Toward a new model of borderline personality disorder: a psychophysiological approach on the link between emotional and behavioural dysregulation

Borderline personality disorder (BPD) is one of the most studied personality disorders, given its prevalence and the severity of its symptoms. In the last years, several models of the disorder were presented, however, no one of this theoretical conceptualization is completely supported by the literature. This thesis aims to present an evidence-based alternative model of the disorder. A central core in BPD pathology is related to the connection between emotional and behavioural dysregulations that characterize these subjects. Emotional dysregulation processes in BPD subjects seem to be elicited by specific difficulties in difficulties in neuroception -the unconscious perception of dangers and threats present in the subject's surroundings- rather than being generally triggered. This could be due to differences in analyzing social contexts given by attentional and cognitive biases and to the ruminative states caused by the difficulties reported in the social environment. The studies presented in this dissertation analyze the effect of negative affective states on executive performance, emotional response, and attentional biases, in response to socio-emotional cues, and the efficacy of a mindfulness exercise in reducing negative affective states. Self-reported, behavioural, physiological, and eye-tracking data were collected and analyzed during the tasks. Finally, starting from the results obtained in these studies, and the data presented in the literature a model of BPD emotional functioning will be presented. El trastorno límite de personalidad (BPD) es uno de los trastornos de personalidad más estudiados, por su prevalencia y la severidad de sus síntomas. En los últimos años, diferentes modelos de este trastorno han sido presentados en la literatura científica. Sin embargo, ninguna de estas conceptualizaciones teóricas ha sido completamente confirmada. El objetivo de esta tesis es de presentar una conceptualización alternativa del trastorno mediante un enfoque basado en evidencias. Una característica central en el BPD es la conexión entre la desregulación emotiva y la desregulación comportamental que caracteriza estos sujetos. La desregulación emotiva en los pacientes con BPD podría ser generada por dificultades especificas en la neurocepción – la percepción subconsciente de peligros y amenazas presente en el entorno- en lugar de ser activada de forma generalizada. Esto puede depender de las diferencias en la que los pacientes con BPD analizan su propio ent