Brain Differences Tied to Emotional Tumult in Borderline Illness

A new study probes the brain anomalies that may underlie the emotional upheaval experienced by patients with borderline personality disorder (BPD).

The study appears in the journal Biological Psychiatry.

The meta-analysis, or comprehensive review, was performed by Dr. Lars Schulze at Freie Universität Berlin and colleagues at Heidelberg University. The researchers focused on difficulties associated with emotional processing and related functional and structural abnormalities in patients with borderline personality disorder.

Those diagnosed with BPD have problems regulating emotional mood swings. This emotional instability leaves them vulnerable to emotional tumult that puts them at risk for problem behaviors, including self-destructive acts and impulsive aggression.

Investigators pooled functional data from 19 published studies, providing a total of 281 patients with BPD and 293 healthy control subjects. Structural data was available for 10 studies, with a total of 263 patients with BPD and 278 healthy subjects.

Their analyses revealed that during the processing of negative emotions, BPD patients show enhanced activations of the left amygdala along with blunted responses of the dorsolateral prefrontal cortex compared to healthy controls. These brain regions were also found to overlap with abnormalities in gray matter volume.

“Our results highlight brain abnormalities in the amygdala and the dorsolateral prefrontal cortex,” said Schulze.

“The amygdala is known to process emotional arousal and is hyperactive in BPD. The dorsolateral prefrontal cortex, which has a key role in the regulation of emotions, is less active during the processing of negative emotional stimuli in BPD.”

“In order to understand these findings, it might be useful to imagine that the brain was a like a car,” explains Dr. John Krystal, Editor of Biological Psychiatry.

“The gas pedal for emotion might be the amygdala and the emotional brake might be the dorsolateral prefrontal cortex. The current findings seem to suggest that, in borderline personality disorder, the brain steps on the gas yet does not as effectively brake emotion.”

Together, these findings support the concept of borderline personality disorder as a disorder of emotion dysregulation.

Investigators believe treatment options that help fine-tune the brain’s “motor” may alleviate some of the distressing clinical symptoms that individuals with BPD experience and grapple with on a daily basis.

Schulze added, “It is my hope that these findings will give an impetus to future neuroimaging studies evaluating different treatment options in BPD, such as psycho- or pharmacotherapy.”

Source: Elsevier/EurekAlert