479-017-0071-7.
Loas G, Speranza M, Pham-Scottez A, Perez-Diaz F, Corcos M. Alexithymia in adolescents with borderline personality disorder. J Psychosom Res. 2012;72(2):147–52. https://doi.org/10.1016/j.jpsychores.2011.11.006.
New AS, Mah R, Ripoll LH, Perez-Rodriguez MM, Lazarus S, Zipursky E, et al. Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. J Personal Disord. 2012;26(5):660–75. https://doi.org/10.1521/pedi.2012.26.5.660.
Korzekwa MI, Dell PF, Pain C. Dissociation and borderline personality disorder: an update for clinicians. Curr Psychiatry Rep. 2009;11(1):82–8. https://doi.org/10.1007/s11920-009-0013-1.
Popkirov S, Flasbeck V, Schlegel U, Juckel G, Brüne M. Childhood trauma and dissociative symptoms predict frontal EEG asymmetry in borderline personality disorder. J Trauma Dissociation. 2019;20(1):32–47. https://doi.org/10.1080/15299732.2018.1451808.
Löffler A, Foell J, Bekrater-Bodmann R. Interoception and its interaction with self, other, and emotion processing: implications for the understanding of psychosocial deficits in borderline personality disorder. Curr Psychiatr Rep. 2018;20(4):28. https://doi.org/10.1007/s11920-018-0890-2.
James W. What is an emotion? Mind. 1884;1(9):188–205. https://doi.org/10.1093/mind/os-IX.34.188.
Lange CG. In: Dunlap D, editor. The mechanism of the emotions. [in the emotions]. Baltimore: Williams & Wilkins; 1885.
Damasio AR. Descartes’ error. Emotion, reason and the human brain, vol. 1994. New York: Grosset/Putnam; 1994.
Evren C, Cınar O, Evren B. Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Compr Psychiatry. 2012;53(6):854–9. https://doi.org/10.1016/j.comppsych.2011.11.009.
Grabe H-J, Rainermann S, Spitzer C, Gänsicke M, Freyberger HJ. The relationship between dimensions of alexithymia and dissociation. Psychother Psychosom. 2000;69(3):128–31. https://doi.org/10.1159/000012380.
Popkirov S, Flasbeck V, Schlegel U, Juckel G, Brüne M. Alexithymia in borderline personality disorder is not associated with deficits in automatic visual processing of negative emotional stimuli. Psychiatry Res. 2018;263:121–4 http://www.sciencedirect.com/science/article/pii/S0165178117307898.
Montoya P, Schandry R, Müller A. Heartbeat evoked potentials (HEP): topography and influence of cardiac awareness and focus of attention. Electroencephalogr Clin Neurophysiol/Evoked Potentials Sect. 1993;88(3):163–72.
Schandry R, Weitkunat R. Enhancement of heartbeat-related brain potentials through cardiac awareness training. Int J Neurosci. 1990;53(2–4):243–53. https://doi.org/10.3109/00207459008986611.
Weitkunat R, Schandry R. Motivation and heartbeat evoked potentials. J Psychophysiol. 1990;4(1):33–40.
Yuan H, Yan H-M, Xu X-G, Han F, Yan Q. Effect of heartbeat perception on heartbeat evoked potential waves. Neurosci Bull. 2007;23(6):357–62. https://doi.org/10.1007/s12264-007-0053-7.
Pollatos O, Schandry R. Accuracy of heartbeat perception is reflected in the amplitude of the heartbeat-evoked brain potential. Psychophysiology. 2004;41(3):476–82. https://doi.org/10.1111/1469-8986.2004.00170.x.
Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3(8):655–66. https://doi.org/10.1038/nrn894.
Pollatos O, Kirsch W, Schandry R. Brain structures involved in interoceptive awareness and cardioafferent signal processing: a dipole source localization study. Hum Brain Mapp. 2005;26(1):54–64. https://doi.org/10.1002/hbm.20121.
Saper CB. The central autonomic nervous system: conscious visceral perception and autonomic pattern generation. Annu Rev Neurosci. 2002;25(1):433–69. https://doi.org/10.1146/annurev.neuro.25.032502.111311.
Damasio AR. The feeling of what happens: body and emotion in the making of consciousness: Houghton Mifflin Harcourt; 1999.
Dunn BD, Galton HC, Morgan R, Evans D, Oliver C, Meyer M, et al. Listening to your heart: how Interoception shapes emotion experience and intuitive decision making. Psychol Sci. 2010;21(12):1835–44. https://doi.org/10.1177/0956797610389191.
Herbert BM, Herbert C, Pollatos O. On the relationship between interoceptive awareness and alexithymia: is interoceptive awareness related to emotional awareness? J Pers. 2011;79(5):1149–75. https://doi.org/10.1111/j.1467-6494.2011.00717.x.
Pollatos O, Kirsch W, Schandry R. On the relationship between interoceptive awareness, emotional experience, and brain processes. Cogn Brain Res. 2005;25(3):948–62. https://doi.org/10.1016/j.cogbrainres.2005.09.019.
