Interoceptive Processing in Borderline Personality Pathology: a Review on Neurophysiological Mechanisms

Purpose of ReviewThis review summarizes empirical evidence on alterations in four distinct interoceptive facets, namely, objective physiological states, interoceptive accuracy, interoceptive sensitivity, and interoceptive awareness in borderline personality disorder (BPD) and related conditions. We focus on psychological and neurophysiological mechanisms and discuss their possible relevance for the pathogenesis of BPD.Recent FindingsRecent findings on objective physiological states suggest that patients with BPD likely exhibit reduced central representation of interoceptive signals as baseline, which might be related to diminished autonomic balance in these patients. Findings on interoceptive accuracy in BPD either suggest reduced or intact interoceptive processing during conscious attention towards inner sensations, eventually presenting a potential target of therapeutic intervention for particular subgroups. Although evidence is sparse, interoceptive sensitivity may be reduced in BPD.SummaryDistinguishing levels of interoception according to Forkmann et al. (2016) revealed a severe pattern of disturbed neurophysiological processing, including difficulties in representing inner sensations and regulating emotions, such as a generally reduced trait to focus on bodily sensations. We propose a heightened attentional bias towards external cues to guide behavior together with a reduced integration of inner sensations, potentially resulting from a learning history of invalidation of own sensations and feelings in childhood.