From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz).
J Psychiatry Neurosci. 2018 Jan;43(1):37-47. doi: 10.1503/jpn.170008.
Borderline personality disorder (BPD) is characterized by emotion dysregulation; however, it is unclear whether this is restricted to negative emotional stimuli or to what degree this is specific to BPD. We investigated neural correlates of hypothesized increased emotional sensitivity and impaired emotion regulation in patients with BPD.
During functional MRI (fMRI) scanning, patients with BPD, nonpatient controls and patients with cluster-C personality disorder completed an emotion regulation task, including negative, positive and erotic social pictures.
We included 55 patients with BPD, 42 nonpatient controls and 24 patients with cluster-C personality disorder in our analyses. Passive viewing of negative stimuli resulted in greater activity in the anterior insula, temporoparietal junction and dorsolateral prefrontal cortex in patients with BPD than in nonpatient controls. The increased activity in the anterior insula and temporoparietal junction was also present when patients with BPD viewed positive stimuli. During regulation of negative stimuli compared with passive viewing, nonpatient controls showed greater activity in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, middle temporal gyrus and bilateral inferior parietal lobule. Patients with BPD did not show this increase in activity.
Findings cannot be generalized to men, and patients represented a heterogeneous group regarding comorbid diagnoses and medication.
When looking at emotional stimuli, patients with BPD showed a unique pattern of activity, suggesting an increase in brain activity involved in emotion generation. In the case of negative stimuli this is accompanied by increased activity in regulation areas. In contrast, increase of regulation processes seems absent when patients with BPD are explicitly instructed to regulate. Results of diagnosis specificity support a dimensional rather than a dichotomous differentiation between BPD and cluster-C personality disorder regarding emotional sensitivity and emotional regulation of social stimuli.
边缘型人格障碍（BPD）的特征是情绪失调；然而，目前尚不清楚这种失调是否仅限于负面情绪刺激，或者这种失调在多大程度上是 BPD 特有的。我们研究了 BPD 患者情绪敏感性增加和情绪调节受损的神经相关性。
在功能磁共振成像（fMRI）扫描期间，BPD 患者、非患者对照组和具有 Cluster-C 人格障碍的患者完成了一项情绪调节任务，包括负面、正面和色情社交图片。
我们将 55 名 BPD 患者、42 名非患者对照组和 24 名 Cluster-C 人格障碍患者纳入我们的分析。与非患者对照组相比，BPD 患者被动观看负面刺激时，前岛叶、颞顶联合区和背外侧前额叶皮层的活动增加。当 BPD 患者观看正面刺激时，前岛叶和颞顶联合区的活动增加。与被动观看相比，在调节负面刺激时，非患者对照组在前扣带皮层背侧、背外侧前额叶皮层、中颞叶和双侧下顶叶显示出更大的活动。BPD 患者没有显示出这种活动的增加。
研究结果不能推广到男性，并且患者在合并诊断和药物治疗方面代表了一个异质群体。
当观察情绪刺激时，BPD 患者表现出一种独特的活动模式，表明与情绪产生相关的大脑活动增加。在负面刺激的情况下，这种情况伴随着调节区域活动的增加。相比之下，当 BPD 患者被明确指示进行调节时，调节过程的增加似乎不存在。诊断特异性的结果支持在情绪敏感性和社会刺激的情绪调节方面，将 BPD 与 Cluster-C 人格障碍区分开来采用维度而不是二分法。
