Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum

Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum

J Psychiatry Neurosci 2019;44(5):303-312 | PDF | Appendix

Agnes Lamers, MSc; Max Toepper, PhD; Silvia Carvalho Fernando, PhD; Nicole Schlosser, PhD; Eva Bauer, PhD; Friedrich Woermann, MD; Martin Driessen, MD, PhD; Thomas Beblo, PhD

Background: Emotion dysfunction is a key symptom in patients with borderline personality disorder (BPD) and is considered a consequence of dysfunctional emotion regulation (e.g., reduced emotion acceptance). In the present functional MRI (fMRI) study, we investigated the neural correlates of habitual emotion acceptance in individuals with BPD.

Methods: Female patients with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. We assessed emotion acceptance using the Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analyses of activation intensity during negative compared with neutral movies.

Results: We included 20 women with BPD and 20 heatlhy controls in our analysis. Compared with healthy controls, patients with BPD showed significantly more activation in frontostriatal brain regions (i.e., left superior frontal gyrus, right caudate) as well as in the left precuneus, left precentral gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative (v. neutral) stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of striatal areas (i.e., left putamen, left caudate) in patients with BPD.

Limitations: Causal conclusions are not possible. Comorbid diagnoses were not excluded, and only female participants were investigated. Stimuli were not rated immediately and may not be generalizable to all negative emotions. We cannot make any statements about other emotion-regulation strategies that may have been applied here.

Conclusion: Data indicate that striatal hyperactivation during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus, individuals with BPD may benefit from therapy approaches that focus on emotion acceptance in order to normalize emotional reactions.


Submitted June 6, 2018; Revised Dec. 11, 2018; Accepted Jan. 24, 2019; Published online Apr. 9, 2019

Acknowledgements: The authors thank Violetta Swiatek for her expertise and kind help during the fMRI investigations. The authors also thank all participants for their willingness to take part in this study. The authors thank the German Research Foundation (“Deutsche Forschungsgemeinschaft”, DFG) for the financial support.

Affiliations: From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann).

Funding: This work was financially supported by the DFG (“Deutsche Forschungsgemeinschaft”, grants: BE 2536 / 9-1, TO 894 / 3-1).

Competing interests: None declared.

Contributors: M. Toepper, S. Carvalho Fernando, M. Driessen and T. Beblo designed the study. A. Lamers, N. Schlosser and F. Woermann acquired the data, which A. Lamers, M. Toepper, S. Carvalho Fernando, E. Bauer, M. Driessen and T. Beblo analyzed. A. Lamers and T. Beblo 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/cjs.180077

Correspondence to: A. Lamers, Evangelisches Klinikum Bethel, Clinic of Psychiatry and Psychotherapy Bethel, Research Division, Remterweg 69-71, 33617 Bielefeld, Germany; agnes.lamers@evkb.de