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Summary ALL Lectures and Articles: Cognitive Neuropsychology UU 2024
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Colleges Cognitive NeuropsychiatryLecture 1: Borderline Personality Disorder
What is Borderline Personality Disorder?
In DSM-5 (Cluster B of the personality disorders), Borderline Personality Disorder (BPD) is
characterized by a pervasive pattern of instability in interpersonal relationships,
self-image, and affect, along with marked impulsivity. The diagnostic criteria include at
least five of the following symptoms:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Typical aspects of BPD is having intense & unstable emotions and moods, impulsive
behavior and over-simplified, black/white, all-or-nothing thinking about self and others. It
all results in an unstable sense of self, sudden radical major life changes (such as career
or relationships), misinterpretation of actions/motivation of others and alternating
between idealization and devaluation. The unstable sense of self can further enhance in
dissociative states.
→ leads to functional impairments
Functional impairment of BPD
Difficult to maintain stable, healthy, relationships with others (romantic, work, friends,
family) and with yourself: social network.
● Example of behavior:
○ Partner of a patient with BPD forgets the anniversary.
■ Black-and-white thinking: he doesn’t love me anymore.
■ All-or-nothing thinking: if he doesn’t love me, then he must hate me.
○ These thoughts lead to intense emotions (such as rejection, abandonment,
sadness, anger).
■ Emotion regulation problems: dealing with intense feelings is difficult,
which makes her highly upset and overwhelmed. The intensity of her
negative emotions seems unbearable.
○ Powerful impulse to do something to regulate her emotions, so they will go
away.
■ Black-and-white & all-or-nothing thinking: you must have an affair or
please don’t leave me.
, ○ Partner is baffled by the extreme reaction. He only forgot the anniversary,
no reason to assume an affair or him leaving. He might get angry at such
wild accusations. Conflict might escalate and become more intense.
○ After the fight the woman feels overwhelming self-loathing or numbness
(unstable sense of self and black-and-white thinking). In order to cope she
engages in self-harm behavior.
○ Partner is perplexed by the extremeness of her behavior given the situation.
She must manipulate me. He expresses concern for her well-being but is also
angry. She feels misunderstood (and the negative spiral begins all over).
BPD treatment in neuropsychology
BPD is not prominent in treatment, because there is not so much room for
neuropsychological assessments. There are mainly some variations/combinations of CBT.
Also there are different symptoms studies in relative isolation.
● Symptom 1: identity disturbance (unstable self-image or sense of self) and transient,
stress-related paranoid ideation or severe dissociative symptoms.
● Symptom 2: Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely
more than a few days).
● Symptom 3: Frantic efforts to avoid real or imagined abandonment.
Identity disturbance in neuropsychology
Identity disturbance, like an unstable self-image or sense of self. An article about body
plasticity in BPD and its link to dissociation. Dissociation is common in BPD, such as
detachment from the body and coping to deal.
● Rubber hand illusion (RHI): we have a body and we perceive it as a coherent whole.
We perceive ownership over it and we know what belongs to our body and what
does not.
● In the Rubber Hand Illusion, this can be manipulated, by making it feel like the
rubber hand is part of our own body.
● The results of the article indicate enhanced body plasticity related to dissociation
in BPD, point to shared neurobiological mechanisms, and might help to elucidate
the body-related perceptual disturbances associated with BPD.
● Dissociation significantly correlated with illusory limb ownership experiences,
making body plasticity a marker for BPD.
Dissociation is very common in BPD
Detachment from the body can result in being less
aware of the own body. This can be seen as a way of
coping with overwhelming emotions. Is it then also
easier to trick the BPD brain into thinking a fake rubber
hand is part of it?
The graph shows that BPD patients are more perceptive
for the illusion. Remission characterized by
normalization of body plasticity. More dissociation
means stronger illusion.
,Why?
● Link dissociation: bottom-up integration deficit is unlikely. This explanation would
say that the stroking during the rubber hand illusion would be processed in a
wrong way, but then this would happen without dissociation.
