Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder

Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder Marie Barthauer, Livia Graumann, An Bin Cho, Eugenia Kulakova, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5566176/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Aug, 2025 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted 9 You are reading this latest preprint version Abstract Background Borderline personality disorder (BPD) is characterized by instability in interpersonal relationships and fear of abandonment, which intensify during stress. Social stressors seem to activate the hypothalamic–pituitary–gonadal (HPG) axis in healthy controls (HC), but this has not been investigated in patients with BPD. This study aimed to investigate the effects of social stress, i.e. social exclusion on progesterone and estradiol levels in women with BPD compared to HC. Methods 82 women with BPD and 82 HC were randomly assigned to either an exclusion or overinclusion condition of the Cyberball paradigm. Saliva samples were collected at baseline and 15 minutes after the task to measure progesterone and estradiol. Two 2 × 2 factorial ANOVAs were conducted with group and condition as the independent variables and Δ-progesterone and Δ-estradiol as dependent variables. Results On progesterone, the analysis revealed no significant main effects of group or condition, but a significant group × condition interaction. Post-hoc tests showed that progesterone responses within the BPD group significantly differed between exclusion and overinclusion, while no significant differences were observed in HC. Descriptively, progesterone levels increased following social exclusion, whereas they decreased after overinclusion in BPD. For estradiol levels no significant main effects for group, condition, or their interaction were found. Discussion This study provides initial evidence that women with BPD exhibit distinct progesterone responses to social exclusion versus overinclusion. BPD participants showed a descriptive decrease in progesterone after overinclusion and a small increase after exclusion. These findings might be interpreted as perhaps a lack of assumed protective effects of progesterone (e.g. calming). Further research is needed to better understand this hormonal pattern and its implications for social functioning in BPD. Borderline personality disorder Social exclusion Progesterone Estradiol Figures Figure 1 Figure 2 Introduction The core symptoms of borderline personality disorder (BPD) involve instability in interpersonal relationships and fear of abandonment ( 1 ). These symptoms often intensify during psychosocial stress, particularly involving social exclusion or (perceived) rejection ( 2 ). Individuals with BPD are more sensitive to experiences of social exclusion and rejection than healthy controls (HC) and tend to exhibit stronger negative emotional reactions in these contexts ( 3 – 5 ). To experimentally induce feelings of ostracism, several studies used the Cyberball paradigm ( 6 ), a virtual ball-tossing game that simulates social inclusion and exclusion by varying the number of ball tosses participants receive from co-players. Patients with BPD consistently perceive exclusion in Cyberball as a strong threat to their social needs and report feeling more excluded, even when being included, compared to HC ( 5 , 7 – 9 ). In response to perceived exclusion, patients with BPD show distinct emotional and physiological reactions, that differ from HC. They tend to show lower emotional empathy for positive emotions, increased other-focused negative emotions, and more hostile-intent attributions compared to HC in response to Cyberball ( 7 , 8 , 10 – 12 ). These reactions are often reflected in aggressive but also defensive behaviors including social withdrawal, which contrast with the more adaptive, calm responses seen in HC. This is also reflected in their physiological responses, where patients with BPD have shown lower parasympathetic activity ( 13 – 15 ). In healthy individuals, Cyberball appears to activate the hypothalamic-pituitary-gonadal (HPG) axis, as suggested by increased progesterone secretion in response to social exclusion in healthy women ( 16 ). Progesterone has been linked to prosocial behavior, enhancing social bonding and interpersonal connections, particularly in stress contexts that include elements of social exclusion ( 17 – 19 ). Thus, it may play an adaptive role in response to social exclusion. Within the central nervous system (CNS), progesterone is associated with anxiolytic effects by enhancing GABAergic inhibition, promoting calmness, and reducing anxiety ( 20 ). However, not all studies align with this finding, with some reporting no significant effects of Cyberball on progesterone levels in healthy controls ( 21 , 22 ). These differences in results compared to the study by Seidel and colleagues (2013) may be due to smaller samples of female participants and methodological differences, such as the timing of hormonal measurements, task design variations, and the methods used to analyze progesterone changes. In addition to progesterone, few studies have also explored the effects of social exclusion on estradiol in healthy participants, though findings remain inconclusive. Estradiol is discussed as having a positive, potentially protective role in stress regulation through its effects on the hippocampus and prefrontal cortex (for an overview see Albert, Pruessner ( 23 )). However, Weik et al. ( 24 ) reported a non-significant drop in plasma estradiol after a public speaking task, possibly due to oral contraceptive use, which can mask natural hormonal responses. Similarly, another study found no estradiol changes in response to the Trier Social Stress Test (TSST; 25) in a mixed-sex sample (n = 39 men, n = 44 women)( 26 ). While the TSST induces performance-based stress and a cortisol spike, Cyberball may uniquely engage pathways related to social pain and exclusion. Although research directly linking progesterone and estradiol to social exclusion in BPD is lacking, some studies have examined hormonal dynamics of progesterone and estradiol in other contexts. Eisenlohr-Moul et al. ( 27 ) investigated naturally occurring hormonal fluctuations in women with BPD and found that symptoms related to interpersonal reactivity, such as irritability, anger, and rejection sensitivity, were more pronounced during the luteal phase, which is characterized by higher progesterone and lower estradiol levels. The same pattern has been shown for increased reactive aggression in BPD ( 28 ). DeSoto et al. ( 29 ) however, found that higher estradiol variability, rather than basal levels, was associated with greater symptom severity in BPD. These findings suggest that progesterone and estradiol secretion may contribute to emotional and interpersonal difficulties in BPD. Additionally, a study by Maner et al. ( 30 ) showed that individuals with high baseline social anxiety, a feature often observed in BPD, display a decrease in progesterone in response to social exclusion. The aim of the present analysis, which was part of a larger study ( 11 ), was to investigate the effects of social exclusion on hormone secretion of progesterone and estradiol in patients with BPD and healthy controls. We hypothesized that in response to social exclusion progesterone would increase in healthy controls ( 16 ) and decrease in women with BPD ( 30 ). We expected no significant changes in estradiol levels in healthy controls following exclusion ( 24 , 26 ). In the control condition, we anticipated no differences in progesterone or estradiol levels between HC and BPD patients. While the impact of estradiol on BPD is inconsistent and data on its role in social exclusion is lacking, we explored the possibility of a decrease in estradiol levels following social exclusion in individuals with BPD. This expectation is based on the known sensitivity of individuals with BPD to social rejection and stress, which often leads to negative mood states. Additionally, lower estradiol levels are linked to increased vulnerability to stress and negative mood states ( 31 , 32 ). Method Participants Participants were recruited through internet postings, leaflets in hospitals, and the Department for Psychiatry and Neurosciences at Charité Berlin. Every participant was provided with both verbal and written details of the procedure and was required to give informed consent before engaging in the study. Participants were compensated 60 Euros, with an additional 30 Euros that could be earned in a computer game (Graumann et al., 2023). The study was approved by the Ethics Committee at Charité. The original sample consisted of 98 women with BPD and 98 healthy controls. We excluded all women using hormonal contraception, resulting in 82 naturally cycling women with BPD and 82 healthy controls. Participants were matched for age, education, and menstrual cycle phase. Healthy participants had no lifetime psychiatric diagnoses or treatments. The age range was 18 to 50 years with a BMI between 17.5 and 30. Exclusion criteria included glucocorticoid intake, pregnancy, neurodegenerative, autoimmune, metabolic, endocrine, central nervous system diseases, and other severe somatic diseases. BPD exclusions included acute suicidal behavior, lifetime psychotic symptoms, substance addiction, and an acute major depressive episode. Additionally, individuals taking more than three different psychotropic substances daily or using benzodiazepines were excluded. Dosage stability for at least one week prior to testing was confirmed. Procedure The study comprised two testing sessions. Trained clinicians conducted the Structural Clinical Interview for DSM-5 Disorders (SCID) (German versions of SCID-5-CV, SCID-5-PD; ( 33 ). Participants completed various psychopathology questionnaires on a computer or tablet in a laboratory setting. Detailed information on the specific questionnaires can be found in Graumann et al. ( 11 ). During the second session, mood, wakefulness, and nervousness were assessed using the Multidimensional Mood State Questionnaire (MDMQ; ( 34 )). Subsequently, participants played Cyberball, followed by repeatedly filling out the MDMQ to measure changes in the variables mentioned above. Participants completed the Need Threat Questionnaire (NTQ; ( 35 )), to assesses need threat related to Cyberball (e.g., 'I felt rejected') and ostracism intensity (e.g., 'I was ignored'). We also assessed the extent to which participants believed they were playing the game with real players. Following the Cyberball task, participants completed computer based tests, which have been reported elsewhere ( 11 , 36 ). Social exclusion Participants were randomized into either an exclusion or an overinclusion condition of the Cyberball paradigm ( 37 ). The overinclusion condition was chosen as the control condition due to BPD patients' biased perception of inclusion ( 8 , 38 ). Each condition lasted two to three minutes with 30 ball tosses. In the exclusion condition, participants received the ball twice within the first six throws, then not again. In the overinclusion condition, participants received 45% of all throws. Participants were instructed to visualize the experience as an authentic interaction with