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Boldrini M, Xiao Y, Sing T, Zhu C, Jabbi M, Pantazopoulos H, Gürsoy G, Martinowich K, Punzi G, Vallender EJ, Zody M, Berretta S, Hyde TM, Kleinman JE, Marenco S, Roussos P, Lewis DA, Turecki G, Lehner T, Mann JJ. Omics Approaches to Investigate the Pathogenesis of Suicide. Biol Psychiatry 2024:S0006-3223(24)01352-0. [PMID: 38821194 DOI: 10.1016/j.biopsych.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
Suicide is the second leading cause of death in U.S. adolescents and young adults and is generally associated with a psychiatric disorder. Suicidal behavior has a complex etiology and pathogenesis. Moderate heritability suggests genetic causes. Associations between childhood and recent life adversity indicate contributions from epigenetic factors. Genomic contributions to suicide pathogenesis remain largely unknown. This article is based on a workshop held to design strategies to identify molecular drivers of suicide neurobiology that would be putative new treatment targets. The panel determined that while bulk tissue studies provide comprehensive information, single-nucleus approaches that identify cell type-specific changes are needed. While single-nuclei techniques lack information on cytoplasm, processes, spines, and synapses, spatial multiomic technologies on intact tissue detect cell alterations specific to brain tissue layers and subregions. Because suicide has genetic and environmental drivers, multiomic approaches that combine cell type-specific epigenome, transcriptome, and proteome provide a more complete picture of pathogenesis. To determine the direction of effect of suicide risk gene variants on RNA and protein expression and how these interact with epigenetic marks, single-nuclei and spatial multiomics quantitative trait loci maps should be integrated with whole-genome sequencing and genome-wide association databases. The workshop concluded with a recommendation for the formation of an international suicide biology consortium that will bring together brain banks and investigators with expertise in cutting-edge omics technologies to delineate the biology of suicide and identify novel potential treatment targets to be tested in cellular and animal models for drug and biomarker discovery to guide suicide prevention.
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Affiliation(s)
- Maura Boldrini
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
| | - Yang Xiao
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Tarjinder Sing
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York; New York Genome Center, New York, New York
| | - Chenxu Zhu
- New York Genome Center, New York, New York; Department of Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Mbemba Jabbi
- Department of Psychiatry and Behavioral Sciences, Mulva Clinics for the Neurosciences, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Harry Pantazopoulos
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Gamze Gürsoy
- New York Genome Center, New York, New York; Departments of Biomedical Informatics and Computer Science, Columbia University, New York, New York
| | - Keri Martinowich
- Lieber Institute for Brain Development, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Giovanna Punzi
- Lieber Institute for Brain Development, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Eric J Vallender
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Sabina Berretta
- Department of Psychiatry, Harvard Brain Tissue Resource Center, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Stefano Marenco
- Human Brain Collection Core, National Institute of Mental Health's (NIMH) Division of Intramural Research Programs, Bethesda, Maryland
| | - Panagiotis Roussos
- Center for Precision Medicine and Translational Therapeutics, Mental Illness Research Education, and Clinical Center (VISN 2 South), James J. Peters VA Medical Center, Bronx, New York
| | - David A Lewis
- Departments of Psychiatry and Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montréal, Québec, Canada
| | | | - J John Mann
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
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Parpart H, Blass J, Meindl T, Blautzik J, Michl P, Beblo T, Engel R, Reiser M, Falkai P, Moeller HJ, Driessen M, Hennig-Fast K. Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates. Brain Sci 2024; 14:549. [PMID: 38928549 PMCID: PMC11201834 DOI: 10.3390/brainsci14060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. METHODS Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. RESULTS BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. CONCLUSIONS Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.
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Affiliation(s)
- Hella Parpart
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Jakob Blass
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Thomas Meindl
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Janusch Blautzik
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Petra Michl
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Rolf Engel
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | | | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
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3
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Schurz M, Berenz JP, Maerz J, Perla R, Buchheim A, Labek K. Brain Activation for Social Cognition and Emotion Processing Tasks in Borderline Personality Disorder: A Meta-Analysis of Neuroimaging Studies. Brain Sci 2024; 14:395. [PMID: 38672044 PMCID: PMC11048542 DOI: 10.3390/brainsci14040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The present meta-analysis summarizes brain activation for social cognition and emotion-processing tasks in borderline personality disorder (BPD). We carried out two meta-analyses to elaborate on commonalities and potential differences between the two types of tasks. In the first meta-analysis, we implemented a more liberal strategy for task selection (including social and emotional content). The results confirmed previously reported hyperactivations in patients with BPD in the bilateral amygdala and prefrontal cortex and hypoactivations in bilateral inferior frontal gyri. When applying a stricter approach to task selection, focusing narrowly on social cognition tasks, we only found activation in prefrontal areas, particularly in the anterior cingulate and ventromedial prefrontal cortex. We review the role of these areas in social cognition in healthy adults, suggesting that the observed BPD hyperactivations may reflect an overreliance on self-related thought in social cognition.
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Affiliation(s)
- Matthias Schurz
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jan-Patrick Berenz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jeff Maerz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Raphael Perla
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Karin Labek
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
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Salas F, Nvo-Fernández M, Leiva-Bianchi M, Sáez DA, Páeza GS, García MV, Villacura-Herrera C. Components of event-related potentials and borderline personality disorder: a meta-analysis. Eur J Psychotraumatol 2024; 15:2297641. [PMID: 38214169 PMCID: PMC10791106 DOI: 10.1080/20008066.2023.2297641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Background: Borderline personality disorder (BPD) is characterized by symptoms associated with difficulties in emotion regulation, altered self-image, impulsivity, and instability in personal relationships. A relationship has been found between BPD symptoms and altered neuropsychological processes. Studies of event-related potentials (ERP) measured with electroencephalogram (EEG) have found neural correlates related to BPD symptoms. Of note is the P300 component, considered a potential mental health biomarker for trauma-associated disorders. However, no meta-analysis has been found to demonstrate this relationship.Objectives: To evaluate the relationship between the P300 component and BPD symptoms. To evaluate the relationship of other ERP components with BPD symptoms.Methods: The method and procedure were adjusted to the PRISMA checklist. The search was performed in three databases: WOS, Scopus and PubMed. A Random Effects Model was used to perform the analysis of the studies. In addition, a meta-regression was performed with % women, Gini and GDP. Finally, a descriptive analysis of the main results found between P300, other ERP components (LPP, P100 and ERN/Ne) and BPD symptoms was performed.Results: From a review of 485 articles, a meta-analysis was performed with six articles that met the inclusion criteria. A moderate, positive relationship was found between the P300 component and BPD symptoms (REM = .489; p < .001). It was not possible to perform meta-analyses for other ERP components (LPP, P100 and ERN/Ne) due to the low number of articles found.Conclusion: The idea that P300 could be considered for use as a biomarker to identify altered neural correlates in BPD is reinforced. In addition, a moderating effect of inequality (Gini) was detected.
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Affiliation(s)
- Fabiola Salas
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Nvo-Fernández
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Leiva-Bianchi
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Daniela Avello Sáez
- School of Occupational Therapy, Faculty of Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Geraldy Sepúlveda Páeza
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marc Via García
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Cesar Villacura-Herrera
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Talca, Chile
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Gómez-Bujedo J, Dacosta-Sánchez D, Pérez-Moreno PJ, García García A, Díaz-Batanero C, Fernández-Calderón F, Delgado-Rico E, Moraleda-Barreno E. Comparison of Emotional Processing Between Patients with Substance Use Disorder and Those with Dual Diagnosis: Relationship with Severity of Dependence and Use During Treatment. J Psychoactive Drugs 2024; 56:97-108. [PMID: 36827487 DOI: 10.1080/02791072.2023.2181241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 02/26/2023]
Abstract
This study analyzed, in a Spanish sample, the differences in emotional processing in patients diagnosed with substance use disorder (SUD) and patients with a dual diagnosis (DD), and tested whether alterations in emotional regulation were related to the severity of dependence and consumption during treatment. A descriptive follow-up study was conducted with 88 adult outpatients (83% men) who were receiving treatment for alcohol and cocaine SUD. Of the sample, 43.2% presented dual diagnosis according to DSM-IV-TR criteria. Emotional processing was assessed with the IAPS, and dependence severity with the SDSS. Consumption was determined with self-reports and toxicological tests. Regression analyses revealed that the DD group had more difficulties in identifying the valence and arousal of the images than patients with SUD. Patients with DD presented more difficulty in identifying images in which valence was manipulated, but not in those in which arousal was manipulated. Cocaine use during treatment was associated with difficulties in identifying unpleasant (U = 734.0; p < .05) and arousing (U = 723.5; p < .05) images. Although these results are preliminary, findings suggest that impaired emotional processing is aggravated in dual patients, although it may be a common transdiagnostic factor in SUD and other comorbid mental disorders. Findings highlight the importance of evaluating emotional regulation to better understand its possible role in the maintenance of substance use.
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Affiliation(s)
- Jesús Gómez-Bujedo
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
| | | | - Pedro J Pérez-Moreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Elena Delgado-Rico
- Department of Educational Psychology and Psychobiology, International University of La Rioja, Logroño, Spain
| | - Enrique Moraleda-Barreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Shafie M, Shahmohamadi E, Cattarinussi G, Sanjari Moghaddam H, Akhondzadeh S, Sambataro F, Moltrasio C, Delvecchio G. Resting-state functional magnetic resonance imaging alterations in borderline personality disorder: A systematic review. J Affect Disord 2023; 341:335-345. [PMID: 37673288 DOI: 10.1016/j.jad.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe psychiatric disorder characterized by emotion dysregulation, impulsivity, and interpersonal disturbances. Several structural and functional neuroimaging abnormalities have been described in BPD. In particular, resting-state functional magnetic resonance imaging (rs-fMRI) studies have recently suggested various connectivity alterations within and between large-scale brain networks in BPD. This review aimed at providing an updated summary of the evidence reported by the available rs-fMRI studies in BPD individuals. METHODS A search on PubMed, Scopus, and Web of Science was performed to identify rs-fMRI alterations in BPD. A total of 15 studies met our inclusion criteria. RESULTS Overall, aberrant resting-state functional connectivity (rs-FC) within and between default mode network (DMN), salience network (SN), and central executive network (CEN) were observed in BPD compared to healthy controls, as well as selective functional impairments in bilateral amygdala, anterior and posterior cingulate cortex, hippocampus, and prefrontal cortex. LIMITATIONS The observational design, small sample size, prevalence of females, high rates of concurrent comorbidities and medications, and heterogeneity across imaging methodologies limit the generalizability of the results. CONCLUSIONS The identification of altered patterns of rs-FC within and between selective brain networks, including DMN, SN, and CEN, could further our knowledge of the clinical symptoms of BPD, and therefore, future studies with multimodal methodologies and longitudinal designs are warranted to further explore the neural correlates of this disorder.
