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Both borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are associated with emotion dysfunction and often co-occur. Emotional reactivity is also evident in some studies in BPD and PTSD. Despite the frequent co-occurrence of these diagnoses, only a few studies have examined the independent and joint effects of BPD and PTSD on emotional functioning. Some data suggest that co-occurring PTSD may drive discordance between domains of emotional reactivity in BPD, dampening physiological reactivity but increasing subjective reactivity. Low reliance on acceptance-based emotion regulation may also account for this divergence. The current study examined the independent and interactive effects of BPD and PTSD on emotional reactivity, regulation, and concordance across physiological and subjective measures. We also examined the role of acceptance in driving concordance across physiological and subjective measures. Participants (N = 195) underwent a diagnostic interview and completed a computerized task including neutral and negative emotion inductions. We examined subjective and physiological outcomes after both inductions. Linear regressions were used to examine relationships between diagnostic group and self-reported reactivity and regulation outcomes, as well the mediating role of acceptance on discordance. Multilevel models were used to examine the associations between diagnostic criteria and time on reactivity and regulation outcomes. We found that BPD and BPDxPTSD, but not PTSD, were significantly associated with greater difficulty regulating and accepting emotions. No significant differences in physiological reactivity and regulation were present across diagnostic groups, and acceptance was not found as a mediator between diagnostic groups and discordance indices. We discuss possible interpretations of our reactivity and regulation findings. Investigating BPD and PTSD’s association with reactivity and regulation, along with the role of emotional acceptance on these outcomes, will extend our understanding of diagnostic profiles and potentially pinpoint how acceptance can be utilized to influence emotional concordance.

Disrupted emotion processes are central features of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), which are linked to altered neural response patterns. However, inconsistent results have led to questions about the reliability of such findings. Heterogeneous clinical presentations across individuals with PTSD and MDD are likely to be associated with heterogeneous neurobehavioral changes which may differ depending on the emotion process studied. Similarly, neurobehavioral signatures of treatment response prediction may vary based on the task or context probed. In these studies, we examined how neuroimaging of emotion processes may shed light on mechanisms underlying symptom heterogeneity in PTSD (Study 1) and how similar neuroimaging signatures may be useful for predicting response to MDD treatment (Study 2). Results showed re-experiencing and hyperarousal symptoms had opponent effects on neural habituation to negative images, such that while increasing severity of hyperarousal symptoms was related to diminished habituation, increasing severity of re-experiencing symptoms was associated with enhanced habituation. Additionally, across MDD studies, two regions of the brain, the right anterior insula and the subgenual anterior cingulate cortex, exhibited pretreatment responses to negative emotional stimuli that were predictive of clinical response to treatment. Considered together, this work demonstrates the translational utility of neuroimaging of negative emotion processes to enhance our understanding of symptomatology and treatment prediction in PTSD and MDD. / Ph.D. / People who have posttraumatic stress disorder (PTSD) or depression often notice changes in the intensity and range of emotions they experience. These changes are thought to be related to differences in how the brain processes emotional information. Using neuroimaging to visualize changes that occur in the brains of individuals with PTSD or depression when they are experiencing negative emotions, we may gain a better understanding of how their symptoms are impacting them and how they may respond to different types of treatments. In these studies, I used brain imaging to measure responses to emotional images of people with and without PTSD. I found that certain PTSD symptoms affected the way people's brains responded over time to negative and neutral images. More several arousal symptoms were linked to less decreases of brain responses over time or less habituation. More severe symptoms of intrusive memories or distress when exposed to reminders of trauma were associated with greater decreases of brain responses to negative images. In a second study, I found that across studies of people with depression, two regions of the brain that are involved in emotion processing and stress responsivity, show pretreatment responses to negative emotional stimuli that are related to how they are likely to respond to treatment for depression. Overall, my research demonstrates how brain responses to negative emotions may be useful for understanding symptoms of mental health disorders and may help with predicting how individuals will respond to treatment.

Posttraumatic Stress Disorder (PTSD) has been demonstrated as the primary pathway through which morbidity and mortality is achieved post-trauma. However, less is known about protective factors to PTSD, depression, and self-reported health outcomes of adults following a traumatic event. Through examination of residential fire survivors, the current project evaluated the predictive validity of protective factors of PTSD as they relate to PTSD, depression, and somatic health outcomes. Additionally, the project collapsed the three outcomes variables into a unified health construct and evaluated protective factors ability to predict health. It was hypothesized the peritraumatic emotionality, social support, and resource loss would predict PTSD, depression, and somatic health. Additionally, it was predicted that peritraumatic emotionality, social support, and resource loss would predict a unified construct of health. Participants were assessed via self-report and semi-structured interviews approximately four months post-fire. Results of the current project demonstrated strong associations amongst peritraumatic emotionality and resource loss for many of the outcome variables. However, social support was not found to be a predictor of any of the outcomes variables. When evaluating the unified health construct, resource loss was found to significant predict a resilient group of trauma survivors four months post-fire. The present study suggests lower peritraumatic emotionality and lower sustained resource loss are significant protective factors for resiliency from trauma. / Ph. D.

Recent trauma research argues trauma results in distinct positive and negative consequences, however; many trauma variables positively correlate with both outcomes. This study examined posttraumatic growth (PTG) and post-traumatic stress disorder (PTSD) symptoms as positive and negative trauma outcomes. Behavioral, cognitive, and demographic correlates and predictors were assessed to help clarify differences between the two outcomes. While several behavioral factors were common to both PTG and PTSD symptoms, centrality of event and problem focused coping were the strongest PTG predictors, whereas centrality of event and avoidant coping were the strongest PTSD predictors. These findings indicate while greater incorporation of a trauma/stressful event into one’s identity is a key component of both PTG and PTSD development, behavioral response may be a determining factor between growth or debilitation.

Posttraumatic Stress Disorder (PTSD) is marked by avoidance, arousal, re-experiencing, and negative mood and cognition. To date, these symptoms are assessed using self-report measures (e.g., the PCL-5) and clinician administered assessments (e.g., the CAPS-5). While these are the present gold-standard assessments for PTSD, they still are prone to bias on behalf of both the administrator and the patient. Presently, there is evidence that individuals with PTSD perform differently than individuals without PTSD on certain cognitive tasks that measure attention bias and avoidance behaviors. As such, creating a battery of these tasks may be a viable route for objectively measuring PTSD. In an effort to provide preliminary evidence for such a battery, we used three cognitive assessments [the Emotional Stroop Task (EST), the Visual Search Task (VST), and the Approach Avoidance Task (AAT)] to assess cognitive performance in veterans with PTSD, and veterans and civilians without PTSD. We hypothesized that veterans with PTSD would perform worse than the other groups (as measured by reaction times and accuracy scores) following the presentation of combat-related stimuli compared to negative and positive stimuli. The results indicated that veterans with PTSD were generally slower across all conditions in the EST, had lower accuracy scores on the VST, and were slower in the combat condition compared to the other control groups in the AAT. This study provides preliminary support for the hypothesis that a battery of cognitive tasks may be an effective tool for objectively identifying PTSD. Furthermore, we discuss important methodological ways in which future studies could improve the sensitivity of these tasks.