Eye-tracking patterns in borderline personality disorder: findings from a relational dot-probe task

Roberta Bortolla, Gea Elena Spada, Eleonora Lazzarino, Cesare Maffei


Background and objectives: Among the main dysfunctions of borderline personality disorder, a topic of interest is the study of attentional mechanisms that evaluates which stimuli attracts patients’ attention and how patients process incoming stimuli. Different attentional biases could be manifested in borderline personality disorder: hypervigilance of emotional cues, difficulties in disengaging attention or avoidance. Additionally, social contents could be particularly problematic for patients given their alterations in the interpersonal domain. The current study aimed to investigate alterations in attentional mechanisms in response to interpersonal stimuli (positive, negative, and erotic) in this clinical population.

Methods: A modified version of the dot-probe task using socio-relational pictures was administered to 31 patients with borderline personality disorder and 31 healthy controls. The relational stimuli had a positive, negative, and erotic valence to test possible difference related to specific contents administered. Reaction times and eye-tracking data were collected during the tasks.

Results: Borderline personality disorder patients showed low latency to negative and erotic contents supporting a condition of hypervigilance associated to these contents. Additionally, patients reported high bias score in response to erotic stimuli manifesting difficulties in disentangling attention from these contents. On the contrary, reduced bias score and low visual exploration were manifested by borderline personality disorder subjects in response to negative stimuli, supporting the use of avoidance mechanisms. Additionally, high levels of negative affectivity affected the previous processes increasing patients’ alertness to potential threating (or rejecting) situations.

Conclusions: As a whole our findings confirm the presence of altered attentional mechanisms in borderline personality disorder. These patients showed hypervigilance to erotic and negative relational situations, in line with well documented interpersonal problems. However, stimuli specific contents (e.g., erotic vs negative) differentiate later stage of attentional process bringing patients to manifest difficulties in disengaging attention in some cases and avoidance mechanisms in others.


Borderline personality disorder; Eye-tracking; Attentional bias; Hypervigilance; Avoidance.

Full Text:



Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: results from a nationally representative population-based study. Journal of psychiatric research, 45(6), 814-822. https://doi.org/10.1016/j.jpsychires.2010.11.008

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.

Baum, C., Schneider, R., Keogh, E., & Lautenbacher, S. (2013). Different stages in attentional processing of facial expressions of pain: a dot-probe task modification. The Journal of Pain, 14(3), 223-232. https://doi.org/10.1016/j.jpain.2012.11.001

Berenson, K. R., Gyurak, A., Ayduk, Ö., Downey, G., Garner, M. J., Mogg, K., ... & Pine, D. S. (2009). Rejection sensitivity and disruption of attention by social threat cues. Journal of research in personality, 43(6), 1064-1072. https://doi.org/10.1016/j.jrp.2009.07.007

Bertsch, K., Gamer, M., Schmidt, B., Schmidinger, I., Walther, S., Kästel, T., ... & Herpertz, S. C. (2013). Oxytocin and reduction of social threat hypersensitivity in women with borderline personality disorder. American Journal of Psychiatry, 170(10), 1169-1177. 10.1176/appi.ajp.2013.13020263

Bertsch, K., Krauch, M., Stopfer, K., Haeussler, K., Herpertz, C., & Gamer, M. (2017). Interpersonal threat sensitivity in borderline personality disorder: an eye- tracking study. Journal of personality disorders, 1-24. https://doi.org/10.1521/pedi_2017_31_273

Bortolla, R., Cavicchioli, M., Galli, M., Verschure, P. F., & Maffei, C. (2019a). A comprehensive evaluation of emotional responsiveness in borderline personality disorder: a support for hypersensitivity hypothesis. Borderline personality disorder and emotion dysregulation, 6(1), 8. https://doi.org/10.1186/s40479-019-0105-4

Bortolla, R., Cavicchioli, M., Rivaldi, J. S., Mateos, J. C. P., Verschure, P. F., & Maffei, C. (2020). Hypersensitivity or hyperreactivity? An experimental investigation in Borderline Personality Disorder. Mediterranean Journal of Clinical Psychology, 8(1). https://doi.org/10.6092/2282-1619/mjcp-2297

