Normalization of elevated heart rate in patients with borderline personality disorder over the course of inpatient treatment (Dialectical Behavior Therapy): A case control study with psychiatric controls.

BACKGROUND

Borderline Personality Disorder (BPD) is characterized by emotional dysregulation and autonomic nervous system (ANS) dysfunction, including elevated heart rate (HR) and reduced heart rate variability. Psychophysiological markers such as HR offer insight into underlying regulatory deficits and treatment response. Dialectical Behaviour Therapy (DBT) has shown efficacy in improving emotional regulation in BPD, but its impact on physiological markers such as HR are insufficiently characterized.

OBJECTIVE

This study examines changes in HR in BPD patients during an inpatient DBT program and compares these outcomes to psychiatric controls. Additionally, it explores the relationship between HR reduction and changes in psychological symptomatology.

METHODS

In a case-control design, data from N = 63 BPD (M = 26.7, SD = 10.2) patients and N = 55 psychiatric controls (M = 26.5, SD = 7.0) without BPD were collected. The psychiatric controls were hospitalized concurrently with the BPD patients and primarily had depression or anxiety disorders. HR was measured via electrocardiogram (ECG) at admission and discharge. Psychological symptomatology was assessed using standardized questionnaires (BDI-II; SCL-90-R, BSL-23, CTQ).

RESULTS

At admission, HR was significantly higher in BPD patients compared to psychiatric controls. Furthermore, BPD patients showed a significant reduction in HR from admission to discharge, with a greater decrease than psychiatric controls. No significant correlation was found between HR reduction and changes in psychological symptom scores. However, baseline symptom severity predicted the extent of HR reduction.

CONCLUSION

Inpatient psychotherapy may contribute to the normalization of autonomic dysregulation in BPD, reflected in decreased HR. HR may serve as a psychophysiological marker for treatment-associated physiological changes, with baseline severity moderating autonomic outcomes.