Wiens S. Interoception in emotional experience. Curr Opin Neurol. 2005;18:4 https://journals.lww.com/co-neurology/Fulltext/2005/08000/Interoception_in_emotional_experience.15.aspx.
Leopold C, Schandry R. The heartbeat-evoked brain potential in patients suffering from diabetic neuropathy and in healthy control persons. Clin Neurophysiol. 2001;112(4):674–82. https://doi.org/10.1016/s1388-2457(01)00480-1.
MacKinnon S, Gevirtz R, McCraty R, Brown M. Utilizing heartbeat evoked potentials to identify cardiac regulation of vagal afferents during emotion and resonant breathing. Appl Psychophysiol Biofeedback. 2013;38(4):241–55. https://doi.org/10.1007/s10484-013-9226-5.
Terhaar J, Viola FC, Bär K-J, Debener S. Heartbeat evoked potentials mirror altered body perception in depressed patients. Clin Neurophysiol. 2012;123(10):1950–7. https://doi.org/10.1016/j.clinph.2012.02.086.
Judah MR, Shurkova EY, Hager NM, White EJ, Taylor DL, Grant DM. The relationship between social anxiety and heartbeat evoked potential amplitude. Biol Psychol. 2018;139:1–7. https://doi.org/10.1016/j.biopsycho.2018.09.013.
Pang J, Tang X, Li H, Hu Q, Cui H, Zhang L, et al. Altered interoceptive processing in generalized anxiety disorder—a heartbeat-evoked potential research. Front Psychiatry. 2019;10:616. https://doi.org/10.3389/fpsyt.2019.00616.
Hart N, McGowan J, Minati L, Critchley HD. Emotional regulation and bodily sensation: interoceptive awareness is intact in borderline personality disorder. J Personal Disord. 2013;27(4):506–18. https://doi.org/10.1521/pedi_2012_26_049.
Mussgay L, Klinkenberg N, Rüddel H. Heart beat perception in patients with depressive, somatoform, and personality disorders. J Psychophysiol. 1999;13(1):27. https://doi.org/10.1027//0269-8803.13.1.27.
Mueller LE, Schulz A, Andermann M, Gäbel A, Gescher DM, Spohn A, et al. Cortical representation of afferent bodily signals in borderline personality disorder: neural correlates and relationship to emotional dysregulation. JAMA Psychiatry. 2015;72(11):1077–86. https://doi.org/10.1001/jamapsychiatry.2015.1252.
Schmitz M, Müller LE, Schulz A, Kleindienst N, Herpertz SC, Bertsch K. Heart and brain: cortical representation of cardiac signals is disturbed in borderline personality disorder, but unaffected by oxytocin administration. J Affect Disord. 2020;264:24–8. https://doi.org/10.1016/j.jad.2019.11.139.
Schaan VK, Schulz A, Rubel JA, Bernstein M, Domes G, Schächinger H, et al. Childhood trauma affects stress-related interoceptive accuracy. Front Psychiatry. 2019;10:750 https://pubmed.ncbi.nlm.nih.gov/31681049.
Beesdo-Baum K, Zaudig M, Wittchen HU. SCID-5-CV. Strukturiertes Klinisches interview für DSM-5®-Störungen–Klinische version. Göttingen: Hogrefe; 2019.
Lehrl S, Merz J, Erzigkeit H, Galster V. Mehrfachwahl-Wortschatz-test. MWT-B [multiple choice verbal ability test]. Erlangen: straube; 1977.
Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9(1):97–113.
Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto alexithymia scale—I. item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23–32.
Bach M, Bach D, Serim M, Böhmer F. Validation of the German version of the 20-item Toronto alexithymia scale in normal persons and psychiatric patients. Psychother Psychosom Med Psychol. 1996;46(1):23–8.
Freyberger HJ, Spitzer C, Stieglitz R-D, Kuhn G, Magdeburg N, Bernstein-Carlson E. Fragebogen zu dissoziativen Symptomen (FDS). Deutsche adaptation, Reliabilität und Validität der amerikanischen dissociative experience scale (DES): PPmP: Psychotherapie Psychosomatik Medizinische Psychologie; 1998.
Bernstein DP, Ahluvalia T, Pogge D, Handelsman L. Validity of the childhood trauma questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry. 1997;36(3):340–8. https://doi.org/10.1097/00004583-199703000-00012.
Klinitzke G, Romppel M, Häuser W, Brähler E, Glaesmer H. Die deutsche version des childhood trauma questionnaire (CTQ)–psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe. PPmP-Psychotherapie Psychosomatik Medizinische Psychologie. 2012;62(02):47–51.
Bohus M, Kleindienst N, Limberger MF, Stieglitz R-D, Domsalla M, Chapman AL, et al. The short version of the borderline symptom list (BSL-23): development and initial data on psychometric properties. Psychopathology. 2009;42(1):32–9. https://doi.org/10.1159/000173701.
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio. 1996;78(2):490–8.
Kühner C, Bürger C, Keller F, Hautzinger M. Reliabilität und validität des revidierten beck-depressionsinventars (BDI-II). Nervenarzt. 2007;78(6):651–6.