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Affiliation(s)
- Mahan Shafie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Hossein Sanjari Moghaddam
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Kawata KHDS, Hirano K, Hamamoto Y, Oi H, Kanno A, Kawashima R, Sugiura M. Motivational decline and proactive response under thermal environmental stress are related to emotion- and problem-focused coping, respectively: Questionnaire construction and fMRI study. Front Behav Neurosci 2023; 17:1143450. [PMID: 37122493 PMCID: PMC10130452 DOI: 10.3389/fnbeh.2023.1143450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Despite the diversity of human behavioral and psychological responses to environmental thermal stress, the major dimensions of these responses have not been formulated. Accordingly, the relevance of these responses to a framework of coping with stress (i.e., emotion- and problem-focused) and the neural correlates are unexplored. In this study, we first developed a multidimensional inventory for such responses using social surveys and a factor analysis, and then examined the neural correlates of each dimension using a functional magnetic resonance imaging; we manipulated the ambient temperature between uncomfortably hot and cold, and the correlations between the inventory factor scores and discomfort-related neural responses were examined. We identified three factors to construct the inventory: motivational decline, proactive response, and an active behavior, which appeared to reflect inefficient emotion-focused coping, efficient problem-focused coping, and positive appreciation of extreme environmental temperatures, respectively, under environmental thermal stress. Motivational decline score was positively associated with common neural response to thermal stress in the frontal and temporoparietal regions, implicated in emotion regulation, while proactive response score negatively with the neural responses related to subjective discomfort in the medial and lateral parietal cortices, implicated in problem-solving. We thus demonstrated that two of three major dimensions of individual variation in response to and coping with environmental thermal stress conform to an influential two-dimensional framework of stress coping. The current three-dimensional model may expand the frontiers of meteorological human science in both basic and application domains.
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Affiliation(s)
- Kelssy Hitomi dos Santos Kawata
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Kanan Hirano
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yumi Hamamoto
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Hajime Oi
- Climate Control and Cooling System Engineering Group, Nissan Motor Co., Ltd., Atsugi, Japan
| | - Akitake Kanno
- Graduate School of Medicine, Tohoku University, Sendai, Japan
- Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
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8
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Sugiura M, Katayori Y, Muratsubaki T, Shiratori M, Hanawa S, Nejad KK, Tamura D, Kawashima R, Fukudo S. Automatic adaptive emotion regulation is associated with lower emotion-related activation in the frontoparietal cortex and other cortical regions with multi-componential organization. Front Behav Neurosci 2023; 17:1059158. [PMID: 36950064 PMCID: PMC10025472 DOI: 10.3389/fnbeh.2023.1059158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Although some researchers consider automatic adaptive emotion regulation to be an automatized strategy whereas others consider it to be implicit disengagement of deliberative process, to date, its neural correlates have been poorly investigated. In addition, the valence specificity of automatic adaptive emotion regulation and levels of activation relative to the neutral condition are controversial; the former is relevant to the attribution of resilient emotion regulation to positivity bias or emotional stability, and the latter to determining whether regulation is based on emotion-specific or emotion-non-specific processes. In this functional magnetic resonance imaging (fMRI) study, we presented positive and negative emotional pictures to healthy young participants and investigated the neural correlates of automatic adaptive emotion regulation in spontaneous emotional response. A significant negative trait effect (i.e., regression coefficient) on activation was identified both for positive and negative emotional responses in various cortical regions. A cluster analysis identified three clusters among these regions based on the valence specificity of the trait effect and level of activation relative to neutral stimuli. Cluster 1 included regions in the sensorimotor cortex characterized by negative emotion-specific decreases in activation relative to neutral stimuli in adaptive individuals. Cluster 2 included several cortical regions including the bilateral dorsal executive network, anterior cingulate, and inferior frontal gyrus, which were characterized by valence-independent decreases in activation in adaptive individuals. Cluster 3 included the bilateral ventrolateral and dorsomedial prefrontal cortices, right insula, and other posterior regions, which were characterized by increased activation for negative stimuli in non-adaptive individuals. These findings support the assumption that automatic adaptive emotion regulation involves the implicit disengagement of deliberative process and suggest the relevance of different cortical networks to the potential emotion- and valence-specificity of adaptive regulation.
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Affiliation(s)
- Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Yoko Katayori
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Muratsubaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miyuki Shiratori
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sugiko Hanawa
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | | | - Daisaku Tamura
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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9
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Hazlett EA, Goldstein KE, Haznedar MM, McClure MM, Perez-Rodriguez MM, New AS, Goodman M, Govindarajulu U, Kapil-Pair KN, Feinberg A, Smith E, Dolgopolskaia ES. Hyperreactivity and Impaired Habituation of Startle Amplitude During Unpleasant Pictures in Borderline but Not Schizotypal Personality Disorder: Quantifying Emotion Dysregulation. Biol Psychiatry 2022; 92:573-582. [PMID: 35717211 DOI: 10.1016/j.biopsych.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by greater intensity of reactions to unpleasant emotional cues and a slower-than-normal return of these responses to baseline. Habituation is defined as decreased response to repeated stimulation. Affect-modulated startle (AMS), a translational psychophysiological approach, is mediated by the amygdala and used to study emotion processing in both humans and animals. This is the first study to examine the specificity of habituation anomalies in BPD during passive emotional and neutral picture processing. METHODS A total of 90 participants were studied: patients with BPD (n = 35), patients with schizotypal personality disorder (n = 26; included as a psychopathological comparison group), and healthy control subjects (n = 29). Participants received rigorous clinical assessments, and patients were unmedicated. AMS was examined during a series of intermixed unpleasant, neutral, and pleasant pictures. RESULTS Compared with the other groups, patients with BPD showed greater overall AMS during unpleasant pictures and prolonged habituation of startle amplitude during unpleasant pictures from early to later trials. The groups did not differ in AMS during neutral or pleasant pictures or self-reported picture valence. Among the patients with BPD, prolonged habituation to unpleasant pictures was associated with greater symptom severity and suicidal/self-harming behavior. CONCLUSIONS These findings 1) indicate that abnormal processing of and habituation to unpleasant pictures is observed in BPD but not schizotypal personality disorder, suggesting that these deficits are not simply characteristics of personality disorders in general; 2) are consistent with studies showing deficient amygdala habituation to unpleasant pictures in BPD; and 3) have significant implications for clinical assessment and treatment of BPD, e.g., alternative therapies for BPD such as gradual exposure to unpleasant emotional stimuli or amygdala neurofeedback may aid habituation deficits.
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Affiliation(s)
- Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York.
| | - Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Outpatient Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Margaret M McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Abigail Feinberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emma Smith
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Kruger THC, Schulze J, Bechinie A, Neumann I, Jung S, Sperling C, Engel J, Müller A, Kneer J, Kahl KG, Karst M, Herrmann J, Fournier-Kaiser L, Peters L, Jürgensen F, Nagel M, Prager W, Dulz B, Wohlmuth P, Heßelmann V, Sinke C, Wollmer MA. Neuronal effects of glabellar botulinum toxin injections using a valenced inhibition task in borderline personality disorder. Sci Rep 2022; 12:14197. [PMID: 35987909 PMCID: PMC9392726 DOI: 10.1038/s41598-022-17509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Previous studies have indicated that glabellar botulinum toxin (BTX) injections may lead to a sustained alleviation of depression. This may be accomplished by the disruption of a facial feedback loop, which potentially mitigates the experience of negative emotions. Accordingly, glabellar BTX injection can attenuate amygdala activity in response to emotional stimuli. A prototypic condition with an excess of negative emotionality and impulsivity accompanied by elevated amygdala reactivity to emotional stimuli is borderline personality disorder (BPD). In order to improve the understanding of how glabellar BTX may affect the processing of emotional stimuli and impulsivity, we conducted a functional magnetic resonance imaging (fMRI) study. Our hypotheses were (1) glabellar BTX leads to increased activation in prefrontal areas during inhibition performance and (2) BTX decreases amygdala activity during the processing of emotional stimuli in general. Using an emotional go-/no-go paradigm during fMRI, the interference of emotion processing and impulsivity in a sample of n = 45 women with BPD was assessed. Subjects were randomly assigned to BTX treatment or serial acupuncture (ACU) of the head. After 4 weeks, both treatments led to a reduction in the symptoms of BPD. However, BTX treatment was specifically associated with improved inhibition performance and increased activity in the motor cortex. In addition, the processing of negative emotional faces was accompanied by a reduction in right amygdala activity. This study provides the first evidence that glabellar BTX injections may modify central neurobiological and behavioural aspects of BPD. Since the control treatment produced similar clinical effects, these neurobiological findings may be specific to BTX and not a general correlate of symptomatic improvement.
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11
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Goldfarb EV, Scheinost D, Fogelman N, Seo D, Sinha R. High-Risk Drinkers Engage Distinct Stress-Predictive Brain Networks. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:805-813. [PMID: 35272096 PMCID: PMC9378362 DOI: 10.1016/j.bpsc.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive alcohol intake is a major public health problem and can be triggered by stress. Heavy drinking in patients with alcohol use disorder also alters neural, physiological, and emotional stress responses. However, it is unclear whether adaptations in stress-predictive brain networks can be an early marker of risky drinking behavior. METHODS Risky social drinkers (regular bingers; n = 53) and light drinker control subjects (n = 51) aged 18 to 53 years completed a functional magnetic resonance imaging-based sustained stress protocol with repeated measures of subjective stress state, during which whole-brain functional connectivity was computed. This was followed by prospective daily ecological momentary assessment for 30 days. We used brain computational predictive modeling with cross-validation to identify unique brain connectivity predictors of stress in risky drinkers and determine the prospective utility of stress-brain networks for subsequent loss of control over drinking. RESULTS Risky drinkers had anatomically and functionally distinct stress-predictive brain networks (showing stronger predictions from visual and motor networks) compared with light drinkers (default mode and frontoparietal networks). Stress-predictive brain networks defined for risky drinkers selectively predicted future real-world stress levels for risky drinkers and successfully predicted prospective future real-world loss of control over drinking across all participants. CONCLUSIONS These results indicate adaptations in computationally derived stress-related brain circuitry among high-risk drinkers, suggesting potential targets for early preventive intervention and revealing the malleability of the neural processes that govern stress responses.
