Hypersensitivity to Social Threat, Anger, and Aggression in BPD

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Aggression is highly prevalent in borderline personality disorder (BPD) and causes not only an immense burden for the individual patient, but also for society raising urgent questions about effective treatments. Data collected in the first funding period (supplemented by data from other groups) suggest five behavioral and neurobiological mechanisms which may mediate reactive aggression in BPD: (1.) threat hypersensitivity resp. attentional threat bias, (2.) maladaptive anger regulation, (3.) a tendency to rather approach than avoid social threat, (4.) deficits in cognitive empathy, and (5.) enhanced emotional simulation. These suggested biobehavioral mechanisms offer a promising starting point for the selection of treatment targets and for specifying the processes needed for change. Following the RDoC approach, we therefore intend to develop a new treatment to reduce aggression in BPD in the second funding period that targets the identified dimensions of neurobiology and observable behavior suggested to mediate reactive aggression in BPD. We plan to compose a symptom-oriented, mechanism-based group psychotherapy selecting techniques from evidence-based treatment programs for BPD. We will (1.) test the effects of this Mechanism-based Anti-Aggression Psychotherapy (MAAP) against a Non- Specific Supportive Psychotherapy (NSSP) in a randomized controlled trial with severity of aggressive behaviors as the primary outcome (measured with the change-sensitive Overt Aggression Scale - Modified (OAS-M)) assessed over a six-week period after finalizing the trial. Treatment effects will also be assessed at 6 months follow-up. (2.) We will validate the biobehavioral mechanisms as processes responsible for change in aggression of patients with BPD. The highly focused psychotherapy will allow a cost-effective intervention and might support current efforts in psychiatry to develop mechanism-based treatments in the future.