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Nikolic M, Pezzoli P, Jaworska N, Seto MC. Brain responses in aggression-prone individuals: A systematic review and meta-analysis of functional magnetic resonance imaging (fMRI) studies of anger- and aggression-eliciting tasks. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110596. [PMID: 35803398 DOI: 10.1016/j.pnpbp.2022.110596] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
Reactive aggression in response to perceived threat or provocation is part of humans' adaptive behavioral repertoire. However, high levels of aggression can lead to the violation of social and legal norms. Understanding brain function in individuals with high levels of aggression as they process anger- and aggression-eliciting stimuli is critical for refining explanatory models of aggression and thereby improving interventions. Three neurobiological models of reactive aggression - the limbic hyperactivity, prefrontal hypoactivity, and dysregulated limbic-prefrontal connectivity models - have been proposed. However, these models are based on neuroimaging studies involving mainly non-aggressive individuals, leaving it unclear which model best describes brain function in those with a history of aggression. We conducted a systematic literature search (PubMed and Psycinfo) and Multilevel Kernel Density meta-analysis (MKDA) of nine functional magnetic resonance imaging (fMRI) studies (eight included in the between-group analysis [i.e., aggression vs. control groups], five in the within-group analysis). Studies examined brain responses to tasks putatively eliciting anger and aggression in individuals with a history of aggression alone and relative to controls. Individuals with a history of aggression exhibited greater activity in the superior temporal gyrus and in regions comprising the cognitive control and default mode networks (right posterior cingulate cortex, precentral gyrus, precuneus, right inferior frontal gyrus) during reactive aggression relative to baseline conditions. Compared to controls, individuals with a history of aggression exhibited increased activity in limbic regions (left hippocampus, left amygdala, left parahippocampal gyrus) and temporal regions (superior, middle, inferior temporal gyrus), and reduced activity in occipital regions (left occipital cortex, left calcarine cortex). These findings lend support to the limbic hyperactivity model in individuals with a history of aggression, and further indicate altered temporal and occipital activity in anger- and aggression-eliciting conditions involving face and speech processing.
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Affiliation(s)
- Maja Nikolic
- McGill University, Montreal, QC, Canada; McMaster University, Hamilton, ON, Canada.
| | - Patrizia Pezzoli
- University College London, London, United Kingdom; University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.
| | - Natalia Jaworska
- University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, ON, Canada; Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Michael C Seto
- University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.
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2
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Karas KH, Baharikhoob P, Kolla NJ. Borderline personality disorder and its symptom clusters: A review of positron emission tomography and single photon emission computed tomography studies. Psychiatry Res Neuroimaging 2021; 316:111357. [PMID: 34488007 DOI: 10.1016/j.pscychresns.2021.111357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are two neuroimaging techniques that have led to important insights into the pathophysiology of borderline personality disorder (BPD) and its symptom clusters. This paper provides the most up-to-date review of PET and SPECT studies targeting BPD. A systematic search of PET and SPECT studies using the databases PsycINFO, PubMed, and Embase was implemented, which yielded 30 articles in the end. Earlier PET studies largely reported decreased glucose metabolism in prefrontal brain regions. More recent PET research has pointed to alterations in monoaminergic systems, greater activation of the opioid system during sadness induction, as well as abnormalities of the brain endocannabinoid system in BPD. SPECT studies of BPD mainly identified changes in regional cerebral blood flow and alterations of the serotonergic system. Such PET and SPECT study abnormalities have been suggested to relate to the symptomatology of BPD, including impulsivity, aggression, and mood changes. The implications of these neuroimaging studies in terms of shedding new light on the pathophysiology of BPD and providing new avenues for drug development are discussed.
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Affiliation(s)
- Karolina H Karas
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada
| | - Paria Baharikhoob
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan J Kolla
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
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3
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Sadek MN, Ismail ES, Kamel AI, Saleh AA, Youssef AA, Madbouly NM. Diffusion tensor imaging of corpus callosum in adolescent females with borderline personality disorder. J Psychiatr Res 2021; 138:272-279. [PMID: 33872964 DOI: 10.1016/j.jpsychires.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to assess the structural alteration of corpus callosum (CC) in adolescent females with Borderline Personality Disorder (BPD) and detect the relationship between these changes and BPD symptoms. METHODS A comparative case control study was conducted on 50 adolescent females that were divided into 2 groups; 25 outpatients suffering from BPD (according to DSM-IV-TR diagnostic criteria) compared to 25 healthy adolescents. All subjects were assessed by Borderline Personality Questionnaire, Barratt impulsivity scale-11, Brief Non-Suicidal Self-Injury Assessment tool, Beck Scale for Suicidal Ideation, and Diffusion tensor imaging. RESULTS Relative to control subjects, BPD patients had significantly lower fractional anisotropy (FA) values in the genu and lower mean diffusivity (MD) values in the body of CC. There was a negative correlation between FA values in the genu and body of CC and impulsivity. MD in the body of CC was positively correlated with motor impulsiveness and negatively correlated with suicidality. CONCLUSION Adolescent females with BPD show structural alterations in the CC that are related to symptoms of emotional dysregulation and impulsivity.
