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Abstract
Several psychiatric disorders, including borderline personality disorder (BPD), are characterized by emotional dysregulation and impulse dyscontrol. More specifically, symptoms in patients with BPD often occur within the context of disruptions in attachment and related distortions in cognitive-affective processing of the self and others. From a neurocircuitry perspective, findings include prefrontal hypoactivity, amygdala hyperreactivity, and alterations in prefrontal-limbic interaction. Molecular pathways relevant to these circuits include the serotonergic, noradrenergic, and dopaminergic systems, and there is some evidence that pharmacotherapy with agents that act on these systems may be useful. Given the disruptions in attachment and schemas of the self and others in BPD, establishing a therapeutic alliance is crucial while psychotherapy remains the cornerstone of an integrated approach to management.
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202
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Neural correlates of emotion processing in borderline personality disorder. Psychiatry Res 2009; 172:192-9. [PMID: 19394205 PMCID: PMC4153735 DOI: 10.1016/j.pscychresns.2008.07.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 05/19/2008] [Accepted: 07/04/2008] [Indexed: 01/18/2023]
Abstract
Emotional instability is a hallmark feature of borderline personality disorder (BPD), yet its biological underpinnings are poorly understood. We employed functional magnetic resonance imaging (fMRI) to compare patterns of regional brain activation in BPD patients and healthy volunteers as they process positive and negative social emotional stimuli. fMRI images were acquired while 19 BPD patients and 17 healthy controls (HC) viewed emotion-inducing pictures from the International Affective Pictures System set. Activation data were analyzed with SPM5 ANCOVA models to derive the effects of diagnosis and stimulus type. BPD patients demonstrated greater differences in activation than controls, when viewing negative pictures compared with rest, in the amygdala, fusiform gyrus, primary visual areas, superior temporal gyrus (STG), and premotor areas, while healthy controls showed greater differences than BPD patients in the insula, middle temporal gyrus and dorsolateral prefrontal cortex (BA46). When viewing positive pictures compared with rest, BPD patients showed greater differences in the STG, premotor cortex, and ventrolateral prefrontal cortex. These findings suggest that BPD patients show greater amygdala activity and heightened activity of visual processing regions relative to findings for HC subjects in the processing of negative social emotional pictures compared with rest. The patients activate neural networks in emotion processing that are phylogeneticall older and more reflexive than those activated by HC subjects.
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203
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Wingenfeld K, Rullkoetter N, Mensebach C, Beblo T, Mertens M, Kreisel S, Toepper M, Driessen M, Woermann FG. Neural correlates of the individual emotional Stroop in borderline personality disorder. Psychoneuroendocrinology 2009; 34:571-86. [PMID: 19042093 DOI: 10.1016/j.psyneuen.2008.10.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events. METHODS Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant. RESULTS While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as well as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes. CONCLUSIONS These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients.
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Affiliation(s)
- Katja Wingenfeld
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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204
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Abstract
BACKGROUND Clinical experience and recent research convey that patients with personality disorders who harm themselves with a suicidal intention should be treated differently than those who do so without a suicidal intention. The purpose of this article is to give an overview of non-suicidal self-harm in these patients. MATERIAL AND METHOD The article is based on a non-systematic literature search in PsycINFO, Medline, Clinical Evidence and Cochrane and own clinical experience. RESULTS Self-harm in patients with personality disorders is associated with borderline personality traits. Up to 70 % of patients with borderline personality disorders have reported non-suicidal self-harm. Non-suicidal self-harm is one of the risk factors for suicide. Borderline personality disorder develops due to interaction between genetic vulnerability and a traumatic and unsafe upbringing. The patients are often influenced by intense negative emotions and have reduced ability to regulate and handle these in interpersonal situations. Self-harm can give short-term alleviation of the inner pain associated with emotion dysregulation. Dialectical behavior therapy and mentalization-based therapy is shown to reduce the prevalence of self-harm in patients with borderline personality disorder. Acute referral to in-patient treatment should only be used in crises that cannot be handled in out-patient treatment. The regular general practitioner can function as a stable attachment figure and contribute to self-regulation. INTERPRETATION Non-suicidal self-harm in patients with personality disorders should be given more attention.
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Affiliation(s)
- Oyvind Urnes
- Avdeling for personlighetspsykiatri Oslo universitetssykehus, Ullevål 0407 Oslo.
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205
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Clonidine improves hyperarousal in borderline personality disorder with or without comorbid posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychopharmacol 2009; 29:170-3. [PMID: 19512980 DOI: 10.1097/jcp.0b013e31819a4bae] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition borderline personality disorder (BPD) seems to constitute a very heterogeneous category. Therefore, pharmacological therapy is symptom-oriented or targets comorbid conditions. A high comorbidity exists between BPD and posttraumatic stress disorder (PTSD). In a double-blind, randomized, placebo-controlled crossover study, we sought to determine whether the antinoradrenergic agent clonidine was effective in reducing hyperarousal and measures of BPD-specific and general psychopathology in a sample of 18 patients with BPD, with or without comorbid PTSD, and with a prominent hyperarousal syndrome. Hyperarousal as measured by the Clinician Administered PTSD scale improved significantly compared with placebo (P = 0.003) irrespective of PTSD comorbidity. Improvements in general and BPD-typical psychopathology were mainly seen in the PTSD-positive subgroup, whereas the subjective sleep latency (P = 0.005) and the restorative qualities of the sleep (P = 0.014) improved in the whole sample. Improvements, despite the small sample size of this pilot study, lead us to conclude that clonidine might be a useful adjunct to pharmacotherapy in patients with BPD who have marked hyperarousal and/or sleep problems and, in particular, in patients with BPD who have a PTSD comorbidity.
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206
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Siever LJ, Weinstein LN. The neurobiology of personality disorders: implications for psychoanalysis. J Am Psychoanal Assoc 2009; 57:361-98. [PMID: 19516057 DOI: 10.1177/0003065109333502] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As advances in neuroscience have furthered our understanding of the role of brain circuitry, genetics, stress, and neuromodulators in the regulation of normal behavior and in the pathogenesis of psychopathology, an increasing appreciation of the role of neurobiology in individual differences in personality and their pathology in personality disorders has emerged. Individual differences in the regulation and organization of cognitive processes, affective reactivity, impulse/action patterns, and anxiety may in the extreme provide susceptibilities to personality disorders such as borderline and schizotypal personality disorder. A low threshold for impulsive aggression, as observed in borderline and antisocial personality disorders, may be related to excessive amygdala reactivity, reduced prefrontal inhibition, and diminished serotonergic facilitation of prefrontal controls. Affective instability may be mediated by excessive limbic reactivity in gabaminergic/glutamatergic/cholinergic circuits, resulting in an increased sensitivity or reactivity to environmental emotional stimuli as in borderline personality disorder and other cluster B personality disorders. Disturbances in cognitive organization and information processing may contribute to the detachment, desynchrony with the environment, and cognitive/perceptional distortions of cluster A or schizophrenia spectrum personality disorders. A low threshold for anxiety may contribute to the avoidant, dependent, and compulsive behaviors observed in cluster C personality disorders. These alterations in critical regulatory domains will influence how representations of self and others are internalized. Aspects of neurobiological functioning themselves become cognized through the medium of figurative language into an ongoing narrative of the self, one that can be transformed through the analytic process, allowing for the modulation of genetic/biological thresholds.
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Affiliation(s)
- Larry J Siever
- Department of Psychiatry, Mount Sinai School of Medicine, Bronx, NY, USA.
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207
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Lobbestael J, Arntz A, Cima M, Chakhssi F. Effects of induced anger in patients with antisocial personality disorder. Psychol Med 2009; 39:557-568. [PMID: 19171078 DOI: 10.1017/s0033291708005102] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anger is the main deregulated emotion in patients with antisocial personality disorder (ASPD). The aim of this study was to examine emotional, cognitive and physiological correlates of anger and compare these between ASPD patients with varying degree of psychopathy (PP) and control groups. METHOD Assessment of the effect of anger induction on self-reported emotions and schema modes, psychophysiology and implicit reaction-time tasks measuring self-anger and aggressor-swearword associations. Participants (n=147) were patients with DSM-IV antisocial (n=21), borderline (n=45) and cluster C personality disorder (n=46) and non-patient controls (n=35). RESULTS Groups did not differ in self-reported anger. ASPD patients displayed a decrease in heart rate and systolic blood pressure (SBP) and stronger implicit self-anger associations. ASPD patients scoring low on affective PP reported less negative emotions and displayed a greater decrease in diastolic blood pressure (DBP). CONCLUSIONS ASPD patients did not display a deviant self-reported anger but physiological hyporesponsivity and cognitive hyper-responsivity. This ASPD anger response might reflect a controlled predatory-like fight preparation.
