Reduced positive attentional bias in patients with borderline personality disorder compared with non-patients: results from a free-viewing eye-tracking study

Attentional processes are important for regulating emotional states and coping with stressful events. Orientation of attention acts as filter for subsequent information processing. So far, only few eye-tracking studies have examined attentional processes during emotion perception in borderline personality disorder (BPD). In these studies, gaze behaviour was analysed during simultaneous or delayed evaluation of single stimuli. The objective of the present eye-tracking study was to investigate early and late attention allocation towards emotional facial expressions in patients with BPD and non-patients (NPs) based on a free-viewing paradigm, which allows to examine processes of self-generated attention deployment. In a multiple-stimulus free-viewing task with facial expressions, i.e. happy, angry, sad, and neutral faces, presented simultaneously early and late attentional allocation was analysed in 43 patients with BPD and 43 age- and sex-matched NPs. We assessed study participants’ trait anxiety, depressive symptoms, level of alexithymia, traumatic childhood experiences, and borderline symptoms. Entry time was used to measure initial gaze orientation, whereas dwell time was calculated as an index of late attention allocation. As could be expected, patients with BPD reported more anxiety, depressive symptoms, experiences of childhood maltreatment, and showed higher levels of alexithymia than NPs. Patients differed from NPs in dwell time on happy facial expressions but not in dwell time on angry, sad, and neutral expressions. Contrary to our hypothesis, patients did not differ from NPs concerning entry times on angry facial expressions. According to our results, patients with BPD show a reduced attentional preference for happy facial expression during free viewing compared to NPs. A decreased positive attentional bias at a late processing stage could be part of emotion regulation impairments and add to the vulnerability for negative affects in BPD, which represent core symptoms of the disorder. In contrast to previous eye-tracking research in BPD examining attention during evaluative processing, our dwell time data could be more indicative of self-generated, endogenously controlled attentional processes in emotion perception. The present data do not support an early vigilance for threatening social information in BPD.