Cortical morphology changes in women with borderline personality disorder: a multimodal approach

Objective: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUniversidade Federal do ABC Center of Mathematics, Computation and CognitionUniversidade Federal de São Paulo (UNIFESP) Department of Diagnostic RadiologyUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Outpatient Clinic for Personality Disorders (AMBORDER)UNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUNIFESP, Department of Diagnostic RadiologyUNIFESP, Department of Psychiatry Outpatient Clinic for Personality Disorders (AMBORDER)SciEL

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Animal studies suggest that structural changes occur in the maternal brain during the early postpartum period in regions such as the hypothalamus, amygdala, parietal lobe, and prefrontal cortex and such changes are related to the expression of maternal behaviors. In an attempt to explore this in humans, we conducted a prospective longitudinal study to examine gray matter changes using voxel-based morphometry on high resolution magnetic resonance images of mothers' brains at two time points: 2-4 weeks postpartum and 3-4 months postpartum. Comparing gray matter volumes across these two time points, we found increases in gray matter volume of the prefrontal cortex, parietal lobes, and midbrain areas. Increased gray matter volume in the midbrain including the hypothalamus, substantia nigra, and amygdala was associated with maternal positive perception of her baby. These results suggest that the first months of motherhood in humans are accompanied by structural changes in brain regions implicated in maternal motivation and behaviors

The Pathogenesis and Treatment of Emotion Dysregulation in Borderline Personality Disorder

Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD). This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author’s own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more parsimonious interpretation of brain imaging findings. In closing, the author draws implications of the proposed theory for clinical practice. He reports an efficacy study for treatment of emotion dysregulation based on that theory

Factores neurobiologicos del trastorno de personalidad limite

El trastorno de personalidad límite (TPL) es una alteración de la personalidad considerada de las más graves. Se caracteriza por presentar síntomas muy heterogéneos y diversos, aunque los que suelen predominar en el cuadro clínico son la impulsividad, la falta de regulación emocional e inestabilidad en las relaciones interpersonales. A ello se le suma la alta comorbilidad que presenta con otras alteraciones psicológicas. Algunos de estos síntomas son potencialmente dañinos para el paciente, ya que realizan actos autolíticos o parasuicidas, así como presentan alta impulsividad en ciertas conductas como son el sexo o las drogas que pueden llevar a poner en riesgo su vida. Su curso no es estable, a pesar de tratarse de un trastorno de personalidad. La etiología no está clara, pero todo apunta a una interacción entre factores biológicos y acontecimientos vitales estresantes, sobre todo en la infancia. En este escrito, presentamos datos sobre los factores neurobiológicos del TPL recogidos en la bibliografía. A pesar de los escasos estudios existentes, los autores determinan la existencia de una red frontolímbica disfuncional, en la que la corteza prefrontal y la amígdala juegan un papel muy importante en la expresión de los síntomas

Brain responses in aggression-prone individuals: A systematic review and meta-analysis of functional magnetic resonance imaging (fMRI) studies of anger- and aggression-eliciting tasks

Reactive aggression in response to perceived threat or provocation is part of humans' adaptive behavioral repertoire. However, high levels of aggression can lead to the violation of social and legal norms. Understanding brain function in individuals with high levels of aggression as they process anger- and aggression-eliciting stimuli is critical for refining explanatory models of aggression and thereby improving interventions. Three neurobiological models of reactive aggression - the limbic hyperactivity, prefrontal hypoactivity, and dysregulated limbic-prefrontal connectivity models - have been proposed. However, these models are based on neuroimaging studies involving mainly non-aggressive individuals, leaving it unclear which model best describes brain function in those with a history of aggression. We conducted a systematic literature search (PubMed and Psycinfo) and Multilevel Kernel Density meta-analysis (MKDA) of nine functional magnetic resonance imaging (fMRI) studies (eight included in the between-group analysis [i.e., aggression vs. control groups], five in the within-group analysis). Studies examined brain responses to tasks putatively eliciting anger and aggression in individuals with a history of aggression alone and relative to controls. Individuals with a history of aggression exhibited greater activity in the superior temporal gyrus and in regions comprising the cognitive control and default mode networks (right posterior cingulate cortex, precentral gyrus, precuneus, right inferior frontal gyrus) during reactive aggression relative to baseline conditions. Compared to controls, individuals with a history of aggression exhibited increased activity in limbic regions (left hippocampus, left amygdala, left parahippocampal gyrus) and temporal regions (superior, middle, inferior temporal gyrus), and reduced activity in occipital regions (left occipital cortex, left calcarine cortex). These findings lend support to the limbic hyperactivity model in individuals with a history of aggression, and further indicate altered temporal and occipital activity in anger- and aggression-eliciting conditions involving face and speech processing

