Resting-state autonomic function in the development of personality disorders

Theoretical and empirical advances have shifted the understanding of personality pathology (PP) toward more integrative conceptualizations that focus on the interplay between genetic vulnerability and developmental influences. PP is increasingly understood as a dimensional construct reflecting developmentally rooted deviations from normative personality functioning rather than discrete diagnostic categories. In this context, traditional diagnostic categories, such as personality disorders (PDs), are regarded as manifestations of a broader spectrum of underlying psychopathology. Within this framework, genetically based self-regulatory tendencies are considered early precursors of PP and other psychopathology.
From an etiological perspective, the Neurovisceral Integration Model (NIM) offers a neurophysiological framework of brain–autonomic integration, positing that self-regulatory capacity is reflected in autonomic nervous system (ANS) functioning. Within the NIM framework and its developmental extension, heart rate variability (HRV) is assumed to represent a physiological correlate of self-regulatory capacity. Moreover, HRV has been proposed as a transdiagnostic indicator of psychopathology. Consistent with developmental and trait–state models of personality, autonomic indices such as heart rate (HR) and HRV are assumed to interact with both trait-like self-regulatory capacity and state-like fluctuations in response to situational demands, linking physiological regulation with PP-related traits and behaviors. These interactions are clinically relevant as they suggest that autonomic indices may predict treatment response and guide intervention selection, while also advancing insight into the underlying mechanisms of PP.
The present dissertation investigated associations between PP and resting-state ANS function in adolescence. Across two empirical studies, the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) borderline personality disorder (BPD) symptom severity was negatively associated with HRV, whereas no consistent associations were found between the Semistructured Interview for Personality Functioning (STiP-5.1) impairments in personality functioning and autonomic indices. Study 2 extended these findings, showing that reduced baseline HRV was associated with subsequent increases in BPD and depression severity and with decreases in psychosocial functioning, whereas increased. HR, in turn, was associated with subsequent decreases in depression severity and psychosocial functioning. Neither HRV nor HR was associated with subsequent NSSI frequency. Taken together, these findings provide preliminary support for resting-state HRV as a developmentally sensitive marker of autonomic regulation and self-regulatory difficulties in adolescence.

2026

dissertation

true