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Affiliation(s)
- J Lobbestael
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
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208
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Staebler K, Gebhard R, Barnett W, Renneberg B. Emotional responses in borderline personality disorder and depression: assessment during an acute crisis and 8 months later. J Behav Ther Exp Psychiatry 2009; 40:85-97. [PMID: 18533129 DOI: 10.1016/j.jbtep.2008.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 02/06/2008] [Accepted: 04/18/2008] [Indexed: 11/30/2022]
Abstract
Stability of subjective emotional responses to positive and negative film stimuli was examined in female patients with borderline personality disorder (BPD, n=30), depressed patients (n=27) and a non-clinical control group (n=30). At first assessment (t1) clinical participants were inpatients. The second assessment was conducted 8 months later, when clinical participants were not in an acute crisis. Positive emotions and other-focused negative emotions were successfully induced in all participants. Altogether, more negative baseline emotionality describes both patient groups better than differences in emotional reactivity. Our findings contradict the hypothesis of general emotional hyperreactivity in BPD patients for both positive and negative emotions.
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Affiliation(s)
- Katja Staebler
- Department of Psychology, University of Heidelberg, Hauptstr. 47-51, 69117 Heidelberg, Germany.
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209
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Driessen M, Wingenfeld K, Rullkoetter N, Mensebach C, Woermann FG, Mertens M, Beblo T. One-year functional magnetic resonance imaging follow-up study of neural activation during the recall of unresolved negative life events in borderline personality disorder. Psychol Med 2009; 39:507-516. [PMID: 18466663 DOI: 10.1017/s0033291708003358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recall of adverse life events under brain imaging conditions has been shown to coincide with activation of limbic and prefrontal brain areas in borderline personality disorder (BPD). We investigate changes of functional magnetic resonance imaging (fMRI) activation patterns during the recall of unresolved adverse life events (ULE) over 1 year. METHOD Thirteen female BPD patients participated in the study. During fMRI measurement subjects recalled ULE and negative but resolved life events (RLE) after individual cue words to stimulate autobiographical memory retrieval. Subjective intensity of emotional and sensoric experiences during recall was assessed as well as standardized measures of psychopathology. RESULTS A 2x2 factorial analysis of fMRI data (Deltat1/t2xDeltaULE/RLE) revealed major right more than left differences of activation (i.e. t1>t2) of the posterior more than anterior cingulate, superior temporal lobes, insula, and right middle and superior frontal lobes (second-level analysis, t=3.0, puncorrected=0.003). The opposite contrast (Deltat2/t1xDeltaULE/RLE) did not reveal any differences. We did not find changes of emotional or sensoric qualities during recall (ULE versus RLE) or of psychopathology measures over the 1-year period. CONCLUSIONS Although subjective and clinical data did not change within 1 year, we observed a substantial decrease of temporo-frontal activation during the recall of ULE from t1 to t2. If future research confirms these findings, the question arises whether the decrease of neural activation precedes clinical improvement in BPD.
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Affiliation(s)
- M Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Bielefeld, Germany.
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210
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Mensebach C, Beblo T, Driessen M, Wingenfeld K, Mertens M, Rullkoetter N, Lange W, Markowitsch HJ, Ollech I, Saveedra AS, Rau H, Woermann FG. Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: an fMRI study. Psychiatry Res 2009; 171:94-105. [PMID: 19176280 DOI: 10.1016/j.pscychresns.2008.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 04/24/2007] [Accepted: 02/18/2008] [Indexed: 01/18/2023]
Abstract
Verbal memory impairment in borderline personality disorder (BPD) is still a matter of debate. In this study we combine investigations of both, memory retrieval as well as underlying neural circuits in BPD. Functional magnetic resonance imaging (fMRI) was used to study regional brain activation in 18 right-handed female patients with BPD and 18 matched controls during the retrieval of an episodic memory retrieval (EMR) task (free recall of a word list) and a semantic memory retrieval (SMR) task (verbal fluency). Despite unaffected performance in EMR and SMR, patients with BPD showed task-specific increased activation compared with controls. During EMR, the increased activation encompassed the posterior cingulate cortex bilaterally, the left middle and superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus. SMR was associated with increased activation of the posterior cingulate cortex, of the right fusiform gyrus, of the left anterior cingulate cortex, and of the left postcentral gyrus. Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.
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Affiliation(s)
- Christoph Mensebach
- Department of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Bielefeld, Germany.
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211
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212
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Völlm BA, Zhao L, Richardson P, Clark L, Deakin JFW, Williams S, Dolan MC. A voxel-based morphometric MRI study in men with borderline personality disorder: preliminary findings. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2009; 19:64-72. [PMID: 19172640 DOI: 10.1002/cbm.716] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE There is increasing evidence for subtle changes in brain morphology and function in patients with borderline personality disorder (BPD). Structural brain imaging studies show lower volume in frontal, temporal and parietal brain regions than in healthy controls. The aim of our preliminary study of men with BPD was to investigate structural brain changes and their relationship with a measure of impulsivity. METHODS We examined seven male patients with BPD and six control men using voxel-based morphometry. Analysis of covariance was carried out to assess regionally specific differences in grey and white matter (WM) volumes. Correlations between trait impulsivity as measured using the Impulsiveness-Venturesomeness-Empathy scale and brain volumes were studied. RESULTS Compared with healthy men, men with BPD had similar WM volumes but smaller grey matter (GM) volumes in frontal, temporal and parietal cortices. The latter were negatively correlated with trait impulsivity. CONCLUSIONS Our findings fit with previous reports of smaller regional GM volumes reported in women with BPD, and suggest that in men there may be an association between smaller GM volumes and impulsivity.
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Affiliation(s)
- Birgit A Völlm
- Section of Forensic Mental Health, Division of Psychiatry, University of Nottingham, UK.
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213
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Gratz KL, Tull MT, Reynolds EK, Bagge CL, Latzman RD, Daughters SB, Lejuez CW. Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: the roles of affective dysfunction, disinhibition, and self- and emotion-regulation deficits. Dev Psychopathol 2009; 21:1263-91. [PMID: 19825268 PMCID: PMC2993639 DOI: 10.1017/s0954579409990150] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although research has been conducted on the course, consequences, and correlates of borderline personality disorder (BPD), little is known about its emergence in childhood, and no studies have examined the extent to which theoretical models of the pathogenesis of BPD in adults are applicable to the correlates of borderline personality symptoms in children. The goal of this study was to examine the interrelationships between two BPD-relevant personality traits (affective dysfunction and disinhibition), self- and emotion-regulation deficits, and childhood borderline personality symptoms among 263 children aged 9 to 13. We predicted that affective dysfunction, disinhibition, and their interaction would be associated with childhood borderline personality symptoms, and that self- and emotion-regulation deficits would mediate these relationships. Results provided support for the roles of both affective dysfunction and disinhibition (in the form of sensation seeking) in childhood borderline personality symptoms, as well as their hypothesized interaction. Further, both self- and emotion-regulation deficits partially mediated the relationship between affective dysfunction and childhood borderline personality symptoms. Finally, results provided evidence of different gender-based pathways to childhood borderline personality symptoms, suggesting that models of BPD among adults are more relevant to understanding the factors associated with borderline personality symptoms among girls than boys.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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214
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Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res 2008; 164:223-36. [PMID: 19019636 PMCID: PMC3286221 DOI: 10.1016/j.pscychresns.2008.02.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 02/04/2008] [Accepted: 02/07/2008] [Indexed: 11/22/2022]
Abstract
Imaging studies using region-of-interest morphometry and positron emission tomography have contributed to our understanding of structural and functional abnormalities in borderline personality disorder (BPD); however, both methods have practical limitations to their usefulness for exploratory studies of brain-behavior relationships. We used voxel-based morphometry (VBM) in 34 subjects with BPD and 30 healthy control (HC) subjects to study effects of diagnosis, gender, childhood sexual abuse, depressed mood, impulsivity and aggression on group differences. VBM is a computer-based method for whole brain analysis that combines the advantages of a functional study with a structural method. The BPD subjects, diagnosed with the Diagnostic Interview for Borderline Patients and the International Personality Disorders Examination, were compared with 30 HC subjects, with age and gender covaried. Analyses were repeated separately by gender and, in women, by histories of childhood sexual abuse. Depressed mood, impulsivity, and aggression were covaried in separate analyses. Compared with HC, BPD subjects had significant bilateral reductions in gray matter concentrations in ventral cingulate gyrus and several regions of the medial temporal lobe, including the hippocampus, amygdala, parahippocampal gyrus, and uncus. BPD women (and abused BPD women), but not BPD men, had significant reductions in medial temporal lobe, including the amygdala. BPD men, but not BPD women, showed diminished gray matter concentrations in the anterior cingulate gyrus compared with findings in HC subjects. Covarying for depressed mood rendered group differences non-significant in the ventral cingulate but had little effect on differences in medial temporal cortex. Covarying for aggression (LHA) had relatively little effect on group differences, while covarying for impulsivity, as determined by the Barratt Impulsiveness Scale, rendered all previously noted voxel-level group differences non-significant. Diminished gray matter in the prefrontal cortex and the medial temporal cortex may mediate the dysregulation of impulse and affect in BPD. Group differences varied greatly by gender, levels of depression, and impulsivity. VBM is an efficient method for exploratory study of brain-behavior relationships.
