Neural correlates of attachment trauma in borderline personality disorder: A functional magnetic resonance imaging study

Department of Psychosomatic Medicine and Psychotherapy, University Ulm, Am Hochstraess 8, 89081 Ulm, Germany.
Psychiatry Research (Impact Factor: 2.47). 08/2008; 163(3):223-35. DOI: 10.1016/j.pscychresns.2007.07.001
Source: PubMed


Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first time the functional neuroanatomy of attachment trauma in BPD patients using functional magnetic resonance imaging (fMRI) during the telling of individual stories. A group of 11 female BPD patients and 17 healthy female controls, matched for age and education, told stories in response to a validated set of seven attachment pictures while being scanned. Group differences in narrative and neural responses to "monadic" pictures (characters facing attachment threats alone) and "dyadic" pictures (interaction between characters in an attachment context) were analyzed. Behavioral narrative data showed that monadic pictures were significantly more traumatic for BPD patients than for controls. As hypothesized BPD patients showed significantly more anterior midcingulate cortex activation in response to monadic pictures than controls. In response to dyadic pictures patients showed more activation of the right superior temporal sulcus and less activation of the right parahippocampal gyrus compared to controls. Our results suggest evidence for potential neural mechanisms of attachment trauma underlying interpersonal symptoms of BPD, i.e. fearful and painful intolerance of aloneness, hypersensitivity to social environment, and reduced positive memories of dyadic interactions.

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    • "AAP–AAI convergence for secure versus insecure classifications was 0.95 (κ = 0.75, p = 0.000); convergence for the four major attachment groups was 0.89 (κ = 0.84, p = 0.000; George and West, 2001, 2012; West and George, 2002). The AAP has also been shown to be useful in studying the neurobiological and emotional expression correlates of attachment in non-clinical and clinical samples (Buchheim and Benecke, 2007; Buchheim et al., 2007, 2008, 2009; Fraedrich et al., 2010) as well as in single case studies (Lis et al., 2011). "
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    ABSTRACT: There is a gap between proposed theoretical attachment theory frameworks, measures of attachment in the assessment phase and their relationship with changes in outcome after a psychodynamic oriented psychotherapy. Based on a clinical case study of a young woman with Panic Attack Disorder, this paper examined psychotherapy outcome findings comparing initial and post-treatment assessments, according to the mental functioning in S and M-axis of the psychodynamic diagnostic manual. Treatment planning and post-treatment changes were described with the main aim to illustrate from a clinical point of view why a psycho-dynamic approach, with specific attention to an "attachment theory stance," was considered the treatment of choice for this patient. The Symptom Check List 90 Revised (SCL-90-R) and the Shedler-Westen Assessment Procedure (SWAP-200) were administered to detect patient's symptomatic perception and clinician's diagnostic points of view, respectively; the Adult Attachment Interview and the Adult Attachment Projective Picture System (AAP) were also administered as to pay attention to patient's unconscious internal organization and changes in defense processes. A qualitative description of how the treatment unfolded was included. Findings highlight the important contribution of attachment theory in a 22-month psychodynamic psychotherapy framework, promoting resolution of patient's symptoms and adjustment.
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    • "The treatment was paid by the health insurance. This study was approved by the ethical committee by the University of Ulm in the context of the Hanse-Neuro-Psychoanalysis Study (Buchheim et al., 2008, 2012). The patient gave written informed consent to the publication of the data. "
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    • "The analysis of the narratives showed monadic pictures to be associated with more traumatic material in BPD patients than in controls, which showed distinct activation in several brain areas. The most striking finding was the demonstration of a differential activation in the anterior cingulate cortex (ACC), a part of the limbic system located deep in the midline of the brain, when producing narratives from monadic pictures (Buchheim et al., 2008). The observed ACC activation in our study was located in the anterior midcingulate cortex (aMCC). "
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