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Affiliation(s)
| | | | - Ayman Isamil Kamel
- Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Alia Adel Saleh
- Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ayda Aly Youssef
- Department of Radiology, National Cancer Institute, Cairo University, Cairo, Egypt.
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4
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Lou J, Sun Y, Cui Z, Gong L. Common and distinct patterns of gray matter alterations in borderline personality disorder and posttraumatic stress disorder: A dual meta-analysis. Neurosci Lett 2020; 741:135376. [PMID: 33221476 DOI: 10.1016/j.neulet.2020.135376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are severe psychiatric disorders and often co-occur, either of the two will seriously threaten to public health. However, we lack ample evidences to understand the potential pathophysiologic mechanisms of gray matter (GM) alterations in the two disorders. METHODS We performed a meta-analysis in both BPD (15 datasets including 442 BPD subjects versus 441 healthy controls) and PTSD (11 datasets including 214 PTSD subjects versus 258 healthy controls) applying anisotropic effect-size-based algorithms (AES-SDM) method. RESULTS Conjunction analysis found relative GM volume reductions in both disorders in the orbitofrontal gyrus and anterior cingulate cortex, contrarily, differences were predominantly observed that GM volume increased in the posterior cingulate gyrus and precuneus in BPD subjects, and GM volume decreased in the amygdala-hippocampal fear circuit, fusiform gyrus in PTSD subjects. CONCLUSIONS Group comparisons and conjunction analyses in BPD and PTSD identified same regions of GM volume reductions in the orbitofrontal gyrus and anterior cingulate cortex, which may provide clues for the neurobiological mechanisms and clinical diagnosis underpinning two disorders.
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Affiliation(s)
- Jing Lou
- Dalian Medical University, Neuropsychological Department, Liaoning Province, China
| | - Yueji Sun
- Dalian Medical University, Neuropsychological Department, Liaoning Province, China.
| | - Zhixi Cui
- Dalian Medical University, Neuropsychological Department, Liaoning Province, China
| | - Lei Gong
- Dalian Medical University, Neuropsychological Department, Liaoning Province, China
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5
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Davies G, Hayward M, Evans S, Mason O. A systematic review of structural MRI investigations within borderline personality disorder: Identification of key psychological variables of interest going forward. Psychiatry Res 2020; 286:112864. [PMID: 32163818 DOI: 10.1016/j.psychres.2020.112864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.
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Affiliation(s)
- Geoff Davies
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK; Surrey & Borders NHS Trust, UK.
| | - Mark Hayward
- School of Psychology, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, UK
| | - Simon Evans
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Oliver Mason
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
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6
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Nenadić I, Voss A, Besteher B, Langbein K, Gaser C. Brain structure and symptom dimensions in borderline personality disorder. Eur Psychiatry 2020; 63:e9. [PMID: 32093800 PMCID: PMC8057374 DOI: 10.1192/j.eurpsy.2019.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) presents with symptoms across different domains, whose neurobiology is poorly understood. METHODS We applied voxel-based morphometry on high-resolution magnetic resonance imaging scans of 19 female BPD patients and 50 matched female controls. RESULTS Group comparison showed bilateral orbitofrontal gray matter loss in patients, but no significant changes in the hippocampus. Voxel-wise correlation of gray matter with symptom severity scores from the Borderline Symptom List (BSL-95) showed overall negative correlation in bilateral prefrontal, right inferior temporal/fusiform and occipital cortices, and left thalamus. Significant (negative) correlations with BSL-95 subscores within the patient cohort linked autoaggression to left lateral prefrontal and insular cortices, right inferior temporal/temporal pole, and right orbital cortex; dysthymia/dysphoria to right orbitofrontal cortex; self-perception to left postcentral, bilateral inferior/middle temporal, right orbitofrontal, and occipital cortices. Schema therapy-based Young Schema Questionnaire (YSQ-S2) scores of early maladaptive schemas on emotional deprivation were linked to left medial temporal lobe gray matter reductions. CONCLUSIONS Our results confirm orbitofrontal structural deficits in BPD, while providing a framework and preliminary findings on identifying structural correlates of symptom dimensions in BPD, especially with dorsolateral and orbitofrontal cortices.
