The Latest Neuroimaging Findings in Borderline Personality Disorder

  • Annegret Krause-Utz
  • Dorina Winter
  • Inga Niedtfeld
  • Christian Schmahl
Personality Disorders (C Schmahl, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Personality Disorders

Abstract

Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced deficits in emotion regulation, cognitive disturbances including dissociation, impulsivity, and interpersonal disturbances. Over the last decades, neuroimaging has become one of the most important methods to investigate neurobiological alterations possibly underlying core features of BPD. The aim of our article is to provide an overview of the latest neuroimaging research in BPD focusing on functional and structural MRI studies published since 2010. Findings of these studies are depicted and discussed referring to central domains of BPD psychopathology. On a neurochemical level, altered function in neurotransmitter systems including the serotonin, glutamate, and GABA systems was observed in patients with BPD. On a neural level, individuals with BPD showed structural and functional abnormalities in a fronto-limbic network including regions involved in emotion processing (e.g., amygdala, insula) and frontal brain regions implicated in regulatory control processes (e.g., anterior cingulate cortex, medial frontal cortex, orbitofrontal cortex, and dorsolateral prefrontal cortex). Limbic hyperreactivity and diminished recruitment of frontal brain regions may yield a link between disturbed emotion processing and other core features of BPD such as impulsivity and interpersonal disturbances. To clarify whether findings are specific to BPD, comparisons with other clinical groups are needed.

Keywords

Borderline personality disorder Dissociation Emotion regulation Functional magnetic resonance imaging Impulsivity Interpersonal disturbances Neuroimaging Pain processing Structural magnetic resonance imaging 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry. 2006;188:423–31. doi:10.1192/bjp.188.5.423.PubMedGoogle Scholar
  2. 2.
    Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Personal Disord. 2010;24(4):412–26. doi:10.1521/pedi.2010.24.4.412.Google Scholar
  3. 3.
    Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–45.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Lis E, Greenfield B, Henry M, Guile JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci. 2007;32(3):162–73.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet. 2011;377(9759):74–84. doi:10.1016/s0140-6736(10)61422-5.PubMedGoogle Scholar
  6. 6.
    O'Neill A, Frodl T. Brain structure and function in borderline personality disorder. Brain Struct Funct. 2012;217(4):767–82. doi:10.1007/s00429-012-0379-4.PubMedGoogle Scholar
  7. 7.
    Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364(9432):453–61. doi:10.1016/s0140-6736(04)16770-6.PubMedGoogle Scholar
  8. 8.
    Mauchnik J, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2010;12(1):46–55. doi:10.1007/s11920-009-0089-7.PubMedGoogle Scholar
  9. 9.
    Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR. Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis. J Pers Disord. 2009;23(4):333–45. doi:10.1521/pedi.2009.23.4.333.PubMedGoogle Scholar
  10. 10.
    Ochsner KN, Gross JJ. The Neural Architecture of Emotion Regulation. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 87–109.Google Scholar
  11. 11.
    Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, et al. Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010;167(6):640–7. doi:10.1176/appi.ajp.2009.09081168.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Karl A, Schaefer M, Malta LS, Dorfel D, Rohleder N, Werner A. A meta-analysis of structural brain abnormalities in PTSD. Neurosci Biobehav Rev. 2006;30(7):1004–31. doi:10.1016/j.neubiorev.2006.03.004.PubMedGoogle Scholar
  13. 13.
    Rodrigues E, Wenzel A, Ribeiro MP, Quarantini LC, Miranda-Scippa A, de Sena EP, et al. Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: a meta-analysis. Eur Psychiatry. 2011;26(7):452–6. doi:10.1016/j.eurpsy.2010.07.005.PubMedGoogle Scholar
  14. 14.
    Niedtfeld I, Schulze L, Krause-Utz A, Demirakca T, Bohus M, Schmahl C. Voxel-based morphometry in women with borderline personality disorder with and without comorbid posttraumatic stress disorder. PLoS One. 2013;8(6):e65824. doi:10.1371/journal.pone.0065824.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Kuhlmann A, Bertsch K, Schmidinger I, Thomann PA, Herpertz SC. Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder. J Psychiatry Neurosci. 2013;38(2):129–37. doi:10.1503/jpn.120039.PubMedCentralPubMedGoogle Scholar
  16. 16.
    O'Neill A, D'Souza A, Carballedo A, Joseph S, Kerskens C, Frodl T. Magnetic resonance imaging in patients with borderline personality disorder: a study of volumetric abnormalities. Psychiatry Res. 2013;213(1):1–10. doi:10.1016/j.pscychresns.2013.02.006.PubMedGoogle Scholar
  17. 17.
