Time course of facial emotion processing in women with borderline personality disorder: an ERP study

Time course of facial emotion processing in women with borderline personality disorder: an ERP study


J Psychiatry Neurosci 2016;41(1):16-26

Natalie A. Izurieta Hidalgo, MSc; Rieke Oelkers-Ax, MD; Krisztina Nagy, PhD; Falk Mancke, MD; Martin Bohus, MD; Sabine C. Herpertz, MD; Katja Bertsch, PhD


Background: Borderline personality disorder (BPD) is characterized by a negative perception of others. Previous studies have revealed deficits and biases in facial emotion recognition. This study investigates the behavioural and electrophysiological correlates underlying facial emotion processing in individuals with BPD.

Methods: The present study was conducted between July 2012 and May 2014. In an emotion classification task, unmedicated female patients with BPD as well as healthy women had to classify faces displaying blends of anger and happiness while the electroencephalogram was recorded. We analyzed visual event-related potentials (ERPs) reflecting early (P100), structural (N170) and categorical (P300) facial processing in addition to behavioural responses.

Results: We included 36 women with BPD and 29 controls in our analysis. Patients with BPD were more likely than controls to classify predominantly happy faces as angry. Independent of facial emotion, women with BPD showed enhanced early occipital P100 amplitudes. Additionally, temporo-occipital N170 amplitudes were reduced at right hemispherical electrode sites. Centroparietal P300 amplitudes were reduced particularly for predominantly happy faces and increased for highly angry faces in women with BPD, whereas in healthy volunteers this component was modulated by both angry and happy facial affect.

Limitations: Our sample included only women, and no clinical control group was investigated.

Conclusion: Our findings suggest reduced thresholds for facial anger and deficits in the discrimination of facial happiness in individuals with BPD. This biased perception is associated with alterations in very early visual as well as deficient structural and categorical processing of faces. The current data could help to explain the negative perception of others that may be related to the patients’ impairments in interpersonal functioning.

Submitted Aug. 6, 2014; Revised Feb. 23, 2015; Accepted Apr. 4, 2015; Early-released Aug. 18, 2015

Acknowledgments: The authors thank K. Herwig for supporting the EEG measurement and analysis, L. Kramer, L. Müller, A. Gäbel and D. Gescher for their help with data collection, the Informatics team for programming, and the team of the Clinical Research Group on Mechanisms of Disturbed Emotion Processing in Borderline Personality Disorder (KFO 256) for participant recruitment and organization. The study was supported by grants from the German Research Foundation (DFG) awarded to S.C. Herpertz (He 2660/12-1; He 2660/7-2). Preliminary data of this study were presented at the DGPPN conference 2013 in Berlin and at the EPA Conference 2014 in Munich, Germany.

Affiliations: From the Department for General Psychiatry, Center of Psychosocial Medicine, University of, Heidelberg, Germany (Izurieta Hidalgo, Nagy, Mancke, Herpertz, Bertsch); the Department for Child and Adolescent Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Oelkers-Ax); and the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Bohus).

Competing interests: None declared.

Contributors: N. Izureta, R. Oelkers-Ax, M. Bohus, S. Herpertz and K. Bertsch designed the study. N. Izureta, K. Nagy, F. Mancke, M. Bohus and K. Bertsch acquired the data, which N. Izureta, R. Oelkers-Ax, S. Herpertz and K. Bertsch analyzed. N. Izureta and K. Bertsch wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.140215

Correspondence to: N.A. Izurieta Hidalgo, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Voßstraße 4, Center of Psychosocial Medicine, 69115 Heidelberg, Germany; natalie.izurieta@med.uni-heidelberg.de