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Affiliation(s)
- Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps University Marburg & Marburg University Hospital/UKGM, Marburg, Germany.,Center for Mind, Brain, and Behaviour (CMBB), Marburg, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Annika Voss
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
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7
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Scarpazza C, Ferracuti S, Miolla A, Sartori G. The charm of structural neuroimaging in insanity evaluations: guidelines to avoid misinterpretation of the findings. Transl Psychiatry 2018; 8:227. [PMID: 30367031 PMCID: PMC6203853 DOI: 10.1038/s41398-018-0274-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023] Open
Abstract
Despite the popularity of structural neuroimaging techniques in twenty-first-century research, its results have had limited translational impact in real-world settings, where inferences need to be made at the individual level. Structural neuroimaging methods are now introduced frequently to aid in assessing defendants for insanity in criminal forensic evaluations, with the aim of providing "convergence" of evidence on the mens rea of the defendant. This approach may provide pivotal support for judges' decisions. Although neuroimaging aims to reduce uncertainty and controversies in legal settings and to increase the objectivity of criminal rulings, the application of structural neuroimaging in forensic settings is hampered by cognitive biases in the evaluation of evidence that lead to misinterpretation of the imaging results. It is thus increasingly important to have clear guidelines on the correct ways to apply and interpret neuroimaging evidence. In the current paper, we review the literature concerning structural neuroimaging in court settings with the aim of identifying rules for its correct application and interpretation. These rules, which aim to decrease the risk of biases, focus on the importance of (i) descriptive diagnoses, (ii) anatomo-clinical correlation, (iii) brain plasticity and (iv) avoiding logical fallacies, such as reverse inference. In addition, through the analysis of real forensic cases, we describe errors frequently observed due to incorrect interpretations of imaging. Clear guidelines for both the correct circumstances for introducing neuroimaging and its eventual interpretation are defined.
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Affiliation(s)
- C Scarpazza
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy.
- Department of Psychosis Studies, Institute of Psychiatry, Psychosis and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - S Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, P.le A Moro 5, 00185, Roma, Italy
| | - A Miolla
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy
| | - G Sartori
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy
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8
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Guerrero-Apolo JD, Navarro-Pastor JB, Bulbena-Vilarrasa A, Gabarre-Mir J. The slant of the forehead as a craniofacial feature of impulsiveness. ACTA ACUST UNITED AC 2018. [PMID: 29538488 PMCID: PMC6899405 DOI: 10.1590/1516-4446-2017-2339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: Impulsiveness has been the subject of much research, but little is known about the possible relationship between craniofacial anatomy and impulsiveness. The present study was designed to investigate the relationship between one aspect of craniofacial structure (the angle of inclination of the forehead) and impulsiveness. Method: Photographs in profile were obtained from 131 volunteers who had been fined for driving at high speed and were undergoing a court-mandated driving license point-recovery course. They completed the Barratt Impulsiveness Scale (BIS-11), the Impulsive Behavior Scale (UPPS-P), and Zuckerman’s Sensation Seeking Scale (V). The angle of the slant of the forehead was measured with a photographic support and a protractor. Results: High positive concordance was found between forehead inclination and 14 out of the 15 impulsiveness factors studied. Conclusions: The angle of inclination of the forehead was significantly associated with self-reported impulsiveness in this sample of traffic violators.
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Affiliation(s)
- J David Guerrero-Apolo
- Departament de Psiquiatria i Medicina Legal, Doctorat en Psiquiatria, Facultat de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institute of Craniofacial Psychology, Barcelona, Spain
| | - J Blas Navarro-Pastor
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Facultat de Psicologia, UAB, Barcelona, Spain
| | - Antonio Bulbena-Vilarrasa
- Departament de Psiquiatria i Medicina Legal, Doctorat en Psiquiatria, Facultat de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Unitat d'Ansietat, Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, UAB, Barcelona, Spain
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9
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Zhang C, Luo T, Liu L, Dong H, Hao W. Prevalence Rates of Personality Disorder and Its Association With Methamphetamine Dependence in Compulsory Treatment Facilities in China. Front Psychiatry 2018; 9:698. [PMID: 30618872 PMCID: PMC6299101 DOI: 10.3389/fpsyt.2018.00698] [Citation(s) in RCA: 6] [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: 02/14/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022] Open
Abstract
Methamphetamine use is popular and rapidly increasing in China, and the co-occurrence of personality disorders has an impact on treatment outcomes and may increase vulnerability of developing dependence. The aim of the present study was to investigate the prevalence rates of personality disorders in methamphetamine users and further explore the association between personality disorders and methamphetamine use status. Five hundred and seventy-seven male methamphetamine users were recruited. The self-developed questionnaire was used for demographics, and a Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I/II) was performed covering psychiatric diagnosis. Our study found the prevalence of antisocial personality disorder in male methamphetamine users was 71.4%, followed by borderline (20.2%) and obsessive-compulsive (17.9%) personality disorder. Borderline and antisocial personality disorders were found to be risk factors of methamphetamine dependence (adjusted odds ratio = 2.891, p = 0.007 and adjusted odds ratio = 1.680, p = 0.042). These findings suggested personality disorders were highly prevalent in male methamphetamine users, and the comorbidity of antisocial and borderline personality disorders are especially associated with methamphetamine dependence.