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215
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Borderline personality disorder features and cognitive, emotional, and predicted behavioral reactions to teasing. JOURNAL OF RESEARCH IN PERSONALITY 2008. [DOI: 10.1016/j.jrp.2008.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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216
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Jacob GA, Guenzler C, Zimmermann S, Scheel CN, Rüsch N, Leonhart R, Nerb J, Lieb K. Time course of anger and other emotions in women with borderline personality disorder: a preliminary study. J Behav Ther Exp Psychiatry 2008; 39:391-402. [PMID: 18171575 DOI: 10.1016/j.jbtep.2007.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 10/11/2007] [Accepted: 10/11/2007] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by emotional dysregulation including strong emotional reactions to emotional stimuli and a slow return to baseline emotions. Difficulties controlling anger are particularly prominent in BPD. To experimentally test emotional dysregulation with a special focus on anger, we investigated whether a standardized anger induction by a short story caused stronger and prolonged anger reactions in women with BPD (n=27) as compared to female healthy controls (n=26) and whether other emotions were affected by the anger induction. Although the anger reaction was not stronger in the BPD group, it was significantly prolonged. The BPD group showed also stronger negative emotions over the whole experiment. The study is the first to demonstrate prolonged anger reactions in BPD patients in an experimental setting.
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Affiliation(s)
- Gitta A Jacob
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, D-79104 Freiburg, Germany.
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217
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New AS, Goodman M, Triebwasser J, Siever LJ. Recent advances in the biological study of personality disorders. Psychiatr Clin North Am 2008; 31:441-61, vii. [PMID: 18638645 DOI: 10.1016/j.psc.2008.03.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
While it is premature to provide a simple model for the vulnerability to the development of either borderline (BPD) or schizotypal (SPD) personality disorder, it is clear that these heritable disorders lend themselves to fruitful neurobiological exploration. The most promising findings in BPD suggest that a diminished top-down control of affective responses, which is likely to relate to deceased responsiveness of specific midline regions of prefrontal cortex, may underlie the affective hyperresponsiveness in this disorder. In addition, genetic and neuroendocrine and molecular neuroimaging findings point to a role for serotonin in this affective disinhibition. Clearly SPD falls within the schizophrenia spectrum, but precisely the nature of what predicts full-blown schizophrenia as opposed to the milder symptoms of SPD is not yet clear.
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Affiliation(s)
- Antonia S New
- The Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1217, New York, NY 10029, USA.
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218
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Buchheim A, Erk S, George C, Kächele H, Kircher T, Martius P, Pokorny D, Ruchsow M, Spitzer M, Walter H. Neural correlates of attachment trauma in borderline personality disorder: a functional magnetic resonance imaging study. Psychiatry Res 2008; 163:223-35. [PMID: 18635342 DOI: 10.1016/j.pscychresns.2007.07.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 07/04/2007] [Accepted: 07/04/2007] [Indexed: 01/18/2023]
Abstract
Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first time the functional neuroanatomy of attachment trauma in BPD patients using functional magnetic resonance imaging (fMRI) during the telling of individual stories. A group of 11 female BPD patients and 17 healthy female controls, matched for age and education, told stories in response to a validated set of seven attachment pictures while being scanned. Group differences in narrative and neural responses to "monadic" pictures (characters facing attachment threats alone) and "dyadic" pictures (interaction between characters in an attachment context) were analyzed. Behavioral narrative data showed that monadic pictures were significantly more traumatic for BPD patients than for controls. As hypothesized BPD patients showed significantly more anterior midcingulate cortex activation in response to monadic pictures than controls. In response to dyadic pictures patients showed more activation of the right superior temporal sulcus and less activation of the right parahippocampal gyrus compared to controls. Our results suggest evidence for potential neural mechanisms of attachment trauma underlying interpersonal symptoms of BPD, i.e. fearful and painful intolerance of aloneness, hypersensitivity to social environment, and reduced positive memories of dyadic interactions.
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Affiliation(s)
- Anna Buchheim
- Department of Psychosomatic Medicine and Psychotherapy, University Ulm, Am Hochstraess 8, 89081 Ulm, Germany.
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219
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Zetzsche T, Preuss UW, Bondy B, Frodl T, Zill P, Schmitt G, Koutsouleris N, Rujescu D, Born C, Reiser M, Möller HJ, Meisenzahl EM. 5-HT1A receptor gene C -1019 G polymorphism and amygdala volume in borderline personality disorder. GENES BRAIN AND BEHAVIOR 2008; 7:306-13. [PMID: 18387137 DOI: 10.1111/j.1601-183x.2007.00353.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Alterations of amygdala structure and function have been repeatedly described in patients with borderline personality disorder (BPD). The aim of our study was to determine whether a functional polymorphism of the 5-hydroxytryptamine(1A) receptor (5-HTR(1A)) gene C -1019 G (identity number: rs6295 G/C) is associated with structural changes of the amygdala in patients with BPD. Twenty-five right-handed female inpatients with BPD according to DSM IV and 25 healthy controls matched for age, sex, handedness and educational status were enrolled. Brain volumetry of the amygdala was performed with a 1.5-T Magnetom Vision apparatus (Siemens, Erlangen, Germany) and analyzed by the software program 'BRAINS'. Patients who have the 5-HTR(1A) gene G allele had significantly smaller amygdala volumes than C/C genotype carriers (P = 0.02). While no difference of allelic distribution between patients and controls was detected, the described effect of 5-HTR(1A) genotype on amygdala volume was found for the whole group of patients, as well as in the subgroup of patients with comorbid major depression (P = 0.004) but not in controls. In contrast to these subgroups of BPD patients who had significant amygdala volume differences, the mean amygdala volume of the whole group of BPD patients was not significantly different from that of controls. In summary, our study provides first evidence that 5-HTR(1A) gene C -1019 G polymorphism is associated with structural changes in the limbic system of BPD patients, a finding that might be disease related and might contribute to explanation of previous discrepant results regarding amygdala volume changes in BPD. Future research is recommended to clarify possible interactions between this functional polymorphism and symptoms, course and treatment responses in this disorder.
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Affiliation(s)
- T Zetzsche
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
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220
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Kober H, Barrett LF, Joseph J, Bliss-Moreau E, Lindquist K, Wager TD. Functional grouping and cortical-subcortical interactions in emotion: a meta-analysis of neuroimaging studies. Neuroimage 2008; 42:998-1031. [PMID: 18579414 PMCID: PMC2752702 DOI: 10.1016/j.neuroimage.2008.03.059] [Citation(s) in RCA: 750] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 03/05/2008] [Accepted: 03/26/2008] [Indexed: 01/11/2023] Open
Abstract
We performed an updated quantitative meta-analysis of 162 neuroimaging studies of emotion using a novel multi-level kernel-based approach, focusing on locating brain regions consistently activated in emotional tasks and their functional organization into distributed functional groups, independent of semantically defined emotion category labels (e.g., "anger," "fear"). Such brain-based analyses are critical if our ways of labeling emotions are to be evaluated and revised based on consistency with brain data. Consistent activations were limited to specific cortical sub-regions, including multiple functional areas within medial, orbital, and inferior lateral frontal cortices. Consistent with a wealth of animal literature, multiple subcortical activations were identified, including amygdala, ventral striatum, thalamus, hypothalamus, and periaqueductal gray. We used multivariate parcellation and clustering techniques to identify groups of co-activated brain regions across studies. These analyses identified six distributed functional groups, including medial and lateral frontal groups, two posterior cortical groups, and paralimbic and core limbic/brainstem groups. These functional groups provide information on potential organization of brain regions into large-scale networks. Specific follow-up analyses focused on amygdala, periaqueductal gray (PAG), and hypothalamic (Hy) activations, and identified frontal cortical areas co-activated with these core limbic structures. While multiple areas of frontal cortex co-activated with amygdala sub-regions, a specific region of dorsomedial prefrontal cortex (dmPFC, Brodmann's Area 9/32) was the only area co-activated with both PAG and Hy. Subsequent mediation analyses were consistent with a pathway from dmPFC through PAG to Hy. These results suggest that medial frontal areas are more closely associated with core limbic activation than their lateral counterparts, and that dmPFC may play a particularly important role in the cognitive generation of emotional states.