FACTORES ASOCIADOS A PACIENTES CON TRASTORNO DE PERSONALIDAD LÍMITE HOSPITALIZADOS EN EL SERVICIO DE PSIQUIATRÍA DEL HOSPITAL REGIONAL HONORIO DELGADO ESPINOZA EN LOS AÑOS 2011- 2014

TRASTORNOS DE PERSONALIDAD TRASTORNO DE PERSONALIDAD LÍMITE DIAGNÓSTICO DIFERENCIAL DEFINICIÓN TRASTORNO DE PERSONALIDAD LÍMITE DEFINICIÓN EPIDEMIOLOGÍA ETIOLOGÍA CUADRO CLÍNICO Y DIAGNÓSTICO DIAGNÓSTICO DIFERENCIAL DESARROLLO Y CURSO INTERVENCIONES TERAPÉUTICA

Activation and Habituation of the Cingulate Cortex during Emotion Processing in Healthy Controls, Borderline, and Schizotypal Personality Disorder

Disturbances in emotional functioning are central features of the clinical profiles of both borderline and schizotypal personality disorder (BPD and SPD, respectively). BPD is characterized by a high sensitivity to emotional stimuli and unusually strong and long-lasting reactions, indicative of impaired habituation to emotional stimuli (Linehan, 1993). Previous research suggests that SPD patients demonstrate limbic hyper-reactivity to unpleasant stimuli, at least initially, but intact habituation to repeated presentation of unpleasant stimuli (Hazlett et al., 2012). The cingulate cortex supports various aspects of emotion processing and regulation, and abnormalities of this region have been related to emotion dysfunction in SPD and BPD (Koenigsberg, Fan, et al., 2009; Modinos, Ormel, & Aleman, 2010). However, findings of functional cingulate abnormalities in the context of emotion processing have been inconsistent in BPD and limited in SPD. The current study utilized event-related functional magnetic resonance imaging (fMRI) in three groups, BPD patients, SPD patients, and healthy control individuals, during a task involving an intermixed series of unpleasant, neutral, and pleasant pictures, each presented twice within their respective trial. This approach permitted the examination of reactivity to emotional stimuli and habituation of emotional responses within the cingulate. Blood-oxygen-level dependent response values were obtained within the manually delineated anterior cingulate cortex (ACC) and posterior cingulate cortex (PCC) and compared across groups. Compared to healthy controls and SPD patients, BPD patients exhibited significantly greater activity in the ACC during the presentation of neutral pictures. Heightened activity in the BPD group persisted across the initial and repeated presentations of neutral pictures. On the other hand, SPD patients exhibited greater activity in the ACC compared to healthy controls and BPD patients during the initial presentation of unpleasant pictures, but activity normalized when the pictures were repeated. The two patient groups demonstrated heightened ACC activation, but these abnormalities were differentiated by associated picture-type (neutral versus unpleasant) and attenuation of the response upon repeated presentation of the stimuli. Diagnostic differences in PCC activation did not reach significance. Overall results suggest unique involvement of the ACC in BPD and SPD symptomatology