Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder—A Script-Based fMRI Study

Abstract

Background: Anger and aggression belong to the core symptoms of borderline personality disorder. Although an early and specific treatment of BPD is highly relevant to prevent chronification, still little is known about anger and aggression and their neural underpinnings in adolescents with BPD.Method: Twenty female adolescents with BPD (age 15–17 years) and 20 female healthy adolescents (age 15–17 years) took part in this functional magnetic resonance imaging (fMRI) study. A script-driven imagery paradigm was used to induce rejection-based feelings of anger, which was followed by descriptions of self-directed and other-directed aggressive reactions. To investigate the specificity of the neural activation patterns for adolescent patients, results were compared with data from 34 female adults with BPD (age 18–50 years) and 32 female healthy adults (age 18–50 years).Results: Adolescents with BPD showed increased activations in the left posterior insula and left dorsal striatum as well as in the left inferior frontal cortex and parts of the mentalizing network during the rejection-based anger induction and the imagination of aggressive reactions compared to healthy adolescents. For the other-directed aggression phase, a significant diagnosis by age interaction confirmed that these results were specific for adolescents.Discussion: The results of this very first fMRI study on anger and aggression in adolescents with BPD suggest an enhanced emotional reactivity to and higher effort in controlling anger and aggression evoked by social rejection at an early developmental stage of the disorder. Since emotion dysregulation is a known mediator for aggression in BPD, the results point to the need of appropriate early interventions for adolescents with BPD.

An Integrative Way for Studying Neural Basis of Basic Emotions With fMRI

“…However, some findings also show a hypoactivation in the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC), but strong activity in amygdala (Fulwiler et al, 2012; Siep et al, 2018). A meta-analysis study confirmed enhanced activation in the left amygdala to angry stimuli (Bertsch et al, 2018; Krauch et al, 2018). These controversies might be due to the fact that amygdala activity is related to initiation of fear, while activation of the orbitofrontal cortex is involved in the fear extinction (Milad and Rauch, 2007; Siep et al, 2018).…”

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

“…Results of studies assessing neural correlates of ED in adolescents with BPD are heterogeneous. Comparing female adolescents with BPD and healthy controls, Krauch et al ( 304 ) found increased activation in the left posterior insula and left dorsal striatum as well as in the inferior frontal gyrus and parts of the mentalizing network. This suggests an enhanced emotional reactivity to interpersonal threat- or rejection-related situations early in the development of BPD.…”

Effects of Childhood Maltreatment on Social Cognition and Brain Functional Connectivity in Borderline Personality Disorder Patients

“…It noteworthy that these regions are components of the fronto-limbic circuit and are related to a broad range of cognitive and emotional processes, which have been described as being altered in BPD. These processes have been studied as dysfunctional traits in this disorder and include emotional dysregulation, impulsiveness, aggressive behavior, suicidal tendencies, and self-destructive behavior (59). Some of these regions are a part the default mode network, which is usually related to processes that involve thought formation by self as autobiographical memory, future planning, and inferring one's mental states and those of others (60), which are all processes involved in social cognition (61).…”