    Rossi R, Lanfredi M, Pievani M, Boccardi M, Beneduce R, Rillosi L, et al. Volumetric and topographic differences in hippocampal subdivisions in borderline personality and bipolar disorders. Psychiatry Res. 2012;203(2–3):132–8. doi:10.1016/j.pscychresns.2011.12.004.PubMedGoogle Scholar
  18. 18.
    Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res. 2008;164(3):223–36. doi:10.1016/j.pscychresns.2008.02.003.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Soloff PH, Pruitt P, Sharma M, Radwan J, White R, Diwadkar VA. Structural brain abnormalities and suicidal behavior in borderline personality disorder. J Psychiatr Res. 2012;46(4):516–25. doi:10.1016/j.jpsychires.2012.01.003.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Sala M, Caverzasi E, Lazzaretti M, Morandotti N, De Vidovich G, Marraffini E, et al. Dorsolateral prefrontal cortex and hippocampus sustain impulsivity and aggressiveness in borderline personality disorder. J Affect Disord. 2011;131(1–3):417–21. doi:10.1016/j.jad.2010.11.036.PubMedGoogle Scholar
  21. 21.
    Pessoa L, Padmala S, Kenzer A, Bauer A. Interactions between cognition and emotion during response inhibition. Emotion. 2012;12(1):192–7. doi:10.1037/a0024109.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Brodmann K. Vergleichende Lokalisationslehre der Grosshirnrinde in ihren Prinzipien dargestellt auf Grund des Zellenbaues. Leipzig: J. A. Barth; 1909.Google Scholar
  23. 23.
    Mylius V, Ayache SS, Ahdab R, Farhat WH, Zouari HG, Belke M, et al. Definition of DLPFC and M1 according to anatomical landmarks for navigated brain stimulation: inter-rater reliability, accuracy, and influence of gender and age. Neuroimage. 2013;78:224–32. doi:10.1016/j.neuroimage.2013.03.061.PubMedGoogle Scholar
  24. 24.
    Goodman M, Hazlett EA, Avedon JB, Siever DR, Chu KW, New AS. Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression. J Psychiatr Res. 2011;45(6):803–7. doi:10.1016/j.jpsychires.2010.11.011.PubMedGoogle Scholar
  25. 25.
    Bertsch K, Grothe M, Prehn K, Vohs K, Berger C, Hauenstein K, et al. Brain volumes differ between diagnostic groups of violent criminal offenders. Eur Arch Psychiatry Clin Neurosci. 2013;263(7):593–606. doi:10.1007/s00406-013-0391-6.PubMedGoogle Scholar
  26. 26.
    Rusch N, Bracht T, Kreher BW, Schnell S, Glauche V, Il'yasov KA, et al. Reduced interhemispheric structural connectivity between anterior cingulate cortices in borderline personality disorder. Psychiatry Res. 2010;181(2):151–4. doi:10.1016/j.pscychresns.2009.08.004.PubMedGoogle Scholar
  27. 27.
    Carrasco JL, Tajima-Pozo K, Diaz-Marsa M, Casado A, Lopez-Ibor JJ, Arrazola J, et al. Microstructural white matter damage at orbitofrontal areas in borderline personality disorder. J Affect Disord. 2012;139(2):149–53. doi:10.1016/j.jad.2011.12.019.PubMedGoogle Scholar
  28. 28.•
    Sato JR, de Araujo Filho GM, de Araujo TB, Bressan RA, de Oliveira PP, Jackowski AP. Can neuroimaging be used as a support to diagnosis of borderline personality disorder? An approach based on computational neuroanatomy and machine learning. J Psychiatr Res. 2012;46(9):1126–32. doi:10.1016/j.jpsychires.2012.05.008. Interesting machine learning account to structural brain alterations in BPD.PubMedGoogle Scholar
  29. 29.
    Chanen AM, Velakoulis D, Carison K, Gaunson K, Wood SJ, Yuen HP, et al. Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder. Psychiatry Res. 2008;163(2):116–25. doi:10.1016/j.pscychresns.2007.08.007.PubMedGoogle Scholar
  30. 30.
    Whittle S, Chanen AM, Fornito A, McGorry PD, Pantelis C, Yucel M. Anterior cingulate volume in adolescents with first-presentation borderline personality disorder. Psychiatry Res. 2009;172(2):155–60. doi:10.1016/j.pscychresns.2008.12.004.PubMedGoogle Scholar
  31. 31.
    Brunner R, Henze R, Parzer P, Kramer J, Feigl N, Lutz K, et al. Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: is it disorder specific? Neuroimage. 2010;49(1):114–20. doi:10.1016/j.neuroimage.2009.07.070.PubMedGoogle Scholar
  32. 32.
    Takahashi T, Chanen AM, Wood SJ, Yucel M, Kawasaki Y, McGorry PD, et al. Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder. Psychiatry Res. 2010;182(1):73–6. doi:10.1016/j.pscychresns.2009.10.014.PubMedGoogle Scholar
  33. 33.
