Elsevier

Biological Psychiatry

Volume 73, Issue 2, 15 January 2013, Pages 153-160
Biological Psychiatry

Archival Report
Neural Correlates of Negative Emotionality in Borderline Personality Disorder: An Activation-Likelihood-Estimation Meta-Analysis

https://doi.org/10.1016/j.biopsych.2012.07.014Get rights and content

Background

Emotional vulnerabilities at the core of borderline personality disorder (BPD) involve a dysfunction of frontolimbic systems subserving negative emotionality. The specific regions identified in individual studies, however, vary widely and provide an incomplete understanding of the functional brain abnormalities that characterize this illness. A quantitative synthesis of functional neuroimaging studies might clarify the neural systems dysfunctions that underlie negative emotionality in BPD.

Methods

An electronic search of Medline and PsycInfo databases from 2000 to 2012 identified 18 potential studies, of which 11 met inclusion criteria for the meta-analysis and comprised a pooled sample of 154 BPD patients and 150 healthy control subjects. Contrasts of negative versus neutral emotion conditions were analyzed with an activation-likelihood-estimation meta-analytic approach. Group comparisons were performed on study-reported between-subjects contrasts and independent subtraction analyses based on within-subjects contrasts.

Results

Healthy control subjects activated a well-characterized network of brain regions associated with processing negative emotions that included the anterior cingulate cortex and amygdala. Compared with healthy control subjects, BPD patients demonstrated greater activation within the insula and posterior cingulate cortex. Conversely, they showed less activation than control subjects in a network of regions that extended from the amygdala to the subgenual anterior cingulate and dorsolateral prefrontal cortex.

Conclusions

Processing of negative emotions in BPD might be subserved by an abnormal reciprocal relationship between limbic structures representing the degree of subjectively experienced negative emotion and anterior brain regions that support the regulation of emotion. Contrary to early studies, BPD patients showed less activation than control subjects in the amygdala under conditions of negative emotionality.

Section snippets

Study Selection

The electronic databases Medline and PsycInfo were searched with the key words “borderline” with independent matched searches with the key word(s) “borderline personality disorder,” “functional magnetic resonance imaging,” “fMRI,” “neuroimaging,” “neural,” “imaging,” “emotion,” and “affect.” The asterisk symbol (*) was used to incorporate all possible suffix variations of the search terms in study retrieval. Both English and non-English language articles were considered in the literature

HC

Our ALE analysis of HC yielded seven clusters of activation that were dependent on five studies reporting negative−neutral contrasts. The right ACC (Brodmann area [BA] 32) contained three independent sites of activation that comprised the dorsal/midcingulate cortex and perigenual and subgenual ACC (Table 3). Significant foci of activation were also found bilaterally in the amygdala (Figure 1). Table 4 provides the weighted center and cluster size for each ALE-based activation site.

Borderline Personality Disorder

A total of

Discussion

Difficulties in the regulation of negative emotions represent a hallmark feature of BPD. Neuroimaging has increasingly been used to understand the neural systems dysfunctions that underlie negative emotionality in BPD, with narrative reviews of this literature suggesting abnormally heightened activity in limbic structures and reduced activation of anterior brain regions during negative emotion processing in this illness (31). Findings across individual studies are highly discrepant, however,

References (69)

  • M. Driessen et al.

    Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder

    Biol Psychiatry

    (2004)
  • A. Kraus et al.

    Amygdala deactivation as a neural correlate of pain processing in patients with borderline personality disorder and co-occurrent posttraumatic stress disorder

    Biol Psychiatry

    (2009)
  • S. Lang et al.

    Cognitive reappraisal in trauma-exposed women with borderline personality disorder

    Neuroimage

    (2012)
  • H.W. Koenigsberg et al.

    Neural correlates of emotion processing in borderline personality disorder

    Psychiatry Res

    (2009)
  • K. Schnell et al.

    Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder

    J Psychiatr Res

    (2007)
  • C.R. Genovese et al.

    Thresholding of statistical maps in functional neuroimaging using the false discovery rate

    Neuroimage

    (2002)
  • S.C. Herpertz et al.

    Evidence of abnormal amygdala functioning in borderline personality disorder: A functional MRI study

    Biol Psychiatry

    (2001)
  • R. Deichmann et al.

    Compensation of susceptibility-induced BOLD sensitivity losses in echo-planar fMRI imaging

    Neuroimage

    (2002)
  • A.C. Ruocco et al.

    Amygdala and hippocampal volume reductions as candidate endophenotypes for borderline personality disorder: A meta-analysis of magnetic resonance imaging studies

    Psychiatry Res

    (2012)
  • E.K. Diekhof et al.

    Fear is only as deep as the mind allows: A coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect

    Neuroimage

    (2011)
  • M.L. Phillips et al.

    Differential neural responses to overt and covert presentations of facial expressions of fear and disgust

    Neuroimage

    (2004)
  • J.R. Augustine

    Circuitry and functional aspects of the insular lobe in primates including humans

    Brain Res Rev

    (1996)
  • L. Tebartz van Elst et al.

    Frontolimbic brain abnormalities in patients with borderline personality disorder: A volumetric magnetic resonance imaging study

    Biol Psychiatry

    (2003)
  • E.A. Hazlett et al.

    Reduced anterior and posterior cingulate gray matter in borderline personality disorder

    Biol Psychiatry

    (2005)
  • H.S. Mayberg et al.

    Deep brain stimulation for treatment-resistant depression

    Neuron

    (2005)
  • A.C. Ruocco et al.

    Abnormal prefrontal cortical response during affective processing in borderline personality disorder

    Psychiatry Res

    (2010)
  • L. Schulze et al.

    Neuronal correlates of cognitive reappraisal in borderline patients with affective instability

    Biol Psychiatry

    (2011)
  • A.C. Ruocco et al.

    Indices of orbitofrontal and prefrontal function in Cluster B and Cluster C personality disorders

    Psychiatry Res

    (2009)
  • A.D. Wagner et al.

    Prefrontal contributions to executive control: fMRI evidence for functional distinctions within lateral Prefrontal cortex

    Neuroimage

    (2001)
  • A.C. Ruocco

    The neuropsychology of borderline personality disorder: A meta-analysis and review

    Psychiatry Res

    (2005)
  • S.B. Eickhoff et al.

    Activation likelihood estimation meta-analysis revisited

    Neuroimage

    (2012)
  • A.C. Ruocco et al.

    Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder

    Psychiatry Res

    (2010)
  • C.G. Schmahl et al.

    A positron emission tomography study of memories of childhood abuse in borderline personality disorder

    Biol Psychiatry

    (2004)
  • S. Whittle et al.

    Anterior cingulate volume in adolescents with first-presentation borderline personality disorder

    Psychiatry Res

    (2009)
  • Cited by (0)

    View full text