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Affiliation(s)
- Elizabeth V. Goldfarb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511,Yale Stress Center, Yale School of Medicine, New Haven, CT 06519,Department of Psychology, Yale University, New Haven, CT 06511,Wu Tsai Institute, Yale University, New Haven, CT 06520
| | - Dustin Scheinost
- Department of Biomedical Engineering, Yale University, New Haven,,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520,Department of Statistics and Data Science, Yale University, New Haven, CT 06511,Child Study Center, Yale University School of Medicine, New Haven, CT 06519
| | - Nia Fogelman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511,Yale Stress Center, Yale School of Medicine, New Haven, CT 06519
| | - Dongju Seo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511,Yale Stress Center, Yale School of Medicine, New Haven, CT 06519
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut; Child Study Center, Yale University School of Medicine, New Haven, Connecticut; Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut.
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12
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Behavioral inhibition and emotional invalidation in the context of personality impairment. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Takahashi T, Sasabayashi D, Velakoulis D, Suzuki M, McGorry PD, Pantelis C, Chanen AM. Heschl's gyrus duplication pattern and clinical characteristics in borderline personality disorder: A preliminary study. Front Psychiatry 2022; 13:1033918. [PMID: 36405909 PMCID: PMC9669378 DOI: 10.3389/fpsyt.2022.1033918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Inter-individual variations in the sulco-gyral pattern of Heschl's gyrus (HG) might contribute to emotional processing. However, it remains largely unknown whether borderline personality disorder (BPD) patients exhibit an altered HG gyrification pattern, compared with healthy individuals, and whether such a brain morphological feature, if present, might contribute to their clinical characteristics. The present study used magnetic resonance imaging to investigate the distribution of HG gyrification patterns (single or duplicated) and their relationship to clinical characteristics in teenage BPD patients with minimal treatment exposure. No significant difference was noted for the prevalence of HG patterns between 20 BPD and 20 healthy participants. However, the BPD participants with left duplicated HG were characterized by higher prevalence of comorbid disruptive behavior disorders, with higher externalizing score compared with those with left single HG. Our preliminary results suggest that neurodevelopmental pathology associated with gyral formation might be implicated in the neurobiology of early BPD, especially for emotional and behavioral control.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Dennis Velakoulis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Patrick D McGorry
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,North Western Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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14
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Fernando SC, Beblo T, Lamers A, Schlosser N, Woermann FG, Driessen M, Toepper M. Neural correlates of emotion acceptance and suppression in borderline personality disorder. Front Psychiatry 2022; 13:1066218. [PMID: 36704727 PMCID: PMC9871986 DOI: 10.3389/fpsyt.2022.1066218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emotion dysregulation is a central feature of borderline personality disorder (BPD). Since impaired emotion regulation contributes to disturbed emotion functioning in BPD, it is crucial to study underlying neural activity. The current study aimed at investigating the neural correlates of two emotion regulation strategies, namely emotion acceptance and suppression, which are both important treatment targets in BPD. METHODS Twenty-one women with BPD and 23 female healthy control participants performed an emotion regulation task during functional magnetic resonance imaging (fMRI). While watching fearful movie clips, participants were instructed to either accept or to suppress upcoming emotions compared to passive viewing. RESULTS Results revealed acceptance-related insular underactivation and suppression-related caudate overactivation in subjects with BPD during the emotion regulation task. CONCLUSION This is a first study on the neural correlates of emotion acceptance and suppression in BPD. Altered insula functioning during emotion acceptance may reflect impairments in emotional awareness in BPD. Increased caudate activity is linked to habitual motor and cognitive processes and therefore may accord to the well-established routine in BPD patients to suppress emotional experiences.
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Affiliation(s)
- Silvia Carvalho Fernando
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Agnes Lamers
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Nicole Schlosser
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Friedrich G Woermann
- Epilepsy Center Bethel, Mara Hospital, University of Bielefeld, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Max Toepper
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
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15
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Wainsztein AE, Castro MN, Goldberg X, Camacho-Téllez V, Vulcano M, Abulafia C, Ladrón-de-Guevara S, Cardoner N, Nemeroff CB, Menchón JM, Soriano-Mas C, Villarreal MF, Guinjoan SM. Childhood adversity modulation of central autonomic network components during cognitive regulation of emotion in major depressive disorder and borderline personality disorder. Psychiatry Res Neuroimaging 2021; 318:111394. [PMID: 34673383 DOI: 10.1016/j.pscychresns.2021.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
Adverse childhood experiences (ACEs) have lifelong effects on emotional behavior and are frequent in Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD). The Central Autonomic Network (CAN), which modulates heart rate variability (HRV), comprises brain regions that mediate emotion regulation processes. However, it remains unclear the effect of ACEs on CAN dynamics and its relationship with HRV in these disorders. We studied the effects of ACEs on the brain and HRV simultaneously, during regulation of psychological stress in 19 BPD, 20 MDD and 20 healthy controls (HC). Participants underwent a cognitive reappraisal task during fMRI with simultaneous ECG acquisition. ACEs exposure was associated with increased activity of CAN and salience network components in patients with MDD compared to BPD during cognitive reappraisal. A brain-autonomic coupling was found in BPD relative to HC during emotion regulation, whereby greater activity of left anterior cingulate and medial superior frontal gyrus areas was coupled with increased HRV. Results suggest that ACEs exposure is associated with a distinct activation of the CAN and salience network regions governing responses to psychological stress in MDD compared to BPD. These alterations may constitute a distinctive neurobiological mechanism for abnormal emotion processing and regulation related to ACEs in MDD.
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Affiliation(s)
- Agustina E Wainsztein
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Mariana N Castro
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Department of Physiology, School of Medicine, UBA, Argentina
| | - Ximena Goldberg
- Mental Health Department, Neuroscience and Mental Health Research Area, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Vicente Camacho-Téllez
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Department of Psychiatry, FLENI, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Mercedes Vulcano
- Department of Psychiatry, FLENI, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina
| | - Carolina Abulafia
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Soledad Ladrón-de-Guevara
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Narcís Cardoner
- Mental Health Department, Neuroscience and Mental Health Research Area, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Charles B Nemeroff
- Institute for Early Life Adversity Research, Dell Medical School, The University of Texas at Austin, United States of America
| | - José M Menchón
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Physics, UBA, Argentina; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Mirta F Villarreal
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Department of Physics, UBA, Argentina
| | - Salvador M Guinjoan
- Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Laureate Institute for Brain Research, Tulsa, United States of America; Neurophysiology, School of Psychology, UBA, Argentina.
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16
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Caudate hyperactivation during the processing of happy faces in borderline personality disorder. Neuropsychologia 2021; 163:108086. [PMID: 34774878 DOI: 10.1016/j.neuropsychologia.2021.108086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Emotion dysfunction and anhedonia are main problems in borderline personality disorder (BPD). In the present functional magnetic resonance imaging (fMRI) study, we investigated neural activation during the processing of happy faces and its correlates with habitual emotion acceptance in patients with BPD. METHODS 22 women with BPD and 26 female healthy controls watched movie clips of happy and neutral faces during fMRI without any instruction of emotion regulation. To associate neural activation with habitual emotion acceptance, we included individual scores of the Emotion Acceptance Questionnaire (EAQ) as a covariate in brain data analysis. RESULTS All participants showed amygdala, temporal and occipital activation during the processing of happy compared to neutral faces. Compared with healthy controls, patients with BPD showed significantly more activation within the bilateral caudate. We did not find significant correlations with emotion acceptance. CONCLUSIONS Our results indicate caudate hyperactivation in patients with BPD during the processing of happy faces. Although patients reported significantly less emotion acceptance of positive emotions, an association with neural activation was not detectable.
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17
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Neukel C, Bertsch K, Wenigmann M, Spieß K, Krauch M, Steinmann S, Herpertz SC. A Mechanism-Based Approach to Anti-Aggression Psychotherapy in Borderline Personality Disorder: Group Treatment Affects Amygdala Activation and Connectivity. Brain Sci 2021; 11:brainsci11121627. [PMID: 34942929 PMCID: PMC8699721 DOI: 10.3390/brainsci11121627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Aggression is highly prevalent in borderline personality disorder (BPD). Previous studies have identified specific biobehavioral mechanisms underlying aggression in BPD, threat sensitivity being among them. We composited the mechanism-based anti-aggression psychotherapy (MAAP) in order to target these specific mechanisms, and MAAP was found to be superior to non-specific supportive psychotherapy (NSSP) in reducing aggressive behavior. In the present study, we investigated whether underlying brain mechanisms expected to be involved were affected by MAAP. To this end, n = 33 patients with BPD and overt aggressive behavior (n = 20 in MAAP, n = 13 in NSSP) and n = 25 healthy participants took part in a functional magnetic resonance imaging emotional face-matching task before and after treatment, or at a similar time interval for controls. Overt aggressive behavior was assessed using the overt aggression scale, modified. Results showed a decrease in amygdala activation in response to facial stimuli after MAAP, whereas an increase in amygdala activation was found after NSSP. Furthermore, in the MAAP group, connectivity between amygdala and dorsomedial prefrontal cortex increased from pre- to post-treatment compared to the NSSP group. Hence, the results suggest an impact of MAAP on brain mechanisms underlying the salience circuit in response to threat cues.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Correspondence:
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Department of Psychology, Ludwig-Maximilians-University Munich, 80802 Munich, Germany
| | - Marc Wenigmann
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
| | - Karen Spieß
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Institute of Medical Psychology, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany
| | - Sylvia Steinmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany;
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
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18
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Zarnowski O, Ziton S, Holmberg R, Musto S, Riegle S, Van Antwerp E, Santos-Nunez G. Functional MRI findings in personality disorders: A review. J Neuroimaging 2021; 31:1049-1066. [PMID: 34468063 DOI: 10.1111/jon.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.
