Investigating visuo-tactile mirror properties in Borderline Personality Disorder: a TMS-EEG study

Patients with Borderline Personality Disorder (pw-BPD) are characterized by lower levels of cognitive empathy compared to healthy controls (HCs), indicating difficulties in understanding others’ perspective. A candidate neural mechanism subtending empathic abilities is represented by the Tactile Mirror System (TaMS), which refers to mirror-like mechanisms in the somatosensory cortices. However, little is known about TaMS alterations in BPD, specifically in terms of brain connectivity within this network. Here, we aimed at providing novel insights on TaMS as neurophysiological candidate for BPD empathic deficits, with a special focus on TaMS connectivity by means of the combined use of transcranial magnetic stimulation and electroencephalography (TMS-EEG). Twenty pw-BPD and 20 HCs underwent a thorough investigation: we collected measures of empathic abilities obtained from self-report questionnaires, behavioral performance in a visuo-tactile spatial congruency task, and TMS-evoked potentials (TEPs) as effective connectivity indexes. In the TMS-EEG session, TMS was delivered over the right primary somatosensory cortex (S1) following the presentation of real touches and visual touches, while 74-channel EEG was continuously recorded. In the visuo-tactile spatial congruency task and the TMS-EEG recording, control conditions with visual touches on objects instead of body parts enabled to disentangle the involvement of TaMS from non-specific effects. The study is the first one employing TMS-EEG in pw-BPD and it has been preregistered before data collection. Consistent with previous findings, results show that pw-BPD reported significantly lower levels of cognitive empathy. Moreover, pw-BPD made significantly more errors than controls in the visuo-tactile spatial congruency task during visual touches on human body parts and not on objects. Finally, pw-BPD displayed a different connectivity pattern from S1-TEPs that was not specific for TaMS: they showed a lower P60 component during touch observation, as well as reduced amplitude of later TEPs responses (after ∼100 ms) during real touches. Overall, the present study shows behavioral evidence of TaMS impairment and a more general alteration in the connectivity pattern of the somatosensory network in pw-BPD.