Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms

Abstract

Background Borderline personality disorder (BPD) and avoidant personality disorder (AvPD) are characterized by hyper-reactivity to negatively-perceived interpersonal cues, yet they differ in degree of affective instability. Recent work has begun to elucidate the neural (structural and functional) and cognitive-behavioral underpinnings of BPD, although some initial studies of brain structure have reached divergent conclusions. AvPD, however, has been almost unexamined in the cognitive neuroscience literature. Methods In the present study we investigated group differences among 29 BPD patients, 27 AvPD patients, and 29 healthy controls (HC) in structural brain volumes using voxel-based morphometry (VBM) in five anatomically-defined regions of interest: amygdala, hippocampus, medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC). We also examined the relationship between individual differences in brain structure and self-reported anxiety and affective instability in each group. Results We observed reductions in MPFC and ACC volume in BPD relative to HC, with no significant difference among patient groups. No group differences in amygdala volume were found. However, BPD and AvPD patients each showed a positive relationship between right amygdala volume and state-related anxiety. By contrast, in HC there was an inverse relationship between MPFC volume and state and trait-related anxiety as well as between bilateral DLPFC volume and affective instability. Limitations Current sample sizes did not permit examination of gender effects upon structure-symptom correlations. Conclusions These results shed light on potentially protective, or compensatory, aspects of brain structure in these populations–namely, relatively reduced amygdala volume or relatively enhanced MPFC and DLPFC volume.

Factores clínicos y psicológicos asociados a las conductas autolíticas en el trastorno límite de personalidad

“…Varios estudios y meta-análisis describen anomalías estructurales y funcionales a nivel cerebral mediante neuroimagen en pacientes TLP, siendo las principales una disminución del volumen de la corteza prefrontal ventromedial y orbitofrontal, una disminución de la corteza cingulada anterior dorsal y disfunción de la amígdala (Carrasco et al, 2012;Denny et al, 2016;Kimmel et al, 2016;Visintin et al, 2016). Los estudios de neuroimagen muestran que existen algunas áreas de superposición y algunas diferencias entre el Trastorno Bipolar y el TLP (Sripada and Silk, 2007).…”

Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design

“…Although there is some evidence that suggests a smaller volume of the amygdala in PTSD patients [ 17 ], other studies found no differences in its morphology compared to healthy controls [ 18 , 19 ]. In contrast, amygdala volume is consistently lower in BPD patients relative to healthy controls [ 14 ], while to the best of our knowledge only one study has been conducted in CPD [ 20 ], showing no difference in amygdala volume between patients with avoidant personality disorder and healthy control subjects.…”

Hippocampal Volume in Psychiatric Diagnoses: Should Psychiatry Biomarker Research Account for Comorbidities?

“…For example in BPD, several studies found significant bilateral volume reductions in the hippocampus compared to HC [21][22][23][24][25][26][27][28] as well as significant bilateral volume reductions in the amygdala. 22,[24][25][26][27] However, there have also been several dissenting studies: three found no significant volume reductions in the hippocampus [29][30][31] and six found no significant reduction in amygdala volumes 29,30,[32][33][34][35] in BPD versus HC.…”