    Walterfang M, Chanen AM, Barton S, Wood AG, Jones S, Reutens DC, et al. Corpus callosum morphology and relationship to orbitofrontal and lateral ventricular volume in teenagers with first-presentation borderline personality disorder. Psychiatry Res. 2010;183(1):30–7. doi:10.1016/j.pscychresns.2010.04.001.PubMedGoogle Scholar
  34. 34.
    New AS, Carpenter DM, Perez-Rodriguez MM, Ripoll LH, Avedon J, Patil U, et al. Developmental differences in diffusion tensor imaging parameters in borderline personality disorder. J Psychiatr Res. 2013;47(8):1101–9. doi:10.1016/j.jpsychires.2013.03.021.PubMedGoogle Scholar
  35. 35.
    Maier-Hein KH, Brunner R, Lutz K, Henze R, Parzer P, Feigl N, et al. Disorder-specific white matter alterations in adolescent borderline personality disorder. Biol Psychiatry. 2013. doi:10.1016/j.biopsych.2013.03.031.PubMedGoogle Scholar
  36. 36.
    Dannlowski U, Stuhrmann A, Beutelmann V, Zwanzger P, Lenzen T, Grotegerd D, et al. Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biol Psychiatry. 2012;71(4):286–93. doi:10.1016/j.biopsych.2011.10.021.PubMedGoogle Scholar
  37. 37.
    Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68–81. doi:10.1016/S0140-6736(08)61706-7.PubMedGoogle Scholar
  38. 38.•
    Wolf RC, Sambataro F, Vasic N, Schmid M, Thomann PA, Bienentreu SD, et al. Aberrant connectivity of resting-state networks in borderline personality disorder. J Psychiatry Neurosci. 2011;36(2):100150. doi:10.1503/jpn.100150. First study suggesting altered resting state functioning in BPD.Google Scholar
  39. 39.
    Doll A, Sorg C, Manoliu A, Woller A, Meng C, Forstl H, et al. Shifted intrinsic connectivity of central executive and salience network in borderline personality disorder. Front Hum Neurosci. 2013;7:727. doi:10.3389/fnhum.2013.00727.PubMedCentralPubMedGoogle Scholar
  40. 40.
    Krause-Utz A, Veer IM, Rombouts SARB, Bohus M, Elzinga B, Schmahl C. Amygdala and anterior cingulate resting-state functional connectivity in borderline personality disorder patients with a history of interpersonal trauma. under review.Google Scholar
  41. 41.•
    Kluetsch RC, Schmahl C, Niedtfeld I, Densmore M, Calhoun VD, Daniels J, et al. Alterations in default mode network connectivity during pain processing in borderline personality disorder. Arch Gen Psychiatry. 2012;69(10):993–1002. doi:10.1001/archgenpsychiatry.2012.476. This study reveals alterations in brain networks during pain processing in BPDs.PubMedGoogle Scholar
  42. 42.
    Carpenter RW, Trull TJ. Components of emotion dysregulation in borderline personality disorder: a review. Curr Psychiatry Rep. 2013;15(1):335. doi:10.1007/s11920-012-0335-2.PubMedGoogle Scholar
  43. 43.
    Donegan N. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003;54(11):1284–93. doi:10.1016/s0006-3223(03)00636-x.PubMedGoogle Scholar
  44. 44.
    Herpertz SC, Dietrich TM, Wenning B, Krings T, Erberich SG, Willmes K, et al. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study. Biol Psychiatry. 2001;50(4):292–8.PubMedGoogle Scholar
  45. 45.
    Koenigsberg HW, Fan J, Ochsner KN, Liu X, Guise KG, Pizzarello S, et al. Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biol Psychiatry. 2009;66(9):854–63. doi:10.1016/j.biopsych.2009.06.010.PubMedCentralPubMedGoogle Scholar
  46. 46.•
    Krause-Utz A, Oei NY, Niedtfeld I, Bohus M, Spinhoven P, Schmahl C, et al. Influence of emotional distraction on working memory performance in borderline personality disorder. Psychol Med. 2012;42(10):2181–92. doi:10.1017/S0033291712000153. Functional neuroimaging study providing evidence for heightened emotional distractibility in BPD.PubMedGoogle Scholar
  47. 47.
    Niedtfeld I, Schulze L, Kirsch P, Herpertz SC, Bohus M, Schmahl C. Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biol Psychiatry. 2010;68(4):383–91. doi:10.1016/j.biopsych.2010.04.015.PubMedGoogle Scholar
  48. 48.
    Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res. 2007;155(3):231–43. doi:10.1016/j.pscychresns.2007.03.006.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Schulze L, Domes G, Kruger A, Berger C, Fleischer M, Prehn K, et al. Neuronal correlates of cognitive reappraisal in borderline patients with affective instability. Biol Psychiatry. 2011;69(6):564–73. doi:10.1016/j.biopsych.2010.10.025.PubMedGoogle Scholar
  50. 50.
