“Fight-or-flight” versus “tend-and-befriend” response to behavioral and pharmacological interventions in patients with borderline personality disorder

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Borderline personality disorder (BPD) is characterized by several symptoms, which occur within social contexts, such as fear of abandonment or unstable social relationships. Furthermore, there is evidence that BPD patients are more sensitive to social rejection and negative evaluation, which is an important facet of many stressful situations within the psychosocial context. In recent studies, we found that psychosocial stress led to reduced emotional empathy in BPD, while healthy controls scored higher on emotional empathy after stress (Wingenfeld, Duesenberg et al. 2018). The results in healthy individuals suggest enhanced prosocial behavior, which can be interpreted as “tend-and-befriend” behavior after stress (Wolf, Schulte et al. 2015). In contrast, reduced emotional empathy in BPD might reflect an inhibition of prosocial behavior after stress in favor of a “fight-or-flight” response. We hypothesize that perceived social exclusion might be one reason for these differences, as BPD patients are characterized by high sensitivity to social exclusion (Staebler, Renneberg et al. 2011). Additionally, we could show that after pharmacological stimulation with fludrocortisone – a mineralocorticoid receptor agonist – BPD patients and healthy women had higher emotional empathy scores compared to placebo (Wingenfeld, Kuehl et al. 2014). Based on these results, we now aim to investigate the following questions: 1) Is there a switch from the prosocial “tend-and-befriend” behavior to a “fight-or-flight” response after perceived social exclusion in BPD patients? 2) Can administration of fludrocortisone buffer the stress-associated reduction in prosocial behavior such as empathy in BPD?Therefore, two independent studies we be performed:In a first experiment (study 1), we will examine whether perceived social exclusion provoke a reduction in prosocial behavior, such as empathy, in BPD patients and whether this “fight-or-flight” pattern is also seen in other relevant aspects of social behavior, such as sharing and punishment behavior. To induce social exclusion all participants will play cyberball, either the exclusion condition or the (over)inclusion condition before testingIn study 2 we will examine whether MR stimulation can buffer the diminishing effects of psychosocial stress on prosocial behavior in patients with BPD. Similar to study 1, we will test empathy, as well as sharing and punishment behavior. Before testing, BPD patients and healthy controls will undergo a psychosocial stress test (TSST) either after administration of fludrocortisone or placebo. Furthermore, there will be a control condition without any stress (Placebo-(P)TSST). To have a similar study protocol, a placebo pill will be administered before the P-TSST.These studies will enhance the understanding of BPD psychopathology in the context of stress (hormones) and possibly will lead to new treatment options.