PPI full factorial analysis of positive correlation with the amygdala; interaction effects for group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the middle frontal gyrus (2a), and lentiform nucleus (2b).

<p>PPI full factorial analysis of positive correlation with the amygdala; interaction effects for group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the middle frontal gyrus (2a), and lentiform nucleus (2b).</p

Full Factorial Analysis PPI, significant three-way interaction effects.

<p>Full Factorial Analysis PPI, significant three-way interaction effects.</p

Seed Voxels of the PPI analyses.

<p>(1a); Prefrontal regions with negative coupling to the amygdala (red) insula (yellow) and perigenual ACC (green) in BPD when negative pictures were combined with painful temperature (1b).</p

PPI full factorial analysis of positive interaction with the ACC, interaction effect group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the middle frontal gyrus (4a, 4b) and lentiform nucleus (4c).

<p>PPI full factorial analysis of positive interaction with the ACC, interaction effect group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the middle frontal gyrus (4a, 4b) and lentiform nucleus (4c).</p

Pain Processing after Social Exclusion and Its Relation to Rejection Sensitivity in Borderline Personality Disorder

<div><p>Objective</p><p>There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that “social pain,” as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD) because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity.</p><p>Method</p><p>Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education) played a virtual ball-tossing game (cyberball), with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases). The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity.</p><p>Results</p><p>Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation differences during pain processing following social exclusion and inclusion in the insula and in the amygdala.</p><p>Discussion</p><p>Despite the similar behavioral effects in both groups, BPD patients differed from HC in their neural processing of physical pain depending on the preceding social situation. Rejection sensitivity further modulated the impact of social exclusion on neural pain processing in BPD, but not in healthy controls.</p></div

PPI full factorial analysis of positive correlation with the insula; interaction effect group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the putamen (3a), and precuneus (3b), dlPFC (3c), PCC (3d), nucleus caudatus (3e).

<p>PPI full factorial analysis of positive correlation with the insula; interaction effect group by valence by temperature, mean beta values and standard error of the mean of the peak voxels in the putamen (3a), and precuneus (3b), dlPFC (3c), PCC (3d), nucleus caudatus (3e).</p

Subjective pain ratings following the different cyberball conditions together with results of the 2x3-rm-ANOVA.

<p>Subjective pain ratings following the different cyberball conditions together with results of the 2x3-rm-ANOVA.</p

Demographic and clinical variables in patients with borderline personality disorder (BPD) and in healthy controls (HC) with results of the t-tests (independent, two-tailed).

<p>PTSD, Posttraumatic Stress Disorder; OCD, Obsessive-Compulsive Disorder</p><p>Demographic and clinical variables in patients with borderline personality disorder (BPD) and in healthy controls (HC) with results of the t-tests (independent, two-tailed).</p

Insula and amygdala mean activation during painful compared to non-painful stimuli following social exclusion.

<p>a) mean beta values of peak voxel activation for HC and BPD in the insula, b) insula activation during pain after social exclusion independent of group (red), and the overlap of the general pain activation and the insula activation enhanced in BPD (yellow) (threshold for display: p < 0.005 uncorrected); mean beta values of peak voxel activation within c) the right amygdala, d) the left amygdala.</p

Test-statistics for the repeated measures ANOVA main effects of target type, group and their interaction for studies 1, 2, and 3.

<p>Test-statistics for the repeated measures ANOVA main effects of target type, group and their interaction for studies 1, 2, and 3.</p