    Beblo T, Driessen M, Mertens M, Wingenfeld K, Piefke M, Rullkoetter N, et al. Functional MRI correlates of the recall of unresolved life events in borderline personality disorder. Psychol Med. 2006;36(6):845–56. doi:10.1017/S0033291706007227.PubMedGoogle Scholar
  51. 51.•
    Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73(2):153–60. doi:10.1016/j.biopsych.2012.07.014. Meta-analysis on neural correlates of emotional hyperreactivity in BPD.PubMedGoogle Scholar
  52. 52.
    Kamphausen S, Schroder P, Maier S, Bader K, Feige B, Kaller CP et al. Medial prefrontal dysfunction and prolonged amygdala response during instructed fear processing in borderline personality disorder. World J Biol Psychiatry. 2013;14(4):307-18, S1-4. doi:10.3109/15622975.2012.665174.Google Scholar
  53. 53.
    Damasio AR, Grabowski TJ, Bechara A, Damasio H, Ponto LLB, Parvizi J, et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci. 2000;3(10):1049–56.PubMedGoogle Scholar
  54. 54.
    Menon V, Uddin LQ. Saliency, switching, attention and control: a network model of insula function. Brain Struct Funct. 2010;214(5–6):655–67. doi:10.1007/s00429-010-0262-0.PubMedCentralPubMedGoogle Scholar
  55. 55.
    Lang PJ, Bradley MM, Cuthbert BN. International Affective Picture System (IAPS): Technical manual and affective ratings. The Center for Research in Psychophysiology. Gainesville: University of Florida; 1997.Google Scholar
  56. 56.
    Daros AR, Zakzanis KK, Ruocco AC. Facial emotion recognition in borderline personality disorder. Psychol Med. 2013;43(9):1953–63. doi:10.1017/S0033291712002607.PubMedGoogle Scholar
  57. 57.
    Donegan NH, Sanislow CA, Blumberg HP, Fulbright RK, Lacadie C, Skudlarski P, et al. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003;54(11):1284–93.PubMedGoogle Scholar
  58. 58.
    Lis S, Bohus M. Social interaction in borderline personality disorder. Curr Psychiatry Rep. 2013;15(2):338. doi:10.1007/s11920-012-0338-z.PubMedGoogle Scholar
  59. 59.
    New AS, Hazlett EA, Buchsbaum MS, Goodman M, Mitelman SA, Newmark R, et al. Amygdala-prefrontal disconnection in borderline personality disorder. Neuropsychopharmacology. 2007;32(7):1629–40. doi:10.1038/sj.npp.1301283.PubMedGoogle Scholar
  60. 60.
    Prossin AR, Love TM, Koeppe RA, Zubieta J-K, Silk KR. Dysregulation of regional endogenous opioid function in borderline personality disorder. Am J Psychiatry. 2010;167(8):925–33. doi:10.11 76/appi.ajp.2010.09091 348.PubMedGoogle Scholar
  61. 61.
    Cullen KR, Vizueta N, Thomas KM, Han GJ, Lim KO, Camchong J, et al. Amygdala functional connectivity in young women with borderline personality disorder. Brain Connect. 2011;1(1):61–71. doi:10.1089/brain.2010.0001.PubMedGoogle Scholar
  62. 62.
    Scherpiet S, Bruhl AB, Opialla S, Roth L, Jancke L, Herwig U. Altered emotion processing circuits during the anticipation of emotional stimuli in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci. 2013. doi:10.1007/s00406-013-0444-x.PubMedGoogle Scholar
  63. 63.
    Ochsner KN, Bunge SA, Gross JJ, Gabrieli JD. Rethinking feelings: an FMRI study of the cognitive regulation of emotion. J Cogn Neurosci. 2002;14(8):1215–29. doi:10.1162/089892902760807212.PubMedGoogle Scholar
  64. 64.
    Lang S, Kotchoubey B, Frick C, Spitzer C, Grabe HJ, Barnow S. Cognitive reappraisal in trauma-exposed women with borderline personality disorder. Neuroimage. 2012;59(2):1727–34. doi:10.1016/j.neuroimage.2011.08.061.PubMedGoogle Scholar
  65. 65.
    Welch SS, Linehan MM, Sylvers P, Chittams J, Rizvi SL. Emotional responses to self-injury imagery among adults with borderline personality disorder. J Consult Clin Psychol. 2008;76(1):45–51. doi:10.1037/0022-006X.76.1.45.PubMedGoogle Scholar
  66. 66.
    Schmahl C, Greffrath W, Baumgartner U, Schlereth T, Magerl W, Philipsen A, et al. Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain. 2004;110(1–2):470–9. doi:10.1016/j.pain.2004.04.035.PubMedGoogle Scholar
  67. 67.