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Affiliation(s)
- Hedy Kober
- Department of Psychology, Columbia University, USA
| | - Lisa Feldman Barrett
- Department of Psychology, Boston College, USA
- Psychiatric Neuroimaging Research Program, Massachusetts General Hospital, Harvard Medical School, USA
| | - Josh Joseph
- Department of Psychology, Columbia University, USA
| | | | | | - Tor D. Wager
- Department of Psychology, Columbia University, USA
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221
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Sinzig J, Bruning N, Morsch D, Lehmkuhl G. Attention profiles in autistic children with and without comorbid hyperactivity and attention problems. Acta Neuropsychiatr 2008; 20:207-15. [PMID: 25385656 DOI: 10.1111/j.1601-5215.2008.00292.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Psychopathological, neuropsychological and genetic findings indicate an association between ASD Spectrum Disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The goal of this study was to compare the neuropsychological profiles of attention functions in children with ADHD and with ASD and without comorbid ADHD. The hypothesis was that either ADHD and autistic children with comorbid ADHD symptoms were more impaired in inhibition and sustained attention performance and that all individuals with ASD show more deficits in divided attention. METHOD Children aged 6 to 18 years old with ADHD (n = 30) or ASD with (n = 21) and without comorbid ADHD (n = 20) and 30 healthy children were included consecutively. Psychopathology was evaluated using the KIDDIE-SADS and symptom checklists for ADHD and ASD according to DSM-IV. Assessed neuropsychological functioning included inhibition, sustained as well as divided attention and alertness tasks. RESULTS Age and IQ-corrected z-scores were used. Statistically significant group effects were found for the variables sustained attention median (F = 3.2, = .02), hits (F = 3.3, p = .02) and false alarms (F = 3.9, p = .01), divided attention hits (F = 3.3, p = .02), errors (F = 3.1, p = .03) and false alarms (F = 3.3, p = .03) and alertness false alarms (F = 2.9, p = .04). Pearson Correlations revealed associations between ADHD symptoms and sustained attention in the ADHD group and between ADHD symptoms and inhibition in the ASD+ group. CONCLUSION Our hypothesis was partly confirmed as ADHD children showed more deficits in sustained attention and ASD children in divided attention tasks. However there was no evidence that children with ASD and comorbid ADHD symptoms have a specific profile in comparison to pure ASD children.
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Affiliation(s)
- Judith Sinzig
- 1Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
| | - Nicole Bruning
- 1Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
| | - Dagmar Morsch
- 1Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
| | - Gerd Lehmkuhl
- 1Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
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222
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Herpertz SC, Huebner T, Marx I, Vloet TD, Fink GR, Stoecker T, Shah NJ, Konrad K, Herpertz-Dahlmann B. Emotional processing in male adolescents with childhood-onset conduct disorder. J Child Psychol Psychiatry 2008; 49:781-91. [PMID: 18598245 DOI: 10.1111/j.1469-7610.2008.01905.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Boys with early onset of conduct disorder (CD), most of whom also meet diagnostic criteria of a comorbid attention deficit hyperactivity disorder (ADHD), tend to exhibit high levels of aggression throughout development. While a number of functional neuroimaging studies on emotional processing have been performed in antisocial adults, little is known about how CD children process emotional information. METHOD Functional magnetic resonance imaging data were analyzed in 22 male adolescents aged 12 to 17 years with childhood-onset CD (16 of them with comorbid ADHD) compared to 22 age-matched male healthy controls. In order to consider the likely confounding of results through ADHD comorbidity, we performed a supplementary study including 13 adolescent subjects with pure ADHD who were compared with healthy controls. To challenge emotional processing of stimuli, a passive viewing task was applied, presenting pictures of negative, positive or neutral valence. RESULTS When comparing CD/combined disorder patients with healthy controls, we found enhanced left-sided amygdala activation in response to negative pictures as compared to neutral pictures in the patient group. In addition, these boys exhibited no reduced activation in the orbitofrontal, anterior cingulate and insular cortices. By contrast, children with pure ADHD did not show any abnormalities in amygdala activation but showed decreased neural activity in the insula only in response to negative pictures. CONCLUSIONS Increased rather than reduced amygdala activation found in our study may indicate an enhanced response to environmental cues in adolescents with early-onset CD (most of whom also met the condition of ADHD), and is not consistent with the assumption of a reduced capacity to take note of affective information in the social environment. Further studies with an emphasis on developmental aspects of affect regulation are needed to clarify the relationship between CD and adult personality pathology associated with different modes of persistent antisocial behavior.
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Affiliation(s)
- Sabine C Herpertz
- Department of Psychiatry and Psychotherapy, University of Rostock, Germany
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223
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Bornovalova MA, Gratz KL, Daughters SB, Nick B, Delany-Brumsey A, Lynch TR, Kosson D, Lejuez CW. A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment. J Psychiatr Res 2008; 42:717-26. [PMID: 17868698 DOI: 10.1016/j.jpsychires.2007.07.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 06/29/2007] [Indexed: 11/16/2022]
Abstract
The concept of emotion dysregulation has been integrated into theory and treatment for borderline personality disorder (BPD), despite limited empirical support. Expanding upon existing research on the relationship between emotion dysregulation and BPD, the present study utilized a multimodal approach to the assessment of emotion dysregulation (including two behavioral measures of the willingness to tolerate emotional distress, and a self-report measure of emotion dysregulation broadly defined) to examine the relationship between emotion dysregulation and BPD among inner-city substance users in residential treatment (n=76, with 25 meeting criteria for BPD). Results provide laboratory-based evidence for heightened emotion dysregulation in BPD, extending extant research on BPD to underserved clinical populations. Specifically, the presence of a BPD diagnosis among a sample of inner-city inpatient substance users was associated with both higher scores on the self-report measure of emotion dysregulation and less willingness to tolerate emotional distress on the behavioral measures of emotion dysregulation. Moreover, both self-report and behavioral measures of emotion dysregulation accounted for unique variance in BPD status, suggesting the importance of utilizing comprehensive assessments of emotion dysregulation within studies of BPD. Findings suggest the need to further explore the role of emotion dysregulation in the development and maintenance of BPD among inner-city substance users in residential treatment.
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224
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Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Frontolimbic structural changes in borderline personality disorder. J Psychiatr Res 2008; 42:727-33. [PMID: 17825840 PMCID: PMC2708084 DOI: 10.1016/j.jpsychires.2007.07.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Frontolimbic dysfunction is observed in borderline personality disorder (BPD), with responses to emotional stimuli that are exaggerated in the amygdala and impaired in the anterior cingulate cortex (ACC). This pattern of altered function is consistent with animal models of stress responses and depression, where hypertrophic changes in the amygdala and atrophic changes in the ACC are observed. We tested the hypothesis that BPD patients exhibit gross structural changes that parallel the respective increases in amygdala activation and impairment of rostral/subgenual ACC activation. METHODS Twelve unmedicated outpatients with BPD by DSM-IV and 12 normal control (NC) subjects underwent a high-resolution T1-weighted structural MRI scan. Relative gray matter concentration (GMC) in spatially-normalized images was evaluated by standard voxel-based morphometry, with voxel-wise subject group comparisons by t test constrained to amygdala and rostral/subgenual ACC. RESULTS The BPD group was significantly higher than NC in GMC in the amygdala. In contrast, the BPD group showed significantly lower GMC than the NC group in left rostral/subgenual ACC. CONCLUSIONS This sample of BPD patients exhibits gross structural changes in gray matter in cortical and subcortical limbic regions that parallel the regional distribution of altered functional activation to emotional stimuli among these same subjects. While the histological basis for GMC changes in adult clinical populations is poorly-known at present, the observed pattern is consistent with the direction of change, in animal models of anxiety and depression, of neuronal number and/or morphological complexity in both the amygdala (where it is increased) and ACC (where it is decreased).
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225
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A neurocognitive model of borderline personality disorder: effects of childhood sexual abuse and relationship to adult social attachment disturbance. Dev Psychopathol 2008; 20:341-68. [PMID: 18211741 DOI: 10.1017/s0954579408000163] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Borderline personality disorder (BPD) is a paradigmatic disorder of adult attachment, with high rates of antecedent childhood maltreatment. The neurocognitive correlates of both attachment disturbance and maltreatment are both presently unknown in BPD. This study evaluated whether dimensional adult attachment disturbance in BPD is related to specific neurocognitive deficits, and whether childhood maltreatment is related to these dysfunctions. An outpatient BPD group (n=43) performed nearly 1 SD below a control group (n=26) on short-term recall, executive, and intelligence functions. These deficits were not affected by emotionally charged stimuli. In the BPD group, impaired recall was related to attachment-anxiety, whereas executive dysfunction was related to attachment-avoidance. Abuse history was correlated significantly with executive dysfunction and at a trend level with impaired recall. Neurocognitive deficits and abuse history exhibited both independent and interactive effects on adult attachment disturbance. These results suggest that (a) BPD patients' reactivity in attachment relationships is related to temporal-limbic dysfunction, irrespective of the emotional content of stimuli, (b) BPD patients' avoidance within attachment relationships may be a relational strategy to compensate for the emotional consequences of frontal-executive dysregulation, and (c) childhood abuse may contribute to these neurocognitive deficits but may also exert effects on adult attachment disturbance that is both independent and interacting with neurocognitive dysfunction.
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226
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Cartwright D. Borderline Personality Disorder: What do We Know? Diagnosis, Course, Co-Morbidity, and Aetiology. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2008. [DOI: 10.1177/008124630803800212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Evidence regarding the diagnostic dilemmas, course, co-morbidity, and aetiology of Borderline Personality Disorder (BPD) is reviewed. After considering problems that the clinician and researcher face in using BPD as a diagnostic category, I argue that current evidence indicates that there is reason to be more optimistic about the course of BPD. Emerging dilemmas in considering co-morbidity in the BPD patient are considered. Aetiological factors are presented in support of a ‘multiple pathways’ model of aetiology where characterological and temperamental characteristics interact in complex idiosyncratic ways.
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Affiliation(s)
- Duncan Cartwright
- Centre for Applied Psychology, School of Psychology, University of KwaZulu-Natal, Howard College Campus, Private Bag X54001, Durban, 4000 South Africa
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227
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Imagerie cérébrale dans le trouble bipolaire. Encephale 2008; 34 Suppl 4:S146-9. [DOI: 10.1016/s0013-7006(08)80626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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228
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Sharp C, Petersen N, Goodyer I. Emotional reactivity and the emergence of conduct problems and emotional symptoms in 7- to 11-year-olds: a 1-year follow-up study. J Am Acad Child Adolesc Psychiatry 2008; 47:565-573. [PMID: 18356761 DOI: 10.1097/chi.0b013e31816765d4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether individual differences in emotional reactivity predicted high levels of conduct problems and/or emotional (depressive and anxiety) symptoms at 1-year follow-up in a community sample of 7- to 11-year-old children (N = 659). METHOD The study used a prospective design with picture perception methodology at baseline to elicit emotional responses from children. Conduct problems and symptoms of anxiety and depression were evaluated using repeated measures from self-, teacher, and parent report questionnaires completed at baseline and 1 year. RESULTS Children who reported decreased emotional arousal to unpleasant (B = -0.069; p = .011) and pleasant (B = -0.134; p = .036) pictures showed higher levels of self-reported and teacher-reported conduct problems at 1-year follow-up, respectively. Conversely, children who reported increased emotional arousal to neutral pictures (B = 0.661; p = .030) at baseline showed higher levels of anxiety symptoms at follow-up. These findings held when baseline level of problems and symptoms, sex, age, socioeconomic status, and IQ were taken into account. Findings were nonsignificant for symptoms of depression at the multivariate level of analyses. CONCLUSIONS Although findings showed that symptom level at baseline remains the best predictor of symptom level at follow-up, these prospective findings extend previous reports in children and adults and provide predictive validity for decreased arousal correlating with high levels of subsequent conduct problems and increased arousal correlating with high levels of subsequent anxiety symptoms. Differences in emotional processing may constitute a risk process for the subsequent onset of conduct and anxiety disorder in middle childhood.
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Affiliation(s)
- Carla Sharp
- Dr. Sharp is with the Menninger Department of Psychiatry and Behavioral Sciences, and Dr. Petersen is with the Medicine-Health Services Research, Baylor College of Medicine; and Prof. Goodyer is with the Developmental Psychiatry Section, University of Cambridge..
| | - Nancy Petersen
- Dr. Sharp is with the Menninger Department of Psychiatry and Behavioral Sciences, and Dr. Petersen is with the Medicine-Health Services Research, Baylor College of Medicine; and Prof. Goodyer is with the Developmental Psychiatry Section, University of Cambridge
| | - Ian Goodyer
- Dr. Sharp is with the Menninger Department of Psychiatry and Behavioral Sciences, and Dr. Petersen is with the Medicine-Health Services Research, Baylor College of Medicine; and Prof. Goodyer is with the Developmental Psychiatry Section, University of Cambridge
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Abstract
Acts of violence account for an estimated 1.43 million deaths worldwide annually. While violence can occur in many contexts, individual acts of aggression account for the majority of instances. In some individuals, repetitive acts of aggression are grounded in an underlying neurobiological susceptibility that is just beginning to be understood. The failure of "top-down" control systems in the prefrontal cortex to modulate aggressive acts that are triggered by anger provoking stimuli appears to play an important role. An imbalance between prefrontal regulatory influences and hyper-responsivity of the amygdala and other limbic regions involved in affective evaluation are implicated. Insufficient serotonergic facilitation of "top-down" control, excessive catecholaminergic stimulation, and subcortical imbalances of glutamatergic/gabaminergic systems as well as pathology in neuropeptide systems involved in the regulation of affiliative behavior may contribute to abnormalities in this circuitry. Thus, pharmacological interventions such as mood stabilizers, which dampen limbic irritability, or selective serotonin reuptake inhibitors (SSRIs), which may enhance "top-down" control, as well as psychosocial interventions to develop alternative coping skills and reinforce reflective delays may be therapeutic.
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Affiliation(s)
- Larry J. Siever
- Department of Psychiatry, Mount Sinai School of Medicine, New York; the Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York; and VISN 3 Mental Illness Research, Education, and Clinical Center, Bronx, New York
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230
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Hermans EJ, Ramsey NF, van Honk J. Exogenous testosterone enhances responsiveness to social threat in the neural circuitry of social aggression in humans. Biol Psychiatry 2008; 63:263-70. [PMID: 17727825 DOI: 10.1016/j.biopsych.2007.05.013] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 04/04/2007] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND In a range of species, the androgen steroid testosterone is known to potentiate neural circuits involved in intraspecific aggression. Disorders of impulsive aggression in humans have likewise been associated with high testosterone levels, but human evidence for the link between testosterone and aggression remains correlational and inconclusive. METHODS Twelve female participants underwent functional magnetic resonance imaging during three sessions while viewing stimuli differing in social threat value: angry and happy facial expressions. The first session served to establish associations between baseline hormone levels and neural activation. Participants were retested in a second and third session after placebo-controlled sublingual administration of .5 mg testosterone. RESULTS Findings demonstrate consistent activation to angry versus happy faces in areas known to be involved in vertebrate reactive aggression, such as the amygdala and hypothalamus. Suprathreshold clusters were also found in the orbitofrontal cortex (Brodmann area 47), a region implicated in impulse control in humans. Baseline endocrine profiles of high testosterone and low cortisol were associated with stronger activation in subcortical structures. Neural responses in most activated regions were more persistent after testosterone administration than after placebo. CONCLUSIONS These data demonstrate that testosterone enhances responsiveness in neural circuits of social aggression. Based on animal literature, it is argued that actions of testosterone on subcortical reactive aggression circuits give rise to this effect. Implications for our understanding of the pathophysiology of disorders of impulsive aggression are discussed.
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Affiliation(s)
- Erno J Hermans
- Helmholtz Institute, Utrecht University, the Netherlands.
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231
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Woodberry KA, Gallo KP, Nock MK. An experimental pilot study of response to invalidation in young women with features of borderline personality disorder. Psychiatry Res 2008; 157:169-80. [PMID: 17913240 DOI: 10.1016/j.psychres.2007.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 06/05/2007] [Accepted: 06/08/2007] [Indexed: 11/16/2022]
Abstract
One of the leading biosocial theories of borderline personality disorder (BPD) suggests that individuals with BPD have biologically based abnormalities in emotion regulation contributing to more intense and rapid responses to emotional stimuli, in particular, invalidation [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford, New York.]. This study used a 2 by 2 experimental design to test whether young women with features of BPD actually show increased physiological arousal in response to invalidation. Twenty-three women ages 18 to 29 who endorsed high levels of BPD symptoms and 18 healthy controls were randomly assigned to hear either a validating or invalidating comment during a frustrating task. Although we found preliminary support for differential response to these stimuli in self-report of valence, we found neither self-report nor physiological evidence of hyperarousal in the BPD features group, either at baseline or in response to invalidation. Interestingly, the BPD features group reported significantly lower comfort with emotion, and comfort was significantly associated with affective valence but not arousal. We discuss implications for understanding and responding to the affective intensity of this population.
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Affiliation(s)
- Kristen A Woodberry
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
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232
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Rosenthal MZ, Gratz KL, Kosson DS, Cheavens JS, Lejuez CW, Lynch TR. Borderline personality disorder and emotional responding: A review of the research literature. Clin Psychol Rev 2008; 28:75-91. [PMID: 17544188 DOI: 10.1016/j.cpr.2007.04.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 03/28/2007] [Accepted: 04/05/2007] [Indexed: 01/18/2023]
Abstract
Although problems with emotional functioning are considered central to borderline personality disorder (BPD), it is only recently that studies have begun utilizing laboratory biobehavioral measures (including neuroimaging and psychophysiological measures) to examine emotional responding in BPD. The application of basic science methodologies used in a systematic program of research to investigate clinically relevant phenomena, often called translational research, holds much promise in advancing the assessment and treatment of BPD. In this paper, we begin with an overview of the research on self-reported emotional responding in BPD. Next, we outline the advantages that translational research has over traditional self-report methodology in furthering an understanding of emotional responding in BPD, and review the extant laboratory studies of emotional responding in BPD. Finally, problems commonly encountered when conducting translational research on emotion in BPD are outlined, and solutions to these problems are offered.
