Evidence of abnormal amygdala functioning in borderline personality disorder: A functional MRI study

Department of Psychiatry and Psychotherapy, Medical Faculty of Aachen Technical University-RWTH, Aachen, Germany.
Biological Psychiatry (Impact Factor: 10.26). 09/2001; 50(4):292-8. DOI: 10.1016/S0006-3223(01)01075-7
Source: PubMed


Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD); however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates of abnormal emotional processing have been identified so far.
Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (fMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order.
Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects.
Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects' perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.

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    • "Often, however, these stimuli fail to produce significant differences in subjective arousal between individuals with BPD and those without BPD. Thus, while some studies have shown differences in subjectively reported arousal between individuals with BPD, and non-­‐BPD controls (Herpertz et al., 1999; Herpertz et al., 2000; Weinberg et al., 2009), many have not (Austin et al., 2007; Herpertz, Dietrich, et al., 2001; Kuo & Linehan, 2009; Suvak et al., 2012). "
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    ABSTRACT: This investigation sought to validate a stimulus set previously adapted by expert consensus from the International Affective Picture System (IAPS) to be unpleasant and evocative to individuals with borderline personality disorder (BPD). This set was rated as significantly more arousing by 22 individuals diagnosed with BPD compared to 22 healthy controls, though this mean difference appeared to be driven by differences in ratings for a small subset of pictures. The present BPD sample did not rate the BPD-specific picture set as more arousing than a previous BPD sample (Herpertz, Kunert, Schwenger, & Sass, 1999) had rated a different set of unpleasant, but non-BPD-specific IAPS images. Future BPD-specific image sets may benefit from including images that more closely target BPD sensitivities and features.
    Full-text · Article · Dec 2015 · Personality Disorders: Theory, Research, and Treatment
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    • "In addition to the alterations noted within the amygdala, BPDrelated differences in frontal activation are consistently reported. For example, a handful of studies report greater frontal activation, particularly within the lateral frontal cortex in response to images across valence or to pleasant images, specifically (Herpertz et al., 2001; Koenigsberg et al., 2009). However, in response to negative pictures, there is evidence of attenuation in the lateral frontal cortex (Ruocco et al., 2013) and rostral anterior cingulate cortex (Minzenberg et al., 2007). "
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    ABSTRACT: Background: Emotion dysregulation is central to the clinical conceptualization of borderline personality disorder (BPD), with individuals often displaying instability in mood and intense feelings of negative affect. Although existing data suggest important neural and behavioral differences in the emotion processing of individuals with BPD, studies thus far have only explored reactions to overt emotional information. Therefore, it is unclear if BPD-related emotional hypersensitivity extends to stimuli presented below the level of conscious awareness (preattentively). Methods: Functional magnetic resonance imaging (fMRI) was used to measure neural responses to happy, angry, fearful, and neutral faces presented preattentively, using a backward masked affect paradigm. Given their tendency toward emotional hyperreactivity and altered amygdala and frontal activation, we hypothesized that individuals with BPD would demonstrate a distinct pattern of fMRI responses relative to those without BPD during the viewing of masked affective versus neutral faces in specific regions of interests (ROIs). Results: RESULTS indicated that individuals with BPD demonstrated increases in frontal, cingulate, and amygdalar activation represented by number of voxels activated and demonstrated a different pattern of activity within the ROIs relative to those without BPD while viewing masked affective versus neutral faces. Conclusion: These findings suggest that in addition to the previously documented heightened responses to overt displays of emotion, individuals with BPD also demonstrate differential responses to positive and negative emotions, early in the processing stream, even before conscious awareness.
    Full-text · Article · Dec 2015 · Frontiers in Psychology
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    • "Of note, BPD patients often show abnormal activity (e.g. Herpertz et al. 2001; Koenigsberg et al. 2009a, b; Niedtfeld et al. 2010; Schulze et al. 2011; Hazlett et al. 2012) and abnormal connectivity (e.g. New et al. 2007; Silbersweig et al. 2007; Niedtfeld et al. 2012) in these regions, indicating a dysfunctional interplay between (para-)limbic and prefrontal brain regions in BPD (Mauchnik & Schmahl, 2010; Krause-Utz et al. 2014). "
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    ABSTRACT: A dysfunctional network of prefrontal and (para-)limbic brain region has been suggested to underlie emotional dysregulation in borderline personality disorder (BPD). Abnormal activity in this network may be due to structural alterations in white-matter tracts connecting prefrontal and (para-)limbic brain regions. To test this hypothesis, we investigated the structural integrity of major white-matter tracts connecting these regions in BPD. Using diffusion tensor imaging, we investigated fractional anisotropy (FA), axonal anisotropy (AD) and radial diffusivity (RD) in the uncinate fasciculus, the major white-matter tract connecting (para-)limbic and prefrontal brain regions, in 26 healthy controls (HC) and 26 BPD participants. To clarify the specificity of possible white-matter alterations among HC and BPD participants, FA, AD and RD were also investigated in the cingulum. We found distinct structural alterations in the uncinate fasciculus but not in the cingulum of BPD participants. Compared to HC participants, BPD participants showed lower FA and higher RD in the uncinate fasciculus. By contrast, AD did not differ in the uncinate fasciculus of HC and BPD participants. Our finding of abnormal FA and RD in the uncinate fasciculus indicates distinct white-matter alterations in BPD, presumably due to stress-induced myelin degeneration in the aftermath of stressful life events. Although these alterations may account for abnormal activity in brain regions implicated in emotion dysregulation, such as the amygdala, anterior cingulate cortex and prefrontal cortex, it remains to be determined whether these alterations are specific for BPD.
    Full-text · Article · Jun 2015 · Psychological Medicine
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