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Affiliation(s)
- Oskar Zarnowski
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shirley Ziton
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rylan Holmberg
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sarafina Musto
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean Riegle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Emily Van Antwerp
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Gabriela Santos-Nunez
- University of Massachusetts Memorial Medical Center, Radiology Department, Worcester, Massachusetts, USA
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19
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De la Peña-Arteaga V, Berruga-Sánchez M, Steward T, Martínez-Zalacaín I, Goldberg X, Wainsztein A, Abulafia C, Cardoner N, Castro MN, Villarreal M, Menchón JM, Guinjoan SM, Soriano-Mas C. An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder. Eur Psychiatry 2021; 64:e56. [PMID: 34465401 PMCID: PMC8516744 DOI: 10.1192/j.eurpsy.2021.2231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations. METHODS We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity. RESULTS When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. CONCLUSIONS This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders.
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Affiliation(s)
- Víctor De la Peña-Arteaga
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
| | - Mercedes Berruga-Sánchez
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Ignacio Martínez-Zalacaín
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
| | - Ximena Goldberg
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Agustina Wainsztein
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto de Investigaciones Biomédicas, Facultad de Medicina, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Carolina Abulafia
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
| | - Narcís Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mariana N. Castro
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Department of Physiology and Department of Mental Health, Medicine School, University of Buenos Aires, Buenos Aires, Argentina
| | - Mirta Villarreal
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - José M. Menchón
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Salvador M. Guinjoan
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Carles Soriano-Mas
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
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20
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Functional alterations of the suicidal brain: a coordinate-based meta-analysis of functional imaging studies. Brain Imaging Behav 2021; 16:291-304. [PMID: 34351557 DOI: 10.1007/s11682-021-00503-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 01/22/2023]
Abstract
Altered brain activities in suicidal subjects have been reported in a number of neuroimaging studies. However, the activity aberrances were inconsistent in previous investigations. Thus, we aimed to address activity abnormalities in suicidal individuals. Databases were searched to perform a meta-analysis of whole-brain functional MRI studies of suicidal individuals through January 14, 2020. Meta-analyses were conducted using Seed-based d Mapping software. Based on a meta-analysis of 17 studies comprising 381 suicidal individuals and 642 controls, we mainly found that increased activity in the bilateral superior temporal gyrus, left middle temporal gyrus, and bilateral middle occipital gyrus, along with decreased activity in the right putamen and left insula, were detected in suicidal individuals compared with nonsuicidal subjects. To reduce methodological heterogeneity between the included studies, subanalyses of behavioral domains were conducted, and the right superior temporal gyrus was found to increase in all subanalyses of domains. In subanalyses of suicidal attempters and ideators, suicide attempters displayed hyperactivation in the bilateral superior temporal gyrus and left middle temporal gyrus and blunted responses in the left insula relative to controls. Suicidal ideators demonstrated elevated activation in the right middle occipital gyrus and reduced activity in the right putamen relative to controls. The bilateral superior temporal gyrus was the most robust finding, replicable in all data sets in the jackknife sensitive analysis. Moreover, increased activity in the right superior temporal gyrus, left middle temporal gyrus, and right middle occipital gyrus was found to be involved with higher suicide ideation scores. This study revealed several brain regions associated with suicidality. These findings may contribute to our understanding of the pathophysiology of suicide and have important implications for suicide prevention and interventions.
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21
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Less is more: Morphometric and psychological differences between low and high reappraisers. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 20:128-140. [PMID: 31858436 DOI: 10.3758/s13415-019-00757-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Emotion regulation plays a crucial role in an individual's well-being, as it is known that deficits in regulating emotions can lead to psychological and psychiatric disorders. Cognitive reappraisal is widely considered to be an adaptive and effective emotion-regulation strategy. People are more or less able to apply it, but it is still not clear how reappraisal affects brain structures and the psychological profile of individuals. In our study we thus aimed to explore the impact of applying reappraisal at both the neural and the psychological level. Source-based morphometry (SBM), a whole-brain multivariate method based on the Independent Component Analysis that extracts patterns of covariation of gray matter ("independent networks"), was applied to the MRI images of 37 participants. In order to enrich their psychological profiles, we measured their experienced affectivity (PANAS) and their empathic abilities (IRI). Based on the frequency of applying reappraisal (ERQ), participants were divided into low and high reappraisers (18 vs. 19). An independent source of gray matter emerged as being different between the groups: specifically, low reappraisers showed more gray matter volume concentration in a network including the frontal, temporal, and parietal regions as compared to high reappraisers. At the psychological level, low reappraisers reported a more strongly experienced negative affect, while no difference among reappraisers emerged with regard to empathic abilities. Capitalizing on a multivariate method for structural analysis that is innovative in this field, this study extends previous observations on individual differences in the ability to regulate emotions, and it describes a plausible impact of reappraisal on brain structures and affectivity.
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22
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Aberrant functional connectivity profiles of brain regions associated with salience and reward processing in female patients with borderline personality disorder. Brain Imaging Behav 2021; 14:485-495. [PMID: 30847803 DOI: 10.1007/s11682-019-00065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Recent resting-state functional connectivity studies have shown significant group differences in several networks between patients suffering from borderline personality disorder (BPD) and healthy controls. However, reliable and consistent findings have not been reported yet. Several methodological factors might be responsible for the discrepant findings, including the heterogeneity of patient samples in terms of symptom severity. In the current study, we combined investigations of the whole-brain resting-state functional connectivity patterns of BPD patients with seed-based connectivity measures and then computed the correlation of connectivity measures with borderline symptom severity. Correlation-based connectivity analysis was performed on resting-state functional magnetic resonance imaging (fMRI) data from 26 female BPD patients and 26 healthy controls. Increased intrinsic connectivity was found in clusters involving part of the caudate nucleus and the left insula in the patient group, indicating greater integration of each region. Further seed-based connectivity analyses revealed that with the caudate seed, the patient data exhibited an increased resting-state functional connectivity in the bilateral ventral striatum and the midline prefrontal regions extending to the ACC, a network associated with reward processing. The left insula seed showed significantly increased connectivity with the bilateral fronto-orbital/insula, the inferior parietal lobule and the mid-cingulate cortex, a network involved in attention and salience encoding, in the patient population. Moreover, symptom severity, as assessed with the BSL-95 outside the scanner, was negatively correlated with the coupling of the insula and the striatum in the BPD group. Overall, an increased functional connectivity within two large-scale circuitries underlying reward and salience processing was evident in patients, as compared to healthy participants. When correlated with borderline symptom severity, a reduced connectivity between key regions belonging to the reward system and salience network was observed in the patients. These findings may be helpful for facilitating further understanding of the potential mechanisms underlying the BPD pathophysiology and thereby delineate potential treatment targets.
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23
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Ferber SG, Hazani R, Shoval G, Weller A. Targeting the Endocannabinoid System in Borderline Personality Disorder: Corticolimbic and Hypothalamic Perspectives. Curr Neuropharmacol 2021; 19:360-371. [PMID: 32351183 PMCID: PMC8033970 DOI: 10.2174/1570159x18666200429234430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD - the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary - gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.
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Affiliation(s)
| | | | - Gal Shoval
- Address correspondence to this author at the Geha Mental Health Center, Petah Tiqva, Israel; Tel: 972-3-925-8440; Fax: 972-3-925-8276;, E-mail:
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24
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Sverak T, Linhartova P, Gajdos M, Kuhn M, Latalova A, Lamos M, Ustohal L, Kasparek T. Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder. Front Psychiatry 2021; 12:770353. [PMID: 35115961 PMCID: PMC8804206 DOI: 10.3389/fpsyt.2021.770353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) is an innovative method in the treatment of borderline personality disorder (BPD). We hypothesized that prefrontal rTMS in patients with BPD leads to improved BPD symptoms and that these effects are associated with brain connectivity changes. METHODS Fourteen patients with BPD received 15 sessions of individually navigated prefrontal rTMS over the right dorsolateral prefrontal cortex. Clinical effects were measured by the Borderline Symptom List 23, UPPS-P, the Difficulties in Emotion Regulation Scale (DERS), the Zung Self-Rating Anxiety Scale (SAS), and the Montgomery and Åsberg Depression Rating Scale (MADRS). Effects of rTMS on brain connectivity were observed with a seed correlation analysis on resting-state fMRI and with a beta series correlation analysis on Go/No Go tasks during fMRI. Assessments were made before and immediately after the treatment. RESULTS The assessments after rTMS showed significant reductions in two subscales of UPPS-P, and in DERS, SAS, and MADRS. The brain connectivity analysis revealed significant decreases in amygdala and insula connectivity with nodes of the posterior default mode network (pDMN; precuneus, posterior cingulate cortex, parietal lobules). Connectivity changes were observed both in the resting state and during inhibition. The decrease of amygdala-pDMN connectivity was positively correlated with reduced depression and lack of premeditation after rTMS. CONCLUSIONS Despite the study limitations (open single-arm study in a small sample), our findings suggest a possible neural mechanism of rTMS effect in BPD, reduced amygdala connectivity with the pDMN network, which was positively associated with symptom reduction.
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Affiliation(s)
- Tomas Sverak
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Gajdos
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Matyas Kuhn
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Adela Latalova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Lamos
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Libor Ustohal
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomas Kasparek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
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25
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Molina-Ruiz RM, García-Saiz T, Looi JCL, Via Virgili E, Rincón Zamorano M, de Anta Tejado L, López HT, Perera JLC, Díaz-Marsá M. Neural Mechanisms in Eating Behaviors: A Pilot fMRI Study of Emotional Processing. Psychiatry Investig 2020; 17:225-236. [PMID: 32160692 PMCID: PMC7113175 DOI: 10.30773/pi.2019.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/14/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Emotional processing dysfunction evident in eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN), is considered relevant to the development and maintenance of these disorders. The purpose of the current functional magnetic resonance imaging (fMRI) study was to pilot a comparison of the activity of the fronto-limbic and fronto-striatal brain areas during an emotion processing task in persons with ED. METHODS 24 women patients with ED were scanned, while showing emotionally stimulating (pleasant, unpleasant) and neutral images from the International Affective Picture System (IAPS). RESULTS During the pleasant condition, significant differences in Dorsolateral Prefrontal Cortex (DLPFC) activations were found with AN participants presenting greater activation compared to BN and ED comorbid groups (EDc) and healthy controls also showing greater activation of this brain area compared to BN and EDc. Left putamen was less activated in EDc compared to both controls (C) and AN. During the unpleasant condition, AN participants showed hyperactivation of the Orbito-frontal Cortex (OFC) when compared to EDc. CONCLUSION This study highlights the potential functional relevance of brain areas that have been associated with self-control. These findings should help advance understanding the neural substrate of ED, though they should be considered as preliminary and be cautiously interpreted.