    Schmahl C, Bohus M, Esposito F, Treede RD, Di Salle F, Greffrath W, et al. Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry. 2006;63(6):659–67. doi:10.1001/archpsyc.63.6.659.PubMedGoogle Scholar
  68. 68.
    Kraus A, Esposito F, Seifritz E, Di Salle F, Ruf M, Valerius G, et al. Amygdala deactivation as a neural correlate of pain processing in patients with borderline personality disorder and co-occurrent PTSD. Biol Psychiatry. 2010;65(9):819–22.Google Scholar
  69. 69.
    Kraus A, Valerius G, Seifritz E, Ruf M, Bremner JD, Bohus M, et al. Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study. Acta Psychiatr Scand. 2010;121(1):41–51. doi:10.1111/j.1600-0447.2009.01417.x.PubMedCentralPubMedGoogle Scholar
  70. 70.
    Pessoa L, McKenna M, Gutierrez E, Ungerleider LG. Neural processing of emotional faces requires attention. Proc Natl Acad Sci U S A. 2002;99(17):11458–63. doi:10.1073/pnas.172403899.PubMedCentralPubMedGoogle Scholar
  71. 71.
    Niedtfeld I, Kirsch P, Schulze L, Herpertz SC, Bohus M, Schmahl C. Functional connectivity of pain-mediated affect regulation in borderline personality disorder. PLoS One. 2012;7(3):e33293. doi:10.1371/journal.pone.0033293.PubMedCentralPubMedGoogle Scholar
  72. 72.
    Ochsner KN, Ray RD, Cooper JC, Robertson ER, Chopra S, Gabrieli JD, et al. For better or for worse: neural systems supporting the cognitive down- and up-regulation of negative emotion. Neuroimage. 2004;23(2):483–99. doi:10.1016/j.neuroimage.2004.06.030.PubMedGoogle Scholar
  73. 73.
    Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, et al. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry. 2002;159(2):276–83.PubMedGoogle Scholar
  74. 74.
    Baer RA, Peters JR, Eisenlohr-Moul TA, Geiger PJ, Sauer SE. Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature. Clin Psychol Rev. 2012;32(5):359–69. doi:10.1016/j.cpr.2012.03.002.PubMedGoogle Scholar
  75. 75.
    Moritz S, Schilling L, Wingenfeld K, Kother U, Wittekind C, Terfehr K, et al. Psychotic-like cognitive biases in borderline personality disorder. J Behav Ther Exp Psychiatry. 2011;42(3):349–54. doi:10.1016/j.jbtep.2011.02.003.PubMedGoogle Scholar
  76. 76.
    Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M. Aversive tension in patients with borderline personality disorder: a computer-based controlled field study. Acta Psychiatr Scand. 2005;111(5):372–9. doi:10.1111/j.1600-0447.2004.00466.x.PubMedGoogle Scholar
  77. 77.
    Stiglmayr CE, Ebner-Priemer UW, Bretz J, Behm R, Mohse M, Lammers CH, et al. Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatr Scand. 2008;117(2):139–47. doi:10.1111/j.1600-0447.2007.01126.x.PubMedGoogle Scholar
  78. 78.
    Korzekwa MI, Dell PF, Links PS, Thabane L, Fougere P. Dissociation in borderline personality disorder: a detailed look. J Trauma Dissociation: Off J Int Soc Stud Dissociation. 2009;10(3):346–67. doi:10.1080/15299730902956838.Google Scholar
  79. 79.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington: American Psychiatric Association; 2000.Google Scholar
  80. 80.
    Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, Schnurr PP. The dissociative subtype of PTSD: a replication and extension. Depress Anxiety. 2012;29(8):679–88. doi:10.1002/da.21946.PubMedGoogle Scholar
  81. 81.
    Ludäscher P, Valerius G, Stiglmayr C, Mauchnik J, Lanius R, Bohus M, et al. Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid PTSD - a pilot study. J Psychiatry Neurosci. 2010;35(3):177–84.PubMedCentralPubMedGoogle Scholar
  82. 82.
    Sierra M, Berrios GE. Depersonalization: neurobiological perspectives. Biol Psychiatry. 1998;44(9):898–908.PubMedGoogle Scholar
  83. 83.
    de la Fuente JM, Goldman S, Stanus E, Vizuete C, Morlan I, Bobes J, et al. Brain glucose metabolism in borderline personality disorder. J Psychiatr Res. 1997;31(5):531–41.Google Scholar
  84. 84.
    Juengling FD, Schmahl C, Hesslinger B, Ebert D, Bremner JD, Gostomzyk J, et al. Positron emission tomography in female patients with borderline personality disorder. J Psychiatr Res. 2003;37(2):109–15.PubMedGoogle Scholar
  85. 85.
