Intrusive imagery in borderline personality disorder : assessment, occurrence, and physiological correlates

Abstract

Over the past decade, there has been growing research pointing to the relevance of prospective imagery in directing future behavior (e.g., Libby, Shaeffer, Eibach, & Slemmer, 2007; Pictet, Coughtrey, Mathews, & Holmes, 2011). With respect to mental disorders, deleterious effects of prospective images on the psychological well-being of several mental disorders, especially depressive or bipolar disorders (e.g., Morina, Deeprose, Pusowski, Schmid, & Holmes, 2011) were detected. Additionally, neuronal correlates of mental imagery (e.g., Kosslyn, Ganis, & Thompson, 2001; for a review see Ji, Kavanagh, Holmes, Macleod, & Di Simplicio, 2019) have been detected, however, a thorough understanding of physiological mechanisms possibly underlying mental imagery (e.g., associated endocrinological functioning) in clinical disorders, is still pending. More recent findings related to Borderline Personality Disorder (BPD) suggest the high clinical relevance of prospective mental imagery within the disorder, as scientific results revealed their impact on suicidal ideation (Schultebraucks, Duesenberg, Simplicio, Holmes, & Roepke, 2019) and non-suicidal self-injury (Schaitz, Kröner, Maier, & Sosic-Vasic, 2018). However, despite these important findings, to date, the evaluation of prospective mental imagery among German populations was limited due to the lack of an available German self-report questionnaire assessing prospective intrusive imagery. In order to deepen the scientific knowledge about the interplay of mental imagery and borderline symptomatology, the present study consisted out of three distinct parts: In an initial step, an English questionnaire assessing intrusive prospective imagery (IFES; Deeprose & Holmes, 2010) has been translated and validated at hand of a German healthy control-, and clinical sample. Afterwards, the validated questionnaire (IFES-S; Kroener, Schaitz, Maier, Connemann, & Sosic-Vasic, 2019) has been applied to patients suffering from BPD to assess the occurrence of those images within the disorder. Lastly, patients diagnosed with BPD underwent an imagery stress task (IST) and a real couple stress task (CST) to evaluate additional physiological correlates of intrusive imagery such as cortisol and sAA release. Results demonstrated good psychometric properties for the German IFES-S. Furthermore, suitable cut-off-scores allowing for an optimal distinguishment between individuals with high and low expressions of intrusive mental imagery have been established. Within the BPD sample, results demonstrated that BPD patients experience similar amounts of intrusive prospective imagery as depressed patients, but elevated levels of those images when compared to healthy controls before controlling for depressive symptoms, whereas thereinafter, BPD patients did no longer differ from healthy participants. Lastly, initial results indicated that BPD patients experience a similar endocrinological stress response towards an imagined stressor, as compared to a real interpersonal stressor, operationalized by a laboratory conflict discussion with their romantic partner. In summary, the current dissertation provides initial evidence about the occurrence of intrusive imagery in BPD and as well as first indication about a possible interplay between these imaginations and physiological correlates. Despite several, in detail discussed limitations of the presented findings, the results provide first insights into the physiological processing of intrusive imagery of an interpersonal conflict as compared to a real-world interpersonal conflict, indicating similar physiological as well as subjective experiences of stress across both stressors.