Bortolla, R., Galli, M., Ramella, P., Sirtori, F., Visintini, R., & Maffei, C. (2020a). Negative bias and reduced visual information processing of socio-emotional context in borderline personality disorder: A support for the hypersensitivity hypothesis. Journal of Behavior Therapy and Experimental Psychiatry, 69, 101589. https://doi.org/10.1016/j.jbtep.2020.101589

Bortolla, R., Spada, G. E., Galli, M., Visitini, R., Talè, C., & Maffei, C. (2022). Psychophysiological aspects of Borderline Personality Disorder reactivity to interpersonal stimuli: associations to components of childhood abuse. Mediterranean Journal of Clinical Psychology, 10(2). https://doi.org/10.13129/2282-1619/mjcp-3435

Bradley, M. M., Codispoti, M., Cuthbert, B. N., & Lang, P. J. (2001). Emotion and motivation I: Defensive and appetitive reactions in picture processing. Emotion, 1(3), 276–298. https://doi.org/10.1037/1528-3542.1.3.276

Burklund, L. J., Eisenberger, N. I., & Lieberman, M. D. (2007). The face of rejection: rejection sensitivity moderates dorsal anterior cingulate activity to disapproving facial expressions. Social neuroscience, 2(3-4), 238-253. https://doi.org/10.1080/17470910701391711

Cavicchioli, M., Rugi, C., & Maffei, C. (2015). Inability to withstand present-moment experiences in borderline personality disorder: a meta-analytic review. Clinical Neuropsychiatry, (4).

Cisler, J. M., & Koster, E. H. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical psychology review, 30(2), 203-216. https://doi.org/10.1016/j.cpr.2009.11.003

Downey, G., Mougios, V., Ayduk, O., London, B. E., & Shoda, Y. (2004). Rejection sensitivity and the defensive motivational system: Insights from the startle response to rejection cues. Psychological Science, 15(10), 668-673. https://doi.org/10.1111/j.0956-7976.2004.00738.x

Elices, M., Soler, J., Fernández, C., Martín-Blanco, A., Portella, M. J., Pérez, V., ... & Pascual, J. C. (2012). Physiological and self-assessed emotional responses to emotion-eliciting films in borderline personality disorder. Psychiatry Research, 200(2-3), 437-443. https://doi.org/10.1016/j.psychres.2012.07.020

Fertuck, E. A., Grinband, J., & Stanley, B. (2013). Facial trust appraisal negatively biased in borderline personality disorder. Psychiatry research, 207(3), 195-202. https://doi.org/10.1016/j.psychres.2013.01.004

First, M. B. (2014). Structured clinical interview for the DSM (SCID). The encyclopedia of clinical psychology, 1-6.

Frick, C., Lang, S., Kotchoubey, B., Sieswerda, S., Dinu-Biringer, R., Berger, M., ... & Barnow, S. (2012). Hypersensitivity in borderline personality disorder during mindreading. PLoS One, 7(8), e41650. https://doi.org/10.1371/journal.pone.0041650

Giromini, L., Velotti, P., De Campora, G., Bonalume, L., & Cesare Zavattini, G. (2012). Cultural adaptation of the difficulties in emotion regulation scale: Reliability and validity of an Italian version. Journal of clinical psychology, 68(9), 989-1007. https://doi.org/10.1002/jclp.21876

Lavan, H., & Johnson, J. G. (2002). The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence. Journal of Personality Disorders, 16(1), 73-94. https://doi.org/10.1521/pedi.

Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford press.

MacLeod, Mathews, & Tata (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15–20.