    Lange C, Kracht L, Herholz K, Sachsse U, Irle E. Reduced glucose metabolism in temporo-parietal cortices of women with borderline personality disorder. Psychiatry Res. 2005;139(2):115–26. doi:10.1016/j.pscychresns.2005.05.003.PubMedGoogle Scholar
  86. 86.
    Salavert J, Gasol M, Vieta E, Cervantes A, Trampal C, Gispert JD. Fronto-limbic dysfunction in borderline personality disorder: a 18 F-FDG positron emission tomography study. J Affect Disord. 2011;131(1–3):260–7. doi:10.1016/j.jad.2011.01.001.PubMedGoogle Scholar
  87. 87.
    Wolf RC, Thomann PA, Sambataro F, Vasic N, Schmid M, Wolf ND. Orbitofrontal cortex and impulsivity in borderline personality disorder: an MRI study of baseline brain perfusion. Eur Arch Psychiatry Clin Neurosci. 2012;262(8):677–85. doi:10.1007/s00406-012-0303-1.PubMedGoogle Scholar
  88. 88.
    Schulz CS, Camchong J, Romine A, Schlesinger A, Kuskowski M, Pardo JV, et al. An exploratory study of the relationship of symptom domains and diagnostic severity to PET scan imaging in borderline personality disorder. Psychiatry Res. 2013;214(2):161–8. doi:10.1016/j.pscychresns.2013.05.007.Google Scholar
  89. 89.
    Perez-Rodriguez MM, Weinstein S, New AS, Bevilacqua L, Yuan Q, Zhou Z, et al. Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls. J Psychiatr Res. 2010;44(15):1075–81. doi:10.1016/j.jpsychires.2010.03.014.PubMedCentralPubMedGoogle Scholar
  90. 90.
    McCloskey MS, New AS, Siever LJ, Goodman M, Koenigsberg HW, Flory JD, et al. Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder. J Psychiatr Res. 2009;43(12):1036–48. doi:10.1016/j.jpsychires.2009.01.002.PubMedCentralPubMedGoogle Scholar
  91. 91.
    Goodman M, New AS, Triebwasser J, Collins KA, Siever L. Phenotype, endophenotype, and genotype comparisons between borderline personality disorder and major depressive disorder. J Pers Disord. 2010;24(1):38–59. doi:10.1521/pedi.2010.24.1.38.PubMedGoogle Scholar
  92. 92.
    Mak AD, Lam LC. Neurocognitive profiles of people with borderline personality disorder. Curr Opin Psychiatry. 2013;26(1):90–6. doi:10.1097/YCO.0b013e32835b57a9.PubMedGoogle Scholar
  93. 93.•
    Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, et al. Correlation of glutamate levels in the anterior cingulate cortex with self-reported impulsivity in patients with borderline personality disorder and healthy controls. Arch Gen Psychiatry. 2010;67(9):946–54. doi:10.1001/archgenpsychiatry.2010.93. Links alterations in BPD patients’ impulsivity to neurochemical markers.PubMedGoogle Scholar
  94. 94.
    Coccaro EF, Lee R, Vezina P. Cerebrospinal fluid glutamate concentration correlates with impulsive aggression in human subjects. J Psychiatr Res. 2013;47(9):1247–53. doi:10.1016/j.jpsychires.2013.05.001.PubMedGoogle Scholar
  95. 95.
    New AS, Hazlett EA, Newmark RE, Zhang J, Triebwasser J, Meyerson D, et al. Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder. Biol Psychiatry. 2009;66(12):1107–14. doi:10.1016/j.biopsych.2009.07.015.PubMedCentralPubMedGoogle Scholar
  96. 96.
    Perez-Rodriguez MM, Hazlett EA, Rich EL, Ripoll LH, Weiner DM, Spence N, et al. Striatal activity in borderline personality disorder with comorbid intermittent explosive disorder: sex differences. J Psychiatr Res. 2012;46(6):797–804. doi:10.1016/j.jpsychires.2012.02.014.PubMedCentralPubMedGoogle Scholar
  97. 97.
    Evenden JL. Varieties of impulsivity. Psychopharmacology (Berl). 1999;146(4):348–61.Google Scholar
  98. 98.
    Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158(11):1783–93.PubMedGoogle Scholar
  99. 99.
    Bornovalova MA, Lejuez CW, Daughters SB, Zachary Rosenthal M, Lynch TR. Impulsivity as a common process across borderline personality and substance use disorders. Clin Psychol Rev. 2005;25(6):790–812. doi:10.1016/j.cpr.2005.05.005.PubMedGoogle Scholar
  100. 100.
    Sebastian A, Jacob G, Lieb K, Tuscher O. Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Curr Psychiatry Rep. 2013;15(2):339.PubMedGoogle Scholar
  101. 101.
