title: Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder.
abstract: 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.
authors.affiliation: James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA. antonia.new@mssm.edu
authors.forename: Antonia S
authors.initials: AS
authors.lastname: New
authors.forename: Erin A
authors.initials: EA
authors.lastname: Hazlett
authors.forename: Randall E
authors.initials: RE
authors.lastname: Newmark
authors.forename: Jane
authors.initials: J
authors.lastname: Zhang
authors.forename: Joseph
authors.initials: J
authors.lastname: Triebwasser
authors.forename: David
authors.initials: D
authors.lastname: Meyerson
authors.forename: Sophie
authors.initials: S
authors.lastname: Lazarus
authors.forename: Roanna
authors.initials: R
authors.lastname: Trisdorfer
authors.forename: Kim E
authors.initials: KE
authors.lastname: Goldstein
authors.forename: Marianne
authors.initials: M
authors.lastname: Goodman
authors.forename: Harold W
authors.initials: HW
authors.lastname: Koenigsberg
authors.forename: Janine D
authors.initials: JD
authors.lastname: Flory
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Siever
authors.forename: Monte S
authors.initials: MS
authors.lastname: Buchsbaum
mesh_terms: 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
chemical_list: D019788:Fluorodeoxyglucose F18