Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder
Introduction
Structural magnetic resonance imaging (MRI) findings in adults with borderline personality disorder (BPD (reviewed in Schmahl and Bremner, 2006) include volume reductions in the amygdala (Driessen et al., 2000, Rusch et al., 2003, Schmahl et al., 2003, Tebartz van Elst et al., 2003), hippocampus (Driessen et al., 2000, Schmahl et al., 2003, Tebartz van Elst et al., 2003, Brambilla et al., 2004, Irle et al., 2005), orbitofrontal cortex (OFC) (Tebartz van Elst et al., 2003), frontal lobes (Lyoo et al., 1998) and cingulate cortex (Tebartz van Elst et al., 2003, Hazlett et al., 2005). However, it is unclear whether these findings are associated with a vulnerability to BPD itself, severity or duration of BPD, treatment or other factors, such as cumulative traumatic events, associated lifestyle factors or the co-occurrence or duration of common mental disorders. Studies of samples earlier in the course of BPD reduce the effects of duration of illness factors upon brain morphology. This is the first study to measure hippocampal, amygdala and OFC volumes in teenagers with first-presentation BPD in order to ascertain whether the changes found in previous studies of adults pre-date the full expression of BPD. In addition, we explored how co-occurring clinical characteristics were associated with brain morphology.
Section snippets
Participants
Twenty patients meeting Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) (First et al., 1997) criteria for BPD were recruited from a specialized early intervention program for BPD at ORYGEN Youth Health in Melbourne, Australia. They had minimal exposure to psychiatric interventions and had never received specific treatment for BPD. Sixteen patients (80%) had a lifetime history of non-specialized prior counseling or psychotherapy (median = 6 sessions, range = 1–140). One (5%)
Volumetric findings
The raw data for all structural volume measures are displayed in Table 3. Analysis of covariance, using height as the covariate, did not reveal any significant differences between the BPD and healthy control groups on measures of WBV or ICV (all P > 0.5).
MANOVA on the four OFC volume measures revealed a significant group by side by region interaction (F1,36 = 4.68, P = 0.037). Further pairwise tests (see Table 4) revealed a significant difference between left and right OFC grey matter for normal
Discussion
Three main findings emerge from this unique study of teenagers with first-presentation BPD. Firstly, there is a reversal of the normal (right > left) asymmetry of OFC grey matter in the BPD group, reflecting right-sided OFC grey matter loss in the BPD group that is not related to gender, the clinical features of BPD or other mental state phenomena. Secondly, hippocampal and amygdala volumes are not reduced in BPD participants compared with healthy controls. Thirdly, in females with BPD, large and
Acknowledgements
The authors thank the patients and staff of the HYPE Clinic at ORYGEN Youth Health. Thanks are also due to Ms Caroline Weinstein, A/Prof. Warrick Brewer and Ms Deidre Smith for assistance with data collection and to Dr Jem Riffkin for assistance with imaging analysis.
Funding/support: This work was supported in part by grants 98-0198 from the Victorian Health Promotion Foundation, Melbourne, Australia and grant 990748 from the National Health and Medical Research Council (NHMRC), Canberra,
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