real players. The instructions explicitly conveyed that they would be participating in a virtual ball-tossing activity with two co-players through an internet connection, notwithstanding the fact that these co-players were computer-generated. All participants were debriefed after the experiment. Physiological outcome variables Physiological outcome variables For analyses of progesterone and estradiol, salvia samples were collected using SaliCap devices (IBL, Hamburg, Germany) at the following time points: baseline (0) and 15 minutes after Cyberball (+ 35). Samples were stored at − 80°C until biochemical analyses, performed at the Neurobiology Laboratory of the Department of Psychiatry and Psychotherapy, Charité, Universitätsmedizin Berlin. Progesterone and estradiol levels were determined using a competitive immunoassay (IBL/TECAN, Hamburg, Germany). The limit of detection was 3.31 pg/ml for progesterone and 2.1 pg/ml for estradiol. Prediction parameters (coefficient of variation; CV) for medium concentrations at 50 pg/ml averaged below 5% for intra-assay and below 10% for inter-assay variance. Statistics Statistical analyses were conducted using SPSS version 29. Continuous demographic variables were compared using t-tests, while categorical variables were analyzed using χ² tests. Differences in hormonal baseline values were analyzed using t-tests. Log transformation was applied to progesterone and estradiol values to correct non-normal distribution. We calculated the changes in progesterone levels after the Cyberball task compared to baseline levels. Previous studies indicate that initial changes in progesterone can be detected in saliva approximately after 15 minutes ( 16 , 30 ). Therefore, we selected the third measurement point (T3, 15 minutes after Cyberball) and subtracted the first measurement point (T1, baseline) to determine the change (Δ) in progesterone and estradiol (Δ-progesterone and Δ-estradiol, calculated as T3-T1). Two 2 × 2 factorial ANOVAs were conducted, with group and condition as the independent variables and Δ-progesterone and Δ-estradiol as dependent variables. Significant interaction effects were followed by simple effects post-hoc tests and t-tests. Results Demographic and clinical data There were no significant differences between the groups in terms of age and phase of the menstrual cycle. There were more smokers, and BMI was higher in the BPD group. For results, see Table 1. In the exclusion condition, there were 44 women with BPD and 45 HC. In the overinclusion condition, there were 38 women with BPD and 37 HC. Conditions did not differ in age, education, smoking, menstrual cycle phase, or BMI, all p s > 0.05. Of the BPD group, 37 women were inpatients and 51 were outpatients. Forty-two women with BPD were free of psychotropic medication, and 40 reported medication use. The most frequent comorbid diagnosis in BPD was PTSD n = 20. For further details on medication and comorbid diagnoses, see supplementary material. Women with BPD had significantly higher scores on all self-report questionnaires for clinical symptoms and rejection sensitivity, all p s < .001. For results, see Table 1. Table 1 Sample characteristics, psychopathology questionnaire data and Cyberball manipulation check Sample characteristics and psychopathology questionnaire data Variable BPD n=82 HC n=82 Statistics Age (mean/SD) 28.52 (7.51) 27.72 (6.47) t (162) = .73, p = .46 Years of school education (mean/SD) 11.72 (1.22) 12.02 (.96) t (162) = –1.77, p = . 08 Smoker (y/n) 37/45 11/71 χ 2 (1) = 19.91, p < .001 Body mass index (mean/ SD) 22.88 (3.24) 21.85 (2.50) t (162) = 2.27, p = .01 Cycle phase (follicular/luteal/no cycle) 26/50/4 (2 missing) 30/50/2 χ 2 (2) = .93, .p = .63 BDI-II (mean/SD) 27.23 (12.12) 1.56 (2.14) t (161) = 18.88, p < .001 BSL-23 (mean/SD) 1.91 (.88) .08 (.12) t (162) = 18.49, p < .001 ITQ (mean/SD) 10.43 (6.19) .85 (1.71) t (162) = 13.49, p < .001 RSQ (mean/SD) 18.06 (6.64) 6.06 (2.72) t (162) = 15.97, p < .001 Results Manipulation check: Need Threat Questionnaire Results Variable Group Condition M SD Statistics Need threat BPD Overincl. 11.67 3.08 group: F (1,160) = 73.9, p < .001 , η 2 = .32 Exclusion 17.09 2.89 condition: F (1,160) = 114.19, p < .001, η 2 = .42 HC Overincl. 8.95 1.56 Exclusion 12.64 2.87 group × condition: F (1,160) = 3.77, p = .05 , η 2 = .02 Ostracism Intensity BPD Overincl. 2.97 1.84 group: F (1,60) = 18.48, p < .001, η 2 = . 10 Exclusion 8.57 1.91 condition: F (1,160) = 369.96, p < .001, η 2 = .70 HC Overincl. 2.19 0.74 Exclusion 7.02 2.01 group × condition: F (1,160) = 1.97, p = .16, η 2 = .01 Belief cover story BPD Overincl. 2.22 1.03 group: F (1,157) = 4.77, p = .03, η 2 = . 03 Exclusion 1.64 0.96 condition: F (1,157) = 13.401, p < .001, η 2 = . 08. HC Overincl. 1.84 0.87 Exclusion 1.42 0.58 group × condition: F (1,157) = 0.33, p = .57, η 2 = .00 Note. BPD borderline personality disorder, HC healthy controls, n sample size, M Mean, SD standard deviation, y yes, n no, BDI-II Beck Depression Inventory, BSL-23 Borderline Symptom List-short version, ITQ International Trauma Questionnaire, RSQ Rejection Sensitivity Questionnaire, NTQ Need Threat Questionnaire Table 2 Results of the Multidimensional Mood State Questionnaire (MDMQ) MDMQ Scale Group Condition Time M SD Statistic Good vs. bad BPD Overincl. Before 12.79 3.10 Between-subjects After 12.58 3.67 group: F (1,159) = 282.69, p < .001***, η 2 = .62 Excl. Before 12.53 3.52 condition: F (1,159) = 1.46, p = .31, η 2 = .01 After 11.37 3.49 group × condition: F (1,159) = .61, p = .44, η 2 = .01 HC Overincl. Before 18.59 0.90 Within subjects After 18.54 1.19 time: F (1,159) = 4.14, p = .04*, η 2 = .03 Excl. Before 18.47 1.60 time × group: F (1,159) = 2.55, p = .11, η 2 = .02 After 18.36 1.63 time × condition: F (1,159) = 1.78, p = .18, η 2 =. 01 time × group × condition: F (1,159) = 1.40, p = .24, η 2 =. 01 Awake vs. tired BPD Overincl. Before 11.45 3.76 Between-subjects After 11.03 3.33 group: F (1,159) = 133.67, p < .001***, η 2 = .46 Excl. Before 10.84 3.35 condition: F (1,159) = 3.53, p = .06, η 2 = .02 After 9.91 3.07 group × condition: F (1,159) = 0.00, p = .98, η 2 = .00 HC Overincl. Before 16.41 2.51 Within subjects After 16.51 2.64 time: F (1,159) = 4.35, p = .04*, η 2 = .03 Excl. Before 15.76 2.84 time × group: F (1,159) = 2.72, p = .10, η 2 = .02 After 15.49 3.12 time × condition: F (1,159) = 1.49, p = .22, η 2 =. 01 time × group × condition: F (1,159) = .04, p = .85, η 2 =. 00 Calm vs. nervous BPD Overincl. Before 11.61 3.05 Between-subjects After 11.82 3.93 group: F (1,159) = 224.84, p < .001***, η 2 = .59 Excl. Before 10.02 3.44 condition: F (1,159) = 5.15, p = .03*, η 2 = .03 After 10.72 3.51 group x condition: F (1,159) = .76, p = .39, η 2 = .01 HC Overincl. Before 17.86 2.00 Within subjects After 17.59 2.34 time: F (1,159) = 1.98, p = .16, η 2 = .01 Excl. Before 16.91 2.45 time × group: F (1,159) = .91, p = .34, η 2 = .01 After 17.36 2.52 time × condition: F (1,159) = 2.44, p = .12, η 2 =. 01 time × group × condition: F (1,159) = .09, p = .76, η 2 =. 00 Note. BPD Borderline Personality Disorder, HC Healthy controls, M Mean, SD Standard deviation Cyberball- Manipulation check The Need Threat Questionnaire (NTQ) results indicated successful Cyberball manipulation. Participants reported higher need threat after exclusion than overinclusion. Women with BPD reported higher need threat and ostracism intensity than HC. There was a group × condition interaction, with women with BPD reacting more strongly to exclusion than HC. Women with BPD believed the cover story more than HC did. Mean values and statistics of NTQ are reported in Table 1. Further results on Cyberball manipulation check can be found elsewhere (11). On the Multidimensional Mood State Questionnaire (MDMQ), women with BPD reported worse mood, feeling more tired and more nervous than HC, all p s < .001. Mean values and statistics of the MDMQ are reported in Table 2. Endocrinological Data Progesterone Groups did not differ in basal progesterone levels ( t (153) = 0.42, p = .68, 95% CI [-26.53, 40.82]). The 2 × 2 ANOVA revealed a significant group × condition interaction effect on the change of progesterone levels from T1 to T3 ( F (1, 151) = 4.19, p = .04, η² = .03). There were no main effects of group (F(1, 151) = 0.07, p = .79, η² = .00) or condition (F(1, 151) = 1.20, p = .28, η² = .01). Results are displayed in Figure 1. Simple effects post-hoc tests indicated that within the BPD group, the exclusion condition led to a significantly different direction of change in progesterone levels compared to the overinclusion condition ( F (1, 75) = 4.86, p = .03, η² = .06). Descriptively, progesterone levels in BPD showed a slight increase in the exclusion condition while in the overinclusion condition progesterone decreased. In the HC group, there were no significant differences in progesterone changes between conditions ( F (1, 76) = 0.46, p = .50, η² = .01). There was no significant difference between the BPD and HC groups in the overinclusion condition ( F (1, 68) = 1.42, p = .24, η² = .02). In the exclusion condition, there was a trend towards a difference between BPD and HC, with women with BPD showing almost no hormonal change, whole HC showed a decrease, but this effect was not statistically significant ( F (1, 83) = 3.00, p = .09, η² = .03). Fig. 1 Mean Δ-progesterone (in pg/ml) measured in saliva at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There was a significant group × condition interaction ( p = .04). Simple post-hoc test in BPD showed p = .03. Error bars represent standard error of the mean. Estradiol Groups did not differ in basal estradiol levels ( t (158) = 0.63, p = .53, 95% CI [-0.10, 0.19]). The 2 × 2 ANOVA revealed no significant effect of group × condition on Δ-estradiol ( F (1, 156) = 0.12, p = .73, η² = .00). There were no main effects observed for group ( F (1, 156) = 1.24, p = .27, η² = .01) or condition ( F (1, 156) = 0.05, p = .83, η² = .00). Results are presented in Figure 2. Fig. 2 Mean Δ-estradiol (in pg/ml). Measured by saliva samples at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There were no significant effects, all p s > .001. Error bars represent standard error of the mean. The inclusion of BMI and menstrual cycle phase as covariates in the analysis of both progesterone and estradiol did not change the significance of the findings. Discussion This study examined the effects of social exclusion on progesterone and estradiol levels in women with BPD compared to healthy women. For progesterone, a significant interaction between group and condition was observed, with post-hoc tests revealing differing responses between conditions within the BPD group. In contrast, healthy controls showed no significant differences in progesterone levels between conditions. For estradiol, no significant main or interactions effects were observed. Below, we discuss these findings, focusing first on progesterone, followed by estradiol. Progesterone We hypothesized that healthy controls would show an increase in progesterone following social exclusion, consistent with a previous study ( 16 ). However, our results did not support this hypothesis. No significant changes in progesterone were observed in neither the exclusion nor the overinclusion condition in