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Affiliation(s)
- Chenxi Zhang
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Tao Luo
- Department of Psychology, JiangXi Mental Health Center, Nanchang, China
| | - Liang Liu
- Clinical Psychiatry Department, Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Huixi Dong
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Wei Hao
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
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10
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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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11
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Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry 2017; 17:221. [PMID: 28619017 PMCID: PMC5472954 DOI: 10.1186/s12888-017-1383-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experiences during childhood. We have searched for studies reporting possible alterations in several biological processes and brain morphological features in relation to childhood trauma experiences and to BPD. We have also looked for epigenetic mechanisms as they could be mediators of the effects of childhood trauma in BPD vulnerability. DISCUSSION We prove the role of alterations in Hypothalamic-Pituitary-Adrenal (HPA) axis, in neurotrasmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD; we also confirm the presence of morphological changes in several BPD brain areas and in particular in those involved in stress response. Not so many studies are available on epigenetic changes in BPD patients, although these mechanisms are widely investigated in relation to stress-related disorders. A better comprehension of the biological and epigenetic mechanisms, affected by childhood trauma and altered in BPD patients, could allow to identify "at high risk" subjects and to prevent or minimize the development of the disease later in life.
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Affiliation(s)
- Nadia Cattane
- grid.419422.8Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Roberta Rossi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Mariangela Lanfredi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy. .,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK. .,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK.
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12
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Hou J, Song B, Chen ACN, Sun C, Zhou J, Zhu H, Beauchaine TP. Review on Neural Correlates of Emotion Regulation and Music: Implications for Emotion Dysregulation. Front Psychol 2017; 8:501. [PMID: 28421017 PMCID: PMC5376620 DOI: 10.3389/fpsyg.2017.00501] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Previous studies have examined the neural correlates of emotion regulation and the neural changes that are evoked by music exposure. However, the link between music and emotion regulation is poorly understood. The objectives of this review are to (1) synthesize what is known about the neural correlates of emotion regulation and music-evoked emotions, and (2) consider the possibility of therapeutic effects of music on emotion dysregulation. Music-evoked emotions can modulate activities in both cortical and subcortical systems, and across cortical-subcortical networks. Functions within these networks are integral to generation and regulation of emotions. Since dysfunction in these networks are observed in numerous psychiatric disorders, a better understanding of neural correlates of music exposure may lead to more systematic and effective use of music therapy in emotion dysregulation.
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Affiliation(s)
- Jiancheng Hou
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Bei Song
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China.,Music Conservatory of HarbinHarbin, China
| | - Andrew C N Chen
- Center for Higher Brain Functions and Institute for Brain Disorders, Capital Medical UniversityBeijing, China
| | - Changan Sun
- School of Education and Public Administration, Suzhou University of Science and TechnologySuzhou, China
| | - Jiaxian Zhou
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China
| | - Haidong Zhu
- Department of Psychology, Shihezi UniversityShihezi, China
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13
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Gan J, Yi J, Zhong M, Cao X, Jin X, Liu W, Zhu X. Abnormal white matter structural connectivity in treatment-naïve young adults with borderline personality disorder. Acta Psychiatr Scand 2016; 134:494-503. [PMID: 27611589 DOI: 10.1111/acps.12640] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The pathogenesis of borderline personality disorder (BPD) is not well understood. We examined the microstructure of white matter in patients with BPD. METHOD Treatment-naïve young adult with BPD (N = 30) and young-adult healthy controls (HCs; N = 31) were subjected diffusion tensor imaging (DTI). Microstructural parameters were analyzed via tract-based spatial statistics (TBSS) and post hoc tractography. RESULTS TBSS analysis revealed that, relative to the HC group, the BPD group had significantly lower fractional anisotropy (FA) values in the genu and body of the corpus callosum (CC), right superior corona radiate, right anterior corona radiate, as well as higher radial diffusivity (RD) in the left anterior thalamic radiation. Tractography showed that FA values of fiber bundles passing through the fornix were significantly reduced in BPD group relative to HCs. No significant correlations were observed between clinical symptom and DTI indices in BPD group (FDR corrected). CONCLUSION Focal microstructural alterations were found in BPD group, mainly in the limbic system and CC. The present findings support the fronto-limbic disconnectivity hypothesis and suggest that abnormal maturation of white matter structures may play an important role in mechanism of BPD.
