Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder: A Pilot Study

J Nerv Ment Dis. 2018 Dec;206(12):935-943. doi: 10.1097/NMD.0000000000000905.


Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimuli based on false beliefs. For this pilot study, we assessed eight patients with BPD before and after a 3-month-long psychiatric treatment, using functional magnetic resonance imaging and behavioral tasks. We observed arousal increase within the session of the two-chair dialogue (d = 0.36), paralleled by arousal decrease between sessions (d = 0.80). We found treatment-associated trends for neural activity reduction in brain areas central for EP and TOM. Our exploratory findings using an integrative assessment procedure of changes in EP and TOM point toward evidence for treatment effects at the brain systems level related to behavioral modulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Borderline Personality Disorder / diagnostic imaging
  • Borderline Personality Disorder / physiopathology
  • Borderline Personality Disorder / psychology*
  • Borderline Personality Disorder / therapy
  • Brain / diagnostic imaging
  • Brain / physiopathology
  • Emotional Intelligence* / physiology
  • Emotions
  • Female
  • Functional Neuroimaging
  • Humans
  • Magnetic Resonance Imaging
  • Pilot Projects
  • Self Concept
  • Theory of Mind* / physiology
  • Young Adult