HC. In our sample, healthy women did not report strong negative emotional reactions to Cyberball, as they did not feel notably nervous, tired, or bad after either condition. This suggests that the Cyberball paradigm may not have been sufficiently impactful to elicit a measurable response of progesterone. Our results replicate previous findings that show an absence of significant hormonal responses in progesterone and cortisol within the HC group ( 21 , 22 ). This absence may be due to the Cyberball paradigm's lack of face-to-face interaction, which reduces the immediacy of the social threat. Additionally, the Cyberball paradigm does not require active planning, physical or cognitive engagement, which are factors that seem to activate the HPA and HPG Axis ( 21 ). Our findings diverge from results of Seidel et al. ( 16 ), possibly due to differences in the sample. While the study of Seidel et al. ( 16 ) included both men and women, our research involved a larger, exclusively female sample of 82 women with BPD and 82 healthy controls. This allows for a more reliable analysis of hormonal patterns specific to women. For women with BPD, we hypothesized a decrease in progesterone following social exclusion. This was based on prior research showing a drop in progesterone in individuals with high social anxiety and evidence of withdrawal or socially anxious behavior in BPD patients ( 30 , 39 , 40 ). While our findings did not support this hypothesis, there was a significant difference in progesterone responses between the exclusion and overinclusion conditions within the BPD group. In line with previous studies, our results suggest that women with BPD seem to experience the Cyberball task differently than healthy controls ( 5 , 7 – 9 ). This is reflected in their significantly higher reports of need threat, ostracism, and negative reactions to exclusion, as well as worse mood, tiredness, and nervousness. They were also more likely than HC to believe the cover story, suggesting they perceived the Cyberball game as more realistic. These differences in emotional and cognitive responses may have impacted the hormonal responses observed in the BPD group. Their stronger emotional reactions and greater belief in the exclusion scenario could have had an impact on their physiological responses to the task. Estradiol In contrast to progesterone, our analysis of estradiol levels revealed no significant interaction effects or main effects of group or condition. Both the BPD and HC groups showed no significant changes in estradiol levels from T1 to T3, regardless of whether they experienced social exclusion or overinclusion. This is consistent with previous studies that reported no significant stress-induced changes in estradiol levels during social stress tasks in healthy individuals ( 24 , 26 , 41 ). In BPD, this may indicate that estradiol is less responsive to short-term social stressors like Cyberball, particularly in comparison to progesterone. In animal studies, estradiol appears to be more stable and might be more responsive to physical stressors, such as sleep deprivation, footshock, or swim stress, which involve substantial physiological demands ( 42 , 43 ). Additionally, estradiol synthesis is more complex than progesterone, involving several enzymatic steps ( 44 ), thus the timing of our measurements may not have captured peak changes in estradiol levels, which could have occurred at different intervals post-stressor. Estradiol’s role in social stress responses may also be more complex and influenced by chronic stress, changes in brain structures, and sleep patterns, which were not accounted for in this study ( 45 , 46 ). Strengths and Limitations The study has several strengths and limitations. First, the artificial laboratory setting may not fully capture the complexities of real-world social interactions. Additionally, participants were tested across different menstrual cycle phases, however, including this factor in the analysis did not alter the results. Some BPD patients were taking psychotropic medication or had comorbidities such as PTSD or anxiety disorders, which may have influenced hormonal responses. Moreover, this study focused on women, as BPD is more prevalent in women, limiting the generalizability of the findings to men. One strength of the study was the exclusion of individuals with major depressive episodes, due to variations in the functioning of the hypothalamic-pituitary-adrenal axis between those with and without a depressive episode in patients with BPD ( 47 , 48 ). Furthermore, the exclusion of participants using hormonal contraception ensured that natural progesterone and estradiol secretion were measured. We also excluded individuals with a BMI under 17.5 or over 30, as weight can influence the synthesis of these hormones. Future Directions and Conclusion Interestingly, in the BPD group, there was a strong descriptive decrease in progesterone after overinclusion and a slight increase following social exclusion, although these results were not significant. This specific pattern in women with BPD might be interpreted as perhaps a lack of assumed protective effects of progesterone (e.g. calming) that are typically linked with progesterone in healthy individuals. Future studies should investigate this further, for example by exploring whether pharmacologically increasing progesterone in BPD could modulate responses to social exclusion and overinclusion. Additionally, research could examine progesterone’s role in emotional regulation using methods that more closely mimic real-life social interactions. Integrating self-reported assessments of social affiliation, which is associated with progesterone, with objective hormonal measures and utilizing implicit affiliation tasks could further clarify the behavioral function of progesterone. Finally, fMRI studies could map how varying progesterone levels affect brain areas involved in social processing, offering deeper insights into how progesterone modulates social cognition and behavior in BPD. In conclusion, our findings offer initial evidence that Cyberball conditions affect progesterone secretion differently in individuals with BPD compared to healthy women. Future research should focus on more realistic social exclusion paradigms and longitudinal designs that track hormonal changes over time in response to repeated social stressors, offering deeper insights impact into the regulation of hormonal responses in women with BPD. Declarations Funding The study was funded by the Deutsche Forschungsgemeinschaft (DFG) (WI 3396/12-1). The fund was awarded to KW. Availability of Data and Materials The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Further data are available from the corresponding author (KW) upon reasonable request. Competing Interest The authors declare no competing interests. Ethics approval and Consent to participate The Charité ethics committee approved this study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Consent for publication All participants including patients were informed about the study orally and in written form and had to give written consent before participating. Participants signed informed consent regarding publishing their data. Authors’ contributions: JHR : Writing – review & editing, Resources, Conceptualization. CED : Writing – review & editing, Software. OTW: Writing – review & editing, Conceptualization. EK : Writing – review & editing, Software, Investigation. ABC : Writing – review & editing, Conceptualization. MB Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal Analysis, Data Curation. LG: Writing – review & editing, Investigation. CO : Writing – review & editing, Conceptualization. KW: Writing – review & editing, Methodology, Funding Acquisition. 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Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder. Eur Arch Psychiatry Clin NeuroSci. 2024;274(1):129–38. Seidel E, Silani G, Metzler H, Thaler H, Lamm C, Gur R, et al. The impact of social exclusion vs. inclusion on subjective and hormonal reactions in females and males. Psychoneuroendocrinology. 2013;38(12):2925–32. Brown SL, Fredrickson BL, Wirth MM, Poulin MJ, Meier EA, Heaphy ED, et al. Social closeness increases salivary progesterone in humans. Horm Behav. 2009;56(1):108–11. Schultheiss OC, Wirth MM, Stanton SJ. Effects of affiliation and power motivation arousal on salivary progesterone and testosterone. Horm Behav. 2004;46(5):592–9. Wirth MM, Schultheiss OC. Effects of affiliation arousal (hope of closeness) and affiliation stress (fear of rejection) on progesterone and cortisol. Horm Behav. 2006;50(5):786–95. Zorumski CF, Paul SM, Covey DF, Mennerick S. Neurosteroids as novel antidepressants and anxiolytics: GABA-A receptors and beyond. Neurobiol stress. 2019;11:100196. Gaffey AE, Wirth MM. Stress, rejection, and hormones: cortisol and progesterone reactivity to laboratory speech and rejection tasks in women and men. F1000Research. 2014;3. Radke S, Seidel E, Boubela R, Thaler H, Metzler H, Kryspin-Exner I, et al. Immediate and delayed neuroendocrine responses to social exclusion in males and females. Psychoneuroendocrinology. 2018;93:56–64. Albert K, Pruessner J, Newhouse P. Estradiol levels modulate brain activity and negative responses to psychosocial stress across the menstrual cycle. Psychoneuroendocrinology. 2015;59:14–24. Weik U, Kuepper Y, Hennig J, Deinzer R. Effects of pre-experience of social exclusion on hypothalamus-pituitary-adrenal axis and catecholaminergic responsiveness to public speaking stress. PLoS ONE. 2013;8(4):e60433. Kirschbaum C, Pirke K-M, Hellhammer DH. The ‘Trier Social Stress Test’–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28(1–2):76–81. Schoofs D, Wolf OT. Are salivary gonadal steroid concentrations influenced by acute psychosocial stress? A study using the Trier Social Stress Test (TSST). Int J Psychophysiol. 2011;80(1):36–43. Eisenlohr-Moul TA, DeWall CN, Girdler SS, Segerstrom SC. Ovarian hormones and borderline personality disorder features: Preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol. 2015;109:37–52. Peters JR, Owens SA, Schmalenberger KM, Eisenlohr-Moul TA. Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder. Aggressive Behav. 2020;46(2):151–61. DeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L. Estrogen fluctuations, oral contraceptives and borderline personality. Psychoneuroendocrinology. 2003;28(6):751–66. Maner JK, Miller SL, Schmidt NB, Eckel LA. The endocrinology of exclusion: Rejection elicits motivationally tuned changes in progesterone. Psychol Sci. 2010;21(4):581–8. Goldstein JM, Jerram M, Poldrack R, Ahern T, Kennedy DN, Seidman LJ, et al. Hormonal cycle modulates arousal circuitry in women using functional magnetic resonance imaging. J Neurosci. 2005;25(40):9309–16. Eisenlohr-Moul TA, Peters JR. Ovarian hormones as a source of fluctuating biological vulnerability in borderline personality disorder. Curr psychiatry Rep. 2019;21:1–8. Beesdo-Baum K, Zaudig M, First MB, Wittchen H. U. SCID-5-PD: Strukturiertes Klinisches Interview für DSM- 5-Persönlichkeitsstörungen. Göttingen: Hogrefe; 2019. Steyer R, Schwenkmezger P, Notz P, Eid M. Der Mehrdimensionale Befindlichkeitsfragebogen MDBF Göttingen Hogrefe; 1997. Grzyb K. Sozialer Ausschluss und automatisches Zielstreben Konstanz. Konstanz University; 2005. Graumann L, Kulakova E, Cho AB, Deuter CE, Wolf OT, Schell J, et al. Elevated testosterone and prosocial behavior in female patients with borderline personality disorder independent of social exclusion. Psychoneuroendocrinology. 