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Affiliation(s)
- J Gan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - J Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - M Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - X Cao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - X Jin
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - W Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - X Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China
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14
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Yang X, Hu L, Zeng J, Tan Y, Cheng B. Default mode network and frontolimbic gray matter abnormalities in patients with borderline personality disorder: A voxel-based meta-analysis. Sci Rep 2016; 6:34247. [PMID: 27694955 PMCID: PMC5046132 DOI: 10.1038/srep34247] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/09/2016] [Indexed: 02/05/2023] Open
Abstract
Specific frontolimbic abnormalities are hypothesized to underlie the etiology of borderline personality disorder (BPD). However, findings from neuroimaging studies were inconsistent. In the current study, we aimed to provide a complete overview of cerebral microstructural alterations in gray matter (GM) of BPD patients. A total of 11 studies were enrolled, comprising 275 BPD patients and 290 healthy controls (HCs). A meta-analysis was conduct to quantitatively estimate regional GM abnormalities in BPD patients using the seed-based d mapping (SDM). Meta-regression was also conducted. Compared with HCs, the BPD patients exhibited increased GM mainly in bilateral supplementary motor area extending to right posterior cingulated cortex (PCC) and bilateral primary motor cortex, right middle frontal gyrus (MFG), and the bilateral precuneus extending to bilateral PCC. Decreased GM was identified in bilateral middle temporal gyri, right inferior frontal gyrus extending to right insular, left hippocampus and left superior frontal gyrus extending to left medial orbitofrontal cortex. The mean age of BPD patients were found nagativly associated with GM alterations in right MFG. Our findings suggested that BPD patients have significantly GM abnormalities in the default mode network and frontolimbic circuit. Our results provided further evidences in elucidating the underline neural mechanisms of BPD.
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Affiliation(s)
- Xun Yang
- School of Sociality and Psychology, Southwest University for Nationalities, Chengdu, China.,Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Liyuan Hu
- School of Sociality and Psychology, Southwest University for Nationalities, Chengdu, China
| | - Jianguang Zeng
- School of Accounting, Southwestern University of Finance and Economics, Chengdu, China
| | - Ying Tan
- School of Computer Science and Technology, Southwest University for Nationalities, Chengdu, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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15
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Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
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16
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Kimmel CL, Alhassoon OM, Wollman SC, Stern MJ, Perez-Figueroa A, Hall MG, Rompogren J, Radua J. Age-related parieto-occipital and other gray matter changes in borderline personality disorder: A meta-analysis of cortical and subcortical structures. Psychiatry Res Neuroimaging 2016; 251:15-25. [PMID: 27107250 DOI: 10.1016/j.pscychresns.2016.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 02/01/2016] [Accepted: 04/08/2016] [Indexed: 01/08/2023]
Abstract
Previous research suggests that core borderline personality disorder (BPD) symptoms vary in severity with advancing age. While structural neuroimaging studies show smaller limbic and prefrontal gray matter volumes (GMV) in primarily adult and adolescent BPD patients, respectively, findings are inconsistent. Using the effect-size signed differential mapping (ES-SDM) meta-analytic method, we investigated the relationship between advancing age and GMV abnormalities in BPD patients. A total of nine voxel-based morphometry (VBM) studies comparing regional GMV of 256 BPD patients and 272 healthy control subjects were included. Meta-analysis identified lower GMV in the right superior/middle temporal gyri and higher GMV in the right supplementary motor area of BPD patients. Meta-regression showed that increasing age was significantly associated with increased GMV in the left superior parieto-occipital gyri, with younger-aged patients starting at lower GMV compared to controls. In contrast, increasing age was associated with decreased GMV in the right amygdala. These findings suggest that while GMV deficits in limbic structures may become pronounced with advancing age in the course of BPD, parieto-occipital rather than frontal GMV deficits could be especially prominent in younger-aged BPD patients.
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Affiliation(s)
| | - Omar M Alhassoon
- California School of Professional Psychology, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, San Diego, CA, USA.
| | - Scott C Wollman
- California School of Professional Psychology, San Diego, CA, USA
| | - Mark J Stern
- California School of Professional Psychology, San Diego, CA, USA
| | | | - Matthew G Hall
- California School of Professional Psychology, San Diego, CA, USA
| | | | - Joaquim Radua
- FIDMAG Germanes Hospitalàries - CIBERSAM, Barcelona, Spain; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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17
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Leutgeb V, Ille R, Wabnegger A, Schienle A, Schöggl H, Weber B, Papousek I, Weiss EM, Fink A. Creativity and borderline personality disorder: evidence from a voxel-based morphometry study. Cogn Neuropsychiatry 2016; 21:242-55. [PMID: 27174566 DOI: 10.1080/13546805.2016.1182904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Throughout the history, various examples of eminent creative people suffering from mental disorders along with some empirical research reports strengthened the idea of a potential link between creativity and psychopathology. METHODS This study investigated different facets of psychometrically determined creativity in 20 females diagnosed with borderline personality disorder (BPD) relative to 19 healthy female controls. In addition, group differences in grey matter (GM) were examined. RESULTS Behavioural findings revealed no significant differences between the BPD group and healthy controls with respect to verbal and figural-graphic creative task performance and creativity-related personality characteristics. Whole-brain voxel-based morphometry analyses revealed a distinct pattern of GM reductions in the BPD group (relative to controls) in a network of brain regions closely associated with various cognitive and emotional functions (including the bilateral orbital inferior frontal gyri and the left superior temporal gyrus), partly overlapping with creativity-related brain regions. Correlation analyses moreover revealed that in the BPD group GM reductions in the orbital parts of the inferior and middle frontal gyri were associated with lower levels of creativity. CONCLUSIONS This study provides no indications in favour of the putative link between creativity and psychopathology, as sometimes reported in the literature.
