3 results
Pain perception in borderline personality disorder explored using PMS
- C. Schönfeldt-Lecuona, B.J. Connemann, A.-K. Fladung, T. Kammer, C. Schmahl, P.L. Plener, L.K. Cárdenas-Morales
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- Journal:
- European Psychiatry / Volume 26 / Issue S2 / March 2011
- Published online by Cambridge University Press:
- 16 April 2020, p. 1003
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Different experimental methodologies have been used to investigate pain perception in patients with borderline personality disorder (BPD) overall showing elevated pain thresholds (PT). We assessed PT, sensorial and affective components of pain processing in BPD patients and healthy controls using repetitive peripheral magnetic stimulation (rPMS) as a novel tool for provoking controlled aversive cutaneous sensation. In 10 BPD patients and 8 healthy women we assessed PT, cutaneous sensation, emotional valence and arousal level during rPMS at different intensities on two consecutive days. Additionally, inner tension level was assessed before and after each session.
We found significantly higher PT in BPD patients (91% of maximal output of stimulator, vs. 56% in controls); these measures were consistent among both days of assessment, showing a high intra-individual repeat-reliability. In BPD, PT correlated positively with motivational factors of non-suicidal self-injury (to avoid feeling of emptiness r = 0.823, p = 0.023; to punish oneself r = 0.774, p = 0.041). All stimulation intensities used were discriminated similarly in both groups. However, emotional valence and arousal level did not vary with stimulus intensity in BPD patients. Furthermore, BPD patients were found to have higher baseline levels of inner tension than controls and, as opposed to controls, they experienced subjective relief after stimulation. Besides demonstrating a distinctive pattern of affective components of pain in BPD, the present study demonstrates that rPMS is a suitable and well-tolerated method for the assessment of pain sensation.
CS04-01 - Starving Instead of Eating as a Reward: the Case of Anorexia Nervosa
- A.-K. Fladung
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- Journal:
- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Anorexia nervosa is characterized by severe emaciation, amenorrhea and hyperactivity. Aetiology of the disorder is unknown however evidence grows that factors that maintain the core symptoms are important for the understanding of the chronicity of the disorder.
ObjectivesTheories based on research on self-starvation in animals emphasise the interaction of stress and feeding behaviour, since under certain dietary conditions and possibility for non-forced physical activity, self-starvation through excessive wheel running until death is seen in rodents. Results of these studies suggest a pivotal role for the mesolimbic dopaminergic reward system of the brain in self-starvation in the animal. The activity level of this system with the ventral striatum as a core structure is modulated by expectation or receipt of rewards. There is also growing evidence referring to reward related processes in patients with anorexia nervosa with the mesolimbic dopaminergic reward system being essential in mediating maintenance of the disorder. It is suggested that alterations in the dopaminergic neurotransmission could affect the evaluation of reward stimuli in the patients, resulting in reduced responsiveness towards disease-unspecific rewarding stimuli, and obsessive and increased reaction towards disease-specific stimuli, like cues for emaciation or experience of the own cachectic body.
AimsThe present study examined activity in the ventral striatal system in response to disease specific stimuli in acute anorexia patients.
MethodsDuring functional magnetic resonance imaging 14 patients with anorexia nervosa and 14 healthy control women evaluated images of a BMI-standardized female body depicting features of under-, normal- and overweight. Photorealistic textures were used to give a familiar presentation of specific features according to the particular BMI. Subjects were asked to process the stimuli in a self-referring way (task “feel”: Imagine you have the same body shape as this woman. How would you feel?), and to give ratings by four buttons on a keyboard (scaling from 1 “very bad” to 4 “very good”). In the control task “weight” subjects had to estimate the weight of the images as one out of four categories (30 - 45 - 60 - 75 kg).
ResultsBehaviourally, patients with anorexia nervosa rated underweight stimuli as the most preferred, while healthy control women preferred normal weight stimuli. The groups did not differ with regard to correctness or decision times in the control task. Functionally, ventral striatal activity demonstrated a highly significant group-by-stimulus interaction for underand normal weight stimuli during self-referred processing of the stimuli: In patients activation was higher during processing of underweight compared to normal weight stimuli. The reversed pattern was observed in controls. Differential responses on overweight stimuli did not substantially contribute to the overall effect either behaviourally or functionally in either task
ConclusionsThis pattern of activation is in good agreement with previous assumptions concerning differential responsiveness upon disease-specific and -unspecific stimulation in patients with anorexia nervosa. Results also align with predictions derived from animal studies on the pivotal role of the human dopaminergic reward system, and thereby support theories of starvation-dependence to account for the maintenance of the disease.
Cognitive reappraisal modulates performance following negative feedback in patients with major depressive disorder
- A.-K. Fladung, U. Baron, I. Gunst, M. Kiefer
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- Journal:
- Psychological Medicine / Volume 40 / Issue 10 / October 2010
- Published online by Cambridge University Press:
- 05 January 2010, pp. 1703-1710
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Background
Depressed patients show impaired performance following negative feedback; the probability of committing an error is increased immediately after an error. This deficit is assumed to be highly specific and to represent a trait marker of major depressive disorder (MDD). Inconsistencies in currently available data could reflect inter-individually different strategies to regulate negative affect. The present study examined modulation of performance following negative feedback by cognitive reappraisal to regulate aversive affect in depressed patients.
MethodThirty-three depressed patients and 33 control subjects performed tasks of varying difficulty over a prolonged time. Emotional feedback was given immediately after each trial. Performance was further analysed within subgroups using cognitive reappraisal of aversive events with high and low frequency.
ResultsA significant group by task difficulty interaction for absolute number of subsequent errors revealed that depressed patients were especially impaired when receiving negative feedback more frequently. An increased probability of subsequent errors was shown in patients irrespective of task difficulty. Analysis of subgroups revealed higher absolute number and probability of subsequent errors only in depressed patients habitually not using cognitive reappraisal to regulate aversive emotions. Depressed patients using this strategy did not differ from controls.
ConclusionsThe present results replicate the observation of impaired performance in depressed patients following failure feedback. Most importantly, a subgroup of patients who habitually rely on cognitive reappraisal of aversion-eliciting events, such as negative performance feedback, was not impaired. This modulatory influence of emotion regulation strategies on performance subsequent to negative feedback suggests that training emotion regulation in achievement situations should be incorporated in current concepts to prevent relapse.