Miano, A., Fertuck, E. A., Arntz, A., & Stanley, B. (2013). Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. Journal of personality disorders, 27(4), 442-456. https://doi.org/10.1521/pedi_2013_27_096

Kaiser, D., Jacob, G. A., van Zutphen, L., Siep, N., Sprenger, A., Tuschen-Caffier, B., ... & Domes, G. (2020). Patients with borderline personality disorder and comorbid PTSD show biased attention for threat in the facial dot-probe task. Journal of Behavior Therapy and Experimental Psychiatry, 67, 101437. https://doi.org/10.1016/j.jbtep.2018.11.005

Kaiser D, Jacob GA, Domes G, Arntz A. (2017) Attentional Bias for Emotional Stimuli in Borderline Personality Disorder: A Meta-Analysis. Psychopathology, 49(6):383–96. https://doi.org/10.1159/000448624

Koenig, J., Kemp, A. H., Feeling, N. R., Thayer, J. F., & Kaess, M. (2016). Resting state vagal tone in borderline personality disorder: a meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 18-26. https://doi.org/10.1016/j.pnpbp.2015.07.002

Koenigsberg, H. W., Harvey, P. D., Mitropoulou, V., Schmeidler, J., New, A. S., Goodman, M., ... & Siever, L. J. (2002). Characterizing affective instability in borderline personality disorder. American Journal of Psychiatry, 159(5), 784-788. https://doi.org/10.1176/appi.ajp.159.5.784

Krueger, R. F., Eaton, N. R., Clark, L. A., Watson, D., Markon, K. E., Derringer, J., ... & Livesley, W. J. (2011). Deriving an empirical structure of personality pathology for DSM-5. Journal of personality disorders, 25(2), 170-191. https://doi.org/10.1521/pedi.2011.25.2.170

Pomplun, M., Ritter, H., & Velichkovsky, B. (1996). Disambiguating complex visual information: Towards communication of personal views of a scene. Perception, 25(8), 931-948. https://doi.org/10.1068/p250931

Price, R. B., Kuckertz, J. M., Siegle, G. J., Ladouceur, C. D., Silk, J. S., Ryan, N. D., ... & Amir, N. (2015). Empirical recommendations for improving the stability of the dot-probe task in clinical research. Psychological assessment, 27(2), 365. https://doi.org/10.1037/pas0000036

Rehder, B., & Hoffman, A. B. (2005). Thirty-something categorization results explained: selective attention, eyetracking, and models of category learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 31(5), 811. https://doi.org/10.1037/0278-7393.31.5.811

Reichenberger, J., Eibl, J. J., Pfaltz, M., Wilhelm, F. H., Voderholzer, U., Hillert, A., & Blechert, J. (2017). Don't praise me, don't chase me: Emotional reactivity to positive and negative social-evaluative videos in patients with borderline personality disorder. Journal of Personality Disorders, 31(1), 75-89. https://doi.org/10.1521/pedi_2016_30_238

Sansone, R. A., Barnes, J., Muennich, E., & Wiederman, M. W. (2008). Borderline personality symptomatology and sexual impulsivity. The International Journal of Psychiatry in Medicine, 38(1), 53-60. https://doi.org/10.2190%2FPM.38.1.e

Sansone, R. A., & Wiederman, M. W. (2009). Borderline personality symptomatology, casual sexual relationships, and promiscuity. Psychiatry (Edgmont), 6(3), 36-40.

Sansone, R. A., & Sansone, L. A. (2011). Sexual behavior in borderline personality: a review. Innovations in clinical neuroscience, 8(2), 14.

Sarlo, M., Palomba, D., Buodo, G., Minghetti, R., & Stegagno, L. (2005). Blood pressure changes highlight gender differences in emotional reactivity to arousing pictures. Biological Psychology, 70(3), 188–196. https://doi.org/10.1016/j.biopsycho.2005.01.005

Schofield, C. A., Johnson, A. L., Inhoff, A. W., & Coles, M. E. (2012). Social anxiety and difficulty disengaging threat: Evidence from eye-tracking. Cognition & emotion, 26(2), 300-311. https://doi.org/10.1080/02699931.2011.602050

Schulte‐Herbrüggen, O., Ahlers, C. J., Kronsbein, J. M., Rüter, A., Bahri, S., Vater, A., & Roepke, S. (2009). Impaired sexual function in patients with borderline personality disorder is determined by history of sexual abuse. The journal of sexual medicine, 6(12), 3356-3363. https://doi.org/10.1111/j.1743-6109.2009.01422.x