2025;171:107232. Williams KD, Jarvis B, Cyberball. A program for use in research on interpersonal ostracism and acceptance. Behav Res Methods. 2006;38:174–80. De Panfilis C, Riva P, Preti E, Cabrino C, Marchesi C. When social inclusion is not enough: Implicit expectations of extreme inclusion in borderline personality disorder. Personality Disorders: Theory Res Treat. 2015;6(4):301. Quenneville AF, Badoud D, Nicastro R, Jermann F, Favre S, Kung A-L, et al. Internalized stigmatization in borderline personality disorder and attention deficit hyperactivity disorder in comparison to bipolar disorder. J Affect Disord. 2020;262:317–22. Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother. 2011;18(4):275–83. Heinz A, Hermann D, Smolka MN, Rieks M, Gräf K-J, Pöhlau D, et al. Effects of acute psychological stress on adhesion molecules, interleukins and sex hormones: implications for coronary heart disease. Psychopharmacology. 2003;165:111–7. Andersen M, Bignotto M, Machado R, Tufik S. Different stress modalities result in distinct steroid hormone responses by male rats. Braz J Med Biol Res. 2004;37:791–7. Shors TJ, Pickett J, Wood G, Paczynski M. Acute stress persistently enhances estrogen levels in the female rat. Stress. 1999;3(2):163–71. Sundström-Poromaa I, Comasco E, Sumner R, Luders E. Progesterone – Friend or foe? Front Neuroendocr. 2020;59:100856. Baker FC, Sassoon SA, Kahan T, Palaniappan L, Nicholas CL, Trinder J, et al. Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome. J Sleep Res. 2012;21(5):535–45. Albert KM, Newhouse PA. Estrogen, stress, and depression: cognitive and biological interactions. Ann Rev Clin Psychol. 2019;15(1):399–423. Wingenfeld K, Driessen M, Terfehr K, Schlosser N, Fernando SC, Otte C, et al. Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression. Psychol Med. 2013;43(3):495–505. Wingenfeld K, Wolf OT. Effects of cortisol on cognition in major depressive disorder, posttraumatic stress disorder and borderline personality disorder-2014 Curt Richter Award Winner. Psychoneuroendocrinology. 2015;51:282–95. Additional Declarations No competing interests reported. Supplementary Files SocialExclusionandProgesteronandEstradiolinBPDSupplemantaryMaterial.docx Cite Share Download PDF Status: Published Journal Publication published 25 Aug, 2025 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted Editorial decision: Revision requested 13 Jan, 2025 Reviews received at journal 12 Jan, 2025 Reviews received at journal 10 Jan, 2025 Reviewers agreed at journal 22 Dec, 2024 Reviewers agreed at journal 22 Dec, 2024 Reviewers invited by journal 20 Dec, 2024 Editor assigned by journal 20 Dec, 2024 Submission checks completed at journal 19 Dec, 2024 First submitted to journal 02 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5566176","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":393341365,"identity":"beec4077-90e8-4a4c-b7ed-73fda4a0efac","order_by":0,"name":"Marie Barthauer","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Barthauer","suffix":""},{"id":393341366,"identity":"e2f47b18-3808-4106-8fa9-c8b59c67e835","order_by":1,"name":"Livia Graumann","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Livia","middleName":"","lastName":"Graumann","suffix":""},{"id":393341367,"identity":"5e503a20-91a0-4455-a154-47e3ef747757","order_by":2,"name":"An Bin Cho","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"An","middleName":"Bin","lastName":"Cho","suffix":""},{"id":393341368,"identity":"12446b9a-c538-4318-a6c1-8759ac3ca67c","order_by":3,"name":"Eugenia Kulakova","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Eugenia","middleName":"","lastName":"Kulakova","suffix":""},{"id":393341369,"identity":"76fa850a-a0eb-48b2-8566-11f7e4fa8279","order_by":4,"name":"Christian Eric Deuter","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"Eric","lastName":"Deuter","suffix":""},{"id":393341370,"identity":"8143d098-0ac0-464b-8889-8b654682f632","order_by":5,"name":"Oliver T. Wolf","email":"","orcid":"","institution":"Institut für Kognitive Neurowissenschaft, Ruhr Universitaet Bochum, Germany","correspondingAuthor":false,"prefix":"","firstName":"Oliver","middleName":"T.","lastName":"Wolf","suffix":""},{"id":393341371,"identity":"b61f7d93-b337-41fc-8809-be2db12a60d1","order_by":6,"name":"Julian Hellmann-Regen","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Julian","middleName":"","lastName":"Hellmann-Regen","suffix":""},{"id":393341372,"identity":"1d4ae036-b58d-4127-8bce-ac94b0c27fab","order_by":7,"name":"Stefan Roepke","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Stefan","middleName":"","lastName":"Roepke","suffix":""},{"id":393341373,"identity":"286601a3-7322-49ff-a0ec-7ab6b5650463","order_by":8,"name":"Christian Otte","email":"","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Otte","suffix":""},{"id":393341374,"identity":"d49b29f3-e053-4187-b354-23eae6841c69","order_by":9,"name":"Katja Wingenfeld","email":"data:image/png;base64,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","orcid":"","institution":"Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitaetsmedizin Berlin","correspondingAuthor":true,"prefix":"","firstName":"Katja","middleName":"","lastName":"Wingenfeld","suffix":""}],"badges":[],"createdAt":"2024-12-02 16:38:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5566176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5566176/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40479-025-00307-1","type":"published","date":"2025-08-25T15:57:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":72374526,"identity":"9bfda100-a4ee-406c-a97e-72a5c4492af4","added_by":"auto","created_at":"2024-12-26 08:14:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9134,"visible":true,"origin":"","legend":"\u003cp\u003eMean Δ-progesterone (in pg/ml) measured in saliva at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There was a significant group × condition interaction (\u003cem\u003ep\u003c/em\u003e = .04). Simple post-hoc test in BPD showed \u003cem\u003ep\u003c/em\u003e = .03. Error bars represent standard error of the mean.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5566176/v1/a728e8f29488986d2668e944.png"},{"id":72375635,"identity":"7cb86c48-32b3-46ec-ac4f-4666549940ba","added_by":"auto","created_at":"2024-12-26 08:22:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8955,"visible":true,"origin":"","legend":"\u003cp\u003eMean Δ-estradiol (in pg/ml). Measured by saliva samples at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There were no significant effects, all \u003cem\u003ep\u003c/em\u003es \u0026gt; .001. Error bars represent standard error of the mean.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5566176/v1/90a9f831d3a0aa9f3835df51.png"},{"id":90344823,"identity":"d5af3ef4-7632-4e43-b320-f4a2961c3010","added_by":"auto","created_at":"2025-09-01 16:04:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1064072,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5566176/v1/81d1f88a-9b11-4579-8b33-ea8fa2a0d534.pdf"},{"id":72374528,"identity":"008cdc4a-2e51-4e03-82c7-477e15705a79","added_by":"auto","created_at":"2024-12-26 08:14:11","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27182,"visible":true,"origin":"","legend":"","description":"","filename":"SocialExclusionandProgesteronandEstradiolinBPDSupplemantaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-5566176/v1/45f49eb6e62e3c01d51185aa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe core symptoms of borderline personality disorder (BPD) involve instability in interpersonal relationships and fear of abandonment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These symptoms often intensify during psychosocial stress, particularly involving social exclusion or (perceived) rejection (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Individuals with BPD are more sensitive to experiences of social exclusion and rejection than healthy controls (HC) and tend to exhibit stronger negative emotional reactions in these contexts (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). To experimentally induce feelings of ostracism, several studies used the Cyberball paradigm (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), a virtual ball-tossing game that simulates social inclusion and exclusion by varying the number of ball tosses participants receive from co-players. Patients with BPD consistently perceive exclusion in Cyberball as a strong threat to their social needs and report feeling more excluded, even when being included, compared to HC (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn response to perceived exclusion, patients with BPD show distinct emotional and physiological reactions, that differ from HC. They tend to show lower emotional empathy for positive emotions, increased other-focused negative emotions, and more hostile-intent attributions compared to HC in response to Cyberball (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These reactions are often reflected in aggressive but also defensive behaviors including social withdrawal, which contrast with the more adaptive, calm responses seen in HC. This is also reflected in their physiological responses, where patients with BPD have shown lower parasympathetic activity (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn healthy individuals, Cyberball appears to activate the hypothalamic-pituitary-gonadal (HPG) axis, as suggested by increased progesterone secretion in response to social exclusion in healthy women (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Progesterone has been linked to prosocial behavior, enhancing social bonding and interpersonal connections, particularly in stress contexts that include elements of social exclusion (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Thus, it may play an adaptive role in response to social exclusion. Within the central nervous system (CNS), progesterone is associated with anxiolytic effects by enhancing GABAergic inhibition, promoting calmness, and reducing anxiety (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, not all studies align with this finding, with some reporting no significant effects of Cyberball on progesterone levels in healthy controls (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These differences in results compared to the study by Seidel and colleagues (2013) may be due to smaller samples of female participants and methodological differences, such as the timing of hormonal measurements, task design variations, and the methods used to analyze progesterone changes.