    Stahl C, Voss A, Schmitz F, Nuszbaum M, Tuscher O, Lieb K, et al. Behavioral components of impulsivity. J Exp Psychol Gen. 2013. doi:10.1037/a0033981.PubMedGoogle Scholar
  102. 102.
    Wingenfeld K, Mensebach C, Rullkoetter N, Schlosser N, Schaffrath C, Woermann FG, et al. Attentional bias to personally relevant words in borderline personality disorder is strongly related to comorbid posttraumatic stress disorder. J Pers Disord. 2009;23(2):141–55.PubMedGoogle Scholar
  103. 103.
    Smoski MJ, Salsman N, Wang L, Smith V, Lynch TR, Dager SR, et al. Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder. Pers Disord. 2011;2(3):230–41. doi:10.1037/a0022228.Google Scholar
  104. 104.
    Prehn K, Schulze L, Rossmann S, Berger C, Vohs K, Fleischer M, et al. Effects of emotional stimuli on working memory processes in male criminal offenders with borderline and antisocial personality disorder. World J Biol Psychiatry. 2013;14(1):71–8. doi:10.3109/15622975.2011.584906.PubMedGoogle Scholar
  105. 105.
    Holtmann J, Herbort MC, Wustenberg T, Soch J, Richter S, Walter H, et al. Trait anxiety modulates fronto-limbic processing of emotional interference in borderline personality disorder. Front Hum Neurosci. 2013;7:54. doi:10.3389/fnhum.2013.00054.PubMedCentralPubMedGoogle Scholar
  106. 106.
    Enzi B, Doering S, Faber C, Hinrichs J, Bahmer J, Northoff G. Reduced deactivation in reward circuitry and midline structures during emotion processing in borderline personality disorder. World J Biol Psychiatry. 2013;14(1):45–56. doi:10.3109/15622975.2011.579162.PubMedGoogle Scholar
  107. 107.
    Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, et al. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry. 2007;164(12):1832–41. doi:10.1176/appi.ajp.2007.06010126.PubMedGoogle Scholar
  108. 108.
    Jacob GA, Zvonik K, Kamphausen S, Sebastian A, Maier S, Philipsen A, et al. Emotional modulation of motor response inhibition in women with borderline personality disorder: an fMRI study. J Psychiatry Neurosci. 2013;38(3):164–72. doi:10.1503/jpn.120029.PubMedCentralPubMedGoogle Scholar
  109. 109.
    Fertuck EA, Lenzenweger MF, Clarkin JF, Hoermann S, Stanley B. Executive neurocognition, memory systems, and borderline personality disorder. Clin Psychol Rev. 2006;26(3):346–75. doi:10.1016/j.cpr.2005.05.008.PubMedGoogle Scholar
  110. 110.
    Gunderson JG. Disturbed relationships as a phenotype for borderline personality disorder. Am J Psychiatry. 2007;164(11):1637–40. doi:10.1176/appi.ajp.2007.07071125.PubMedGoogle Scholar
  111. 111.
    Gunderson JG, Lyons-Ruth K. BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Pers Disord. 2008;22(1):22–41. doi:10.1521/pedi.2008.22.1.22.PubMedCentralPubMedGoogle Scholar
  112. 112.
    King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science. 2008;321(5890):806–10. doi:10.1126/science.1156902.PubMedGoogle Scholar
  113. 113.
    Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother. 2010. doi:10.1002/cpp.705.PubMedGoogle Scholar
  114. 114.
    Renneberg B, Herm K, Hahn A, Staebler K, Lammers CH, Roepke S. Perception of social participation in borderline personality disorder. Clin Psychol Psychother. 2012;19(6):473–80. doi:10.1002/cpp.772.PubMedGoogle Scholar
  115. 115.
    Domes G, Czieschnek D, Weidler F, Berger C, Fast K, Herpertz SC. Recognition of facial affect in Borderline Personality Disorder. J Pers Disord. 2008;22(2):135–47.PubMedGoogle Scholar
  116. 116.
    Domes G, Schulze L, Herpertz SC. Emotion recognition in borderline personality disorder-a review of the literature. J Pers Disord. 2009;23(1):6–19. doi:10.1521/pedi.2009.23.1.6.PubMedGoogle Scholar
  117. 117.
    Dyck M, Habel U, Slodczyk J, Schlummer J, Backes V, Schneider F, et al. Negative bias in fast emotion discrimination in borderline personality disorder. Psychol Med. 2009;39(5):855–64. doi:10.1017/S0033291708004273.PubMedGoogle Scholar
  118. 118.
    Barnow S, Stopsack M, Grabe HJ, Meinke C, Spitzer C, Kronmuller K, et al. Interpersonal evaluation bias in borderline personality disorder. Behav Res Ther. 2009;47(5):359–65. doi:10.1016/j.brat.2009.02.003.PubMedGoogle Scholar
  119. 119.
