Affective interference in borderline personality disorder: The lethality of suicidal behavior predicts functional brain profiles

Abstract

Background.-Negative affective interference with executive cognition is associated with emotion dysregulation and behavioral dyscontrol in BPD, including a diathesis to suicidal and self-injurious behavior. While clinically well described, the neural basis of affective interference with central executive network function, and resulting suicidal behavior is poorly understood. Method.-In an fMRI study, 23 BPD suicide attempters completed an affectively modified Continuous Performance Task(X-CPT), in which targets and distractors were rendered on Negative, Positive and Neutral Ekman faces, with a Distorted image as a behavioral baseline. Responses to targets were contextualized by the affective context of the face. Lethality Rating Scale scores(LRS) were modeled as the primary regressor of interest on activation peaks, with HamD scores covaried. Results.-In the Negative vs. Neutral contrast, LRS scores were inversely related to activation in the ACC, parietal precuneus, BG and OFC, with no positive relationships. Results were similar in the Negative vs Positive contrast. In the Neutral vs. Positive contrast, activations were much less extensive, with mixed positive and negative relationships. Contextualizing responses based on the effects of valence decreased participant's ability to distinguish between targets and distracters; however, no differences were observed between valence contexts. fMRI-estimated effects were not confounded by differences in behavioral sensitivity across contexts. Limitations.-In this female-only sample, possible gender differences were not addressed.

Stimulus valence, episodic memory, and the priming of brain activation profiles in borderline personality disorder

“…Normative studies of brain function In experimental contexts, both positive and negative valence hold substantial salience in the typical human brain and underpin brain networks that drive social interactions (Nummenmaa et al, 2012). However, whereas positively valenced stimuli are 'preferred' in healthy controls (Nielen et al, 2009;Winecoff et al, 2013), negatively valenced stimuli are more salient to patients with BPD (Soloff et al, 2015;Soloff, Chowdury, & Diwadkar, 2019). Positive valence carries higher emotional salience presumably because the presentation of stimuli with positive valence activates latent representations of existing connections associated with positive life experiences (Lempert, Speer, Delgado, & Phelps, 2017;Pool, Brosch, Delplanque, & Sander, 2016;Reggev, Bein, & Maril, 2016).…”

“…In this vein, the examination of other dimensional contributions including suicidality and childhood trauma (particularly sexual abuse) will be warranted in future investigations. We have shown that the lethality of suicidal attempts is related to fMRI responses to negative valenced stimuli used during sustained attention tasks (Soloff et al, 2019), consistent with altered fMRI profiles during self-reflection on aversive memories (Silvers et al, 2016). Childhood trauma (and particularly sexual abuse) is a known risk factor for BPD, with impacts particularly on medial temporal lobe structures such as the amygdala and hippocampus (Soloff, Nutche, Goradia, & Diwadkar, 2008), and also on brain network profiles during social cognition tasks (Duque-Alarcon, Alcala-Lozano, Gonzalez-Olvera, Garza-Villarreal, & Pellicer, 2019).…”

Functional MRI findings in personality disorders: A review

“…BPD‐tb‐1, 119 BPD‐tb‐4, 122 BPD‐tb‐5, 123 BPD‐tb‐6, 124 and BPD‐tb‐9 125 demonstrated increased activity in the precuneus in response to varying negative stimuli. BPD‐tb‐7 126 also employed a negative (painful) stimulus and uncovered altered right supramarginal gyrus (rSMG) activity.…”

Translating Interventional Neuroscience to Suicide: It’s About Time

“…These findings highlight valence network emotion and feedback learning pathways that influence stable risk, proximal risk, and phenotypic expression. Other valence correlates of ideation (48, 49), attempt (50)(51)(52)(53)(54)(55), and attempt lethality (43,56,57) have also been reported.…”