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Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50\u2009years of age were confronted with pictures of self\u2010cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self\u2010Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self\u2010cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self\u2010cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self\u2010cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long\u2010lasting consequences of self\u2010cutting behavior in the patients. Implications for therapy are discussed.<\/jats:p>","DOI":"10.1002\/pmh.1583","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:49:04Z","timestamp":1681278544000},"page":"328-351","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The riddle of deliberate self\u2010harm: Physiological and subjective effects of self\u2010cutting cues in patients with borderline personality disorder and healthy controls"],"prefix":"10.1002","volume":"17","author":[{"given":"Valeska Reichel","family":"Pape","sequence":"first","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Rostock  Gehlsheimer Stra\u00dfe 20 18147 Rostock Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silke","family":"Braun","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Giessen  Klinikstra\u00dfe 36 35392 Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svenja","family":"Peters","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Giessen  Klinikstra\u00dfe 36 35392 Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Stingl","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Giessen  Klinikstra\u00dfe 36 35392 Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Tucha","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Rostock  Gehlsheimer Stra\u00dfe 20 18147 Rostock Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gebhard","family":"Sammer","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Psychotherapy University Medicine Giessen  Klinikstra\u00dfe 36 35392 Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2016.06.010"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027063"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291711001917"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029777"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1529100619860513"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.12795"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8986.2005.00271.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0165-1781(00)00179-7"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2018_32_382"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/1528-3542.1.3.276"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7916(94)90063-9"},{"key":"e_1_2_10_14_1","volume-title":"Handbook of emotion elicitation and assessment","author":"Bradley M. 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