Beblo Thomas, Driessen Martin, Mertens Markus, Wingenfeld Katja, Piefke Martina, Rullkoetter Nina, Silva-Saavedra Anamaria, Mensebach Christoph, Reddemann Luise, Rau Harald, Markowitsch Hans J, Wulff Hella, Lange Wolfgang, Berea Cristina, Ollech Isabella, Woermann Friedrich G
Department of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Germany.
Psychol Med. 2006 Jun;36(6):845-56. doi: 10.1017/S0033291706007227.
Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls.
Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories.
When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2 x 2 factorial analysis (DeltaBPD - Deltacontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition.
The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.
边缘型人格障碍（BPD）患者经常报告有未解决的生活事件，但目前人们对这些经历在大脑中的表现仍知之甚少。本研究使用功能磁共振成像（fMRI），旨在调查BPD患者和健康对照者回忆未解决生活事件时的神经关联。
20名女性BPD患者和21名健康对照者接受了fMRI检查。在测量过程中，受试者回忆未解决和已解决的负面生活事件。使用个体提示词来激发自传体记忆。扫描后，受试者对回忆这两种记忆时的情绪状态进行评分。
在对比未解决和已解决的生活事件时，患者的额颞叶区域出现显著的双侧激活，包括脑岛、杏仁核、前扣带回皮层、左侧后扣带回皮层、右侧枕叶皮层、双侧小脑和中脑。在健康受试者中，没有发现与这些情况相关的脑区差异激活。2×2析因分析（BPD组差值 - 对照组差值）显示了类似的结果，额叶皮层出现双侧激活，包括部分脑岛和眶额皮层，颞叶激活包括杏仁核，右侧枕叶皮层激活，以及部分小脑激活。与已解决的记忆状态相比，患者在回忆未解决的记忆状态时报告的焦虑和无助水平更高，而对照组则不然。
杏仁核和前额叶区域的激活可能反映出，BPD患者在回忆未解决的生活事件时，为控制强烈情绪做出了更多努力，但效果不佳。