● Ketamine induces dissociation and a higher susceptibility to the RHI
● Disturbed neurochemical processes in BPD?
● RHI in schizophrenia and eating disorders. Also there is dissociation + unstable self
Unstable moods and neuropsychology
BPD and emotion regulation:
● Surprised and overwhelmed by emotions
● Emotions are not gradual but sudden
● Emotions are very extreme
● So caught up in emotions that regulation is no longer an option
What might go wrong if you are too late in regulating your emotions?
The body and emotions in neuropsychology
Touch is the very first form of emotion regulation. When a pregnant mother touches the
stomach the baby moves to this touch and when other people touch the stomach the
baby touches itself. Increasing the carrying of a baby reduces crying. Less cortisol in
babies due to breastfeeding and co-sleeping.
We learn how to use touch to communicate our emotions as well -> children learn how to
communicate by touching each other. Social touch remains very important in the rest of
our lives.
Not only the skin and interpersonal touch are important, but the entire body is crucial for
communicating and experiencing emotions. Language and emotions are also really
entwined with each other. Emotions are grounded in bodily experiences.
Bijvoorbeeld: she had butterflies in her stomach or having a lump in your throat.
James-Lange: Theory of emotion
Sight of upcoming car (perception of stimulus) → Pounding heart (arousal) → Fear
(Emotion).
This is also what happens during a panic attack. The wrong interpretation of a bodily
sensation. In order to accurately perceive and regulate our emotions, we must perceive
and interpret bodily signals correctly.
Touch can be processed in different ways
There are different nerve fibers responsible for:
● Sensing (in Somatosensory cortex): fast touch, pokes, pinpricks, pressure,
vibrations and spatial locations
● Feeling (in Insular cortex): deep pain, temperature and pleasant touch. This is less
known. Slow touch activates different nerve fibers compared to fast touch. It is
processed in the brain that is important for social behavior.
Slow stroking activates C-tactile fibers and communicates directly with the insula.
Social/emotional evaluation of touch. The touch provider and context matter.
Affective touch has beneficial effects, like it reduces psychical and mental pain,
acts as a social buffer to stress/anxiety.
,Affective touch
Study shows that slow brushing reduces heat pain in humans (pain afflicted by heat
stimulus that is perceived as painful). Slow brushing was better than fast brushing by
researchers, because more affective touch. In the same study, stroking from a partner
showed that the quality of the relationship was related to the amount of pain reduction.
Parental touch
Parental touch reduces social vigilance (waakzaamheid) in children. Children that got a
shoulder touch before doing a task, could look longer towards threatening faces
compared to children who did not get the shoulder touch. Also, shoulder touch had more
impact for young children compared to teenagers. Teenagers are distancing themselves
more from their parents, because they become more independent.
Do people with BPD also like touch?
Study was done with 85 female participants (32 healthy controls, 30 BPD and 23 trauma
patients).
The experiment:
Do patients and controls differ on pleasantness ratings of touch?
● Pleasantness of touch: the healthy control had the best perceived pleasantness of
touch, BDP minder en trauma nog minder.
,Do patients and control differ on pleasantness ratings of touch?
The healthy group significantly liked the touching more compared to patients -> the
trauma group didn’t really like the touch.
For the fast stroking wasn’t liked by any group, there were no differences. There was a
significant difference between optimal and non-optimal stroking between healthy control
and BPD groups, but there was no difference in the trauma group. They don’t differentiate
between two types of touch.
How do we feel - literally?
The groups differ in pleasantness perception, namely HC > BPD > Trauma. Whereby trauma
patients did not differentiate between fast and slow touches. Might it be linked to (lack of)
affective touch in daily life? The touch experience is altered in BPD.
Is there a relation between emotion regulation and touch perception?
The more participants that dislike being touched, the more emotion regulation problems
they report.