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Affiliation(s)
| | - Kim L Gratz
- Center for Addictions, Personality, and Emotion Research and the University of Maryland, United States
| | - David S Kosson
- Rosalind Franklin University of Medicine and Science, United States
| | | | - C W Lejuez
- Center for Addictions, Personality, and Emotion Research and the University of Maryland, United States
| | - Thomas R Lynch
- Duke University and Duke University Medical Center, United States
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233
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Decety J, Moriguchi Y. The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. Biopsychosoc Med 2007; 1:22. [PMID: 18021398 PMCID: PMC2206036 DOI: 10.1186/1751-0759-1-22] [Citation(s) in RCA: 294] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/16/2007] [Indexed: 12/30/2022] Open
Abstract
Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined.
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Affiliation(s)
- Jean Decety
- Departments of Psychology and Psychiatry, The University of Chicago, 5848 S. University Avenue, Chicago, IL 60637, USA
| | - Yoshiya Moriguchi
- Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi Cho, Kodaira City, Tokyo, 187-8551, Japan
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234
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Domes G, Heinrichs M, Gläscher J, Büchel C, Braus DF, Herpertz SC. Oxytocin attenuates amygdala responses to emotional faces regardless of valence. Biol Psychiatry 2007; 62:1187-90. [PMID: 17617382 DOI: 10.1016/j.biopsych.2007.03.025] [Citation(s) in RCA: 568] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 03/06/2007] [Accepted: 03/30/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oxytocin is known to reduce anxiety and stress in social interactions as well as to modulate approach behavior. Recent studies suggest that the amygdala might be the primary neuronal basis for these effects. METHODS In a functional magnetic resonance imaging study using a double-blind, placebo-controlled within-subject design, we measured neural responses to fearful, angry, and happy facial expressions after intranasal application of 24 IU oxytocin compared with placebo. RESULTS Oxytocin reduced right-sided amygdala responses to all three face categories even when the emotional content of the presented face was not evaluated explicitly. Exploratory whole brain analysis revealed modulatory effects in prefrontal and temporal areas as well as in the brainstem. CONCLUSIONS Results suggest a modulatory role of oxytocin on amygdala responses to facial expressions irrespective of their valence. Reduction of amygdala activity to positive and negative stimuli might reflect reduced uncertainty about the predictive value of a social stimulus and thereby facilitates social approach behavior.
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Affiliation(s)
- Gregor Domes
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany.
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235
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Völlm B, Richardson P, McKie S, Elliott R, Dolan M, Deakin B. Neuronal correlates of reward and loss in Cluster B personality disorders: a functional magnetic resonance imaging study. Psychiatry Res 2007; 156:151-67. [PMID: 17920821 DOI: 10.1016/j.pscychresns.2007.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 03/12/2007] [Accepted: 04/08/2007] [Indexed: 11/17/2022]
Abstract
Decision making is guided by the likely consequences of behavioural choices. Neuronal correlates of financial reward have been described in a number of functional imaging studies in humans. Areas implicated in reward include ventral striatum, dopaminergic midbrain, amygdala and orbitofrontal cortex. Response to loss has not been as extensively studied but may involve prefrontal and medial temporal cortices. It has been proposed that increased sensitivity to reward and reduced sensitivity to punishment underlie some of the psychopathology in impulsive personality disordered individuals. However, few imaging studies using reinforcement tasks have been conducted in this group. In this fMRI study, we investigate the effects of positive (monetary reward) and negative (monetary loss) outcomes on BOLD responses in two target selection tasks. The experimental group comprised eight people with Cluster B (antisocial and borderline) personality disorder, whilst the control group contained fourteen healthy participants. A key finding was the absence of prefrontal responses and reduced BOLD signal in the subcortical reward system in the PD group during positive reinforcement. Impulsivity scores correlated negatively with prefrontal responses in the PD but not the control group during both, reward and loss. Our results suggest dysfunctional responses to rewarding and aversive stimuli in Cluster B personality disordered individuals but do not support the notion of hypersensitivity to reward and hyposensitivity to loss.
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Affiliation(s)
- Birgit Völlm
- Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Rd, Manchester M13 9PT, UK.
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236
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Schnell K, Herpertz SC. Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. J Psychiatr Res 2007; 41:837-47. [PMID: 17064731 DOI: 10.1016/j.jpsychires.2006.08.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 08/01/2006] [Accepted: 08/23/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Affective hyperarousal is the hallmark of borderline personality disorder (BPD) and the main target for dialectic-behavioral-therapy (DBT). This pilot study examined whether improved regulation of affective arousal following DBT translates into changes in relevant neural systems. METHODS We applied five sequential fMRI scans over a 12-week in-patient treatment program. Six female BPD patients and six controls were included in an event-related fMRI design which induced emotional arousal through standardized images. In addition to analyzing valence-based stimulus categories over time, the study assessed the modulation of hemodynamic responses through emotional arousal by means of parametric HRF modulation with self-ratings of stimulus dependent arousal. RESULTS BPD data revealed a decreasing hemodynamic response to negative stimuli in the right-sided anterior cingulate, temporal and posterior cingulate cortices as well as in the left insula. In addition, these areas displayed a continuous decrease in HRF modulation through individual arousal in BPD patients. Moreover the four DBT responders displayed reduction of HRF modulation in the left amygdala and both hippocampi. CONCLUSIONS fMRI designs that use multiple repeated measures are suitable for application in therapy research. In our pilot study DBT treatment was accompanied by neural changes in limbic and cortical regions resembling those reported on psychotherapy effects in other mental disorders.
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Affiliation(s)
- Knut Schnell
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Mimische Affektivität von Patientinnen mit einer Borderline-Persönlichkeitsstörung während des Adult Attachment Projective. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2007. [DOI: 10.13109/zptm.2007.53.4.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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238
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Zanetti MV, Soloff PH, Nicoletti MA, Hatch JP, Brambilla P, Keshavan MS, Soares JC. MRI study of corpus callosum in patients with borderline personality disorder: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1519-25. [PMID: 17703861 DOI: 10.1016/j.pnpbp.2007.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 06/29/2007] [Accepted: 07/12/2007] [Indexed: 11/18/2022]
Abstract
This pilot study examined the integrity of the corpus callosum in a sample of patients with borderline personality disorder (BPD), as abnormalities in inter-hemispheric communication could possibly be involved in illness pathophysiology. We utilized magnetic resonance imaging (MRI) signal intensity (SI) and morphometric measures. Ten BPD and 20 healthy control subjects were assessed for current and past Axis I and Axis II comorbidities and histories of childhood abuse. Regional CC SI and areas were measured with semi-automated software from three-dimensional gradient echo imaging scans. Analysis of covariance was conducted to evaluate the results. No significant differences were observed between BPD and controls in the SI or area of any CC region. Abnormalities in interhemispheric connectivity do not appear necessary for the development of BPD. Further studies with larger samples are needed to confirm this preliminary finding.
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Affiliation(s)
- Marcus V Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department and Institute of Psychiatry, University of São Paulo, São Paulo, SP, Brazil.
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Soloff PH, Price JC, Meltzer CC, Fabio A, Frank GK, Kaye WH. 5HT2A receptor binding is increased in borderline personality disorder. Biol Psychiatry 2007; 62:580-7. [PMID: 17448449 DOI: 10.1016/j.biopsych.2006.10.022] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 09/08/2006] [Accepted: 10/13/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND Postmortem studies in suicide victims demonstrate an increase in the number of post-synaptic 5-HT(2A) receptor binding sites in ventral lateral and orbital frontal cortex. Diminished metabolic responses to serotonergic activation are noted in these areas in impulsive subjects with borderline personality disorder (BPD), a group at high risk for suicidal behaviors. We examined 5HT(2A) receptor binding potential (BP) in impulsive subjects with BPD, with positron emission tomography neuroimaging with [(18)F] altanserin. METHODS Fourteen female subjects with BPD were assessed for Axis I comorbidity, depressed mood, impulsivity, aggression, suicidality, childhood abuse, and compared with 11 healthy female control subjects. The 5HT(2A) receptor binding was evaluated in prefrontal cortex, anterior cingulate, hippocampus, temporal lobe, occipital cortex, and thalamus. Data were analyzed with Logan graphical analysis and a four-compartment (4C) model. RESULTS Hippocampal 5HT(2A) receptor binding was significantly increased in BPD subjects compared with control subjects in both Logan and 4C analyses, covarying for age. Hippocampal BP values were related to comorbid major depressive episode, with highest values found in non-depressed BPD subjects and lowest in healthy control subjects. The BP values were not related to depressed mood, impulsivity, aggression, suicidality, or childhood abuse. CONCLUSIONS 5HT(2A) receptor binding is increased in the hippocampus of BPD subjects independent of depressed mood, impulsivity, aggression, suicidality, or childhood abuse. Dysregulation of serotonergic function in hippocampus might contribute to affective and behavioral symptoms in BPD.
