Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder.
BACKGROUND
Borderline personality disorder (BPD) is often associated with symptoms of impulsive aggression, which poses a threat to patients themselves and to others. Preclinical studies show that orbital frontal cortex (OFC) plays a role in regulating impulsive aggression. Prior work has found OFC dysfunction in BPD.


METHODS
We employed a task to provoke aggressive behavior, the Point Subtraction Aggression Paradigm (PSAP), which has never previously been used during functional brain imaging. Thirty-eight BPD patients with intermittent explosive disorder (BPD-IED) and 36 age-matched healthy control subjects (HCs) received (18)fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) on two occasions with a provocation and nonprovocation version of the PSAP. Mean relative glucose metabolism was measured throughout the cortex, and difference scores (provoked - nonprovoked) were calculated. A whole brain exploratory analysis for the double difference of BPD-IED - HC for provoked - nonprovoked was also conducted.


RESULTS
BPD-IED patients were significantly more aggressive than HCs on the PSAP. BPD-IED patients also increased relative glucose metabolic rate (rGMR) in OFC and amygdala when provoked, while HCs decreased rGMR in these areas. However, HCs increased rGMR in anterior, medial, and dorsolateral prefrontal regions during provocation more than BPD-IED patients.


CONCLUSIONS
Patients responded aggressively and showed heightened rGMR in emotional brain areas, including amygdala and OFC, in response to provocation but not in more dorsal brain regions associated with cognitive control of aggression. In contrast, HCs increased rGMR in dorsal regions of PFC during aggression provocation, brain regions involved in top-down cognitive control of aggression, and, more broadly, of emotion.
New
Antonia S
AS
James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA. antonia.new@mssm.edu
Hazlett
Erin A
EA
Newmark
Randall E
RE
Zhang
Jane
J
Triebwasser
Joseph
J
Meyerson
David
D
Lazarus
Sophie
S
Trisdorfer
Roanna
R
Goldstein
Kim E
KE
Goodman
Marianne
M
Koenigsberg
Harold W
HW
Flory
Janine D
JD
Siever
Larry J
LJ
Buchsbaum
Monte S
MS
D000328:Adult; D000374:Aggression / Q000523:psychology; D000704:Analysis of Variance; D001883:Borderline Personality Disorder / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001931:Brain Mapping; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007175:Impulsive Behavior / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D055815:Young Adult
D019788:Fluorodeoxyglucose F18