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

边缘型人格障碍（BPD）的特征是在社会环境中出现的几种症状，例如害怕被遗弃或不稳定的社会关系。此外，有证据表明BPD患者对社会排斥和负面评价更敏感，这是心理社会背景下许多压力情况的重要方面。在最近的研究中，我们发现心理社会压力导致BPD的情感同理心降低，而健康对照组在压力后的情感同理心得分更高（Wingenfeld，Duesenberg等人2018）。健康个体的结果表明，亲社会行为增强，这可以解释为压力后的“照顾和交友”行为（Wolf，Schulte et al. 2015）。相反，BPD患者的情感共情减少可能反映了压力后亲社会行为的抑制，有利于“战斗或逃跑”的反应。我们假设感知到的社会排斥可能是这些差异的原因之一，因为BPD患者的特征是对社会排斥的高度敏感性（Staebler，Renneberg等人，2011）。此外，我们可以证明，在使用氟氢可的松（一种盐皮质激素受体激动剂）进行药物刺激后，BPD患者和健康女性的情感同理心评分高于安慰剂（Wingenfeld，Kuehl et al. 2014）。基于这些结果，我们现在的目标是研究以下问题：1） BPD患者在感知到社会排斥后，是否会从亲社会的“照顾和交友”行为转变为“战斗或逃跑”反应？（二） 氟氢可的松能否缓解BPD患者与压力相关的亲社会行为（如共情）减少？因此，我们进行了两项独立的研究：在第一个实验（研究1）中，我们将研究是否感知到社会排斥引起BPD患者的亲社会行为减少，如移情，以及这种“战斗或逃跑”模式是否也出现在社会行为的其他相关方面，如分享和惩罚行为。为了诱导社会排斥，所有参与者将在测试前玩网络球，无论是排除条件还是（过度）包含条件。在研究2中，我们将研究MR刺激是否可以缓冲心理社会压力对BPD患者亲社会行为的影响。与研究1类似，我们将测试共情，以及分享和惩罚行为。在测试之前，BPD患者和健康对照将在给予氟氢可的松或安慰剂后进行心理社会应激测试（TSST）。此外，将有一个无任何强制降解的对照条件（安慰剂-（P）TSST）。为了有一个类似的研究方案，在P-TSST之前将给予安慰剂药丸。这些研究将提高对压力（激素）背景下BPD精神病理学的理解，并可能导致新的治疗选择。

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.