Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder

Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder

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J Psychiatry Neurosci 2018;43(1):37-47

Linda van Zutphen, PhD; Nicolette Siep, PhD; Gitta A. Jacob, PhD; Gregor Domes, PhD; Andreas Sprenger, PhD; Bastian Willenborg, MD; Rainer Goebel, PhD; Arnoud Arntz, PhD

Abstract

Background: Borderline personality disorder (BPD) is characterized by emotion dysregulation; however, it is unclear whether this is restricted to negative emotional stimuli or to what degree this is specific to BPD. We investigated neural correlates of hypothesized increased emotional sensitivity and impaired emotion regulation in patients with BPD.

Methods: During functional MRI (fMRI) scanning, patients with BPD, nonpatient controls and patients with cluster-C personality disorder completed an emotion regulation task, including negative, positive and erotic social pictures.

Results: We included 55 patients with BPD, 42 nonpatient controls and 24 patients with cluster-C personality disorder in our analyses. Passive viewing of negative stimuli resulted in greater activity in the anterior insula, temporoparietal junction and dorsolateral prefrontal cortex in patients with BPD than in nonpatient controls. The increased activity in the anterior insula and temporoparietal junction was also present when patients with BPD viewed positive stimuli. During regulation of negative stimuli compared with passive viewing, nonpatient controls showed greater activity in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, middle temporal gyrus and bilateral inferior parietal lobule. Patients with BPD did not show this increase in activity.

Limitations: Findings cannot be generalized to men, and patients represented a heterogeneous group regarding comorbid diagnoses and medication.

Conclusion: When looking at emotional stimuli, patients with BPD showed a unique pattern of activity, suggesting an increase in brain activity involved in emotion generation. In the case of negative stimuli this is accompanied by increased activity in regulation areas. In contrast, increase of regulation processes seems absent when patients with BPD are explicitly instructed to regulate. Results of diagnosis specificity support a dimensional rather than a dichotomous differentiation between BPD and cluster-C personality disorder regarding emotional sensitivity and emotional regulation of social stimuli.


Submitted Jan. 12, 2017; Revised May 4, 2017; Accepted July 4, 2017; Online first Oct. 31, 2017

Affiliations: From the Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (van Zutphen, Siep, Arntz); the Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (Jacob); the Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany (Domes); the Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany (Domes); the Department of Biological and Clinical Psychology, University of Trier, Trier, Germany (Domes); the Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany (Sprenger); the Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany (Willenborg); the Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands (Goebel); the Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands (Goebel); and the Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands (Arntz).

Acknowledgements: The authors thank Deborah Kaiser and Alena Senft for the participant recruitment and measurements at the German sites, Freiburg and Lubeck, respectively. The authors also thank Simon Maier, Oliver Tüscher, Armin Heinecke and Vincent van de Ven for their technical support of the analyses.

Funding: This work has been conducted in the program “Open Research Area in the Social Sciences,” supported by the Netherlands Organization for Scientific Research (NWO) (R.G., 464-10-080); and the German Research Foundation (G.A.J., JA1785/3-1).

Competing interests: None declared.

Contributors: N. Siep, G. Jacob, G. Domes, B. Willenborg and A. Arntz designed the study. L. van Zutphen, N. Siep, G. Domes, A. Sprenger and B. Willenborg acquired the data, which L. van Zutphen, N. Siep, R. Goebel and A. Arntz analyzed. L. van Zutphen, N. Siep and A. Arntz wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

DOI: 10.1503/jpn.170008

Correspondence to: L. van Zutphen, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; linda.vanzutphen@maastrichtuniversity.nl