Attentional Bias for Emotional Stimuli in Borderline Personality Disorder: A Meta-Analysis

Background: In borderline personality disorder (BPD), attentional bias (AB) to emotional stimuli may be a core component in disorder pathogenesis and maintenance.

Sampling: 11 emotional Stroop task (EST) studies with 244 BPD patients, 255 nonpatients (NPs) and 95 clinical controls and 4 visual dot-probe task (VDPT) studies with 151 BPD patients or subjects with BPD features and 62 NPs were included.

Methods: We conducted two separate meta-analyses for AB in BPD. One meta-analysis focused on the EST for generally negative and BPD-specific/personally relevant negative words. The other meta-analysis concentrated on the VDPT for negative and positive facial stimuli.

Results: There is evidence for an AB towards generally negative emotional words compared to NPs (standardized mean difference, SMD = 0.311) and to other psychiatric disorders (SMD = 0.374) in the EST studies. Regarding BPD-specific/personally relevant negative words, BPD patients reveal an even stronger AB than NPs (SMD = 0.454). The VDPT studies indicate a tendency towards an AB to positive facial stimuli but not negative stimuli in BPD patients compared to NPs.

Conclusions: The findings rather reflect an AB in BPD to generally negative and BPD-specific/personally relevant negative words rather than an AB in BPD towards facial stimuli, and/or a biased allocation of covert attentional resources to negative emotional stimuli in BPD and not a bias in focus of visual attention. Further research regarding the role of childhood traumatization and comorbid anxiety disorders may improve the understanding of these underlying processes.