边缘型人格障碍的排斥困扰抑制了前额叶内侧皮层。
Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder.
机构信息
Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, New York; Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
出版信息
Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Jun;8(6):651-659. doi: 10.1016/j.bpsc.2022.11.006. Epub 2022 Dec 5.
BACKGROUND
Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context.
METHODS
Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis.
RESULTS
Although rejection distress was higher in participants with BPD (F = 5.25, p = .027, η = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = -0.30, p = .050.
CONCLUSIONS
Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD.
背景
边缘型人格障碍（BPD）的特征是对社会排斥（即拒绝痛苦）的反应升高，但其神经机制尚不清楚。社会排斥的功能磁共振成像研究依赖于经典版的 Cyberball 任务，该任务不适用于功能磁共振成像。我们的目标是使用改良版的 Cyberball 来阐明 BPD 中拒绝痛苦的神经基础，这使我们能够将排斥事件的神经反应与其排斥环境的调制分开。
方法
23 名 BPD 女性和 22 名健康对照组参与者完成了 Cyberball 的一项新的功能磁共振成像修改版，该版本有 5 种不同排斥概率的运行，并在每次运行后对其拒绝痛苦进行评分。我们使用全脑单变量分析测试了排斥事件的全脑反应以及排斥痛苦对该反应的参数调制的组间差异。
结果
尽管 BPD 参与者的拒绝痛苦更高（F=5.25，p=0.027，η=0.12），但两组对排斥事件的神经反应相似。然而，随着拒绝痛苦的增加，BPD 组中排斥事件的前扣带皮层反应降低，但对照组参与者没有。BPD 组中排斥痛苦对前扣带皮层反应的调节越强，特质性排斥预期越高，r=−0.30，p=0.050。
结论
BPD 中增强的拒绝痛苦可能源于无法维持或上调前扣带皮层的活动，前扣带皮层是心理化网络的关键节点。排斥痛苦与心理化相关脑活动之间的反向耦合可能导致 BPD 中更高的排斥预期。
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