Department of Psychology, University of Toronto Scarborough, Toronto, Canada.
Biol Psychiatry. 2013 Jan 15;73(2):153-60. doi: 10.1016/j.biopsych.2012.07.014. Epub 2012 Aug 17.
Emotional vulnerabilities at the core of borderline personality disorder (BPD) involve a dysfunction of frontolimbic systems subserving negative emotionality. The specific regions identified in individual studies, however, vary widely and provide an incomplete understanding of the functional brain abnormalities that characterize this illness. A quantitative synthesis of functional neuroimaging studies might clarify the neural systems dysfunctions that underlie negative emotionality in BPD.
An electronic search of Medline and PsycInfo databases from 2000 to 2012 identified 18 potential studies, of which 11 met inclusion criteria for the meta-analysis and comprised a pooled sample of 154 BPD patients and 150 healthy control subjects. Contrasts of negative versus neutral emotion conditions were analyzed with an activation-likelihood-estimation meta-analytic approach. Group comparisons were performed on study-reported between-subjects contrasts and independent subtraction analyses based on within-subjects contrasts.
Healthy control subjects activated a well-characterized network of brain regions associated with processing negative emotions that included the anterior cingulate cortex and amygdala. Compared with healthy control subjects, BPD patients demonstrated greater activation within the insula and posterior cingulate cortex. Conversely, they showed less activation than control subjects in a network of regions that extended from the amygdala to the subgenual anterior cingulate and dorsolateral prefrontal cortex.
Processing of negative emotions in BPD might be subserved by an abnormal reciprocal relationship between limbic structures representing the degree of subjectively experienced negative emotion and anterior brain regions that support the regulation of emotion. Contrary to early studies, BPD patients showed less activation than control subjects in the amygdala under conditions of negative emotionality.
边缘型人格障碍（BPD）的核心情绪脆弱性涉及到负责负性情绪的额眶部-边缘系统功能障碍。然而，个体研究中确定的特定区域差异很大，无法全面了解该疾病的特征性功能性脑异常。对功能神经影像学研究进行定量综合分析可能会阐明导致 BPD 负性情绪的神经功能系统障碍。
通过电子检索 2000 年至 2012 年 Medline 和 PsycInfo 数据库，确定了 18 项潜在的研究，其中 11 项符合荟萃分析的纳入标准，包含了 154 名 BPD 患者和 150 名健康对照者的汇总样本。采用激活似然估计荟萃分析方法分析了负性与中性情绪条件的对比。基于组间对比和基于个体内对比的独立差减分析，对研究报告的组间对比进行了组间比较。
健康对照组激活了与处理负性情绪相关的一组特征明确的脑区网络，包括前扣带回和杏仁核。与健康对照组相比，BPD 患者在内侧脑岛和后扣带回的激活程度更大。相反，与对照组相比，BPD 患者在一个从杏仁核延伸到扣带回前亚区和背外侧前额叶的脑区网络中的激活程度更低。
BPD 中负性情绪的处理可能由代表主观体验负性情绪程度的边缘结构与支持情绪调节的前脑区域之间的异常相互关系来调节。与早期研究相反，BPD 患者在负性情绪条件下的杏仁核激活程度低于对照组。