Abandonment and neuropsychology
Does the social touch system still function in BPD patients? They might especially need
this system. The results show that BPD dislikes touch and that touch reduces feelings of
social exclusion.
It shows that even when someone does not enjoy being touched, it is still beneficial for
them.
Post-Auricular Muscle (PAR) is active when pleasant
stimuli are shown. Does this also work with touch?
● PAR relax is modulated by rewarding stimuli.
Potential objective measure of reward value of
social touch. Also the case in BPD?
● Clinical implications: touch experiences are
part of clinical intake, touch interactions are
not part of the therapeutic process and
therapists can help in communicating touch
needs and boundaries in their own social
network.
Summary
Neuropsychology offers tools to deepen our
understanding of BPD.
● Unstable sense of self extends to malleable body image
● Altered affective touch perception
,Summary of the Article - Body plasticity in borderline personality disorder: A link to
dissociation
Introduction:
Borderline Personality Disorder (BPD) patients often experience an unstable sense of self
and heightened dissociation, which can lead to a labile body perception, suggesting
increased body plasticity. However, there's a lack of experimental data on body plasticity
in BPD.
Materials and Methods:
The study used the Rubber Hand Illusion (RHI) to test body plasticity by inducing a feeling
of ownership for an artificial limb. Female patients with current and remitted BPD were
compared to healthy controls in terms of their proneness to perceive the RHI, and this
perception was related to their dissociative states.
Results:
Patients with current BPD showed a higher tendency to perceive the RHI compared to
healthy controls (p < .05, effect size [Cohen's d] of 0.68). The remission of BPD was linked to
stabilized perceptions. The vividness of the RHI was positively associated with both state
and trait dissociation across all groups and particularly in current BPD after controlling
for symptom severity (all Pearson's r ≥ .30, p < .05).
Discussion:
The results suggest enhanced body plasticity related to dissociation in BPD, indicating
potential shared neurobiological mechanisms. The findings might help understand
body-related perceptual disturbances linked with BPD.
Conclusion:
The study offers initial empirical evidence of significant changes in body ownership
processing in current BPD patients, leading to increased body plasticity. Dissociation was
found to correlate with illusory limb ownership experiences, highlighting body plasticity
as a potential marker for BPD. The results point towards underlying neural dysfunctions
related to BPD.
, Lecture 2: Body Integrity Dysphoria
The body as a multisensory object
The way we relate to our body, including the way we perceive it, control it and affectively
react to what happens to it, is unlike the way we relate to other objects.
We are aware of our bodies. I see the world by opening my eyes, I feel the motion of my
eyelid or that I feel tired and thirsty.
Body representation
● Cognitive structures that function to track and encode the state of the body
● The brain is using available sensory evidence to construct experience of the self
● It is a multisensory experience, for example:
○ Visual information about that my body looks like
○ Proprioceptive information on where my hand is in space
○ Interoceptive signals about my pounding heart, which gives me information
about the inner state of the body
Body representation following damage to the brain of body
● Asomatognosia: part of the body
is fading away from awareness
● Somatoparaphrenia: part of the
body belongs to someone else
● Alice in Wonderland Syndrome:
parts of the body are experienced
as much larger or smaller than
they are
● Supernumerary phantom limb:
experience that you have several
phantom limbs
● Phantom limb: occurs after
amputation, it feels like limb is still
there while it is not
Body Integrity Dysphoria (BID)
This is a rare condition characterized by a strong and persistent desire to amputate or
paralyze one or more healthy limbs. This desire presumably arises from experiencing a
mismatch between the perceived body (mental image of the body) and the actual physical
structure/boundaries of the body.
For example: I don’t understand where it comes from or what it is. I just don’t want legs.
Inside I feel that my legs don’t belong to me, they shouldn’t be there. The body does not
feel like mine.
● There is no apparent brain damage
● Normal sensory/motor function
● Not delusional
● Not in DSM-5, but in ICD-11
● Name evolution: Apotemnophilia → Xenomelia → Body integrity identity disorder →
Body integrity dysphoria
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