Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum

Agnes Lamers; Max Toepper; Silvia Carvalho Fernando; Nicole Schlosser; Eva Bauer; Friedrich Woermann; Martin Driessen; Thomas Beblo

doi:10.1503/jpn.180077

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Fig. 1
Brain activation associated with negative emotions (negative – neutral contrast) in (A) healthy controls and (B) patients with BPD as well as (C) increased brain activation related to negative emotions in patients with BPD compared with healthy controls and (D) mean signal changes in different regions of the emotion-regulation network for both groups and hemispheres separately, displayed together with standard errors of the means. Displayed are the whole-brain results of within-group and between-group cluster-level analyses with cluster significance thresholds of p < 0.05, FWE-corrected for multiple comparisons, and minimum cluster sizes of 20 voxels (A–C) and repeated-measures analysis of variance of regions of interest (D). ACC = anterior cingulate cortex; BPD = borderline personality disorder; DLPFC: dorsolateral prefrontal cortex; FWE = family-wise error; HC = healthy controls; L = left hemisphere; R = right hemisphere. Mean signal change in different regions of the emotion regulation network Brain regions Magnitude of signal change for the contrast of negative minus neutral
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Fig. 2
Top: negative correlation between fear-related activation (negative – neutral contrast) and the level of habitual acceptance (EAQ) in patients with BPD. Displayed are the whole-brain results of a within-group cluster-level analysis including the EAQ score as a regressor of interest with a cluster significance threshold of p < 0.05, FWE-corrected for multiple comparisons, with a minimum cluster size of 20 voxels. Bottom: correlation of signal change in the left dorsal striatum (negative – neutral contrast) and acceptance of negative emotions (EAQ) in patients with BPD. BPD = borderline personality disorder; EAQ = Emotion Acceptance Questionnaire; FWE = family-wise error. Acceptance of negative emotions (EAQ) Magnitude of signal change for the negative – neutral contrast

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Table 1

Demographic and clinical characteristics of the study sample

Characteristic	Group; mean ± SD		Statistical test	p value

	BPD n = 20	Control n = 20
Age, yr	25.95 ± 6.94	26.90 ± 9.43	t₃₈ = 0.36	0.72
Education, yr	11.75 ± 1.45	12.40 ± 0.99	t₃₄ = −1.66	0.11
BSL-23	1.95 ± 0.57	0.27 ± 0.23	t₃₈ = −12.29	< 0.001
EAQ	2.53 ± 0.58	4.41 ± 0.85	t₃₃ = 8.16	< 0.001
PANAS, pre^*	9.70 ± 8.16	2.15 ± 2.32	F_1,38 = 13.44	< 0.001^*
PANAS, post^*	7.05 ± 8.24	1.60 ± 3.17

BPD = borderline personality disorder; BSL = Borderline Symptom List; EAQ = Emotion Acceptance Questionnaire; PANAS = Positive and Negative Affect Schedule; SD = standard deviation.
↵* Comparison of groups over both times of assessment (main effect group). While the main effect of time was also significant (p = 0.047), the group × time interaction was not (p = 0.186).

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Table 2

Brain activation associated with negative emotions in patients with BPD and healthy controls as well as significant differences between both groups for the negative – neutral contrast^*

Brain region	MNI space		z	k	Z	p value

	x	y
Healthy controls
L middle occipital	−51	−76	1	1853	6.21	< 0.001
L middle occipital	−27	−91	10		5.60
L fusiform	−36	−58	−8		5.48
R middle occipital	30	−88	22	2168	6.19	< 0.001
R middle occipital	42	−73	4		5.79
R middle temporal	48	−64	7		5.63
L inferior frontal, triangularis	−51	29	7	138	4.31	0.014
L inferior frontal, orbitalis	−51	38	−5		3.77
L inferior frontal, triangularis	−39	26	1		3.57
R inferior frontal, orbitalis	45	26	−5	95	4.31	0.048
R inferior frontal, triangularis	51	29	4		4.05
Patients with BPD
L middle temporal	45	−58	4	6888	6.16	< 0.001
L fusiform	−24	−82	−8		6.08
R caudate	18	−7	22		5.95
Increased brain activation related to negative emotions in patients with BPD compared with healthy controls
L precentral	−42	2	34	707	4.69	< 0.001
R caudate	21	−7	22		4.48
L superior frontal	−15	20	40		4.45
L precuneus	−21	−46	1	117	4.68	0.025
L hippocampus	−24	−31	−2		3.42
L posterior cingulum	−9	−43	13		3.41
Negative correlations between brain activation associated with negative emotions and the level of habitual acceptance in patients with BPD^†
L putamen	−24	14	7	83	4.19	< 0.048
L putamen	−27	2	−2		3.41
L caudate	−9	17	10		3.24

BPD = borderline personality disorder; EAQ = Emotion Acceptance Questionnaire; FWE = family-wise error; L = left hemisphere; MNI = Montreal Neurological Institute; R = right hemisphere.
↵* Displayed are the whole-brain results of a within-group cluster-level analysis with a cluster significance threshold of p <0.05 (FWE-corrected for multiple comparisons) and a minimum cluster size of 20 voxels.
↵† EAQ; included as a covariate.