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Affiliation(s)
- Paul H Soloff
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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v. Ceumern-Lindenstjerna IA, Brunner R, Parzer P, Frey M, Fiedler P, Resch F. Wahrnehmung und Bewertung von emotionalen Gesichtsausdrücken bei weiblichen Jugendlichen mit einer Borderline-Persönlichkeitsstörung. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:333-40. [DOI: 10.1024/1422-4917.35.5.333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Untersuchung der Wahrnehmung von emotionalen und neutralen Gesichtsausdrücken bei weiblichen Jugendlichen mit einer Borderline-Persönlichkeitsstörung (BPS). Methodik: Bei 30 Jugendlichen mit der Diagnose einer BPS, 29 Jugendlichen mit anderen psychischen Störungen sowie 30 psychisch gesunden Jugendlichen wurden emotionale und neutrale Gesichtsausdrücke aus dem Bildersatz von Ekman und Friesen (1976) vorgelegt. Sämtliche Studienteilnehmer waren weiblichen Geschlechts. Mit Hilfe eines selbst konstruierten Fragebogens zur Wahrnehmung von Emotionen in Gesichtsausdrücken sollten die Jugendlichen die Art der dargestellten Emotion benennen sowie Einschätzungen über die wahrgenommene Intensität, Bedrohlichkeit und Positivität vornehmen. Ergebnisse: Jugendliche Patientinnen mit der Diagnose einer BPS zeigten keine Schwierigkeiten bei der Benennung der dargestellten Emotionen sowie bei der subjektiven Einschätzung negativ emotionaler und neutraler Gesichtsausdrücke. In der Wahrnehmung positiv emotionaler Gesichtsausdrücke zeigte sich allerdings, dass Jugendliche mit der Diagnose einer BPS die Positivität und Intensität positiver Gesichtsausdrücke geringer und die Bedrohlichkeit höher einschätzten als die beiden Kontrollgruppen. Schlussfolgerungen: Die Verarbeitung positiver Reize und deren Rolle bei der Emotionsregulation bei Jugendlichen mit einer BPS sollte Gegenstand weiterer Forschung sein. Aufgrund der dysfunktionalen Interpretation positiv emotionaler Stimuli könnte es gewinnbringend sein, differenziert auf die möglichen Wahrnehmungsverzerrungen der Patienten im Therapieprozess einzugehen.
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Affiliation(s)
| | - Romuald Brunner
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für Psychosoziale Medizin, Universität Heidelberg (Direktor: Prof. Dr. med. Franz Resch)
| | - Peter Parzer
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für Psychosoziale Medizin, Universität Heidelberg (Direktor: Prof. Dr. med. Franz Resch)
| | - Mirja Frey
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für Psychosoziale Medizin, Universität Heidelberg (Direktor: Prof. Dr. med. Franz Resch)
| | - Peter Fiedler
- Institut für Psychologie der Ruprecht-Karls Universität Heidelberg Abteilung Klinische Psychologie und Psychotherapie (Gechäftsführende Direktorin: Prof. Dr. phil. Sabina Pauen)
| | - Franz Resch
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für Psychosoziale Medizin, Universität Heidelberg (Direktor: Prof. Dr. med. Franz Resch)
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Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res 2007; 155:231-43. [PMID: 17601709 PMCID: PMC2084368 DOI: 10.1016/j.pscychresns.2007.03.006] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 03/06/2007] [Accepted: 03/14/2007] [Indexed: 01/18/2023]
Abstract
Clinical hallmarks of borderline personality disorder (BPD) include social and emotional dysregulation. We tested a model of fronto-limbic dysfunction in facial emotion processing in BPD. Groups of 12 unmedicated adults with BPD by DSM-IV and 12 demographically-matched healthy controls (HC) viewed facial expressions (Conditions) of neutral emotion, fear and anger, and made gender discriminations during rapid event-related functional magnetic resonance imaging (fMRI). Analysis of variance of Region of Interest signal change revealed a statistically significant effect of the Group-by-Region-by-Condition interaction. This was due to the BPD group exhibiting a significantly larger magnitude of deactivation (relative to HC) in the bilateral rostral/subgenual anterior cingulate cortex (ACC) to fear and in the left ACC to fear minus neutral; and significantly greater activation in the right amygdala to fear minus neutral. There were no significant between-group differences in ROI signal change in response to anger. In voxel-wise analyses constrained within these ROIs, the BPD group exhibited significant changes in the fear minus neutral contrast, with relatively less activation in the bilateral rostral/subgenual ACC, and greater activation in the right amygdala. In the anger minus neutral contrast this pattern was reversed, with the BPD group showing greater activation in the bilateral rostral/subgenual ACC and less activation in the bilateral amygdala. We conclude that adults with BPD exhibit changes in fronto-limbic activity in the processing of fear stimuli, with exaggerated amygdala response and impaired emotion-modulation of ACC activity. The neural substrates underlying processing of anger may also be altered. These changes may represent an expression of the volumetric and serotonergic deficits observed in these brain areas in BPD.
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Coccaro EF, McCloskey MS, Fitzgerald DA, Phan KL. Amygdala and orbitofrontal reactivity to social threat in individuals with impulsive aggression. Biol Psychiatry 2007; 62:168-78. [PMID: 17210136 DOI: 10.1016/j.biopsych.2006.08.024] [Citation(s) in RCA: 349] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 08/23/2006] [Accepted: 08/25/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND Converging evidence from animal and human lesion studies implicates the amygdala and orbitofrontal cortex (OFC) in emotional regulation and aggressive behavior. However, it remains unknown if functional deficits exist in these specific brain regions in clinical populations in which the cardinal symptom is impulsive aggression. We have previously shown that subjects diagnosed with intermittent explosive disorder (IED), a psychiatric disorder characterized by reactive aggressive behavior, perform poorly on facial emotion recognition tasks. In this study we employed a social-emotional probe of amygdala-OFC function in individuals with impulsive aggression. METHODS Ten unmedicated subjects with IED and 10 healthy, matched comparison subjects (HC) underwent functional magnetic resonance imaging while viewing blocks of emotionally salient faces. We compared amygdala and OFC reactivity to faces between IED and HC subjects, and examined the relationship between the extent of activation in these regions and extent of prior history of aggressive behavior. RESULTS Relative to controls, individuals with IED exhibited exaggerated amygdala reactivity and diminished OFC activation to faces expressing anger. Extent of amygdala and OFC activation to angry faces were differentially related to prior aggressive behavior across subjects. Unlike controls, aggressive subjects failed to demonstrate amygdala-OFC coupling during responses to angry faces. CONCLUSIONS These findings provide evidence of amygdala-OFC dysfunction in response to an ecologically-valid social threat signal (processing angry faces) in individuals with a history of impulsive aggressive behavior, and further substantiate a link between a dysfunctional cortico-limbic network and aggression.
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Affiliation(s)
- Emil F Coccaro
- Department of Psychiatry, Biological Sciences Division and the Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637-1470, USA.
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243
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Abstract
BACKGROUND Current biological concepts of borderline personality disorder (BPD) emphasize the interference of emotional hyperarousal and cognitive functions. A prototypical example is episodic memory. Pre-clinical investigations of emotion-episodic memory interactions have shown specific retrograde and anterograde episodic memory changes in response to emotional stimuli. These changes are amygdala dependent and vary as a function of emotional arousal and valence. METHOD To determine whether there is amygdala hyper-responsiveness to emotional stimuli as the underlying pathological substrate of cognitive dysfunction in BPD, 16 unmedicated female patients with BPD were tested on the behavioural indices of emotion-induced amnesia and hypermnesia established in 16 healthy controls. RESULTS BPD patients displayed enhanced retrograde and anterograde amnesia in response to presentation of negative stimuli, while positive stimuli elicited no episodic memory-modulating effects. CONCLUSION These findings suggest that an amygdala hyper-responsiveness to negative stimuli may serve as a crucial aetiological contributor to emotion-induced cognitive dysfunction in BPD.
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Affiliation(s)
- René Hurlemann
- Department of Psychiatry, University of Bonn, Bonn, Germany.