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Affiliation(s)
- Rosa M Molina-Ruiz
- Psychiatry Department, Universitary Hospital Clinico San Carlos de Madrid, IddISC, Madrid, Spain
| | - T García-Saiz
- Artificial Intelligence Department, UNED. E.T.S.I. Informatics, Madrid, Spain
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia
| | - E Via Virgili
- Hospital Materno-Infantil Sant Joan de Déu, Barcelona, Spain
| | - M Rincón Zamorano
- Artificial Intelligence Department, UNED. E.T.S.I. Informatics, Madrid, Spain
| | - Laura de Anta Tejado
- Psychiatry Department, Universitary Hospital Clinico San Carlos de Madrid, IddISC, Madrid, Spain
| | - Helena Trebbau López
- Psychiatry Department, Universitary Hospital Clinico San Carlos de Madrid, IddISC, Madrid, Spain
| | | | - Marina Díaz-Marsá
- Psychiatry Department, Universitary Hospital Clinico San Carlos de Madrid, IddISC, Madrid, Spain
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26
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Bortolla R, Cavicchioli M, Fossati A, Maffei C. Emotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory Studies. J Pers Disord 2020; 34:64-87. [PMID: 30355020 DOI: 10.1521/pedi_2018_32_382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Emotional hyperreactivity (Linehan, 1993) is the most investigated construct in borderline personality disorder (BPD). However, experimental studies revealed mixed results on the topic. Our main objective is to comprehensively summarize the results on emotional reactivity in BPD compared to healthy controls (HCs), using a meta-analytic approach, considering different emotional response systems (physiology, behavior, self-report). We included 31 experimental studies (1,675 subjects). We observed null to small effect sizes for several physiological and behavioral outcomes. Conversely, BPD subjects revealed a moderate to large difference in valence attributed to emotional stimuli and a small difference in self-reported arousal. Significant differences in pooled effect sizes were found between self-report and physiological outcomes. Several sources of heterogeneity were explored. In general, the hyperreactivity hypothesis was not supported. Additional dysfunctional processes should be taken into consideration to understand BPD emotional responsiveness.
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Affiliation(s)
| | | | | | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Hospital, Milan
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27
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Bilek E, Itz ML, Stößel G, Ma R, Berhe O, Clement L, Zang Z, Robnik L, Plichta MM, Neukel C, Schmahl C, Kirsch P, Meyer-Lindenberg A, Tost H. Deficient Amygdala Habituation to Threatening Stimuli in Borderline Personality Disorder Relates to Adverse Childhood Experiences. Biol Psychiatry 2019; 86:930-938. [PMID: 31366446 DOI: 10.1016/j.biopsych.2019.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 06/09/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heightened amygdala response to threatening cues has been repeatedly observed in borderline personality disorder (BPD). A previous report linked hyperactivation to deficient amygdala habituation to repeated stimuli, but the biological underpinnings are incompletely understood. METHODS We examined a sample of 120 patients with BPD and 115 healthy control subjects with a well-established functional magnetic resonance imaging emotional face processing task to replicate the previously reported amygdala habituation deficit in BPD and probed this neural phenotype for associations with symptom severity and early social risk exposure. RESULTS Our results confirm a significant reduction in amygdala habituation to repeated negative stimuli in BPD (pFWE = .015, peak-level familywise error [FWE] corrected for region of interest). Post hoc comparison and regression analysis did not suggest a role for BPD clinical state (pFWE > .56) or symptom severity (pFWE > .45) for this phenotype. Furthermore, deficient amygdala habituation was significantly related to increased exposure to adverse childhood experiences (pFWE = .013, region of interest corrected). CONCLUSIONS Our data replicate a prior report on deficient amygdala habituation in BPD and link this neural phenotype to early adversity, a well-established social environmental risk factor for emotion dysregulation and psychiatric illness.
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Affiliation(s)
- Edda Bilek
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany.
| | - Marlena L Itz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Gabriela Stößel
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Ren Ma
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Laura Clement
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Lydia Robnik
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Michael M Plichta
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Corinne Neukel
- Department of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelburg University, Mannheim, Germany
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28
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Lei X, Zhong M, Zhang B, Yang H, Peng W, Liu Q, Zhang Y, Yao S, Tan C, Yi J. Structural and Functional Connectivity of the Anterior Cingulate Cortex in Patients With Borderline Personality Disorder. Front Neurosci 2019; 13:971. [PMID: 31572119 PMCID: PMC6753388 DOI: 10.3389/fnins.2019.00971] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background Emerging evidences supported the hypothesis that emotional dysregulation results from aberrant connectivity within the fronto-limbic neural networks in patients with borderline personality disorder (BPD). Considering its important role in emotional regulation, the anterior cingulate cortex (ACC) has not yet been fully explored in BPD patients. Therefore, using the seed-based resting state functional connectivity (rsFC) and probabilistic fiber tracking, we aimed to explore the alterations of functional and structural connectivity (SC) of the ACC in patients with BPD. Methods A cohort of 50 unmedicated, young BPD patients and 54 sex-, age-, and education-matched healthy controls (HCs) completed psychological tests and underwent rs-fMRI and diffuse tensor imaging (DTI) scanning. Rs-FC analysis and probabilistic fiber tracking were used to plot SC and FC of the ACC. Results With the left ACC selected as a seed, BPD patients exhibited increased rsFC and abnormal SC with the right middle frontal gyrus (MFG), and decreased rsFC with the left middle temporal gyrus (MTG), compared with HCs. Additionally, negative cognitive emotion regulation and depressive symptoms both correlated negatively with the rsFC of the left ACC in BPD patients. Conclusion Abnormal SC and FC of the ACC underlie the deficient emotional regulation circuitry in BPD patients. Such alterations may be important biomarkers of BPD and thus could point to potential BPD treatment targets.
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Affiliation(s)
- Xiaoxia Lei
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Bowen Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Huihui Yang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanrong Peng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qian Liu
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Yu Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
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29
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Lamers A, Toepper M, Fernando SC, Schlosser N, Bauer E, Woermann F, Driessen M, Beblo T. Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum. J Psychiatry Neurosci 2019; 44:303-312. [PMID: 30964611 PMCID: PMC6710090 DOI: 10.1503/jpn.180077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emotion dysfunction is a key symptom in patients with borderline personality disorder (BPD) and is considered a consequence of dysfunctional emotion regulation (e.g., reduced emotion acceptance). In the present functional MRI (fMRI) study, we investigated the neural correlates of habitual emotion acceptance in individuals with BPD. METHODS Female patients with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. We assessed emotion acceptance using the Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analyses of activation intensity during negative compared with neutral movies. RESULTS We included 20 women with BPD and 20 heatlhy controls in our analysis. Compared with healthy controls, patients with BPD showed significantly more activation in frontostriatal brain regions (i.e., left superior frontal gyrus, right caudate) as well as in the left precuneus, left precentral gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative (v. neutral) stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of striatal areas (i.e., left putamen, left caudate) in patients with BPD. LIMITATIONS Causal conclusions are not possible. Comorbid diagnoses were not excluded, and only female participants were investigated. Stimuli were not rated immediately and may not be generalizable to all negative emotions. We cannot make any statements about other emotion-regulation strategies that may have been applied here. CONCLUSION Data indicate that striatal hyperactivation during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus, individuals with BPD may benefit from therapy approaches that focus on emotion acceptance in order to normalize emotional reactions.
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Affiliation(s)
- Agnes Lamers
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Max Toepper
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Silvia Carvalho Fernando
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Nicole Schlosser
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Eva Bauer
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Friedrich Woermann
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Martin Driessen
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Thomas Beblo
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
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Toward an animal model of borderline personality disorder. Psychopharmacology (Berl) 2019; 236:2485-2500. [PMID: 31201478 PMCID: PMC6697600 DOI: 10.1007/s00213-019-05289-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a pervasive psychiatric disorder characterized by emotion dysregulation, impulsivity, impaired self-perceptions, and interpersonal relationships and currently affects 1-3% of the US population as reported by Torgersen et al. (Arch Gen Psychiatry 58:590-596, Torgersen et al. 2001), Lenzenweger et al. (Biol Psychiatry 62:553-564, Lenzenweger et al. 2007), and Tomko et al. (J Personal Disord 28:734-750, Tomko et al. 2014). One major obstacle to our understanding of the neural underpinnings of BPD is a lack of valid animal models that translate the key known features of the disorder to a system that is amenable to study. OBJECTIVE To summarize the etiology, major symptoms, and symptom triggers of BPD and then propose a blueprint for building an animal model of BPD by choosing key components of the disorder that can be implemented in rodents. RESULTS We identify the role of early life stress and subsequent mild stress in adulthood as contributing etiological factors and the potential use of altered communication between frontal cortices and the amygdala in extinction and habituation, increased impulsivity, dysregulation of the hypothalamic pituitary axis (HPA), and increased neuroinflammation as biological markers of BPD. Building upon these features of BPD, we propose a two-hit animal model that uses maternal abandonment to alter maturation of the HPA axis and mild secondary adult stress to evoke behavioral symptoms such as increased impulsivity and impaired extinction, habituation, and social interactions. CONCLUSION Through exploration of the etiology, symptom presentation, and altered neurological function, we propose an animal model of BPD. We believe that a number of existing animal paradigms that model other mental health disorders should be combined in a unique way to reflect the etiology, symptom presentation, and altered neurological function that is evident in BPD. These model, when compared with available human data, will inform research and treatment in humans for better understanding of systems from the micro-molecular level to more global physiology underlying BPD.