\u003c/p\u003e \u003cp\u003eIn addition to progesterone, few studies have also explored the effects of social exclusion on estradiol in healthy participants, though findings remain inconclusive. Estradiol is discussed as having a positive, potentially protective role in stress regulation through its effects on the hippocampus and prefrontal cortex (for an overview see Albert, Pruessner (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)). However, Weik et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) reported a non-significant drop in plasma estradiol after a public speaking task, possibly due to oral contraceptive use, which can mask natural hormonal responses. Similarly, another study found no estradiol changes in response to the Trier Social Stress Test (TSST; 25) in a mixed-sex sample (n\u0026thinsp;=\u0026thinsp;39 men, n\u0026thinsp;=\u0026thinsp;44 women)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). While the TSST induces performance-based stress and a cortisol spike, Cyberball may uniquely engage pathways related to social pain and exclusion.\u003c/p\u003e \u003cp\u003eAlthough research directly linking progesterone and estradiol to social exclusion in BPD is lacking, some studies have examined hormonal dynamics of progesterone and estradiol in other contexts. Eisenlohr-Moul et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) investigated naturally occurring hormonal fluctuations in women with BPD and found that symptoms related to interpersonal reactivity, such as irritability, anger, and rejection sensitivity, were more pronounced during the luteal phase, which is characterized by higher progesterone and lower estradiol levels. The same pattern has been shown for increased reactive aggression in BPD (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). DeSoto et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) however, found that higher estradiol variability, rather than basal levels, was associated with greater symptom severity in BPD. These findings suggest that progesterone and estradiol secretion may contribute to emotional and interpersonal difficulties in BPD. Additionally, a study by Maner et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) showed that individuals with high baseline social anxiety, a feature often observed in BPD, display a decrease in progesterone in response to social exclusion.\u003c/p\u003e \u003cp\u003eThe aim of the present analysis, which was part of a larger study (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), was to investigate the effects of social exclusion on hormone secretion of progesterone and estradiol in patients with BPD and healthy controls. We hypothesized that in response to social exclusion progesterone would increase in healthy controls (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and decrease in women with BPD (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). We expected no significant changes in estradiol levels in healthy controls following exclusion (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In the control condition, we anticipated no differences in progesterone or estradiol levels between HC and BPD patients. While the impact of estradiol on BPD is inconsistent and data on its role in social exclusion is lacking, we explored the possibility of a decrease in estradiol levels following social exclusion in individuals with BPD. This expectation is based on the known sensitivity of individuals with BPD to social rejection and stress, which often leads to negative mood states. Additionally, lower estradiol levels are linked to increased vulnerability to stress and negative mood states (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants were recruited through internet postings, leaflets in hospitals, and the Department for Psychiatry and Neurosciences at Charit\u0026eacute; Berlin. Every participant was provided with both verbal and written details of the procedure and was required to give informed consent before engaging in the study. Participants were compensated 60 Euros, with an additional 30 Euros that could be earned in a computer game (Graumann et al., 2023). The study was approved by the Ethics Committee at Charit\u0026eacute;.\u003c/p\u003e \u003cp\u003eThe original sample consisted of 98 women with BPD and 98 healthy controls. We excluded all women using hormonal contraception, resulting in 82 naturally cycling women with BPD and 82 healthy controls. Participants were matched for age, education, and menstrual cycle phase. Healthy participants had no lifetime psychiatric diagnoses or treatments. The age range was 18 to 50 years with a BMI between 17.5 and 30. Exclusion criteria included glucocorticoid intake, pregnancy, neurodegenerative, autoimmune, metabolic, endocrine, central nervous system diseases, and other severe somatic diseases. BPD exclusions included acute suicidal behavior, lifetime psychotic symptoms, substance addiction, and an acute major depressive episode. Additionally, individuals taking more than three different psychotropic substances daily or using benzodiazepines were excluded. Dosage stability for at least one week prior to testing was confirmed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe study comprised two testing sessions. Trained clinicians conducted the Structural Clinical Interview for DSM-5 Disorders (SCID) (German versions of SCID-5-CV, SCID-5-PD; (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Participants completed various psychopathology questionnaires on a computer or tablet in a laboratory setting. Detailed information on the specific questionnaires can be found in Graumann et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). During the second session, mood, wakefulness, and nervousness were assessed using the Multidimensional Mood State Questionnaire (MDMQ; (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)). Subsequently, participants played Cyberball, followed by repeatedly filling out the MDMQ to measure changes in the variables mentioned above. Participants completed the Need Threat Questionnaire (NTQ; (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)), to assesses need threat related to Cyberball (e.g., 'I felt rejected') and ostracism intensity (e.g., 'I was ignored'). We also assessed the extent to which participants believed they were playing the game with real players. Following the Cyberball task, participants completed computer based tests, which have been reported elsewhere (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSocial exclusion\u003c/h3\u003e\n\u003cp\u003eParticipants were randomized into either an exclusion or an overinclusion condition of the Cyberball paradigm (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The overinclusion condition was chosen as the control condition due to BPD patients' biased perception of inclusion (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Each condition lasted two to three minutes with 30 ball tosses. In the exclusion condition, participants received the ball twice within the first six throws, then not again. In the overinclusion condition, participants received 45% of all throws. Participants were instructed to visualize the experience as an authentic interaction with real players. The instructions explicitly conveyed that they would be participating in a virtual ball-tossing activity with two co-players through an internet connection, notwithstanding the fact that these co-players were computer-generated. All participants were debriefed after the experiment.\u003c/p\u003e\n\u003ch3\u003ePhysiological outcome variables\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003ePhysiological outcome variables\u003c/div\u003e \u003cp\u003eFor analyses of progesterone and estradiol, salvia samples were collected using SaliCap devices (IBL, Hamburg, Germany) at the following time points: baseline (0) and 15 minutes after Cyberball (+\u0026thinsp;35). Samples were stored at \u0026minus;\u0026thinsp;80\u0026deg;C until biochemical analyses, performed at the Neurobiology Laboratory of the Department of Psychiatry and Psychotherapy, Charit\u0026eacute;, Universit\u0026auml;tsmedizin Berlin. Progesterone and estradiol levels were determined using a competitive immunoassay (IBL/TECAN, Hamburg, Germany). The limit of detection was 3.31 pg/ml for progesterone and 2.1 pg/ml for estradiol. Prediction parameters (coefficient of variation; CV) for medium concentrations at 50 pg/ml averaged below 5% for intra-assay and below 10% for inter-assay variance.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were conducted using SPSS version 29. Continuous demographic variables were compared using t-tests, while categorical variables were analyzed using χ\u0026sup2; tests. Differences in hormonal baseline values were analyzed using t-tests. Log transformation was applied to progesterone and estradiol values to correct non-normal distribution. We calculated the changes in progesterone levels after the Cyberball task compared to baseline levels. Previous studies indicate that initial changes in progesterone can be detected in saliva approximately after 15 minutes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Therefore, we selected the third measurement point (T3, 15 minutes after Cyberball) and subtracted the first measurement point (T1, baseline) to determine the change (Δ) in progesterone and estradiol (Δ-progesterone and Δ-estradiol, calculated as T3-T1). Two 2 \u0026times; 2 factorial ANOVAs were conducted, with group and condition as the independent variables and Δ-progesterone and Δ-estradiol as dependent variables. Significant interaction effects were followed by simple effects post-hoc tests and t-tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic and clinical data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no significant differences between the groups in terms of age and phase of the menstrual cycle. There were more smokers, and BMI was higher in the BPD group. For results, see Table 1. In the exclusion condition, there were 44 women with BPD and 45 HC. In the overinclusion condition, there were 38 women with BPD and 37 HC. Conditions did not differ in age, education, smoking, menstrual cycle phase, or BMI, all \u003cem\u003ep\u003c/em\u003es\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the BPD group, 37 women were inpatients and 51 were outpatients. Forty-two women with BPD were free of psychotropic medication, and 40 reported medication use. The most frequent comorbid diagnosis in BPD was PTSD \u003cem\u003en\u0026nbsp;\u003c/em\u003e= 20. For further details on medication and comorbid diagnoses, see supplementary material. Women with BPD had significantly higher scores on all self-report questionnaires for clinical symptoms and rejection sensitivity, all \u003cem\u003ep\u003c/em\u003es\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026lt; .001. For results, see Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Sample characteristics, psychopathology questionnaire data and Cyberball manipulation check\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 612px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample characteristics and psychopathology questionnaire data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBPD \u003cem\u003en=82\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHC \u003cem\u003en=82\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eAge (mean/SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e28.52 (7.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e27.72 (6.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e (162) = .73, \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eYears of school education (mean/SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e11.72 (1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12.02 (.