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Figures
- Fig. 1
Overview of a single trial of the task. Each 19- to 20.5-s trial consisted of a 2-s visual instruction to either “look” or “realize being safe,” an 8-s presentation of the picture for carrying out the instruction, a 4-s rating period and a 5- to 6.5-s fixation (relax). During the rating period, participants indicated their emotional experience at the moment by moving the pointer on the horizontal scale using a button box between negative (−100) and positive (100). IAPS = International Affective Picture System.
- Fig. 2
Locations and bar plots of b values of clusters resulting from whole brain random-effects analyses of variance testing differences in emotional sensitivity. Bar plots represent blood oxygen level–dependent (BOLD) signal change in z-scores, and error bars indicate standard errors of the mean. Cluster coordinates are reported in Talairach space. BPD = borderline personality disorder; CCP = cluster-C personality disorder; NPC = nonpatient controls.
- Fig. 3
Location of the left and right amygdala regions of interest (Talairach coordinates: x, y, z = ± 21, −5, −15) and bar plots of b values of both amygdala seeds showing a main effect of stimulus category comparing negative versus neutral stimuli. BOLD = blood oxygen level–dependent; BPD = borderline personality disorder; NPC = nonpatient controls; SEM = standard error of the mean.
- Fig. 4
Locations and bar plots of b values of clusters resulting from whole brain random-effects analyses of variance testing differences in emotion regulation concerning negative stimuli. Bar plots represent blood oxygen level–dependent (BOLD) signal change in z-scores, and error bars indicate standard errors of the mean. The F map was overlaid on an average brain of all participants shown in the radiological convention. Cluster coordinates are reported in Talairach space. BPD = borderline personality disorder; CCP = cluster-C personality disorder; NPC = nonpatient controls.
Tables
Characteristic Group; mean ± SD or no. (%) Statistical test p value BPD (n = 55) NPC (n = 42) CCP (n = 24) Age, yr 30.80 ± 8.78 28.33 ± 10.50 30.38 ± 11.46 F = 0.77 0.47 Education level* χ2 = 8.90 0.012‡ Level 1 13 (23.6) 7 (16.7) 4 (16.7) Level 2 8 (14.5) 2 (4.8) 4 (16.7) Level 3 15 (27.3) 4 (9.5) 7 (29.2) Level 4 3 (5.5) 2 (4.8) 3 (12.5) Level 5 13 (23.6) 19 (45.2) 3 (12.5) Level 6 3 (5.5) 7 (16.7) 3 (12.5) Estimated IQ† 96.66 ± 9.93 100.43 ± 11.03 98.05 ± 9.42 F = 1.59 0.21 Handedness, No. left/right/mixed 5/46/3 2/40/0 0/24/0 χ2 = 6.72 0.15§ BSI, total score 1.74 ± 0.57 0.13 ± 0.13 1.08 ± 0.45 F = 150.74 < 0.001¶ BPD checklist, total score 120.60 ± 26.92 50.73 ± 5.03 72.96 ± 17.02 F = 147.41 < 0.001** ITEC F = 9.90 < 0.001†† Sexual abuse 9.10 ± 8.95 0.13 ± 0.41 1.97 ± 5.01 F = 21.57 < 0.001 Physical abuse 16.93 ± 11.77 1.63 ± 3.51 7.12 ± 10.55 F = 27.41 < 0.001 Emotional abuse 20.36 ± 8.53 2.32 ± 3.27 12.92 ± 8.50 F = 63.46 < 0.001 Emotional neglect 10.89 ± 6.95 0.77 ± 2.02 6.37 ± 6.46 F = 32.19 < 0.001 Physical neglect 9.99 ± 9.08 0.82 ± 2.74 4.76 ± 6.99 F = 17.17 < 0.001 Dissociation F = 8.97 < 0.001‡‡ Before scanning 20.16 ± 19.44 5.29 ± 6.51 7.04 ± 8.34 F = 14.46 < 0.001 After scanning 31.86 ± 26.11 6.69 ± 8.36 16.60 ± 20.65 F = 17.45 < 0.001 Anxiety F = 7.68 < 0.001§§ Before scanning 41.90 ± 30.59 10.00 ± 20.03 30.87 ± 30.91 F = 15.37 < 0.001 After scanning 25.60 ± 27.17 5.93 ± 14.75 23.70 ± 32.86 F = 7.66 0.001 Nervousness F = 10.85 < 0.001¶¶ Before scanning 54.75 ± 32.28 15.68 ± 21.94 36.78 ± 30.67 F = 20.90 < 0.001 After scanning 27.49 ± 27.14 6.05 ± 13.90 30.17 ± 36.52 F = 9.79 < 0.001 Axis I disorders Major depressive disorder 49 (89.1) — 13 (54.2) χ2 = 12.07 