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Abstract
The status of borderline personality disorder (BPD) as a diagnostic category is a matter of continuing controversy. In the United States, BPD is one of the most frequent diagnoses of psychiatric inpatients, and a similar tendency emerges in Europe. Nearly all theoretical aspects of BPD have been questioned, including its very position as a personality disorder. In this article, we trace the evolution of the borderline concept from the beginning of the 20th century to the current psychometric research. We argue that the status of BPD is fraught with conceptual difficulties, including an unrecognized semantic drift of major phenomenological terms (e.g., identity), a lack of general principles for the distinction of BPD and the major psychiatric syndromes (e.g., schizophrenia spectrum disorders), and insufficient definitions of key nosological concepts. These difficulties illustrate general problems in today's psychiatry that require consideration.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
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Quattrini G, Marizzoni M, Magni LR, Magnaldi S, Lanfredi M, Rossi G, Frisoni GB, Pievani M, Rossi R. Whole-brain microstructural white matter alterations in borderline personality disorder patients. Personal Ment Health 2019; 13:96-106. [PMID: 30989833 DOI: 10.1002/pmh.1441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/27/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a psychiatric condition associated with the impairment of the frontolimbic network. However, a growing body of studies suggests that brain dysfunction underling BPD could involve other brain areas. We explored the whole-brain white matter (WM) organization in BPD patients to clarify the structural pattern underlying the disease and its relationship with clinical features. METHODS Fourteen BPD patients and 14 healthy controls underwent a multidimensional clinical assessment and diffusion tensor imaging acquisition. Measures of fractional anisotropy (FA) and mean, axial and radial (RD) diffusivity were collected, and alterations in the WM were assessed using the voxelwise approach, including substance and alcohol abuse as covariates. Voxelwise regression analysis was performed to identify associations between microstructural changes and clinical feature in BPD. RESULTS Group comparisons showed alterations only for FA and RD: FA decreased in the right posterior hemisphere, while RD increased bilaterally and widespread in anterior and posterior areas (p < 0.05, threshold-free cluster enhancement corrected). Moreover, WM alterations of the corpus callosum were related to anxiety in BPD group. DISCUSSION Our data support the idea that structural alterations underling BPD also involve cortico-cortical pathways, corticothalamic and corticostriatal tracts, suggesting that the frontolimbic model should be reinterpreted. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Giulia Quattrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura R Magni
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Magnaldi
- Department of Neuroradiology, Poliambulanza Hospital, Brescia, Italy
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Psychiatry, LANVIE-Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Peter M, Arntz A, Klimstra TA, Faulborn M, Vingerhoets AJJM. Subjective emotional responses to IAPS pictures in patients with borderline personality disorder, cluster-C personality disorders, and non-patients. Psychiatry Res 2019; 273:712-718. [PMID: 31207857 DOI: 10.1016/j.psychres.2019.01.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022]
Abstract
According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.
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Affiliation(s)
- M Peter
- Department of Personality Disorders, GGz Breburg, Lage Witsiebaan 4, Tilburg, the Netherlands.
| | - A Arntz
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam, the Netherlands
| | - T A Klimstra
- Developmental Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
| | - M Faulborn
- Department of Forensic Psychiatry, GGz Breburg, Lage Witsiebaan 4, Tilburg, the Netherlands
| | - A J J M Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
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Sosic-Vasic Z, Eberhardt J, Bosch JE, Dommes L, Labek K, Buchheim A, Viviani R. Mirror neuron activations in encoding of psychic pain in borderline personality disorder. Neuroimage Clin 2019; 22:101737. [PMID: 30844640 PMCID: PMC6402375 DOI: 10.1016/j.nicl.2019.101737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023]
Abstract
Borderline personality disorder (BPD) is characterized by pronounced emotional instability in interpersonal relations. Previous studies have shown increased activity in the amygdala, an imaging phenotype of negative affect. However, clinical accounts of BPD have drawn attention to deficits in social cognition and their likely role in engendering emotional instability. BPD patients show enhanced sensitivity to other people's emotions, while being less proficient in reading motives and reasons. In the present functional imaging study, we exposed BPD participants to stylized scenes of individuals affected by loss or separation, an issue to which these patients are particularly sensitive. Previously shown to activate the mirror neuron system, these mourning scenes were here also used to assess differential amygdala activity in stimuli of negative valence, but low arousal. Relative to controls, BPD patients were found to activate sensorimotor areas, a part of the mirror neuron system thought to encode basic aspects of the perception of motoric activity and pain. This contrasted with the activity of areas related to more complex aspects of social cognition, such as the inferior frontal gyrus. The amygdala was more active in patients when viewing these scenes, but this effect also showed a strong association with levels of depressiveness and neuroticism. After adjusting for these covariates, differences in amygdala activation were no longer significant. These findings are consistent with models of social cognition in BPD that attribute emotional sensitivity to emotional contagion through the mirror neuron system, in contrast to areas associated with more sophisticated forms of social cognition. These effects were accompanied by increased amygdala reactivity, consistently with the common occurrence of affective symptoms in these patients.
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Affiliation(s)
- Zrinka Sosic-Vasic
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Julia Eberhardt
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Julia E Bosch
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Lisa Dommes
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
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Iyengar U, Rajhans P, Fonagy P, Strathearn L, Kim S. Unresolved Trauma and Reorganization in Mothers: Attachment and Neuroscience Perspectives. Front Psychol 2019; 10:110. [PMID: 30761051 PMCID: PMC6363675 DOI: 10.3389/fpsyg.2019.00110] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
The onset of motherhood is characterized by significant psychological and neurobiological changes. These changes equip the mother to care for her new child. Although rewarding, motherhood is also an inherently stressful period, more so for mothers with unresolved trauma. Past research has looked at how unresolved trauma can hamper a mother’s caregiving response toward her infant, which further affects the development of secure attachment in her own infant. The Dynamic Maturational Model of Attachment and Adaptation (DMM) has introduced a unique concept of “attachment reorganization” which can be described as a process whereby individuals with unresolved trauma are transitioning toward attachment security based on their enhanced understanding of past and present experiences. Preliminary results from one of our previous studies have shown that, among mothers with unresolved trauma, mothers who themselves demonstrated “reorganizing attachment” toward security, had infants with secure attachment, thereby indicating the potential to halt the intergenerational transmission of insecure attachment. While this concept is of great clinical relevance, further research is required to assess the benefits of attachment reorganization as a protective factor and its positive implications for child development. Thus, the aim of the current review is to expand on the concept of attachment reorganization in mothers with unresolved trauma from both attachment and neuroscience perspectives. To that effect, we will first review the literature on the transition to motherhood from attachment and neuroscience perspectives. Second, we will use attachment and neuroscience approaches to address deviations from normative experiences during motherhood with a specific focus on the role of a mother’s unresolved trauma. Lastly, we will expand on the concept of reorganization and the promise this concept holds in resolving or halting the intergenerational transmission of trauma from mothers to their children.
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Affiliation(s)
- Udita Iyengar
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Purva Rajhans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Peter Fonagy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Anna Freud National Centre for Children and Families, London, United Kingdom.,Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States.,Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
| | - Sohye Kim
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.,Center for Reproductive Psychiatry, Pavilion for Women, Texas Children's Hospital, Houston, TX, United States
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36
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Flasbeck V, Enzi B, Brüne M. Enhanced Processing of Painful Emotions in Patients With Borderline Personality Disorder: A Functional Magnetic Resonance Imaging Study. Front Psychiatry 2019; 10:357. [PMID: 31191371 PMCID: PMC6545793 DOI: 10.3389/fpsyt.2019.00357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022] Open
Abstract
Previous research has demonstrated that patients with borderline personality disorder (BPD) are more sensitive to negative emotions and often show poor cognitive empathy, yet preserved or even superior emotional empathy. However, little is known about the neural correlates of empathy. Here, we examined empathy for pain in 20 patients with BPD and 19 healthy controls (HC) in a functional magnetic resonance imaging (fMRI) study, which comprised an empathy for pain paradigm showing facial emotions prior to hands exposed to painful stimuli. We found a selectively enhanced activation of the right supramarginal gyrus for painful hand pictures following painful facial expressions in BPD patients, and lower activation to nonpainful pictures following angry expressions. Patients with BPD showed less activation in the left supramarginal gyrus when viewing angry facial expressions compared to HC, independent of the pain condition. Moreover, we found differential activation of the left anterior insula, depending on the preceding facial expression exclusively in patients. The findings suggest that empathy for pain becomes selectively enhanced, depending on the emotional context information in patients with BPD. Another preliminary finding was an attenuated response to emotions in patients receiving psychotropic medication compared to unmedicated patients. These effects need to be replicated in larger samples. Together, increased activation during the observation of painful facial expressions seems to reflect emotional hypersensitivity in BPD.
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Affiliation(s)
- Vera Flasbeck
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Björn Enzi
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Brüne
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr-University, Bochum, Germany
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37
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Conceptual Models of Borderline Personality Disorder, Part 2: A Process Approach and Its Implications. Psychiatr Clin North Am 2018; 41:549-559. [PMID: 30447723 DOI: 10.1016/j.psc.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In part 2, the authors argue for a greater focus on a process approach to conceptualizing borderline personality disorder (BPD). The studies reviewed highlight contextual aspects of the pathology, specifically the affective and relational conditions under which BPD features become evident. The authors identify at what level in a complex social cognitive process the pathology may emerge. The implications of these findings for future model conceptualization are discussed, including the centrality of understanding BPD as an emergent phenomenon that cannot be reduced to single explanatory dimensions. The implications of these models for assessment, research, and treatment of BPD are discussed.