Selby, E. A., & Joiner Jr, T. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13(3), 219-229. https://doi.org/10.1037/a0015687

Selby, E. A., Ribeiro, J. D., & Joiner Jr, T. E. (2013). What dreams may come: Emotional cascades and nightmares in borderline personality disorder. Dreaming, 23(2), 126. https://doi.org/10.1037/a0032208

Sesar, K., Dodaj, A., & Kovačević, M. (2022). Childhood maltreatment, aspects of emotional processing and borderline personality disorder. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3373

Spokas, M., Wenzel, A., Stirman, S. W., Brown, G. K., & Beck, A. T. (2009). Suicide risk factors and mediators between childhood sexual abuse and suicide ideation among male and female suicide attempters. Journal of Traumatic Stress, 22(5), 467-470. https://doi.org/10.1002/jts.20438

Staebler, K., Gebhard, R., Barnett, W., & Renneberg, B. (2009). Emotional responses in borderline personality disorder and depression: Assessment during an acute crisis and 8 months later. Journal of Behavior Therapy and Experimental Psychiatry, 40(1), 85-97. https://doi.org/10.1016/j.jbtep.2008.04.003

Stepp, S. D., Scott, L. N., Jones, N. P., Whalen, D. J., & Hipwell, A. E. (2016). Negative emotional reactivity as a marker of vulnerability in the development of borderline personality disorder symptoms. Development and Psychopathology, 28(1), 213-224. https://doi.org/10.1017/S0954579415000395

Tahirovic, S., & Bajric, A. (2016). Child-parent attachment styles and borderline personality disorder relationship. Mediterranean Journal of Clinical Psychology, 4(2). https://doi.org/10.6092/2282-1619/2016.4.1277

Terraciano, A., McCrae, R. R., & Costa Jr, P. T. (2003). Factorial and construct validity of the Italian Positive and Negative Affect Schedule (PANAS). European journal of psychological assessment, 19(2), 131. https://doi.org/10.1027//1015-5759.19.2.131

Thayer, J. F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of behavioral medicine, 37(2), 141-153. https://doi.org/10.1007/s12160-009-9101-z

Trull, T. J. (2001). Structural relations between borderline personality disorder features and putative etiological correlates. Journal of abnormal psychology, 110(3), 471-481. https://doi.org/10.1037/0021-843X.110.3.471

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology, 54(6), 1063-1070. https://doi.org/10.1037/0022-3514.54.6.1063

Wong, H. M., Leung, H. C. M., Chow, L. Y., Kam, W. K., & Tang, A. K. L. (2010). Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm. Journal of personality disorders, 24(6), 800-811. https://doi.org/10.1521/pedi.2010.24.6.800

Westphal, M., Olfson, M., Bravova, M., Gameroff, M. J., Gross, R., Wickramaratne, P., ... & Neria, Y. (2013). Borderline personality disorder, exposure to interpersonal trauma, and psychiatric comorbidity in urban primary care patients. Psychiatry: Interpersonal and Biological Processes, 76(4), 365-380. https://doi.org/10.1521/psyc.2013.76.4.365

Wobbrock, J. O., Findlater, L., Gergle, D., & Higgins, J. J. (2011, May). The aligned rank transform for nonparametric factorial analyses using only anova procedures. In Proceedings of the SIGCHI conference on human factors in computing systems (pp. 143-146). https://doi.org/10.1145/1978942.1978963

Wooding, D. S., Mugglestone, M. D., Purdy, K. J., & Gale, A. G. (2002). Eye movements of large populations: I. Implementation and performance of an autonomous public eye tracker. Behavior Research Methods, Instruments, & Computers, 34, 509-517. https://doi.org/10.3758/BF03195480

Yen, S., Zlotnick, C., & Costello, E. (2002). Affect regulation in women with borderline personality disorder traits. The Journal of nervous and mental disease, 190(10), 693-696. https://doi.org/10.1097/00005053-200210000-00006

DOI: https://doi.org/10.13129/2282-1619/mjcp-3638


  • There are currently no refbacks.