Emotional learning during dissociative states in borderline personality disorder.
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.


CONCLUSIONS
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.
Ebner-Priemer
Ulrich W
UW
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Germany. ulrich.ebner-priemer@zi-mannheim.de
Mauchnik
Jana
J
Kleindienst
Nikolaus
N
Schmahl
Christian
C
Peper
Martin
M
Rosenthal
M Zachary
MZ
Flor
Herta
H
Bohus
Martin
M
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001883:Borderline Personality Disorder / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition; D003214:Conditioning, Classical / Q000502:physiology; D004213:Dissociative Disorders / Q000503:physiopathology / Q000523:psychology*; D004644:Emotions; D005108:Extinction, Psychological / Q000502:physiology; D005260:Female; D005712:Galvanic Skin Response; D006185:Habituation, Psychophysiologic / Q000502:physiology; D006801:Humans; D007858:Learning / Q000502:physiology; D008568:Memory; D010465:Perception; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D011795:Surveys and Questionnaires