Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder.
OBJECTIVE
The authors sought to test the hypothesis that in patients with borderline personality disorder, the ventromedial prefrontal cortex and associated regions would not be activated during a task requiring motor inhibition in the setting of negative emotion. Such a finding would provide a plausible neural basis for the difficulty borderline patients have in modulating their behavior during negative emotional states and a potential marker for treatment interventions.


METHODS
A specifically designed functional magnetic resonance imaging (fMRI) activation probe was used, with statistical parametric mapping analyses, to test hypotheses concerning decreased prefrontal inhibitory function in the context of negative emotion in patients with borderline personality disorder (N=16) and healthy comparison subjects (N=14). 3-T fMRI scanning was used to study brain activity while participants performed an emotional linguistic go/no-go task.


RESULTS
Analyses confirmed that under conditions associated with the interaction of behavioral inhibition and negative emotion, borderline patients showed relatively decreased ventromedial prefrontal activity (including medial orbitofrontal and subgenual anterior cingulate) compared with healthy subjects. In borderline patients, under conditions of behavioral inhibition in the context of negative emotion, decreasing ventromedial prefrontal and increasing extended amygdalar-ventral striatal activity correlated highly with measures of decreased constraint and increased negative emotion, respectively.


CONCLUSIONS
These findings suggest specific frontolimbic neural substrates associated with core clinical features of emotional and behavioral dyscontrol in borderline personality disorder.
Department of Psychiatry, Box 140, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA. dasilber@med.cornell.edu
David
D
Silbersweig
John F
JF
Clarkin
Martin
M
Goldstein
Otto F
OF
Kernberg
Oliver
O
Tuescher
Kenneth N
KN
Levy
Gary
G
Brendel
Hong
H
Pan
Manfred
M
Beutel
Michelle T
MT
Pavony
Jane
J
Epstein
Mark F
MF
Lenzenweger
Kathleen M
KM
Thomas
Michael I
MI
Posner
Emily
E
Stern
D000328:Adult; D000679:Amygdala / Q000502:physiology* / Q000503:physiopathology; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D002755:Choice Behavior / Q000502:physiology; D004644:Emotions / Q000502:physiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007266:Inhibition, Psychological; D008032:Limbic System / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D011932:Reading; D014705:Verbal Behavior / Q000502:physiology