emotion regulation

The Heart of Emotion Regulation

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Through various blog on this site we have suggested that trauma and adverse childhood experiences may have an effect on the ability of the brain to regulate emotion.

We have even suggested that adverse childhood experiences and trauma may actually have a direct effect on the maturation of the regions of the brain implicated in emotion regulaltion.

This very recent study (1) appears to be demonstrating that this may indeed be the case with certain psychiatric disorders.

This study  by Muller and colleagues shows that an electroencephalographic signature of the brain’s representation of internal bodily responses (the amplitude of heartbeat evoked potential) is abnormally attenuated in patients with borderline personality disorder (BPD) – a disorder of emotional regulation.

This deficit predicts symptoms, including the degree of emotional instability, and correlates with structural differences in the gray matter volume in the insula and the anterior cingulate cortex, brain regions engaged during emotional regulation and implicated in the integrative control of mind and body.


“There is an obligatory physiological dimension to emotional experience. Heart rate, respiratory frequency, and sweat gland activity are among the autonomic reactions used as objective indices of the strength of emotional response.

Changes in physiology initiate, accompany, and intensify emotions, to the extent that the sensing of bodily signals (interoception) has been considered a fundamental basis to emotional feelings. But people differ; hence, a person’s sensitivity to internal bodily responses may be a better determinant of emotional style, predicting one’s vulnerability to emotional disorders and the capacity to regulate one’s own emotional state.

Based on “peripheral” theories of emotion, an early prediction was that patients with affective disorders, characterized by strong emotional feelings and poor affect regulation, might show greater heartbeat detection accuracy. States of physiological arousal are characteristic of anxiety, and, correspondingly, symptoms of arousal are featured within many clinical scales of anxiety. On average, interoceptive sensitivity is enhanced across patients with panic and anxiety disorders, with fewer anxious patients classifiable as “poor heartbeat detectors” than nonanxious controls.

However, heartbeat detection accuracy is typically found to be impaired in patients with depression. There are also benefits to having enhanced interoceptive ability, which is associated with more effective intuitive decision making and better emotional self-regulation.

In their study, Müller and colleagues return to the fundamental issue of the quality of the central representation of the bodily signals.

They demonstrate a difference in an electrocortical signature of the integrity of the body-brain axis in BPD, and relate this to the characteristic expression of emotional dysregulation related to early-life trauma and adversity.

Müller and colleagues go further by reporting a relationship with the structural integrity of the brain in patients with BPD, who show a relative reduction in gray matter volume within the insula and anterior cingulate cortices, both regions implicated in the representation and control of emotion-related bodily arousal and the engendered affective feelings.

The implication is that adverse early-life experiences have an effect on the adaptive maturation of the biological substrates supporting affective control and, perhaps more fundamentally, self-representation.

Dissociative symptoms are a clinical expression of disturbed self-representation, and feelings of emptiness with depersonalization and derealization are common experiences of patients with BPD. Dissociation is linked theoretically to the uncoupling of integrative self-processing, notably at the interface between the dynamic representation of the internal body as a physiological entity and the psychological constructions that, in healthy individuals, give rise to a sense of internal agency and control.

The innovative work of Müller and colleagues highlights the fundamental relevance of interoceptive signaling to a personality disorder characterized by emotional instability.”




1. Müller LE, Schulz A, Andermann M, et al. Cortical representation of afferent bodily signals in borderline personality disorder: neural correlates and relationship to emotional dysregulation [published online September 16, 2015].JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.1252


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