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026nbsp;\u003c/em\u003e(162) = \u0026ndash;1.77, \u003cem\u003ep = .\u003c/em\u003e08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eSmoker (y/n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e37/45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11/71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e2\u0026nbsp;(1) = 19.91, p \u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eBody mass index (mean/ SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e22.88 (3.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e21.85 (2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e (162) = 2.27, \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eCycle phase (follicular/luteal/no cycle)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e26/50/4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2 missing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e30/50/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e2\u0026nbsp;(2) = .93, .p = .63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eBDI-II (mean/SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e27.23 (12.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.56 (2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e (161) = 18.88, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eBSL-23 (mean/SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.91 (.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.08 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e (162) = 18.49, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eITQ (mean/SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10.43 (6.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.85 (1.71)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e (162) = 13.49, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eRSQ (mean/SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e18.06 (6.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6.06 (2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026nbsp;\u003c/em\u003e(162) = 15.97, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eResults Manipulation check:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eNeed Threat Questionnaire Results\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"610\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNeed threat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eF\u003c/em\u003e(1,160) = 73.9, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u003cem\u003e,\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026eta;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e17.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,160) = 114.19, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e12.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup \u0026times; condition:\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eF\u003c/em\u003e(1,160) = 3.77, \u003cem\u003ep\u003c/em\u003e = .05\u003cem\u003e,\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026eta;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eOstracism Intensity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 63px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,60) = 18.48, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= .\u003c/em\u003e10\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,160) = 369.96, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001,\u003cem\u003e\u0026nbsp;\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e=\u003cem\u003e\u0026nbsp;\u003c/em\u003e.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup \u0026times; condition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,160) = 1.97, \u003cem\u003ep\u003c/em\u003e = .16, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e=\u003cem\u003e\u0026nbsp;\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 162px;\"\u003e\n \u003cp\u003eBelief cover story\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 63px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,157) = 4.77, \u003cem\u003ep\u003c/em\u003e = .03, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e=\u003cem\u003e\u0026nbsp;.\u003c/em\u003e03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,157) = 13.401, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e=\u003cem\u003e\u0026nbsp;.\u003c/em\u003e08.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eExclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003egroup \u0026times; condition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,157) = 0.33, \u003cem\u003ep\u003c/em\u003e = .57,\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e=\u003cem\u003e\u0026nbsp;\u003c/em\u003e.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. BPD\u0026nbsp;\u003c/em\u003eborderline personality disorder, \u003cem\u003eHC\u0026nbsp;\u003c/em\u003ehealthy controls, \u003cem\u003en\u0026nbsp;\u003c/em\u003esample size, \u003cem\u003eM\u0026nbsp;\u003c/em\u003eMean, \u003cem\u003eSD\u0026nbsp;\u003c/em\u003estandard deviation, \u003cem\u003ey\u0026nbsp;\u003c/em\u003eyes, \u003cem\u003en\u0026nbsp;\u003c/em\u003eno, \u003cem\u003eBDI-II\u0026nbsp;\u003c/em\u003eBeck Depression Inventory, \u003cem\u003eBSL-23\u0026nbsp;\u003c/em\u003eBorderline Symptom List-short version, \u003cem\u003eITQ\u0026nbsp;\u003c/em\u003eInternational Trauma Questionnaire, \u003cem\u003eRSQ\u0026nbsp;\u003c/em\u003eRejection Sensitivity Questionnaire, \u003cem\u003eNTQ\u0026nbsp;\u003c/em\u003eNeed Threat Questionnaire\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 Results of the Multidimensional Mood State Questionnaire (MDMQ)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"608\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMDMQ\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCondition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eGood\u0026nbsp;\u003c/p\u003e\n \u003cp\u003evs. bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e12.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBetween-subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e12.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 282.69, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001***, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u003c/em\u003e .62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e12.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 1.46, \u003cem\u003ep\u003c/em\u003e = .31, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u0026nbsp;\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup \u0026times; condition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = .61, \u003cem\u003ep\u003c/em\u003e = .44, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= .01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWithin subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime: \u003cem\u003eF\u003c/em\u003e(1,159) = 4.14, \u003cem\u003ep\u003c/em\u003e = .04*, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u0026nbsp;\u003c/em\u003e.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group: \u003cem\u003eF\u003c/em\u003e(1,159) = 2.55, \u003cem\u003ep\u003c/em\u003e = .11, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u003c/em\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = 1.78, \u003cem\u003ep\u003c/em\u003e = .18, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = 1.40, \u003cem\u003ep\u003c/em\u003e = .24, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eAwake vs. tired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBetween-subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 133.67, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001***,\u003cem\u003e\u0026nbsp;\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 3.53, \u003cem\u003ep\u003c/em\u003e = .06, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup \u0026times; condition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 0.00, \u003cem\u003ep\u003c/em\u003e = .98,\u003cem\u003e\u0026nbsp;\u0026eta; \u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= .00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWithin subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime: \u003cem\u003eF\u003c/em\u003e(1,159) = 4.35, \u003cem\u003ep\u003c/em\u003e = .04*, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u0026nbsp;\u003c/em\u003e.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e15.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group: \u003cem\u003eF\u003c/em\u003e(1,159) = 2.72, \u003cem\u003ep\u003c/em\u003e = .10, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u003c/em\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e15.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = 1.49, \u003cem\u003ep\u003c/em\u003e = .22, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = .04, \u003cem\u003ep\u003c/em\u003e = .85, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCalm vs. nervous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBetween-subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 224.84, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001***, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003econdition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = 5.15, \u003cem\u003ep\u003c/em\u003e = .03*, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= .03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e10.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003egroup x condition:\u003cem\u003e\u0026nbsp;F\u003c/em\u003e(1,159) = .76, \u003cem\u003ep\u003c/em\u003e = .39,\u003cem\u003e\u0026nbsp;\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u0026nbsp;\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOverincl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e17.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWithin subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e17.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime: \u003cem\u003eF\u003c/em\u003e(1,159) = 1.98, \u003cem\u003ep\u003c/em\u003e = .16, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u0026nbsp;\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExcl.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group: \u003cem\u003eF\u003c/em\u003e(1,159) = .91, \u003cem\u003ep\u003c/em\u003e = .34, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=\u003c/em\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e17.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = 2.44, \u003cem\u003ep\u003c/em\u003e = .12, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003etime \u0026times; group \u0026times; condition: \u003cem\u003eF\u003c/em\u003e(1,159) = .09, \u003cem\u003ep\u003c/em\u003e = .76, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=.