Emotional learning during dissociative states in borderline personality disorder.

Patients with borderline personality disorder who experience high levels of dissociative symptoms show diminished emotional learning during aversive conditioning, as measured by skin conductance responses, compared to patients without dissociation and healthy controls. The dissociative group showed no increase in valence or arousal to the conditioned stimulus and no differential skin conductance responses during acquisition or extinction phases. These differences were not explained by general psychopathology, trauma history, perceptual differences, or posttraumatic stress disorder. The findings suggest that state dissociation inhibits amygdala-based emotional learning processes, which may have implications for exposure-based psychotherapy.

Study at a glance

Abstract

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 x quadratic time x 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. CONCLUSION 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.