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Affiliation(s)
- Verena Leutgeb
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Rottraut Ille
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Albert Wabnegger
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Anne Schienle
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Helmut Schöggl
- b Department of Psychiatry , Medical University of Graz , Graz , Austria
| | - Bernhard Weber
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Ilona Papousek
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Elisabeth M Weiss
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
| | - Andreas Fink
- a Institute of Psychology, BioTechMed-Graz , University of Graz , Graz , Austria
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18
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Jin X, Zhong M, Yao S, Cao X, Tan C, Gan J, Zhu X, Yi J. A Voxel-Based Morphometric MRI Study in Young Adults with Borderline Personality Disorder. PLoS One 2016; 11:e0147938. [PMID: 26808504 PMCID: PMC4726531 DOI: 10.1371/journal.pone.0147938] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/11/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Increasing evidence has documented subtle changes in brain morphology and function in patients with borderline personality disorder (BPD). However, results of magnetic resonance imaging volumetry in patients with BPD are inconsistent. In addition, few researchers using voxel-based morphometry (VBM) have focused on attachment and childhood trauma in BPD. This preliminary study was performed to investigate structural brain changes and their relationships to attachment and childhood trauma in a homogenous sample of young adults with BPD. METHOD We examined 34 young adults with BPD and 34 healthy controls (HCs) to assess regionally specific differences in gray matter volume (GMV) and gray matter concentration (GMC). Multiple regressions between brain volumes measured by VBM and attachment style questionnaire (ASQ) and childhood trauma questionnaire (CTQ) scores were performed. RESULTS Compared with HCs, subjects with BPD showed significant bilateral increases in GMV in the middle cingulate cortex (MCC)/posterior cingulate cortex (PCC)/precuneus. GMC did not differ significantly between groups. In multiple regression models, ASQ insecure attachment scores were correlated negatively with GMV in the precuneus/MCC and middle occipital gyrus in HCs, HCs with more severe insecure attachment showed smaller volumes in precuneus/MCC and middle occipital gyrus, whereas no negative correlations between insecure attachment and GMV in any region were found in BPD group. In addition, CTQ total scores were not correlated with GMV in any region in the two groups respectively. CONCLUSIONS Our findings fit with those of previous reports of larger precuneus GMV in patients with BPD, and suggest that GMV in the precuneus/MCC and middle occipital gyrus is associated inversely with insecure attachment style in HCs. Our finding of increased GMV in the MCC and PCC in patients with BPD compared with HCs has not been reported in previous VBM studies.
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Affiliation(s)
- Xinhu Jin
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, 55 Zhongshan Road, Guangzhou, Guangdong, 510631, P.R. China
| | - Shuqiao Yao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
| | - Xiyu Cao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P. R. China
| | - Jun Gan
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
| | - Xiongzhao Zhu
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
| | - Jinyao Yi
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
- National Technology Institute of Psychiatry, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, P.R. China
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19
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Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis. Biol Psychiatry 2016; 79:97-106. [PMID: 25935068 DOI: 10.1016/j.biopsych.2015.03.027] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/27/2015] [Accepted: 03/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Disturbances in the processing and regulation of emotions are core symptoms of borderline personality disorder (BPD). To further elucidate neural underpinnings of BPD, the present meta-analysis summarizes functional neuroimaging findings of emotion processing tasks, as well as structural neuroimaging findings, and investigates multimodally affected brain regions. METHODS Combined coordinate- and image-based meta-analyses were calculated using anisotropic effect size signed differential mapping. Nineteen functional neuroimaging studies investigating the processing of negative compared with neutral stimuli in a total of 281 patients with BPD and 293 healthy control subjects (HC) were included. In addition, 10 studies investigating gray matter abnormalities in 263 patients with BPD and 278 HC were analyzed. RESULTS Compared with HC, BPD patients showed relatively increased activation of the left amygdala and posterior cingulate cortex, along with blunted responses of the bilateral dorsolateral prefrontal cortex, during the processing of negative emotional stimuli. The multimodal analysis identified the left amygdala to be characterized by a combination of functional hyperactivity and smaller gray matter volume compared with HC. Hyperresponsivity of the amygdala was moderated by medication status of the patient samples. Medication-free samples were characterized by limbic hyperactivity, whereas no such group differences were found in patients currently taking psychotropic medication. CONCLUSIONS Results strengthen the assumption that dysfunctional dorsolateral prefrontal and limbic brain regions are a hallmark feature of BPD and therefore are consistent with the conceptualization of BPD as an emotion dysregulation disorder.
