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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.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Both human and animal studies indicate that early trauma can influence brain development and can lead to dysregulation and dysfunction. This includes cognitive deficits. The risk of childhood trauma (CHT) and resulting cognitive deficits are well established in Posttraumatic Stress Disorder (PTSD). This is not the case for Social Anxiety Disorder (SAD). The experience of CHT does not inevitably lead to later psychopathology, suggesting that resiliency factors may be at play. Indeed, research shows that resilience is protective against the development of PTSD although this has not been well studied in SAD, particularly in the context of childhood trauma and neurocognition. Methods: This exploratory study assessed for the possible contribution of CHT on cognitive functioning in adults with SAD. We assessed 44 individuals who formed part of a larger study on neurocognitive and neuroimaging correlates in a sample drawn from the Western Cape, South Africa. Using a neuropsychological test battery, memory, attention and executive functioning (EF) (underpinned by hippocampal, cingulate cortex and pre frontal-cortex function respectively) were assessed. CHT was assessed with the Childhood Trauma Questionnaire (CTQ). We compared neurocognitive and resilience (CD-RISC) variables across four groups (SAD with trauma, SAD without trauma, PTSD and healthy controls) using analysis of variance (ANOVA) statistics. Results: None of the groups differed significantly on cognitive variables, however, on average all outcomes were in the predicted direction. Separate analyses for the traumatised groups only showed a significant effect for EF and attention, suggesting an association between EF, attention and CHT. On a measure of resilience, healthy controls had significantly higher resilience scores than the other 3 groups. Unexpectedly, SAD and PTSD groups with CHT had higher resilience scores than the SAD group without CHT, suggesting that resilience moderates CHT. Lastly individuals with SAD and PTSD with CHT reported more emotional abuse and neglect than any other type of childhood trauma. Conclusion: This exploratory study is unique in its comparative assessment of the effects of CHT and resilience on discussed. / AFRIKAANSE OPSOMMING: Agtergrond: Beide mens- en dierestudies dui daarop dat vroeë trauma brein ontwikkeling kan beïnvloed en kan lei tot disfunksie. Dit sluit kognitiewe tekortkominge in. Die risiko van vroeë kinderjare trauma (KJT) en die gevolglike kognitiewe tekortkominge is goed gevestig in Posttraumatiese stresversteuring (PTSV). Dit is egter nie die geval in Sosiale angsversteuring (SAV) nie. Die ervaring van KJT lei nie noodwendig tot latere psigopatologie nie, wat daarop dui dat veerkragtigheidsfaktore 'n rol kan speel. Trouens, navorsing toon dat veerkragtigheid beskermend is teen die ontwikkeling van PTSV, maar dit is egter nie behoorlik nagevors in SAV nie - veral nie in die konteks van vroeë kinderjare en neurokognisie nie. Metodologie: Hierdie verkennende studie het die invloed van KJT op kognitiewe funksionering in 44 individue geëvalueer. Hierdie studie het deel gevorm van 'n groter studie oor neurokognitiewe- en neurobeeldingskorrelate in 'n steekproef wat gewerf is uit die Wes-Kaap, Suid-Afrika. ‘n Neurosielkundige toetsbattery was gebruik om geheue, aandag en uitvoerende funksionering (UF) (wat onderskeidelik deur die hippokampus, cingulate korteks en prefrontale korteks ondersteun word) te assesseer. KJT is beoordeel met die "Childhood Trauma Questionnaire" (CTQ). 'n Analise van variansie (ANOVA) was gebruik om die neurokognitiewe en veerkragtigheid (CD-RISC) veranderlikes oor vier groepe (SAV met trauma, SAV sonder trauma, PTSV en gesonde kontrole) te vergelyk. Resultate: Nie een van die groepe het beduidend verskil van mekaar op grond van kognitiewe veranderlikes nie, maar oor die algemeen was alle uitkomste in die voorspelde rigting. Afsonderlike analises op die getraumatiseerde groepe het 'n beduidende effek gehad vir UF en aandag, wat dui op 'n assosiasie tussen UF, aandag en KJT. Die gesonde kontrole het beduidende hoër veerkragtigheid tellings as die ander 3 groepe gehad. SAV en PTSV groepe met KJT het teen verwagtinge hoër veerkragtigheidstellings gehad as die SAV sonder KJT, wat daarop dui dat veerkragtigheid KJT modereer. Laastens, individue met SAV en PTSV met KJT het meer emosionele mishandeling en verwaarlosing gerapporteer as enige ander tipe kinderjare trauma. Bespreking: Hierdie verkennende studie is uniek in sy vergelykende evaluering van die invloed van KJT en veerkragtigheid op die neurokognisie in deelnemers met SAV en PTSV. Beperkings en aanbevelings vir toekomstige navorsing word bespreek.