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.
"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. "
[Show abstract][Hide abstract] 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.
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.
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).
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
"While individuals with complex trauma exposure might be expected to exhibit high physiological arousal (especially in the SNS), recent findings have suggested blunted activity is also typical (Kraus et al., 2009; McTeague et al., 2010). Earlier work by Griffin, Resick, and Mechanic (1997) demonstrated that rape survivors high on peritraumatic dissociation had blunted skin conductance activity during script driven imagery. "
[Show abstract][Hide abstract] ABSTRACT: Exposure to chronic interpersonal violence (IPV) has been associated with psychiatric impairment; however, few studies have investigated attention processes and psychophysiology in this population.
We investigated self-report and physiological correlates of attention biases in 27 IPV-exposed women.
Participants completed self-report measures of trauma history, posttraumatic stress disorder (PTSD) symptoms, and dissociation; were monitored physiologically during baseline; and responded to an emotional dot probe task.
Participants showed bias away from positive and anxiety words, and toward IPV words. Lower baseline respiratory sinus arrhythmia (RSA) and higher skin conductance levels were associated with bias away from anxiety cues. Greater total PTSD symptoms were associated with bias toward IPV cues, and greater PTSD intrusion and avoidance symptoms were associated with lower RSA. Individuals exposed to more types of trauma had lower heart rates.
These data extend the research on emotion-cognition interactions in PTSD and other anxiety disorders to chronic IPV survivors, in part confirming avoidance and intrusion symptom and attention bias relations found in studies. The present work also draws attention to a group that tends to experience a range of severe symptoms associated with apparent blunting in autonomic activity, and suggests that self-report may not be sensitive to physiological and attention alterations in chronic IPV samples.
European Journal of Psychotraumatology 03/2013; 4. DOI:10.3402/ejpt.v4i0.19135 · 2.40 Impact Factor
"Various dissociative symptoms can accompany a number of psychiatric diagnostic entities (other than dissociative or conversion disorders) and have been targeted by several functional imaging studies (Kraus et al., 2009; Ludaescher et al., 2010). For example dissociative amnesia can occur as a symptom in certain anxiety disorders, such as acute stress disorder and post-traumatic stress disorder (PTSD) or in the DSM-IV-TR described somatization disorder or in borderline personality disorder (Zanarini, Frankenburg, Jager- Hyman, Reich, & Fitzmaurice, 2008). "
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