Emotional learning during dissociative states in borderline personality disorder

Emotional learning during dissociative states in borderline personality disorder


J Psychiatry Neurosci 2010; 34(3): 214-222

Ulrich W. Ebner-Priemer, PhD; Jana Mauchnik, PhD; Nikolaus Kleindienst, PhD; Christian Schmahl, MD; Martin Peper, PhD, MD; M. Zachary Rosenthal, PhD; Herta Flor, PhD; Martin Bohus, MD

Ebner-Priemer, Mauchnik, Kleindienst, Schmahl, Bohus — Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, University of Heidelberg; Peper — Institute of Psychology, University of Marburg, Germany; Rosenthal — Department of Psychiatry and Behavioral Science, Duke University Medical Center, USA; Flor — Department of Neuropsychology and Clinical Psychology, Central Institute of Mental Health, University of Heidelberg, Germany


Background: Neurobiological findings and clinical data suggest that dissociative experience inhibits conditioning processes, but experimental
studies are lacking. The aim of our study was to determine whether high states of dissociative experience would specifically alter emotional learning, but not declarative knowledge.

Methods: We used an aversive differential delay conditioning procedure in 33 unmedicated patients with borderline personality disorder (BPD) and 35 healthy controls.

Results: Patients with BPD who had high state dissociative experiences (BPD D+) showed diminished acquisition of differential aversive delay conditioning with respect to emotional learning compared with those who did not experience dissociative symptoms (BPD D–) and healthy controls (skin conductance response; interaction dissociation × quadratic time × type, p = 0.009). Specifically, the control group and the BPD D– subgroup showed an increase in valence and arousal to the conditioned stimulus (CS+) during the conditioning procedure (all p < 0.012) and demonstrated differential skin conductance responses in the acquisition and extinction phases. In contrast, the BPD D+ subgroup showed no increase in valence and arousal to CS+ or differential response regarding skin conductance. We examined general psychopathology, trauma history, perceptual differences and posttraumatic stress disorder as confounding factors, but we found no evidence of bias. Limitations: Subdividing the BPD group reduced power. In addition, because our sample included only women, the generalizability of our results is constrained. Furthermore, we performed no separate analysis of the influence of different aspects of dissociation on the learning process.

Conclusions: Emotional, amygdala-based learning processes seem to be inhibited during state dissociative experience. State dissociative experience may
alter acquisition and extinction processes and should be closely monitored in exposure-based psychotherapy.

Submitted Mar. 14, 2008; Revised Aug. 15, Oct. 13, 2008; Accepted Oct. 15, 2008

Acknowledgements: This study was supported by the German Research Foundation (SFB 636/C2 to M.B.) and the Studienstiftung des Deutschen Volkes (scholarship). The authors thank A. Krause for data collection, K. Jung for figure preparation and T. Michael, J. Blechert and N. Vriends for preparation and testing of the graphical stimuli.

Competing interests: The authors report no conflict of interest in the conduct and disclosure of their research. Drs. Mauchnik, Kleindienst, Peper, Rosenthal and Flor report no biomedical financial interests or potential conflicts of interest. Dr. Ebner-Priemer reports having received a travel grant from GlaxoSmithKline; Dr. Schmahl reports having received travel grants from Pfizer Pharma GmbH, Lilly Deutschland GmbH and Lundbeck Research Inc.; Dr. Bohus reports
having received lecture fees from AstraZeneca and Pfizer.

Contributors: Drs. Ebner-Priemer and Mauchnik contributed equally to this work. Drs. Ebner-Priemer, Peper and Bohus designed the study. Drs. Ebner-Priemer and Mauchnik acquired and analyzed the data, which Drs. Kleindienst, Schmahl, Peper, Rosenthal, Flor and Bohus also analyzed. Drs. Ebner-Priemer and Mauchnik wrote the article. All authors reviewed the article and gave final approval for publication.

Correspondence to: Dr. U.W. Ebner-Priemer, Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, P.O. Box 12 21 20, 68072 Mannheim, Germany; fax 49-621-1703-4405; ulrich.ebner-priemer@zi-mannheim.de