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38
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Schulze L, Schulze A, Renneberg B, Schmahl C, Niedtfeld I. Neural Correlates of Affective Disturbances: A Comparative Meta-analysis of Negative Affect Processing in Borderline Personality Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:220-232. [PMID: 30581154 DOI: 10.1016/j.bpsc.2018.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) are prominent examples of mental disorders with affective disturbances. Notably, all three disorders share a generally heightened negative affect, which is presumably the result of shared neural abnormalities in affective processing. In this meta-analysis, we aimed to identify transdiagnostic and disorder-specific abnormalities during the processing of negative compared with neutral stimuli. METHODS We synthesized neuroimaging findings of affect processing in BPD, MDD, and PTSD and calculated combined coordinate- and image-based meta-analyses. The analysis comprised 70 distinct study samples with a total of 31 unthresholded statistical parametric maps. Twenty-four studies had a focus on BPD (431 individuals with BPD, 436 healthy control subjects [HCs]), 32 studies on MDD (789 individuals with current MDD, 870 HCs), and 14 studies on PTSD (247 individuals with PTSD, 245 HCs). RESULTS Findings showed limbic hyperactivations in BPD and PTSD compared with limbic activation of HCs. In contrast, patients with MDD showed blunted amygdala activation in comparison with that of HCs. Additionally, the calculation of overlapping brain abnormalities in BPD, MDD, and PTSD highlighted transdiagnostic hyperactivation of the right median cingulate gyri and hypoactivation of the right middle frontal gyrus and the right middle occipital gyrus. Finally, disorder-specific comparisons also illustrate unique abnormalities for each mental disorder. CONCLUSIONS The present results support shared and disorder-specific neural abnormalities in patients with affective disturbances.
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Affiliation(s)
- Lars Schulze
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
| | - Andreas Schulze
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
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Scalabrini A, Mucci C, Northoff G. Is Our Self Related to Personality? A Neuropsychodynamic Model. Front Hum Neurosci 2018; 12:346. [PMID: 30337862 PMCID: PMC6180150 DOI: 10.3389/fnhum.2018.00346] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
The concept and the assessment of personality have been extensively discussed in psychoanalysis and in clinical psychology over the years. Nowadays there is large consensus in considering the constructs of the self and relatedness as central criterions to assess the personality and its disturbances. However, the relation between the psychological organization of personality, the construct of the self, and its neuronal correlates remain unclear. Based on the recent empirical data on the neural correlates of the self (and others), on the importance of early relational and attachment experiences, and on the relation with the brain's spontaneous/resting state activity (rest-self overlap/containment), we propose here a multilayered model of the self with: (i) relational alignment; (ii) self-constitution; (iii) self-manifestation; and (iv) self-expansion. Importantly, these different layers of the self can be characterized by different neuronal correlates-this results in different neuronally grounded configurations or organizations of personality. These layers correspond to different levels of personality organization, such as psychotic (as related to the layer of self-constitution), borderline (as related to the layer of self-manifestation) and neurotic (as related to the layer of self-expansion). Taken together, we provide here for the first time a neurobiologically and clinically grounded model of personality organization, which carries major psychodynamic and neuroscientific implications. The study of the spontaneous activity of the brain, intrinsically related to the self (rest-self overlap/containment) and the interaction with stimuli (rest-stimulus interaction) may represent a further advance in understanding how our default state plays a crucial role in navigating through the internal world and the external reality.
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Affiliation(s)
- Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Clara Mucci
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Georg Northoff
- University of Ottawa Institute of Mental Health Research and University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China
- Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
- TMU Research Centre for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
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40
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Vai B, Sforzini L, Visintini R, Riberto M, Bulgarelli C, Ghiglino D, Melloni E, Bollettini I, Poletti S, Maffei C, Benedetti F. Corticolimbic Connectivity Mediates the Relationship between Adverse Childhood Experiences and Symptom Severity in Borderline Personality Disorder. Neuropsychobiology 2018; 76:105-115. [PMID: 29860262 DOI: 10.1159/000487961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/15/2018] [Indexed: 01/13/2023]
Abstract
The interaction between biological and environmental factors (especially adverse childhood experiences, ACEs) plays a crucial role in the development and maintenance of borderline personality disorder (BPD). These factors act influencing BPD core features such as pervasive instability in affect regulation, impulse control, social cognition, and interpersonal relationships. In line with this perspective, abnormalities in social cognition and related neurobiological underpinnings could mediate the relationship between ACEs and psychopathological manifestations in adulthood. In a sample of 14 females, functional connectivity (FC) analyses were performed modeling the interaction between ACEs and corticolimbic dysregulation during emotional processing and its relationship with BPD symptom severity. ACEs were associated with a dampening of the negative FC between (1) the right amygdala (Amy) and right dorsolateral prefrontal cortex (DLPFC) and between (2) the left Amy and bilateral DLPFC, right precuneus, left cerebellum and left dorsomedial prefrontal cortex during emotional processing. The connectivity between right Amy and DLPFC mediates the relationship between childhood adversities and BPD symptomatology. Furthermore, the negative FC between Amy and DLPFC, postcentral gyrus, the vermis of cerebellum and precuneus was also associated with BPD symptom severity, with a weaker negative coupling between Amy and these regions being related to a worse BPD psychopathology. Our results confirm the role of ACEs in contributing to social cognition impairments in BPD and related symptomatology from a neurobiological perspective.
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Affiliation(s)
- Benedetta Vai
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy.,Department of Human Studies, Libera Università Maria Ss. Assunta, Rome, Italy.,Centro di Eccellenza Risonanza Magnetica ad Alto Campo (CERMAC), Università Vita-Salute San Raffaele, Milan, Italy
| | - Laura Sforzini
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Raffaele Visintini
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Martina Riberto
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Chiara Bulgarelli
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy.,Centre for Brain and Cognitive Development, Birkbeck College, London, United Kingdom
| | - Davide Ghiglino
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Elisa Melloni
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Irene Bollettini
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Sara Poletti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy.,Centro di Eccellenza Risonanza Magnetica ad Alto Campo (CERMAC), Università Vita-Salute San Raffaele, Milan, Italy
| | - Cesare Maffei
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, University Vita-Salute, Milan, Italy.,Centro di Eccellenza Risonanza Magnetica ad Alto Campo (CERMAC), Università Vita-Salute San Raffaele, Milan, Italy
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Lake AJ, Finn PR, James TW. Neural correlates of emotion reappraisal in individuals with externalizing psychopathology. Brain Imaging Behav 2018; 11:76-85. [PMID: 26809287 DOI: 10.1007/s11682-015-9500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Externalizing psychopathology (EXT) is characterized by regulatory deficits of behavior, cognition, and negative emotion. Previous research on EXT suggests that cognitive and affective dysregulation are highly related, such that strong affective states constrain a reduced-capacity cognitive system. Reappraisal is an effective emotional control strategy involving complex interactions between cognitive and affective brain functions and may therefore offer novel insight into the specific neural mechanisms of affective dysregulation among individuals with EXT. To evaluate these possibilities, we tested individuals with low or high EXT in a reappraisal paradigm. Neuroimaging results indicated that EXT was associated with hypo-activation in the amygdala and superior parietal lobule during both maintenance and reappraisal as well as poor modulation of the lateral occipital cortex during negative emotion reappraisal. These results suggest a general disruption of perceptual-attentional resource allocation such that high EXT individuals are characterized by poor modulation of perceptual-attentional resources during reappraisal. Subsequently, emotion reappraisal may be a useful but not adequate tool to control negative affect in EXT.
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Affiliation(s)
- Allison J Lake
- Department of Psychological & Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN, 47405, USA
| | - Peter R Finn
- Department of Psychological & Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN, 47405, USA
| | - Thomas W James
- Department of Psychological & Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN, 47405, USA. .,Program in Neuroscience, Indiana University, 1101 E. 10th St., Bloomington, IN, 47405, USA. .,Cognitive Science Program, Indiana University, 819 Eigenmann, 1900 E. 10th St., Bloomington, IN, 47406, USA.
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42
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Cross-cultural studies on the prevalence of personality disorders. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2018. [DOI: 10.5114/cipp.2018.80200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Valdespino A, Antezana L, Ghane M, Richey JA. Alexithymia as a Transdiagnostic Precursor to Empathy Abnormalities: The Functional Role of the Insula. Front Psychol 2017; 8:2234. [PMID: 29312079 PMCID: PMC5742870 DOI: 10.3389/fpsyg.2017.02234] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/08/2017] [Indexed: 12/22/2022] Open
Abstract
Distorted empathic processing has been observed across multiple psychiatric disorders. Simulation theory provides a theoretical framework that proposes a mechanism through which empathy difficulties may arise. Specifically, introspection-centric simulation theory (IST) predicts that an inability to accurately interpret and describe internal affective states may lead to empathy difficulties. The purpose of this review is to synthesize and summarize an empirical literature suggesting that simulation theory provides insights into a cognitive and neurobiological mechanism (i.e., alexithymia and insula pathology) that negatively impacts empathic processing, in addition to how disruptions in these processes manifest across psychiatric disorders. Specifically, we review an emerging non-clinical literature suggesting that consistent with IST, alexithymia and associated insula pathology leads to empathy deficits. Subsequently, we highlight clinical research suggesting that a large number of disorders characterized by empathy pathology also feature alexithymia. Collectively, these findings motivate the importance for future work to establish the role of alexithymia in contributing to empathy deficits across clinical symptoms and disorders. The current review suggests that simulation theory provides a tractable conceptual platform for identifying a potential common cognitive and neural marker that is associated with empathy deficits across a wide array of diagnostic classes.
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Affiliation(s)
- Andrew Valdespino
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Ligia Antezana
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Merage Ghane
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - John A Richey
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
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Bourvis N, Aouidad A, Cabelguen C, Cohen D, Xavier J. How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder? Front Psychol 2017; 8:2054. [PMID: 29250007 PMCID: PMC5714931 DOI: 10.3389/fpsyg.2017.02054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022] Open
Abstract
Borderline personality disorder (BPD) is a severe and frequent disorder characterized by a pervasive pattern of instability affecting impulse control, emotional regulation, cognitive processing, self-image and interpersonal relationships. Patients’ personal histories are often marked by stressful or traumatic experiences, either unique or repeated. Moreover, while clinical signs of the disorder include both chronic and acute features, acute features are mostly triggered by acute stressful situations. Such features include transient cognitive distortion, intense anger, uncontrollable impulsivity, and self-harm behavior – including suicide – and contribute to the burden of the disease. In this paper, we review the various aspects (epidemiological, clinical, and physiological) contributing to the relationship between BDP and stress. In particular, we explore the statistical association between stress exposure and the emergence of BPD while taking into account other psychopathologies, such as post-traumatic stress disorder. Then, the different aspects of stress responses (namely, the phenomenological, behavioral, hormonal, neuro-vegetative and neural responses) are reviewed in BPD patients. Pathophysiological hypotheses are formulated to explain the differences in responses between BPD patients and healthy subjects and their relation to BPD symptoms. Although the pathogenesis remains uncertain, our conclusions seem to reflect a specific biological and neural pattern of altered stress perception and regulation in BPD.