Gratton G, Coles MGH, Donchin E. A new method for off-line removal of ocular artifact. Electroencephalogr Clin Neurophysiol. 1983;55(4):468–84.
Petzschner FH, Weber LA, Wellstein KV, Paolini G, Do CT, Stephan KE. Focus of attention modulates the heartbeat evoked potential. NeuroImage. 2019;186:595–606. https://doi.org/10.1016/j.neuroimage.2018.11.037.
Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of Normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol. 2010;33(11):1407–17. https://doi.org/10.1111/j.1540-8159.2010.02841.x.
Sebastian A, Jung P, Krause-Utz A, Lieb K, Schmahl C, Tüscher O. Frontal dysfunctions of impulse control – a systematic review in borderline personality disorder and attention-deficit/hyperactivity disorder. Front Hum Neurosci. 2014;8:698 https://www.frontiersin.org/article/10.3389/fnhum.2014.00698.
Murphy J, Brewer R, Hobson H, Catmur C, Bird G. Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the heartbeat counting task. Biol Psychol. 2018;136:189–97. https://doi.org/10.1016/j.biopsycho.2018.05.010.
Murphy J, Catmur C, Bird G. Alexithymia is associated with a multidomain, multidimensional failure of interoception: evidence from novel tests. J Exp Psychol. 2018;147(3):398–408. https://doi.org/10.1037/xge0000366.
Zamariola G, Vlemincx E, Corneille O, Luminet O. Relationship between interoceptive accuracy, interoceptive sensibility, and alexithymia. Pers Individ Differ. 2018;125:14–20. https://doi.org/10.1016/j.paid.2017.12.024.
Schulz A, Köster S, Beutel ME, Schächinger H, Vögele C, Rost S, et al. Altered patterns of heartbeat-evoked potentials in depersonalization/Derealization disorder: neurophysiological evidence for impaired cortical representation of bodily signals. Psychosom Med. 2015;77:5 https://journals.lww.com/psychosomaticmedicine/Fulltext/2015/06000/Altered_Patterns_of_Heartbeat_Evoked_Potentials_in.4.aspx.
Austin MA, Riniolo TC, Porges SW. Borderline personality disorder and emotion regulation: insights from the Polyvagal theory. Soc Cogn Affect Neurosci. 2007;65(1):69–76. https://doi.org/10.1016/j.bandc.2006.05.007.
Meyer P-W, Müller LE, Zastrow A, Schmidinger I, Bohus M, Herpertz SC, et al. Heart rate variability in patients with post-traumatic stress disorder or borderline personality disorder: relationship to early life maltreatment. J Neural Transm. 2016;123(9):1107–18. https://doi.org/10.1007/s00702-016-1584-8.
Weinberg A, Klonsky ED, Hajcak G. Autonomic impairment in borderline personality disorder: a laboratory investigation. Brain Cogn. 2009;71(3):279–86. https://doi.org/10.1016/j.bandc.2009.07.014.
Schulz A, Strelzyk F, Ferreira de Sá DS, Naumann E, Vögele C, Schächinger H. Cortisol rapidly affects amplitudes of heartbeat-evoked brain potentials—implications for the contribution of stress to an altered perception of physical sensations? Psychoneuroendocrinology. 2013;38(11):2686–93. https://doi.org/10.1016/j.psyneuen.2013.06.027.
Goerlich-Dobre KS, Bruce L, Martens S, Aleman A, Hooker CI. Distinct associations of insula and cingulate volume with the cognitive and affective dimensions of alexithymia. Neuropsychologia. 2014;53:284–92. https://doi.org/10.1016/j.neuropsychologia.2013.12.006.
Khalsa SS, Lapidus RC. Can Interoception improve the pragmatic search for biomarkers in psychiatry? Front Psychiatry. 2016;7:121. https://doi.org/10.3389/fpsyt.2016.00121.
Pollatos O, Gramann K, Schandry R. Neural systems connecting interoceptive awareness and feelings. Hum Brain Mapp. 2007;28(1):9–18. https://doi.org/10.1002/hbm.20258.
Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res. 2007;155(3):231–43. https://doi.org/10.1016/j.pscychresns.2007.03.006.
Niedtfeld I, Schulze L, Kirsch P, Herpertz SC, Bohus M, Schmahl C. Affect regulation and Pain in borderline personality disorder: a possible link to the understanding of self-injury. Rare Gene Variants Neurodevelopmental Disord. 2010;68(4):383–91. https://doi.org/10.1016/j.biopsych.2010.04.015.
Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Risk Mech Bipolar Disord. 2013;73(2):153–60. https://doi.org/10.1016/j.biopsych.2012.07.014.
Gray MA, Taggart P, Sutton PM, Groves D, Holdright DR, Bradbury D, et al. A cortical potential reflecting cardiac function. Proc Natl Acad Sci USA. 2007;104(16):6818. https://doi.org/10.1073/pnas.0609509104.
Al E, Iliopoulos F, Forschack N, Nierhaus T, Grund M, Motyka P, et al. Heart–brain interactions shape somatosensory perception and evoked potentials. Proc Natl Acad Sci USA. 2020;117(19):10575. https://doi.org/10.1073/pnas.1915629117.