\u003c/em\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e \u003cem\u003eBPD\u003c/em\u003e Borderline Personality Disorder, \u003cem\u003eHC\u003c/em\u003e Healthy controls,\u003cem\u003e\u0026nbsp;M\u003c/em\u003e\u0026nbsp; \u0026nbsp;Mean, \u003cem\u003eSD\u003c/em\u003e Standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCyberball- Manipulation check\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Need Threat Questionnaire (NTQ) results indicated successful Cyberball manipulation. Participants reported higher need threat after exclusion than overinclusion. Women with BPD reported higher need threat and ostracism intensity than HC. There was a group \u0026times; condition interaction, with women with BPD reacting more strongly to exclusion than HC. Women with BPD believed the cover story more than HC did. Mean values and statistics of NTQ are reported in Table 1. Further results on Cyberball manipulation check can be found elsewhere (11). On the Multidimensional Mood State Questionnaire (MDMQ), women with BPD reported worse mood, feeling more tired and more nervous than HC, all \u003cem\u003ep\u003c/em\u003es\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026lt; .001. Mean values and statistics of the MDMQ are reported in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEndocrinological Data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgesterone\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroups did not differ in basal progesterone levels (\u003cem\u003et\u003c/em\u003e(153) = 0.42, \u003cem\u003ep\u003c/em\u003e = .68, 95% CI [-26.53, 40.82]). The 2 \u0026times; 2 ANOVA revealed a significant group \u0026times; condition interaction effect on the change of progesterone levels from T1 to T3 (\u003cem\u003eF\u003c/em\u003e(1, 151) = 4.19, \u003cem\u003ep\u003c/em\u003e = .04, \u0026eta;\u0026sup2; = .03). There were no main effects of group (F(1, 151) = 0.07, p = .79, \u0026eta;\u0026sup2; = .00) or condition (F(1, 151) = 1.20, p = .28, \u0026eta;\u0026sup2; = .01). Results are displayed in Figure 1. Simple effects post-hoc tests indicated that within the BPD group, the exclusion condition led to a significantly different direction of change in progesterone levels compared to the overinclusion condition (\u003cem\u003eF\u003c/em\u003e(1, 75) = 4.86, \u003cem\u003ep\u003c/em\u003e = .03, \u0026eta;\u0026sup2; = .06). Descriptively, progesterone levels in BPD showed a slight increase in the exclusion condition while in the overinclusion condition progesterone decreased. In the HC group, there were no significant differences in progesterone changes between conditions (\u003cem\u003eF\u003c/em\u003e(1, 76) = 0.46, \u003cem\u003ep\u003c/em\u003e = .50, \u0026eta;\u0026sup2; = .01). There was no significant difference between the BPD and HC groups in the overinclusion condition (\u003cem\u003eF\u003c/em\u003e(1, 68) = 1.42, \u003cem\u003ep\u003c/em\u003e = .24, \u0026eta;\u0026sup2; = .02). In the exclusion condition, there was a trend towards a difference between BPD and HC, with women with BPD showing almost no hormonal change, whole HC showed a decrease, but this effect was not statistically significant (\u003cem\u003eF\u003c/em\u003e(1, 83) = 3.00, \u003cem\u003ep\u003c/em\u003e = .09, \u0026eta;\u0026sup2; = .03).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFig. 1\u0026nbsp;\u003c/strong\u003eMean \u0026Delta;-progesterone (in pg/ml) measured in saliva at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There was a significant group \u0026times; condition interaction (\u003cem\u003ep\u003c/em\u003e = .04). Simple post-hoc test in BPD showed \u003cem\u003ep\u003c/em\u003e = .03. Error bars represent standard error of the mean.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEstradiol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroups did not differ in basal estradiol levels (\u003cem\u003et\u003c/em\u003e(158) = 0.63, \u003cem\u003ep\u003c/em\u003e = .53, 95% CI [-0.10, 0.19]). The 2 \u0026times; 2 ANOVA revealed no significant effect of group \u0026times; condition on \u0026Delta;-estradiol (\u003cem\u003eF\u003c/em\u003e(1, 156) = 0.12, \u003cem\u003ep\u003c/em\u003e = .73, \u0026eta;\u0026sup2; = .00). There were no main effects observed for group (\u003cem\u003eF\u003c/em\u003e(1, 156) = 1.24, \u003cem\u003ep\u003c/em\u003e = .27, \u0026eta;\u0026sup2; = .01) or condition (\u003cem\u003eF\u003c/em\u003e(1, 156) = 0.05, \u003cem\u003ep\u003c/em\u003e = .83, \u0026eta;\u0026sup2; = .00). Results are presented in Figure 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFig. 2\u003c/strong\u003e Mean \u0026Delta;-estradiol (in pg/ml). Measured by saliva samples at T1 (before Cyberball overinclusion or exclusion) and T3 (15 minutes after Cyberball overinclusion or exclusion) in patients with borderline personality disorder (BPD) and healthy controls (HC). There were no significant effects, all \u003cem\u003ep\u003c/em\u003es \u0026gt; .001. Error bars represent standard error of the mean.\u003c/p\u003e\n\u003cp\u003eThe inclusion of BMI and menstrual cycle phase as covariates in the analysis of both progesterone and estradiol did not change the significance of the findings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the effects of social exclusion on progesterone and estradiol levels in women with BPD compared to healthy women. For progesterone, a significant interaction between group and condition was observed, with post-hoc tests revealing differing responses between conditions within the BPD group. In contrast, healthy controls showed no significant differences in progesterone levels between conditions. For estradiol, no significant main or interactions effects were observed. Below, we discuss these findings, focusing first on progesterone, followed by estradiol.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eProgesterone\u003c/h2\u003e \u003cp\u003eWe hypothesized that healthy controls would show an increase in progesterone following social exclusion, consistent with a previous study (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, our results did not support this hypothesis. No significant changes in progesterone were observed in neither the exclusion nor the overinclusion condition in HC. In our sample, healthy women did not report strong negative emotional reactions to Cyberball, as they did not feel notably nervous, tired, or bad after either condition. This suggests that the Cyberball paradigm may not have been sufficiently impactful to elicit a measurable response of progesterone. Our results replicate previous findings that show an absence of significant hormonal responses in progesterone and cortisol within the HC group (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This absence may be due to the Cyberball paradigm's lack of face-to-face interaction, which reduces the immediacy of the social threat. Additionally, the Cyberball paradigm does not require active planning, physical or cognitive engagement, which are factors that seem to activate the HPA and HPG Axis (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings diverge from results of Seidel et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), possibly due to differences in the sample. While the study of Seidel et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) included both men and women, our research involved a larger, exclusively female sample of 82 women with BPD and 82 healthy controls. This allows for a more reliable analysis of hormonal patterns specific to women.\u003c/p\u003e \u003cp\u003eFor women with BPD, we hypothesized a decrease in progesterone following social exclusion. This was based on prior research showing a drop in progesterone in individuals with high social anxiety and evidence of withdrawal or socially anxious behavior in BPD patients (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). While our findings did not support this hypothesis, there was a significant difference in progesterone responses between the exclusion and overinclusion conditions within the BPD group. In line with previous studies, our results suggest that women with BPD seem to experience the Cyberball task differently than healthy controls (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This is reflected in their significantly higher reports of need threat, ostracism, and negative reactions to exclusion, as well as worse mood, tiredness, and nervousness. They were also more likely than HC to believe the cover story, suggesting they perceived the Cyberball game as more realistic. These differences in emotional and cognitive responses may have impacted the hormonal responses observed in the BPD group. Their stronger emotional reactions and greater belief in the exclusion scenario could have had an impact on their physiological responses to the task.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEstradiol\u003c/h2\u003e \u003cp\u003eIn contrast to progesterone, our analysis of estradiol levels revealed no significant interaction effects or main effects of group or condition. Both the BPD and HC groups showed no significant changes in estradiol levels from T1 to T3, regardless of whether they experienced social exclusion or overinclusion. This is consistent with previous studies that reported no significant stress-induced changes in estradiol levels during social stress tasks in healthy individuals (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In BPD, this may indicate that estradiol is less responsive to short-term social stressors like Cyberball, particularly in comparison to progesterone. In animal studies, estradiol appears to be more stable and might be more responsive to physical stressors, such as sleep deprivation, footshock, or swim stress, which involve substantial physiological demands (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Additionally, estradiol synthesis is more complex than progesterone, involving several enzymatic steps (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), thus the timing of our measurements may not have captured peak changes in estradiol levels, which could have occurred at different intervals post-stressor. Estradiol\u0026rsquo;s role in social stress responses may also be more complex and influenced by chronic stress, changes in brain structures, and sleep patterns, which were not accounted for in this study (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe study has several strengths and limitations. First, the artificial laboratory setting may not fully capture the complexities of real-world social interactions. Additionally, participants were tested across different menstrual cycle phases, however, including this factor in the analysis did not alter the results. Some BPD patients were taking psychotropic medication or had comorbidities such as PTSD or anxiety disorders, which may have influenced hormonal responses. Moreover, this study focused on women, as BPD is more prevalent in women, limiting the generalizability of the findings to men. One strength of the study was the exclusion of individuals with major depressive episodes, due to variations in the functioning of the hypothalamic-pituitary-adrenal axis between those with and without a depressive episode in patients with BPD (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Furthermore, the exclusion of participants using hormonal contraception ensured that natural progesterone and estradiol secretion were measured. We also excluded individuals with a BMI under 17.5 or over 30, as weight can influence the synthesis of these hormones.