0.001 Dysthymic 4 (7.3) — 1 (4.2) χ2 = 0.27 0.60 Bipolar type II 1 (1.8) — — χ2 = 0.44 0.51 Generalized anxiety disorder 2 (3.6) — 1 (4.2) χ2 = 0.01 0.91 Panic disorder with agoraphobia 7 (12.7) — 2 (8.3) χ2 = 0.32 0.57 Panic disorder 7 (12.7) — 3 (12.5) χ2 = 0.001 0.98 Agoraphobia 4 (7.3) — — χ2 = 1.84 0.18 Specific phobia 10 (18.2) — 1 (4.2) χ2 = 2.74 0.10 Social phobia 19 (34.5) — 6 (25.0) χ2 = 0.70 0.40 Obsessive–compulsive disorder 8 (14.5) — 2 (8.3) χ2 = 0.58 0.45 Posttraumatic stress disorder 20 (36.4) — 3 (12.5) χ2 = 4.61 0.032 Somatoform disorder 5 (9.1) — 4 (16.7) χ2 = 0.95 0.33 Eating disorders 22 (40.0) — 8 (33.3) χ2 = 0.32 0.57 Substance abuse 27 (49.1) — 1 (4.2) χ2 = 14.74 < 0.001 Intermitted explosive disorder 1 (1.8) — — χ2 = 0.44 0.51 Axis II disorders Avoidant PD 27 (49.1) — 17 (70.8) χ2 = 3.20 0.07 Dependent PD 10 (18.2) — 2 (8.3) χ2 = 1.26 0.26 Obsessive compulsive PD 11 (20.0) — 8 (33.3) χ2 = 1.63 0.20 Passive–aggressive PD 4 (7.3) — — χ2 = 1.84 0.18 Depressive PD 15 (27.3) — 2 (8.3) χ2 = 3.85 0.06 Paranoid PD 15 (27.3) — — χ2 = 8.08 0.004 Schizotypal PD 1 (1.8) — — χ2 = 0.44 0.51 Schizoid PD 1 (1.8) — — χ2 = 0.44 0.51*** Medication Antidepressants 37 (67.3) — 9 (37.5) χ2 = 6.09 0.014 Antipsychotics 8 (14.3) — — χ2 = 3.88 0.049 Hypnotics 3 (5.5) — — χ2 = 1.36 0.24 Mood stabilizers 1 (1.8) — — χ2 = 0.44 0.51 ANOVA; analysis of variance; BSI = Brief Symptom Inventory; BPD = borderline personality disorder; df = degrees of freedom; ITEC = Interview Traumatic Events Childhood; MANOVA = multivariate analysis of variance; PD = personality disorder.
↵* Based on International Standard Classification of Education (ISCED); levels range from lower secondary school to master’s degree.
↵† Assessed using 4 subtasks of the Wechsler Adult Intelligence Scale. Data unavailable for 1 nonpatient control; df = 2, 117
↵‡ Kruskal–Wallis test. Data unavailable for 1 nonpatient control; df = 2.
↵§ Data unavailable for 1 patient with BPD; df = 4.
↵¶ Data unavailable for 2 nonpatient controls; df = 2, 116.
↵** Data unavailable for 2 nonpatient controls and 1 patient with cluster-C personality disorder; df = 2, 115.
↵†† The MANOVA (df = 10, 212) and ANOVAs (df = 2, 109) showed significant group effects over traumas. Patients with BPD experienced significantly more trauma than both control groups regarding sexual abuse (both p < 0.001), physical abuse (both p < 0.001) and physical neglect (p < 0.001 v. nonpatient controls; p = 0.014 v. patients with cluster-C personality disorder). The 3 groups significantly differed on emotional abuse (p < 0.001) and emotional neglect (BPD v. nonpatient controls p < 0.001; BPD v. cluster-C personality disorder p = 0.0006; nonpatient controls v. cluster-C personality disorder p = 0.002), with patients with BPD experiencing the most trauma, followed by those with cluster-C personality disorder. Data unavailable for 8 nonpatient controls and 1 patient with cluster-C personality disorder.
↵‡‡ Data available for 51 patients with BPD, 40 nonpatient controls and 23 patients with cluster-C personality disorder. The MANOVA (df = 4, 222) and ANOVAs (df = 2, 111) showed significant group effects over dissociation. Patients with BPD dissociated significantly more before and after scanning than with both control groups (before scanning: BPD v. nonpatient controls p < 0.001, BPD v. cluster-C personality disorder p = 0.001; after scanning: BPD v. nonpatient controls p < 0.001, BPD v. cluster-C personality disorder p = 0.011). Repeated-measures ANOVA showed a significant group × dissociation interaction (F2,11 = 5.27; p = 0.007). Patients with BPD dissociated significantly more after than before scanning compared with nonpatient controls (p = 0.006).