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20
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Volume of hippocampal substructures in borderline personality disorder. Psychiatry Res 2015; 231:218-26. [PMID: 25624067 DOI: 10.1016/j.pscychresns.2014.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/18/2014] [Accepted: 11/14/2014] [Indexed: 12/17/2022]
Abstract
Borderline personality disorder (BPD) may be associated with smaller hippocampi in comparison to hippocampal size in controls. However, specific pathology in hippocampal substructures (i.e., head, body and tail) has not been sufficiently investigated. To address hippocampal structure in greater detail, we studied 39 psychiatric inpatients and outpatients with a DSM-IV diagnosis of BPD and 39 healthy controls. The hippocampus and its substructures were segmented manually on magnetic resonance imaging scans. The volumes of hippocampal substructures (and total hippocampal volume) did not differ between BPD patients and controls. Exploratory analysis suggests that patients with a lifetime history of posttraumatic stress disorder (PTSD) may have a significantly smaller hippocampus - affecting both the hippocampal head and body - in comparison to BPD patients without comorbid PTSD (difference in total hippocampal volume: -10.5%, 95%CI -2.6 to -18.5, significant). Also, patients fulfilling seven or more DSM-IV BPD criteria showed a hippocampal volume reduction, limited to the hippocampal head (difference in volume of the hippocampal head: -16.5%, 95%CI -6.1 to -26.8, significant). Disease heterogeneity in respect to, for example, symptom severity and psychiatric comorbidities may limit direct comparability between studies; the results presented here may reflect hippocampal volumes in patients who are "less" affected or they may simply be a chance finding. However, there is also the possibility that global effects of BPD on the hippocampus may have previously been overestimated.
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21
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Depping MS, Wolf ND, Vasic N, Sambataro F, Thomann PA, Christian Wolf R. Specificity of abnormal brain volume in major depressive disorder: a comparison with borderline personality disorder. J Affect Disord 2015; 174:650-7. [PMID: 25577159 DOI: 10.1016/j.jad.2014.11.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/11/2014] [Accepted: 11/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormal brain volume has been frequently demonstrated in major depressive disorder (MDD). It is unclear if these findings are specific for MDD since aberrant brain structure is also present in disorders with depressive comorbidity and affective dysregulation, such as borderline personality disorder (BPD). In this transdiagnostic study, we aimed to investigate if regional brain volume loss differentiates between MDD and BPD. Further, we tested for associations between brain volume and clinical variables within and between diagnostic groups. METHODS 22 Females with a DSM-IV diagnosis of MDD, 17 females with a DSM-IV diagnosis of BPD and without comorbid posttraumatic stress disorder, and 22 age-matched female healthy controls (HC) were investigated using magnetic resonance imaging. High-resolution structural data were analyzed using voxel-based morphometry. RESULTS A significant (p<0.05, cluster-corrected) volume decrease of the anterior cingulate cortex (ACC) was found in MDD compared to HC, as opposed to volume decreases of the amygdala in BPD compared to both HC and MDD. Sensitivity and specificity of regional gray matter volume for a diagnosis of MDD were modest to fair. Amygdala volume was related to depressive symptoms across the entire patient sample. LIMITATIONS Potential limitations of this study include the modest sample size and the heterogeneous psychotropic drug treatment. CONCLUSIONS ACC volume reduction is more pronounced in MDD with an intermediate degree of volume loss in BPD compared to HC. In contrast, amygdala volume loss is more pronounced in BPD compared to MDD, yet amygdala volume is associated with affective symptom expression in both disorders.
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Affiliation(s)
- Malte S Depping
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Nadine D Wolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Homburg, Germany
| | - Nenad Vasic
- Department for Forensic Psychiatry and Psychotherapy at the District Hospital Günzburg, Ulm University, Ulm, Germany
| | - Fabio Sambataro
- Brain Center for Motor and Social Cognition@UniPR, Istituto Italiano di Tecnologia, Parma, Italy
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - R Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Homburg, Germany.