    Unoka Z, Fogd D, Fuzy M, Csukly G. Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder. Psychiatry Res. 2011;189(3):419–25. doi:10.1016/j.psychres.2011.02.010.PubMedGoogle Scholar
  120. 120.
    Frick C, Lang S, Kotchoubey B, Sieswerda S, Dinu-Biringer R, Berger M, et al. Hypersensitivity in borderline personality disorder during mindreading. PLoS One. 2012;7(8):e41650. doi:10.1371/journal.pone.0041650.PubMedCentralPubMedGoogle Scholar
  121. 121.
    Mier D, Lis S, Esslinger C, Sauer C, Hagenhoff M, Ulferts J, et al. Neuronal correlates of social cognition in borderline personality disorder. Soc Cogn Affect Neurosci. 2013;8(5):531–7. doi:10.1093/scan/nss028.PubMedGoogle Scholar
  122. 122.
    Guitart-Masip M, Pascual JC, Carmona S, Hoekzema E, Berge D, Perez V, et al. Neural correlates of impaired emotional discrimination in borderline personality disorder: an fMRI study. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(8):1537–45. doi:10.1016/j.pnpbp.2009.08.022.PubMedGoogle Scholar
  123. 123.
    Radaelli D, Poletti S, Dallaspezia S, Colombo C, Smeraldi E, Benedetti F. Neural responses to emotional stimuli in comorbid borderline personality disorder and bipolar depression. Psychiatry Res. 2012;203(1):61–6. doi:10.1016/j.pscychresns.2011.09.010.PubMedGoogle Scholar
  124. 124.•
    Dziobek I, Preissler S, Grozdanovic Z, Heuser I, Heekeren HR, Roepke S. Neuronal correlates of altered empathy and social cognition in borderline personality disorder. Neuroimage. 2011;57(2):539–48. doi:10.1016/j.neuroimage.2011.05.005. Large-scale functional neuroimaging study on different aspects of empathy in BPD.PubMedGoogle Scholar
  125. 125.
    Hooley JM, Gruber SA, Parker HA, Guillaumot J, Rogowska J, Yurgelun-Todd DA. Neural processing of emotional overinvolvement in borderline personality disorder. J Clin Psychiatry. 2010;71(8):1017–24. doi:10.4088/JCP.07m03465blu.PubMedGoogle Scholar
  126. 126.
    Ruocco AC, Medaglia JD, Tinker JR, Ayaz H, Forman EM, Newman CF, et al. Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder. Psychiatry Res. 2010;181(3):233–6. doi:10.1016/j.pscychresns.2009.12.001.PubMedGoogle Scholar
  127. 127.
    Domsalla M, Koppe G, Niedtfeld I, Vollstadt-Klein S, Schmahl C, Bohus M, et al. Cerebral processing of social rejection in patients with borderline personality disorder. Soc Cogn Affect Neurosci. 2013. doi:10.1093/scan/nst176.PubMedGoogle Scholar
  128. 128.
    Sanfey AG, Rilling JK, Aronson JA, Nystrom LE, Cohen JD. The neural basis of economic decision-making in the Ultimatum Game. Science. 2003;300(5626):1755–8. doi:10.1126/science.1082976.PubMedGoogle Scholar
  129. 129.
    Meyer-Lindenberg A. Psychology. Trust me on this Science. 2008;321(5890):778–80. doi:10.1126/science.1162908.Google Scholar
  130. 130.
    Krause-Utz A, Schmahl C. Neurobiological differentiation between borderline patients with and without post-traumatic stress disorder. Eur Psych Rev. 2010;3(2):63–8.Google Scholar
  131. 131.
    Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory. Psychol Bull. 2009;135(3):495–510. doi:10.1037/a0015616.PubMedCentralPubMedGoogle Scholar
  132. 132.
    Rueda MR, Posner MI, Rothbart MK. The development of executive attention: contributions to the emergence of self-regulation. Dev Neuropsychol. 2005;28(2):573–94. doi:10.1207/s15326942dn2802_2.PubMedGoogle Scholar
  133. 133.
    Bjorklund DF, Harnishfeger KK. The role of inhibition mechanisms in the evolution of human cognition and behavior. In: DF N, BC J, editors. New perspectives on interference and inhibition in cognition. New York: Academic Press; 1995. p. 141–73.Google Scholar
  134. 134.
    MacLeod C, Rutherford E, Campbell L, Ebsworthy G, Holker L. Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. J Abnorm Psychol. 2002;111(1):107–23.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Annegret Krause-Utz
    • 1
  • Dorina Winter
    • 1
  • Inga Niedtfeld
    • 1
  • Christian Schmahl
    • 1
  1. 1.Department of Psychosomatic Medicine and PsychotherapyCentral Institute of Mental Health, Medical Faculty Mannheim/Heidelberg UniversityMannheimGermany

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