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BackgroundEmotion dysregulation is a central feature of borderline personality disorder (BPD). Since impaired emotion regulation contributes to disturbed emotion functioning in BPD, it is crucial to study underlying neural activity. The current study aimed at investigating the neural correlates of two emotion regulation strategies, namely emotion acceptance and suppression, which are both important treatment targets in BPD.MethodsTwenty-one women with BPD and 23 female healthy control participants performed an emotion regulation task during functional magnetic resonance imaging (fMRI). While watching fearful movie clips, participants were instructed to either accept or to suppress upcoming emotions compared to passive viewing.ResultsResults revealed acceptance-related insular underactivation and suppression-related caudate overactivation in subjects with BPD during the emotion regulation task.ConclusionThis is a first study on the neural correlates of emotion acceptance and suppression in BPD. Altered insula functioning during emotion acceptance may reflect impairments in emotional awareness in BPD. Increased caudate activity is linked to habitual motor and cognitive processes and therefore may accord to the well-established routine in BPD patients to suppress emotional experiences.

Background Emotion dysfunction and anhedonia are main problems in borderline personality disorder (BPD). In the present functional MRI (fMRI) study, we investigated neural activation in the processing of happy faces and its correlates with habitual emotion acceptance in patients with BPD. Methods 22 women with BPD and 26 female healthy controls watched movie clips of happy and neutral faces during fMRI without any instruction of emotion regulation. To associate neural activation with habitual emotion acceptance, we included individual scores of the Emotion Acceptance Questionnaire (EAQ) as a covariate in brain data analysis. Results All participants showed amygdala, temporal and occipital activation in the processing of happy compared to neutral faces. Additionally, healthy controls showed activation of the hippocampus and patients with BPD showed dorso-striatal (caudate, putamen) activation in the happy compared to the neutral condition. Compared with healthy controls, patients with BPD showed significantly more caudate activation. We could not find significant correlations with the EAQ. Conclusions Our results indicate caudate hyperactivation in patients with BPD during the processing of happy faces. Although patients reported significantly less emotion acceptance of positive emotions, an association with neural activation was not detectable.

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