Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder

Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
Biological psychiatry (Impact Factor: 10.26). 05/2009; 65(9):819-22. DOI: 10.1016/j.biopsych.2008.10.028
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Previous studies have revealed altered affective pain processing in patients with borderline personality disorder (BPD) as well as in patients with posttraumatic stress disorder (PTSD). Reduced levels of activation in the amygdala might be related to antinociceptive mechanisms pertinent to both disorders. This study aimed at clarifying whether central antinoceptive mechanisms discriminate BPD patients with and without co-occurrent PTSD.
We investigated 29 medication-free female outpatients with BPD, 12 with and 17 without co-occurrent PTSD. Psychophysical characteristics were assessed, and functional magnetic resonance imaging was performed during heat stimulation with stimuli adjusted for equal subjective painfulness.
No difference in pain sensitivity was found between both groups of patients. Amygdala deactivation, however, was more pronounced in BPD patients with co-occurrent PTSD compared with those without PTSD. Amygdala deactivation was independent of BPD symptom severity and dissociation.
Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD. On the basis of these preliminary findings it might be speculated that reduced pain sensitivity or at least the emotional component of it is associated with amygdala deactivation in patients with both disorders, whereas BPD patients without PTSD use different yet unknown antinociceptive mechanisms.

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    • "Given that any emotional response is a complex, multifaceted phenomenon involving not only subjective experience, but also physiological arousal and motoric behavior, the value of accessing other, much more objective streams of physiological data to complement that of real-time self-report of emotional responding warrants attention (Rosenthal et al., 2008). Specific to the aims of the present study, the ambulatory assessment of physiological responding concurrent with subjective affective reports may prove particularly helpful in clarification of the phenomenology of BPD, PTSD, and BPD-PTSD comorbidity, especially given recent evidence of both similarity and divergence in pathophysiology across these diagnostic groups (e.g., Kraus et al., 2009; Limberg et al., 2011; Rodrigues et al., 2011; Schmahl et al., 2004; Schmahl et al., 2009), along with evidence associating subjective arousal with distress in individuals with BPD (Ebner-Priemer et al., 2008). From a treatment perspective , also, the utilization of EMA methods—including advanced physiological measurements—to longitudinally examine affect dysregulation as a marker of treatment outcome may be a critical direction to pursue in the further development and evaluation of treatment protocols designed to address BPD-PTSD comorbidity. "
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    ABSTRACT: Ecological momentary assessment was utilized to examine affective instability (AI) in the daily lives of outpatients with borderline personality disorder (BPD; N = 78), with and without posttraumatic stress disorder (PTSD). A psychiatric control group (n = 50) composed of outpatients with major depressive disorder/dysthymia (MDD/DYS) was employed to compare across subgroups: BPD-only, BPD+PTSD, MDD/DYS-only, and MDD/DYS+PTSD. Compared with the BPD-only group, the BPD+PTSD group had significantly greater instability of fear and sadness, but did not significantly differ in instability of hostility or aggregate negative affect. This pattern of elevated instability of fear and sadness was not present—and, in fact, was reversed—in the MDD/DYS group. Results emphasize the importance of examining AI within the context of specific comorbidities and affect types. Treatment and research addressing AI in the context of BPD-PTSD comorbidity may benefit from a focus on fear and sadness as separate from hostility or general negative affect.
    04/2015; DOI:10.1177/2167702615573214
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    • "With regards to the direction of startle anomalies, our unpublished data (Wiik et al., 2009) and studies of startle in severely traumatized samples, would have predicted blunted startle responses subsequent to neglect and deprivation. There is in fact a growing body of research suggesting that adversity and trauma may cause blunted affect and discordant emotional experiences in a subset of affected individuals (Bremner et al., 1999; Kraus et al., 2009; Rauch et al., 1996). This cluster of anomalies includes restricted range of affect, dissociation, depression, and persistent avoidance symptoms. "
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    ABSTRACT: This study tested the effect of early neglect on defensive and appetitive physiology during puberty. Emotion-modulated reflexes, eye-blink startle (defensive) and postauricular (appetitive), were measured in 12-to-13-year-old internationally adopted youth (from foster care or from institutional settings) and compared to non-adopted US born controls. Startle Reflex: adopted youth displayed lower overall startle amplitude across all valences and startle potentiation to negative images was negatively related to severity of pre-adoption neglect. Postauricular reflex (PAR): adopted youth showed larger PAR magnitude across all valences. Puberty: adopted youth showed diminished PAR potentiation to positive images and startle potentiation during mid/late puberty versus the opposite pattern in not-adopted. Early neglect was associated with blunted fast defensive reflexes and heightened fast appetitive reflexes. After puberty, early neglected youth showed physiological hyporeactivity to threatening and appetitive stimuli versus heightened reactivity in not adopted youth. Behavioral correlates in this sample and possible neurodevelopmental mechanisms of psychophysiological differences are discussed. © 2015 Wiley Periodicals, Inc. Dev Psychobiol 9999: XX-XX, 2015. © 2015 Wiley Periodicals, Inc.
    Developmental Psychobiology 03/2015; 57(3). DOI:10.1002/dev.21283 · 3.31 Impact Factor
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    • "For example, the studies reporting amygdala hyperactivity (e.g., Koenigsberg et al., 2009; Minzenberg et al., 2007; Schulze et al., 2011) involved unmedicated BPD patients, while the studies demonstrating diminished amygdala responsivity included participants currently taking psychotropic medications (Smoski et al., 2011). Similarly, Axis I co-morbidities such as PTSD may influence amygdala reactivity, particularly in relation to pain perception (Kraus et al., 2009). Cullen et al. (2011) reported increased amygdala connectivity during fear states in 12 females with BPD, suggesting increased use of both overt and automatic fear processing; however, the neutral state revealed lower connectivity between both bilateral amygdala and mid-cingulate regions. "
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    ABSTRACT: Objective: Siever and Davis' (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods: Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results: fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion: These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity-part of the disturbed neural circuitry underlying emotional dysregulation in BPD. Future work includes examining how DBT-induced amygdala changes interact with frontal-lobe regions implicated in emotion regulation.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.020 · 3.96 Impact Factor
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