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Abstract
Recently, more empirical studies have been devoted to the investigation of borderline personality disorder (BPD) in children and adolescents. Against this background, the purpose of the current review is to compare research findings on diagnostic-related phenomena in child and adolescent samples with those in adult samples to establish the utility of the BPD construct in childhood and adolescence. A search of relevant publications reported in Pubmed and PsycInfo from 1940 (the first clinical descriptions of BPD in childhood) to 2006 was carried out. A total of 58 studies were included. The review of the adult literature was not exhaustive but relied on excellent existing and comprehensive reviews of the adult literature carried out in the past 5 years. Although significant differences seem to exist between juveniles and adults in diagnostic-related phenomena associated with BPD, these can be explained by the principle of heterotypic continuity in development. Moreover, enough overlap between juvenile and adult BPD has been observed to warrant further empirical investigation into the construct of juvenile BPD. Specific areas for future research in juvenile BPD suggested by this review include studies of comorbidity, measure development, and the use of neurobiological measures such as functional neuroimaging.
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Affiliation(s)
- Carla Sharp
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas 77030, USA.
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New AS, Hazlett EA, Buchsbaum MS, Goodman M, Mitelman SA, Newmark R, Trisdorfer R, Haznedar MM, Koenigsberg HW, Flory J, Siever LJ. Amygdala-prefrontal disconnection in borderline personality disorder. Neuropsychopharmacology 2007; 32:1629-40. [PMID: 17203018 DOI: 10.1038/sj.npp.1301283] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abnormal fronto-amygdala circuitry has been implicated in impulsive aggression, a core symptom of borderline personality disorder (BPD). We examined relative glucose metabolic rate (rGMR) at rest and after m-CPP (meta-chloropiperazine) with (18)fluorodeoxyglucose (FDG) with positron emission tomography (PET) in 26 impulsive aggressive (IED)-BPD patients and 24 controls. Brain edges/amygdala were visually traced on MRI scans co-registered to PET scans; rGMR was obtained for ventral and dorsal regions of the amygdala and Brodmann areas within the prefrontal cortex (PFC). Correlation coefficients were calculated between rGMR for dorsal/ventral amygdala regions and PFC. Additionally, amygdala volumes and rGMR were examined in BPD and controls. Correlations PFC/amygdala Placebo: Controls showed significant positive correlations between right orbitofrontal (OFC) and ventral, but not dorsal, amygdala. Patients showed only weak correlations between amygdala and the anterior PFC, with no distinction between dorsal and ventral amygdala. Correlations PFC/amygdala: m-CPP response: Controls showed positive correlations between OFC and amygdala regions, whereas patients showed positive correlations between dorsolateral PFC and amygdala. Group differences between interregional correlational matrices were highly significant. Amygdala volume/metabolism: No group differences were found for amygdala volume, or metabolism in the placebo condition or in response to meta-chloropiperazine (m-CPP). We demonstrated a tight coupling of metabolic activity between right OFC and ventral amygdala in healthy subjects with dorsoventral differences in amygdala circuitry, not present in IED-BPD. We demonstrated no significant differences in amygdala volumes or metabolism between BPD patients and controls.
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Affiliation(s)
- Antonia S New
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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246
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Sieswerda S, Arntz A, Mertens I, Vertommen S. Hypervigilance in patients with borderline personality disorder: Specificity, automaticity, and predictors. Behav Res Ther 2007; 45:1011-24. [PMID: 17045566 DOI: 10.1016/j.brat.2006.07.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Revised: 07/07/2006] [Accepted: 07/13/2006] [Indexed: 11/19/2022]
Abstract
According to cognitive theory, an important factor in borderline personality disorder (BPD) is hypervigilance. The aim of the present study was to test whether BPD patients show schema-related biases, and to explore relations with childhood trauma, schemas, and BPD symptoms. Sixteen BPD patients were compared with 18 patients with a cluster C personality disorder, 16 patients with an axis I disorder, and 16 normal controls. An emotional Stroop task was applied with schema-related and unrelated, negative and positive, supra- and subliminal person-related stimuli. BPD patients showed hypervigilance for both negative and positive cues, but were specifically biased towards schema-related negative cues. Predictors were BPD schemas, childhood sexual traumas, and BPD anxiety symptoms. Both BPD and axis I disorder patients showed a trend for a bias for negative schema-related subliminal stimuli. More attention to hypervigilance in BPD is recommended for clinical practice.
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Affiliation(s)
- Simkje Sieswerda
- Department of Medical, Clinical, and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Rüsch N, Weber M, Il'yasov KA, Lieb K, Ebert D, Hennig J, van Elst LT. Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. Neuroimage 2007; 35:738-47. [PMID: 17289404 DOI: 10.1016/j.neuroimage.2006.12.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 11/27/2006] [Accepted: 12/03/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Inferior frontal white matter circuits are likely to be relevant to dysfunctional affect regulation, aggression, dissociative symptoms, neuropsychological functioning and psychopathology in women with borderline personality disorder (BPD) and comorbid attention-deficit hyperactivity disorder (ADHD). METHODS 20 women with BPD and comorbid ADHD and 20 healthy women were investigated, and groups were matched for age, education and premorbid intelligence. Mean diffusivity and fractional anisotropy were measured bilaterally in the inferior frontal white matter by diffusion tensor imaging (DTI). Conflict resolution was assessed by the Attention Network Test, sustained vigilance by the Degraded-Stimulus Continuous Performance Test. RESULTS Among women with BPD and comorbid ADHD, increased mean diffusivity in inferior frontal white matter was associated with higher levels of dysfunctional affect regulation, anger-hostility, dissociative symptoms, and general psychopathology (p<.05, uncorrected). Poor conflict resolution during the attention task was positively associated with anger-hostility, psychopathology, dissociation and the number of ADHD-symptoms, but not related to DTI variables. Both groups did not differ significantly with respect to DTI variables or neuropsychological performance. In the BPD group, a lifetime history of major depression or a current eating disorder were associated with impaired inferior frontal white matter integrity, while a history of sexual abuse or a current posttraumatic stress disorder were not. CONCLUSIONS Inferior frontal white matter microstructural abnormalities may be linked to key aspects of psychopathology in women with BPD and comorbid ADHD and add to alterations in orbitofrontal and limbic areas. The relationship between neuropsychological functioning and white matter structure remains unclear.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry and Psychotherapy, University of Freiburg, Germany.
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Hummelen JW, Rokx TAJJ. Individual–context interaction as a guide in the treatment of personality disorders. Bull Menninger Clin 2007; 71:42-55. [PMID: 17484669 DOI: 10.1521/bumc.2007.71.1.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The diagnosis and treatment of personality disorders is strongly influenced by personality theories based on trait models, and the influence of the context is relatively neglected. Developments within psychology and neurobiology have led to the awareness that the manner in which personality characteristics are expressed is strongly determined by interaction with the context. The clinical implications of these developments are set out and Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999) is highlighted as a development within psychotherapy that is linked to a contextual diagnosis. Employment reintegration of patients with personality disorders is presented as an example of a context-oriented approach. Neurobiological insights support the idea that active focusing on the outer world reduces negative affects.
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Affiliation(s)
- J W Hummelen
- GGNet and UMC St. Radbound Nijmegen, GC Warnsveld, The Netherlands.
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Zetzsche T, Preuss UW, Frodl T, Schmitt G, Seifert D, Münchhausen E, Tabrizi S, Leinsinger G, Born C, Reiser M, Möller HJ, Meisenzahl EM. Hippocampal volume reduction and history of aggressive behaviour in patients with borderline personality disorder. Psychiatry Res 2007; 154:157-70. [PMID: 17306512 DOI: 10.1016/j.pscychresns.2006.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 04/26/2006] [Accepted: 05/01/2006] [Indexed: 11/26/2022]
Abstract
Disturbances of aggression and impulse control are important symptoms of borderline personality disorder (BPD). The hippocampus is part of the limbic system, which is involved in the control of these types of behaviour. The aim of our study was to investigate potential structural changes of the hippocampal formation in BPD and to evaluate if these are related to aggressive and impulsive behaviour. Twenty-five female and right-handed BPD patients (DSM-IV) and 25 healthy control subjects matched according to sex, age, handedness and educational status were examined. Magnetic resonance imaging (MRI) was performed using a 1.5-T Magnetom Vision system. The software program "BRAINS" was employed for segmentation and volumetry of the hippocampal formation. German versions of instruments were used to evaluate impulsive and aggressive behaviour. Hippocampal grey matter volume was significantly decreased in BPD patients: the reduction was more pronounced in patients with multiple hospitalizations. Hippocampal volume of the left hemisphere was inversely correlated with lifetime history of aggressive behaviour. However, no significant relationship was found between hippocampal volume and impulsive behaviour. Our study confirms previous results indicating a volume reduction of the hippocampal formation in BPD patients. Furthermore, this structural change might facilitate aggressive behaviour. Subsequent studies are required to clarify whether the reduction of hippocampal volume is a trait and risk factor for increased aggression.
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Affiliation(s)
- Thomas Zetzsche
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Nussbaumstrasse 7, D-80336 Munich, Germany
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