Potentiated Amygdala Response to Repeated Emotional Pictures in Borderline Personality Disorder

Abstract

Background Borderline personality disorder (BPD) is characterized by an inability to regulate emotional responses. The amygdala is important in learning about the valence (goodness and badness) of stimuli and has been reported to function abnormally in BPD. Methods Event-related functional MRI (fMRI) was employed in three groups: unmedicated BPD (n=33) and schizotypal personality disorder (SPD;n=28) participants and healthy controls (n=32) during a task involving an intermixed series of unpleasant, neutral, and pleasant pictures each presented twice within their respective trial block/run. The amygdala was hand-traced on each participant’s structural-MRI scan which was co-registered to their BOLD-scan. Amygdala responses were examined with a mixed-model MANOVA with repeated measures. Results Compared with both control groups, BPD patients showed greater amygdala activation, particularly to the repeated emotional but not neutral pictures and a prolonged return to baseline for the overall BOLD response averaged across all pictures. Despite amygdala overactivation, BPD patients showed a blunted response on the self-report ratings of emotional but not neutral pictures. Fewer dissociative symptoms in both patient groups were associated with greater amygdala activation to repeated unpleasant pictures. Conclusions The increased amygdala response to the repeated emotional pictures observed in BPD was not observed in SPD patients suggesting diagnostic specificity. This BPD-related abnormality is consistent with the well-documented clinical feature of high sensitivity to emotional stimuli with unusually strong and long-lasting reactions. The finding of a mismatch between physiological and self-report measures of emotion reactivity in BPD patients suggests they may benefit from treatments which help them recognize emotions.

Time course of facial emotion processing in women with borderline personality disorder: an ERP study

“…The results confirm alterations or biases in very early stages of face processing, as has been hypothesized on the basis of eye-tracking and neuroimaging studies. [14][15][16] In addition to these early alterations, patients with BPD showed deficiencies in further stages of structural and categorical face processing that may be related to previously reported deficits in emotion classification, supporting a recent model on altered facial classification. 3 The present study revealed an enhanced likelihood to misclassify predominantly happy faces (20%-40% anger) as angry in patients with BPD.…”

“…This model may explain seemingly inconsistent results from various emotion recognition tasks. It is also congruent with neuroimaging studies that have revealed enhanced and prolonged amygdala activations, 14,15 a decreased prefrontal inhibition of the amygdala and altered insular and anterior cingulate activations [16][17][18] for emotional stimuli in patients with BPD. In combining eye tracking with functional MRI (fMRI), we recently found more and faster initial eye movements toward the eyes, and thus the most threatening part of angry faces, associated with increased amygdala activation in patients with BPD.…”

“…[14][15][16] In the present study, a higher proportion of anger classification was found in patients with increased levels of self-reported unawareness of their own emotions. In addition, misclassification of predominantly happy faces (20%-40% anger) as angry was related to the severity of borderline symptomatology, whereas classification of more ambiguous faces (40%-60% anger) as angry was related to depressiveness.…”

The functional profile of the human amygdala in affective processing: Insights from intracranial recordings

“…Recent neuroimaging data delineated an important relation between deficient behavioral habituation to emotional stimuli and abnormal amygdala-insula functional connectivity amongst BPD individuals (Koenigsberg et al, 2014). As reduced amygdala functioning and volume is consistently reported to contribute to BPD symptomatology (Hazlett et al, 2012;Ruocco, Amirthavasagam, & Zakzanis, 2012), future iEEG research delineating novelty and familiarity detection amongst affectively relevant stimuli would be instrumental to better understand amygdala's role in such processing in healthy and BPD individuals.…”

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…Both research groups noted the difficulty of scanning the amygdala using fMRI, given its proneness to signal dropout and image distortion (because of its location in the brain) [124]. Other potential sources of these inconsistent findings have been suggested, including differences in habituation to emotional stimuli, which have been noted in individuals with BPD [125,126]. Differences in amygdala habituation to fearful stimuli may be a more reliable neural marker than amygdala activation, which may be more variable across an entire task [127,128].…”