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions and Conclusion\u003c/h2\u003e \u003cp\u003eInterestingly, in the BPD group, there was a strong descriptive decrease in progesterone after overinclusion and a slight increase following social exclusion, although these results were not significant. This specific pattern in women with BPD might be interpreted as perhaps a lack of assumed protective effects of progesterone (e.g. calming) that are typically linked with progesterone in healthy individuals. Future studies should investigate this further, for example by exploring whether pharmacologically increasing progesterone in BPD could modulate responses to social exclusion and overinclusion. Additionally, research could examine progesterone\u0026rsquo;s role in emotional regulation using methods that more closely mimic real-life social interactions. Integrating self-reported assessments of social affiliation, which is associated with progesterone, with objective hormonal measures and utilizing implicit affiliation tasks could further clarify the behavioral function of progesterone. Finally, fMRI studies could map how varying progesterone levels affect brain areas involved in social processing, offering deeper insights into how progesterone modulates social cognition and behavior in BPD.\u003c/p\u003e \u003cp\u003eIn conclusion, our findings offer initial evidence that Cyberball conditions affect progesterone secretion differently in individuals with BPD compared to healthy women. Future research should focus on more realistic social exclusion paradigms and longitudinal designs that track hormonal changes over time in response to repeated social stressors, offering deeper insights impact into the regulation of hormonal responses in women with BPD.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe study was funded by the Deutsche Forschungsgemeinschaft (DFG) (WI 3396/12-1). The fund was awarded to KW.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003eThe authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Further data are available from the corresponding author (KW) upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and Consent to participate\u0026nbsp;\u003c/strong\u003eThe Charit\u0026eacute; ethics committee approved this study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003eAll participants including patients were informed about the study orally and in written form and had to give written consent before participating. Participants signed informed consent regarding publishing their data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions: JHR\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing, Resources, Conceptualization. \u003cstrong\u003eCED\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing, Software. \u003cstrong\u003eOTW:\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, Conceptualization. \u003cstrong\u003eEK\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing, Software, Investigation. \u003cstrong\u003eABC\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing, Conceptualization. \u003cstrong\u003eMB\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Methodology, Investigation, Formal Analysis, Data Curation. \u003cstrong\u003eLG:\u0026nbsp;\u003c/strong\u003eWriting \u0026ndash; review \u0026amp; editing, Investigation. \u003cstrong\u003eCO\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing, Conceptualization. \u003cstrong\u003eKW:\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, Methodology, Funding Acquisition. \u003cstrong\u003eSR:\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, Conceptualization. All authors approved of the final version of the manuscript for submission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5ed. Washington, DC.: American Psychiatric Association; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus SA, Cheavens JS, Festa F, Rosenthal MZ. Interpersonal functioning in borderline personality disorder: A systematic review of behavioral and laboratory-based assessments. Clin Psychol Rev. 2014;34(3):193\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCavicchioli M, Maffei C. Rejection sensitivity in borderline personality disorder and the cognitive\u0026ndash;affective personality system: A meta-analytic review. 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The \u0026lsquo;Trier Social Stress Test\u0026rsquo;\u0026ndash;a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28(1\u0026ndash;2):76\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoofs D, Wolf OT. Are salivary gonadal steroid concentrations influenced by acute psychosocial stress? A study using the Trier Social Stress Test (TSST). Int J Psychophysiol. 2011;80(1):36\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEisenlohr-Moul TA, DeWall CN, Girdler SS, Segerstrom SC. Ovarian hormones and borderline personality disorder features: Preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol. 2015;109:37\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters JR, Owens SA, Schmalenberger KM, Eisenlohr-Moul TA. Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder. Aggressive Behav. 2020;46(2):151\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L. Estrogen fluctuations, oral contraceptives and borderline personality. Psychoneuroendocrinology. 2003;28(6):751\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManer JK, Miller SL, Schmidt NB, Eckel LA. The endocrinology of exclusion: Rejection elicits motivationally tuned changes in progesterone. Psychol Sci. 2010;21(4):581\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein JM, Jerram M, Poldrack R, Ahern T, Kennedy DN, Seidman LJ, et al. Hormonal cycle modulates arousal circuitry in women using functional magnetic resonance imaging. 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Ann Rev Clin Psychol. 2019;15(1):399\u0026ndash;423.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWingenfeld K, Driessen M, Terfehr K, Schlosser N, Fernando SC, Otte C, et al. Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression. Psychol Med. 2013;43(3):495\u0026ndash;505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWingenfeld K, Wolf OT. Effects of cortisol on cognition in major depressive disorder, posttraumatic stress disorder and borderline personality disorder-2014 Curt Richter Award Winner. Psychoneuroendocrinology. 2015;51:282\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"borderline-personality-disorder-and-emotion-dysregulation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bded","sideBox":"Learn more about [Borderline Personality Disorder and Emotion Dysregulation](http://bpded.biomedcentral.com)","snPcode":"40479","submissionUrl":"https://submission.nature.com/new-submission/40479/3","title":"Borderline Personality Disorder and Emotion Dysregulation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Borderline personality disorder, Social exclusion, Progesterone, Estradiol","lastPublishedDoi":"10.21203/rs.3.rs-5566176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5566176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBorderline personality disorder (BPD) is characterized by instability in interpersonal relationships and fear of abandonment, which intensify during stress. Social stressors seem to activate the hypothalamic\u0026ndash;pituitary\u0026ndash;gonadal (HPG) axis in healthy controls (HC), but this has not been investigated in patients with BPD. This study aimed to investigate the effects of social stress, i.e. social exclusion on progesterone and estradiol levels in women with BPD compared to HC.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e82 women with BPD and 82 HC were randomly assigned to either an exclusion or overinclusion condition of the Cyberball paradigm. Saliva samples were collected at baseline and 15 minutes after the task to measure progesterone and estradiol. Two 2 \u0026times; 2 factorial ANOVAs were conducted with group and condition as the independent variables and Δ-progesterone and Δ-estradiol as dependent variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOn progesterone, the analysis revealed no significant main effects of group or condition, but a significant group \u0026times; condition interaction. Post-hoc tests showed that progesterone responses within the BPD group significantly differed between exclusion and overinclusion, while no significant differences were observed in HC. Descriptively, progesterone levels increased following social exclusion, whereas they decreased after overinclusion in BPD. For estradiol levels no significant main effects for group, condition, or their interaction were found.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThis study provides initial evidence that women with BPD exhibit distinct progesterone responses to social exclusion versus overinclusion. BPD participants showed a descriptive decrease in progesterone after overinclusion and a small increase after exclusion. These findings might be interpreted as perhaps a lack of assumed protective effects of progesterone (e.g. calming). Further research is needed to better understand this hormonal pattern and its implications for social functioning in BPD.\u003c/p\u003e","manuscriptTitle":"Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-26 08:14:07","doi":"10.21203/rs.3.rs-5566176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-13T07:42:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-12T16:36:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-10T16:04:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18678244363300439610271872264896457350","date":"2024-12-22T11:40:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73479408870106777944411214414401206289","date":"2024-12-22T10:12:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-12-20T07:44:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-20T07:18:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-12-19T14:42:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Borderline Personality Disorder and Emotion Dysregulation","date":"2024-12-02T16:13:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"borderline-personality-disorder-and-emotion-dysregulation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bded","sideBox":"Learn more about [Borderline Personality Disorder and Emotion Dysregulation](http://bpded.biomedcentral.com)","snPcode":"40479","submissionUrl":"https://submission.nature.com/new-submission/40479/3","title":"Borderline Personality Disorder and Emotion Dysregulation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9735c1f6-6a2b-4504-9c0f-b69b5329daf5","owner":[],"postedDate":"December 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T15:59:06+00:00","versionOfRecord":{"articleIdentity":"rs-5566176","link":"https://doi.org/10.1186/s40479-025-00307-1","journal":{"identity":"borderline-personality-disorder-and-emotion-dysregulation","isVorOnly":false,"title":"Borderline Personality Disorder and Emotion Dysregulation"},"publishedOn":"2025-08-25 15:57:00","publishedOnDateReadable":"August 25th, 2025"},"versionCreatedAt":"2024-12-26 08:14:07","video":"","vorDoi":"10.1186/s40479-025-00307-1","vorDoiUrl":"https://doi.org/10.1186/s40479-025-00307-1","workflowStages":[]},"version":"v1","identity":"rs-5566176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5566176","identity":"rs-5566176","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}