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Brain activation in response to overt and covert fear and happy faces in women with borderline personality disorder

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Abstract

Borderline personality disorder (BPD) is a serious condition involving emotion dysregulation. Past research has identified BPD-associated differences within fronto-limbic circuitry during conditions of processing negative emotion. Functional magnetic resonance imaging (fMRI) paradigms that incorporate overt and covert (masked) presentations of emotional stimuli can provide complementary information about neural systems underlying emotion processing (e.g., both slow [overt] and fast [covert; automatic] processing pathways). This study examined brain activation during processing of overt and covert presentations of emotional faces in 12 women with BPD and 12 age-matched healthy controls. To assess a range of emotional valence and arousal, we examined responses to fear, happy and neutral expressions. All participants underwent an fMRI scanning session in which participants passively viewed emotional faces. Scanning sessions consisted of 5 runs including: (1) Overt Fear (OF) versus Neutral (N), (2) Covert Fear (CF) versus Covert Neutral (CN), (3) Overt Happy (OH) versus N, (4) Covert Happy (CH) versus CN, and (5) N versus fixation. We compared whole-brain activation between groups for each run. In response to overt fear, BPD patients showed greater activation both in left amygdala and in several frontal cortical regions. There were no significant differences in brain activation in response to overt happy faces. In response to covert fear and covert happy stimuli, the BPD group also showed greater activation than controls in several regions including frontal and temporal cortical regions, as well as cerebellum and thalamus. These findings add to prior reports suggesting increased amygdala activation in BPD, but we found this only in the overt fear versus fixation condition. In this sample, BPD patients showed hyper-activation, rather than hypo-activation, of cortical regulatory regions during overt fear. Enhanced cortical recruitment in response to covert fear and happy faces in BPD could reflect a more extended response system in which stimuli that typically only activate automatic pathways are additionally tapping into cortical regulatory systems. The observation of this pattern both in response to fear and in response to happy presentations suggests that the effect of arousal may be as or more impactful than the effect of emotional valence.

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Conflicts of interest

Kathryn R. Cullen, Lori LaRiviere, Nathalie Vizueta, Kathleen M. Thomas, Ruskin H. Hunt, Michael J. Miller, Kelvin O. Lim, and Sellman C. Schultz declare that they have no conflicts of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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  1. Department of Psychiatry, University of Minnesota Medical School, F256/2B West Building. 2450 Riverside Avenue, Minneapolis, MN, 55454, USA

    Kathryn R. Cullen, Lori L. LaRiviere, Michael J. Miller, Kelvin O. Lim & Sellman C. Schulz

  2. Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA

    Nathalie Vizueta

  3. Institute of Child Development, University of Minnesota, Minneapolis, MN, USA

    Kathleen M. Thomas & Ruskin H. Hunt

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  1. Kathryn R. Cullen
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Cullen, K.R., LaRiviere, L.L., Vizueta, N. et al. Brain activation in response to overt and covert fear and happy faces in women with borderline personality disorder. Brain Imaging and Behavior 10, 319–331 (2016). https://doi.org/10.1007/s11682-015-9406-4

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