Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, Campus Biotech, Geneva, Switzerland.
Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2022 Nov;7(11):1137-1148. doi: 10.1016/j.bpsc.2021.11.015. Epub 2021 Dec 17.
Patients with borderline personality disorder (BPD) typically present emotion dysregulation (ED) when faced with adversity. However, it is argued that altered stress response may be more influenced by ED than BPD-specific traits. Here, we investigated this issue with functional magnetic resonance imaging using another ED condition as clinical control, i.e., bipolar disorder (BD), and controlling for ED traits.
We recruited 17 patients with BD, 24 patients with BPD, and 32 healthy control (HC) subjects. We adapted a functional magnetic resonance imaging-compatible psychosocial stressor task (Montreal Imaging Stress Task) in which participants are placed under time pressure when performing mental calculations and then receive immediate performance feedback (positive, negative, and neutral). ED traits were measured via self-report questionnaires targeting cognitive emotion dysregulation, affective lability, and trait anger and anxiety.
Relative to patients with BD and HC subjects, patients with BPD exhibited overactive corticolimbic reactivity across all conditions, particularly in self-monitoring and emotion regulation regions such as the orbitofrontal cortex and anterior insula, even when controlling for ED. Conversely, patients with BD exhibited hypoactive corticolimbic reactivity to all feedback conditions compared with patients with BPD and HC subjects, even after controlling for ED. HC subjects exhibited significantly lower amygdala/hippocampus activity compared with both clinical groups, although this did not survive when controlling for ED.
This study provides new insight into BPD-specific neural stress responding, suggesting hyperactive self- and emotion-regulatory neural psychosocial stress responding, independent of ED traits. The findings also highlight the importance of considering BPD as a diagnostic profile distinguishable from other ED disorder clinical groups.
患有边缘型人格障碍（BPD）的患者在面临逆境时通常会出现情绪失调（ED）。然而，有人认为，改变的应激反应可能更多地受到 ED 的影响，而不是 BPD 特异性特征的影响。在这里，我们使用功能磁共振成像技术，以另一种 ED 状态作为临床对照（即双相情感障碍（BD）），并控制 ED 特征，研究了这个问题。
我们招募了 17 名 BD 患者、24 名 BPD 患者和 32 名健康对照（HC）受试者。我们改编了一种功能磁共振成像兼容的心理社会应激任务（蒙特利尔成像应激任务），在该任务中，当参与者进行心理计算时，他们会受到时间压力，然后立即收到表现反馈（积极、消极和中性）。ED 特征通过针对认知情绪失调、情感波动和特质愤怒和焦虑的自我报告问卷进行测量。
与 BD 患者和 HC 受试者相比，BPD 患者在所有条件下都表现出过度活跃的皮质边缘反应，特别是在自我监测和情绪调节区域，如眶额皮质和前岛叶，即使在控制 ED 的情况下也是如此。相比之下，BD 患者在所有反馈条件下都表现出皮质边缘反应低下，与 BPD 患者和 HC 受试者相比，即使在控制 ED 的情况下也是如此。与两个临床组相比，HC 受试者的杏仁核/海马体活动显著降低，尽管在控制 ED 后这一差异不再显著。
这项研究为 BPD 特异性神经应激反应提供了新的见解，表明在不考虑 ED 特征的情况下，自我和情绪调节神经的心理社会应激反应过度活跃。研究结果还强调了考虑 BPD 作为一种与其他 ED 障碍临床群体区分开来的诊断特征的重要性。