↵§§ Data available for 52 patients with BPD patients, 40 nonpatient controls and 23 patients with cluster-C personality disorder. The MANOVA (df = 4, 224) and ANOVAs (df = 2, 112) showed significant group effects over anxiety. Nonpatient controls were significantly less anxious before and after scanning than both other groups (before scanning: BPD v. nonpatient controls p < 0.001, nonpatient controls v. patients with cluster-C personality disorder p = 0.013; after scanning: patients with BPD v. nonpatient controls p = 0.001, nonpatient controls v. patients with cluster-C personality disorder p = 0.023). Repeated-measures ANOVA showed no significant group × anxiety interaction (F2,112 = 2.12; p = 0.125).
↵¶¶ Data available for 51 patients with BPD, 40 nonpatient controls and 23 patients with cluster-C personality disorder. The MANOVA (df = 4, 222) and ANOVAs (df = 2, 111) showed significant group effects over nervousness. All 3 groups significantly differed in their nervousness before scanning, with patients with BPD being most nervous, followed by those with cluster-C personality disorder (BPD v. nonpatient controls p < 0.001, BPD v. patients with cluster-C personality disorder p = 0.042 and nonpatient controls v. patients with cluster-C personality disorder p = 0.017). Nonpatient controls were significantly less nervous after scanning compared with both other groups (BPD v. nonpatient controls p < 0.001, nonpatient controls v. patients with cluster-C personality disorder p = 0.002). Repeated-measures ANOVA showed a significant group × nervousness interaction (F2,111 = 5.57, p = 0.005). Patients with BPD were significantly more nervous after than before scanning compared with nonpatient controls (p = 0.016).
- Table 2
Resulting clusters for whole brain random-effects analysis of variance testing differences in emotional sensitivity and emotion regulation between patients with borderline personality disorder and nonpatient controls regarding negative stimuli*
Analysis; brain region L/R BA Cluster size, mm3 Talairach peak voxel F p value x y z Emotional sensitivity Negative look v. neutral look Anterior insula R 13 1065 33 17 16 9.74 0.002 Middle frontal gyrus, dorsolateral prefrontal cortex L 8 650 −30 35 43 12.55 0.001 Supramarginal gyrus, temporoparietal junction L 40 413 −45 −43 37 9.38 0.003 Cerebellum L 1022 −21 −34 −38 12.59 0.001 Emotion regulation Negative safe v. negative look Middle frontal gyrus, dorsolateral prefrontal cortex R 8 831 36 26 37 13.96 < 0.001 Dorsal anterior cingulate cortex R 32 1791 12 17 34 17.80 < 0.001 Middle temporal gyrus R 21 1596 57 −25 −11 20.47 < 0.001 Supramarginal gyrus, inferior parietal lobule R 40 1228 51 −52 31 12.59 0.001 Supramarginal gyrus, inferior parietal lobule L 40 2496 −45 −43 34 17.54 < 0.001 Cerebellum R 569 27 −37 −42 8.35 0.005 Cerebellum L 1166 −6 −73 −41 3.03 0.085 BA = Brodmann area; L = Left; R = Right.
↵* Thresholded at p < 0.005 and cluster size.
- Table 3
Significance levels of linear and quadratic trends of brain responses in relation to severity of personality psychopathology
Analysis; brain region p value Linear Quadratic Look negative – look neutral Anterior insula 0.002 0.82 Dorsolateral prefrontal cortex 0.001 0.56 Temporoparietal junction 0.002 0.39 Look positive – look neutral Anterior insula 0.043 0.33 Temporoparietal junction 0.008 0.05 Safe negative – look negative Dorsolateral prefrontal cortex 0.001 0.88 Dorsal anterior cingulate cortex < 0.001 0.81 Middle temporal gyrus < 0.001 0.45 Inferior parietal lobule, right 0.001 0.31 Inferior parietal lobule, left < 0.001 0.49 Analysis; confounding factor Left amygdala Right amygdala Statistical test p value Statistical test p value Main effect stimulus F1,95 = 26.97 < 0.001 F1,95 = 31.71 < 0.001 Stimulus × group interaction F1,95 = 0.76 0.39 F1,95 = 0.07 0.79 Time single run 1 F1,92 = 0.001 0.98 F1,92 = 4.94 0.029 Time run 1–4 F1,85 = 0.52 0.47 F1,85 = 0.05 0.82 Dissociation* F1,88 = 0.59 0.44 F1,88 = 0.08 0.77 Childhood trauma severity† F1,86 = 0.06 0.81 F1,86 = 0.05 0.82 Posttraumatic stress disorder F1,94 = 0.58 0.45 F1,94 = 0.22 0.64 Depression (BSI subscale) F1,92 = 0.53 0.47 F1,92 = 0.03 0.86 Medication F1,94 = 0.01 0.93 F1,94 = 0.06 0.80 Lateralization F1,95 = 0.11 0.74 see left amygdala
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