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Affiliation(s)
- Nadège Bourvis
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France.,Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal Toulon - La Seyne, Toulon, France
| | - Aveline Aouidad
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Clémence Cabelguen
- Department de Psychiatrie Infanto Juvénile, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France
| | - Jean Xavier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France
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van Zutphen L, Siep N, Jacob GA, Domes G, Sprenger A, Willenborg B, Goebel R, Arntz A. Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder. J Psychiatry Neurosci 2017; 43:170008. [PMID: 29083990 PMCID: PMC5747534 DOI: 10.1503/jpn.170008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/04/2017] [Accepted: 07/04/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by emotion dysregulation; however, it is unclear whether this is restricted to negative emotional stimuli or to what degree this is specific to BPD. We investigated neural correlates of hypothesized increased emotional sensitivity and impaired emotion regulation in patients with BPD. METHODS During fMRI scanning, patients with BPD, nonpatient controls and patients with cluster-C personality disorder completed an emotion regulation task, including negative, positive and erotic social pictures. RESULTS We included 55 patients with BPD, 42 nonpatient controls and 24 patients with cluster-C personality disorder in our analyses. Passive viewing of negative stimuli resulted in greater activity in the anterior insula, temporoparietal junction and dorsolateral prefrontal cortex in patients with BPD than in nonpatient controls. The increased activity in the anterior insula and temporoparietal junction was also present when patients with BPD viewed positive stimuli. During regulation of negative stimuli compared with passive viewing, nonpatient controls showed greater activity in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, middle temporal gyrus and bilateral inferior parietal lobule. Patients with BPD did not show this increase in activity. LIMITATIONS Findings cannot be generalized to men, and patients represented a heterogeneous group regarding comorbid diagnoses and medication. CONCLUSION When looking at emotional stimuli, patients with BPD showed a unique pattern of activity, suggesting an increase in brain activity involved in emotion generation. In the case of negative stimuli this is accompanied by increased activity in regulation areas. In contrast, increase of regulation processes seems absent when patients with BPD are explicitly instructed to regulate. Results of diagnosis specificity support a dimensional rather than a dichotomous differentiation between BPD and cluster-C personality disorder regarding emotional sensitivity and emotional regulation of social stimuli.
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Affiliation(s)
- Linda van Zutphen
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Nicolette Siep
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Gitta A. Jacob
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Gregor Domes
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Andreas Sprenger
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Bastian Willenborg
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Rainer Goebel
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
| | - Arnoud Arntz
- From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz)
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Brain activation in response to overt and covert fear and happy faces in women with borderline personality disorder. Brain Imaging Behav 2017; 10:319-31. [PMID: 26007149 DOI: 10.1007/s11682-015-9406-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Borderline personality disorder (BPD) is a serious condition involving emotion dysregulation. Past research has identified BPD-associated differences within fronto-limbic circuitry during conditions of processing negative emotion. Functional magnetic resonance imaging (fMRI) paradigms that incorporate overt and covert (masked) presentations of emotional stimuli can provide complementary information about neural systems underlying emotion processing (e.g., both slow [overt] and fast [covert; automatic] processing pathways). This study examined brain activation during processing of overt and covert presentations of emotional faces in 12 women with BPD and 12 age-matched healthy controls. To assess a range of emotional valence and arousal, we examined responses to fear, happy and neutral expressions. All participants underwent an fMRI scanning session in which participants passively viewed emotional faces. Scanning sessions consisted of 5 runs including: (1) Overt Fear (OF) versus Neutral (N), (2) Covert Fear (CF) versus Covert Neutral (CN), (3) Overt Happy (OH) versus N, (4) Covert Happy (CH) versus CN, and (5) N versus fixation. We compared whole-brain activation between groups for each run. In response to overt fear, BPD patients showed greater activation both in left amygdala and in several frontal cortical regions. There were no significant differences in brain activation in response to overt happy faces. In response to covert fear and covert happy stimuli, the BPD group also showed greater activation than controls in several regions including frontal and temporal cortical regions, as well as cerebellum and thalamus. These findings add to prior reports suggesting increased amygdala activation in BPD, but we found this only in the overt fear versus fixation condition. In this sample, BPD patients showed hyper-activation, rather than hypo-activation, of cortical regulatory regions during overt fear. Enhanced cortical recruitment in response to covert fear and happy faces in BPD could reflect a more extended response system in which stimuli that typically only activate automatic pathways are additionally tapping into cortical regulatory systems. The observation of this pattern both in response to fear and in response to happy presentations suggests that the effect of arousal may be as or more impactful than the effect of emotional valence.
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Gratz KL, Weiss NH, McDermott MJ, Dilillo D, Messman-Moore T, Tull MT. Emotion Dysregulation Mediates the Relation Between Borderline Personality Disorder Symptoms and Later Physical Health Symptoms. J Pers Disord 2017; 31:433-448. [PMID: 27322577 PMCID: PMC5472518 DOI: 10.1521/pedi_2016_30_252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite evidence of a relation between borderline personality disorder (BPD) pathology and physical health problems, the mechanisms underlying this relation remain unclear. Given evidence that emotion dysregulation may affect physical health by altering physiological functioning, one mechanism that warrants examination is emotion dysregulation. This study examined BPD symptoms as a prospective predictor of physical health symptoms 8 months later and the mediating role of emotion dysregulation in this relation. Participants completed three assessments over an 8-month period, including a BPD diagnostic interview. Results of analyses examining baseline predictors of later physical health symptoms revealed a significant unique association between baseline BPD symptom severity and physical health symptoms 8 months later, above and beyond baseline physical health symptoms, depression and anxiety symptoms, and emotion dysregulation. Moreover, structural equation modeling revealed a significant indirect relation of BPD symptoms at Wave 1 to physical health symptoms at Wave 3 through emotion dysregulation at Wave 2.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - David Dilillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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Wang J, Lv B, Quan W, Wydell TN, Tian J, Wang P, Liu J, Dong W. Right fronto-temporal activation differs between Chinese first-episode and recurrent Major Depression Disorders during a verbal fluency task: A near-infrared spectroscopy study. Psychiatry Res Neuroimaging 2017; 264:68-75. [PMID: 28463749 DOI: 10.1016/j.pscychresns.2017.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Bin Lv
- China Academy of Telecommunication Research of Ministry of Industry and Information Technology, Beijing, China
| | - Wenxiang Quan
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
| | - Taeko N Wydell
- Centre for Cognition and Neuroimaging, Brunel University London, Uxbridge, UK
| | - Ju Tian
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Pengfei Wang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Jin Liu
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Wentian Dong
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
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49
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Anger provocation in violent offenders leads to emotion dysregulation. Sci Rep 2017; 7:3583. [PMID: 28620226 PMCID: PMC5472615 DOI: 10.1038/s41598-017-03870-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/08/2017] [Indexed: 12/03/2022] Open
Abstract
Anger and anger regulation problems that result in aggressive behaviour pose a serious problem for society. In this study we investigated differences in brain responses during anger provocation or anger engagement, as well as anger regulation or distraction from anger, and compared 16 male violent offenders to 18 non-offender controls. During an fMRI adapted provocation and regulation task participants were presented with angry, happy and neutral scenarios. Prior research on violent offenders indicates that a combination of increased limbic activity (involved in emotion), along with decreased prefrontal activity (involved in emotion regulation), is associated with reactive aggression. We found increased ventrolateral prefrontal activity during anger engagement in violent offenders, while decreased dorsolateral and ventrolateral prefrontal activity was found during anger distraction. This activity pattern was specific for anger. We found no exclusive pattern for happiness. In violent offenders, this suggests an increased need to regulate specifically during anger engagement and regulation difficulties when explicitly instructed to distract. The constant effort required for violent offenders to regulate anger might exhaust the necessary cognitive resources, resulting in a risk for self-control failure. Consequently, continuous provocation might ultimately contribute to reactive aggression.
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50
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Perez-Rodriguez MM, New AS, Goldstein KE, Rosell D, Yuan Q, Zhou Z, Hodgkinson C, Goldman D, Siever LJ, Hazlett EA. Brain-derived neurotrophic factor Val66Met genotype modulates amygdala habituation. Psychiatry Res 2017; 263:85-92. [PMID: 28371657 PMCID: PMC5856456 DOI: 10.1016/j.pscychresns.2017.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/04/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022]
Abstract
A deficit in amygdala habituation to repeated emotional stimuli may be an endophenotype of disorders characterized by emotion dysregulation, such as borderline personality disorder (BPD). Amygdala reactivity to emotional stimuli is genetically modulated by brain-derived neurotrophic factor (BDNF) variants. Whether amygdala habituation itself is also modulated by BDNF genotypes remains unknown. We used imaging-genetics to examine the effect of BDNF Val66Met genotypes on amygdala habituation to repeated emotional stimuli. We used functional magnetic resonance imaging (fMRI) in 57 subjects (19 BPD patients, 18 patients with schizotypal personality disorder [SPD] and 20 healthy controls [HC]) during a task involving viewing of unpleasant, neutral, and pleasant pictures, each presented twice to measure habituation. Amygdala responses across genotypes (Val66Met SNP Met allele-carriers vs. Non-Met carriers) and diagnoses (HC, BPD, SPD) were examined with ANOVA. The BDNF 66Met allele was significantly associated with a deficit in amygdala habituation, particularly for emotional pictures. The association of the 66Met allele with a deficit in habituation to unpleasant emotional pictures remained significant in the subsample of BPD patients. Using imaging-genetics, we found preliminary evidence that deficient amygdala habituation may be modulated by BDNF genotype.
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Affiliation(s)
- M Mercedes Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA; CIBERSAM, Autonoma University, Fundacion Jimenez Diaz and Ramon y Cajal Hospital, Madrid, Spain.
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel Rosell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Qiaoping Yuan
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Zhifeng Zhou
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Colin Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Larry J Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
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