Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study.
BACKGROUND
Stress-induced dissociative states involving analgesia are a common feature of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Our aim was to investigate the psychologic, somatosensory (pain sensitivity) and neural correlates of dissociative states in patients with these disorders.


METHODS
We included 15 women with BPD who were not taking medication; 10 of these women had comorbid PTSD. While undergoing functional magnetic resonance imaging at 1.5 Tesla, participants were exposed to a script describing a personalized dissociation-inducing situation and a personalized script describing a neutral situation. We assessed dissociative psychopathology and pain sensitivity.


RESULTS
Dissociative psychopathology scores were significantly higher and pain sensitivity was lower after the dissociation-inducing script was read compared with the neutral script. The blood oxygen level-dependent (BOLD) signal was significantly increased in the left inferior frontal gyrus (Brodmann area [BA] 9) during the presentation of the dissociation-inducing script. Regression analyses revealed positive correlations between BOLD signal and dissociative psychopathology in the left superior frontal gyrus (BA 6) and negative correlations in the right middle (BA 21) and inferior temporal gyrus (BA 20). In the subgroup of participants with comorbid PTSD, we also found increased activity in the left cingulate gyrus (BA 32) during script-driven imagery-induced dissociation, a positive correlation between dissociation scores and activity in the right and left insula (BA 13) and a negative correlation in the right parahippocampal gyrus (BA 35).


CONCLUSIONS
The main limitation of this pilot study is the absence of a control group. Therefore, the results may also reflect the neural correlates of non-BPD/PTSD specific dissociative states or the neural correlates of emotionally stressful or "loaded" memories. Another limitation is the uncorrected statistical level of the functional magnetic resonance imaging results.


CONCLUSIONS
Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD. These states were characterized by reduced pain sensitivity and a frontolimbic activation pattern, which resembles the findings in participants with PTSD while in dissociative states.
Ludäscher
Petra
P
Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Mannheim, Germany. petra.ludaescher@zi-mannheim.de
Valerius
Gabriele
G
Stiglmayr
Christian
C
Mauchnik
Jana
J
Lanius
Ruth A
RA
Bohus
Martin
M
Schmahl
Christian
C
D000328:Adult; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D015897:Comorbidity; D004213:Dissociative Disorders / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D008032:Limbic System / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D058748:Pain Perception; D017288:Pain Threshold / Q000523:psychology; D020534:Parahippocampal Gyrus / Q000503:physiopathology; D010865:Pilot Projects; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D013702:Temporal Lobe / Q000503:physiopathology