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22
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O'Neill A, D'Souza A, Samson AC, Carballedo A, Kerskens C, Frodl T. Dysregulation between emotion and theory of mind networks in borderline personality disorder. Psychiatry Res 2015; 231:25-32. [PMID: 25482858 DOI: 10.1016/j.pscychresns.2014.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 10/31/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
Abstract
Individuals with borderline personality disorder (BPD) commonly display deficits in emotion regulation, but findings in the area of social cognitive (e.g., theory of mind, ToM) capacities have been heterogeneous. The aims of the current study were to investigate differences between patients with BPD and controls in functional connectivity (1) between the emotion and ToM network and (2) in the default mode network (DMN). Functional magnetic resonance imaging was used to investigate 19 healthy controls and 17 patients with BPD at rest and during ToM processing. Functional coupling was analysed. Significantly decreased functional connectivity was found for patients compared with controls between anterior cingulate cortex and three brain areas involved in ToM processes: the left superior temporal lobe, right supramarginal/inferior parietal lobes, and right middle cingulate cortex. Increased functional connectivity was found in patients compared with controls between the precuneus as the DMN seed and the left inferior frontal lobe, left precentral/middle frontal, and left middle occipital/superior parietal lobes during rest. Reduced functional coupling between the emotional and the ToM network during ToM processing is in line with emotion-regulation dysfunctions in BPD. The increased connectivity between precuneus and frontal regions during rest might be related to extensive processing of internal thoughts and self-referential information in BPD.
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Affiliation(s)
- Aisling O'Neill
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland; Institute of Neuroscience (TCIN), University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Arun D'Souza
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland; Institute of Neuroscience (TCIN), University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Andrea C Samson
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland; Department of Psychology, Stanford University, Jordan Hall, Building 01-420, 450 Serra Mall, Stanford, CA 94305, USA
| | - Angela Carballedo
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland; Institute of Neuroscience (TCIN), University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Christian Kerskens
- Institute of Neuroscience (TCIN), University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Thomas Frodl
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland; Institute of Neuroscience (TCIN), University of Dublin, Trinity College Dublin, Dublin 2, Ireland; Department of Psychiatry, University of Regensburg, MEDBO, Universitätsstr. 84, 93951 Regensburg, Germany.
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23
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van Heeringen K, Bijttebier S, Desmyter S, Vervaet M, Baeken C. Is there a neuroanatomical basis of the vulnerability to suicidal behavior? A coordinate-based meta-analysis of structural and functional MRI studies. Front Hum Neurosci 2014; 8:824. [PMID: 25374525 PMCID: PMC4205829 DOI: 10.3389/fnhum.2014.00824] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/26/2014] [Indexed: 12/25/2022] Open
Abstract
Objective: We conducted meta-analyses of functional and structural neuroimaging studies comparing adolescent and adult individuals with a history of suicidal behavior and a psychiatric disorder to psychiatric controls in order to objectify changes in brain structure and function in association with a vulnerability to suicidal behavior. Methods: Magnetic resonance imaging studies published up to July 2013 investigating structural or functional brain correlates of suicidal behavior were identified through computerized and manual literature searches. Activation foci from 12 studies encompassing 475 individuals, i.e., 213 suicide attempters and 262 psychiatric controls were subjected to meta-analytical study using anatomic or activation likelihood estimation (ALE). Result: Activation likelihood estimation revealed structural deficits and functional changes in association with a history of suicidal behavior. Structural findings included reduced volumes of the rectal gyrus, superior temporal gyrus and caudate nucleus. Functional differences between study groups included an increased reactivity of the anterior and posterior cingulate cortices. Discussion: A history of suicidal behavior appears to be associated with (probably interrelated) structural deficits and functional overactivation in brain areas, which contribute to a decision-making network. The findings suggest that a vulnerability to suicidal behavior can be defined in terms of a reduced motivational control over the intentional behavioral reaction to salient negative stimuli.
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Affiliation(s)
- Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University Ghent, Belgium
| | - Stijn Bijttebier
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University Ghent, Belgium
| | - Stefanie Desmyter
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University Ghent, Belgium
| | - Myriam Vervaet
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University Ghent, Belgium
| | - Chris Baeken
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University Ghent, Belgium
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24
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Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep 2014; 16:438. [PMID: 24492919 DOI: 10.1007/s11920-014-0438-z] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced deficits in emotion regulation, cognitive disturbances including dissociation, impulsivity, and interpersonal disturbances. Over the last decades, neuroimaging has become one of the most important methods to investigate neurobiological alterations possibly underlying core features of BPD. The aim of our article is to provide an overview of the latest neuroimaging research in BPD focusing on functional and structural MRI studies published since 2010. Findings of these studies are depicted and discussed referring to central domains of BPD psychopathology. On a neurochemical level, altered function in neurotransmitter systems including the serotonin, glutamate, and GABA systems was observed in patients with BPD. On a neural level, individuals with BPD showed structural and functional abnormalities in a fronto-limbic network including regions involved in emotion processing (e.g., amygdala, insula) and frontal brain regions implicated in regulatory control processes (e.g., anterior cingulate cortex, medial frontal cortex, orbitofrontal cortex, and dorsolateral prefrontal cortex). Limbic hyperreactivity and diminished recruitment of frontal brain regions may yield a link between disturbed emotion processing and other core features of BPD such as impulsivity and interpersonal disturbances. To clarify whether findings are specific to BPD, comparisons with other clinical groups are needed.
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Affiliation(s)
- Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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