Emotion recognition during emotional arousal in patients with borderline personality disorder

Borderline personality disorder (BPD) is characterized by severe difficulties in
interpersonal relationships and emotional functioning. The purpose of this
study is to investigate how problems in social interaction are related to
emotional instability. The theory of Bateman and Fonagy (2004) sheds light on
this issue and posits that the capacity to make sense of themselves and others
becomes unstable during emotional arousal in individuals with BPD. The current
proposal will test this hypothesis. Specifically we hypothesize that BPD
patients misinterpret facial emotions of others during emotional arousal and we
investigate the influence of specific borderline symptomatology on these
factors.
To test above hypotheses the study uses a experimental design with a facial
emotion recognition task before and after experimentally induced arousal.

To investigate whether emotional arousal impairs facial emotion recognition in
BPD patients and how specific borderline symptomatology is related with this.

Between-group design with measurements before and after experimental
manipulation.

Emotional arousal is induced by the Trier Social Stress Test. This test
consists of a motivated performance task, in which the participant has to
prepare and deliver a free speech and perform mental arithmetic (5 min) in
front of the experimenter and a videocamera. This motivated performance task
isbased on the Trier Social Stress Test, a common used protocol for inducing
mild social stress. The Trier Social Stress Test procedure has been used
successfully in borderline as well as in other psychiatric patients before,
without known complications (Roelofs et al, 2009; Simeon, Knutselska, Smith,
Baker & Hollander, 2004).
For further information see researchprotocol sections 7.3 and 10.4.

Being the first experimental investigation which studies social emotion
recognition during arousal, the current study will contribute significantly to
the understanding of borderline pathology and development of a new theoretical
model for borderline personality disorder, which gives direction to treatment
strategies. With informed consent, the individual patient information which is
delivered after the debriefing can be used to improve the treatment of the
patient. The risk associated with participation can be considered negligible
and the burden can be considered minimal. However, as for any study using this
experimental procedure of the Trier Social Stress Test, the patients may become
upset by the stress manipulation. Nonetheless, we consider the use of this test
essential to investigate our central hypothesis. Although we consider the
chance that the participants will become upset low, patients will be debriefed
and a clinician will be available after the experiment to make sure that the
patients will not leave distressed. The patients will also be able to contact
the clinician in the weeks after the experiment.Patients who are too unstable
to cope with the experiment will be excluded form the study.
Moreover, the Trier Social Stress Test procedure has been used successfully in
borderline as well as other psychiatric patients before, without known
complications (Roelofs et al, 2009; Simeon, Knutselska, Smith, Baker &
Hollander, 2004). No other adverse events are expected, and no pharmacological
nor (otherwise) invasive interventions are applied.