Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis

doi:10.1016/j.biopsych.2015.03.027

Biological Psychiatry

Volume 79, Issue 2, 15 January 2016, Pages 97-106

https://doi.org/10.1016/j.biopsych.2015.03.027 Get rights and content

Abstract

Background

Disturbances in the processing and regulation of emotions are core symptoms of borderline personality disorder (BPD). To further elucidate neural underpinnings of BPD, the present meta-analysis summarizes functional neuroimaging findings of emotion processing tasks, as well as structural neuroimaging findings, and investigates multimodally affected brain regions.

Methods

Combined coordinate- and image-based meta-analyses were calculated using anisotropic effect size signed differential mapping. Nineteen functional neuroimaging studies investigating the processing of negative compared with neutral stimuli in a total of 281 patients with BPD and 293 healthy control subjects (HC) were included. In addition, 10 studies investigating gray matter abnormalities in 263 patients with BPD and 278 HC were analyzed.

Results

Compared with HC, BPD patients showed relatively increased activation of the left amygdala and posterior cingulate cortex, along with blunted responses of the bilateral dorsolateral prefrontal cortex, during the processing of negative emotional stimuli. The multimodal analysis identified the left amygdala to be characterized by a combination of functional hyperactivity and smaller gray matter volume compared with HC. Hyperresponsivity of the amygdala was moderated by medication status of the patient samples. Medication-free samples were characterized by limbic hyperactivity, whereas no such group differences were found in patients currently taking psychotropic medication.

Conclusions

Results strengthen the assumption that dysfunctional dorsolateral prefrontal and limbic brain regions are a hallmark feature of BPD and therefore are consistent with the conceptualization of BPD as an emotion dysregulation disorder.

Section snippets

Study Selection

Studies were identified through a literature search of articles published between 2001 (first neuroimaging study on negative emotion processing in BPD) and June 2014 using the PubMed and Web of Science databases. Keywords used were borderline personality disorder and emotion, valence, or affect and neuroimaging, or fMRI. Reference sections and citations of the articles were cross-checked to identify further articles. Studies were included if 1) patients met diagnostic criteria for BPD according

Meta-Analysis of Functional Brain Abnormalities in BPD

In comparison with HC, patients with BPD showed enhanced activity in a cluster comprising the left amygdala and the left hippocampus, as well as in clusters in the posterior cingulate gyrus and the left middle temporal gyrus (Figure 1). However, findings in the left amygdala/hippocampus region showed significant heterogeneity. Enhanced activations were also found in the left posterior insula and right superior temporal gyrus, but these findings were less robust (cf. Table 1).

Decreased activity

Discussion

The present meta-analysis supports the assumption that structural and functional frontolimbic abnormalities represent a hallmark feature of BPD. In particular, our results demonstrate enhanced activation of the left amygdala along with attenuated activations of the bilateral dlPFC during the processing of negative emotional stimuli in BPD compared with healthy control subjects. Functional differences in frontolimbic brain regions were additionally found to overlap with structural differences in

Acknowledgments and Disclosures

No funding was provided for this project.

We deeply appreciate the help of all researchers who supported this project. In particular, we thank Sabine Herpertz, Anja Kraus, Annegret Krause-Utz, Gin Malhi, Michael Minzenberg, Kristin Prehn, Daniele Radaelli, Knut Schnell, and Moria Smoski for providing additional contrasts or statistical parametric maps from their studies. Their help allowed us to create an exhaustive, quantitative summary of emotion processing in borderline personality disorder.

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Archival ReportNeural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis

Abstract

Background

Methods

Results

Conclusions

Section snippets

Study Selection

Meta-Analysis of Functional Brain Abnormalities in BPD

Discussion

Acknowledgments and Disclosures

Compr Psychiatry

Biol Psychiatry

Biol Psychiatry

Psychiatry Res

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Prog Neuropsychopharmacol Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Eur Psychiatry

Neuroimage

Eur Psychiatry

Neuroimage

J Psychiatr Res

Biol Psychiatry

Psychiatry Res

Psychiatry Res

J Affect Disord

J Psychiatr Res

Psychoneuroendocrinology

Psychiatry Res

Psychiatry Res

Neuroimage

Psychiatry Res

Neurosci Biobehav Rev

J Affect Disord

Neuroimage

Biol Psychiatry

Neuroimage

Neuroimage

Neurosci Biobehav Rev

Biol Psychiatry

Trends Cogn Sci

Cortex

Cortex

Neuroimage

Neuroimage

Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: State of knowledge and research agenda of the German Clinical Research Unit

Borderline Personality Disorder and Emotion Dysregulation

The role of affective instability and impulsivity in predicting future BPD features

J Pers Disord

Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity?

J Pers Disord

State affective instability in borderline personality disorder assessed by ambulatory monitoring

Psychol Med

Influence of emotional distraction on working memory performance in borderline personality disorder

Psychol Med

Archival Report
Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis