title: Structural brain abnormalities and suicidal behavior in borderline personality disorder.
abstract: BACKGROUND
  Structural brain abnormalities have been demonstrated in subjects with BPD in prefrontal and fronto-limbic regions involved in the regulation of emotion and impulsive behavior, executive cognitive function and episodic memory. Impairment in these cognitive functions is associated with increased vulnerability to suicidal behavior. We compared BPD suicide attempters and non-attempters, high and low lethality attempters to healthy controls to identify neural circuits associated with suicidal behavior in BPD.
  
  
  METHODS
  Structural MRI scans were obtained on 68 BPD subjects (16 male, 52 female), defined by IPDE and DIB/R criteria, and 52 healthy controls (HC: 28 male, 24 female). Groups were compared by diagnosis, attempt status, and attempt lethality. ROIs were defined for areas reported to have structural or metabolic abnormalities in BPD, and included: mid-inf. orbitofrontal cortex, mid-sup temporal cortex, anterior cingulate, insula, hippocampus, amygdala, fusiform, lingual and parahippocampal gyri. Data were analyzed using optimized voxel-based morphometry implemented with DARTEL in SPM5, co-varied for age and gender, corrected for cluster extent (p < .001).
  
  
  RESULTS
  Compared to HC, BPD attempters had significantly diminished gray matter concentrations in 8 of 9 ROIs, non-attempters in 5 of 9 ROIs. Within the BPD sample, attempters had diminished gray matter in Lt. insula compared to non-attempters. High lethality attempters had significant decreases in Rt. mid-sup. temporal gyrus, Rt. mid-inf. orbitofrontal gyrus, Rt. insular cortex, Lt. fusiform gyrus, Lt. lingual gyrus and Rt. parahippocampal gyrus compared to low lethality attempters.
  
  
  CONCLUSIONS
  Specific structural abnormalities discriminate BPD attempters from non-attempters and high from low lethality attempters.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States. soloffph@upmc.edu
authors.forename: Paul H
authors.initials: PH
authors.lastname: Soloff
authors.forename: Patrick
authors.initials: P
authors.lastname: Pruitt
authors.forename: Mohit
authors.initials: M
authors.lastname: Sharma
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Radwan
authors.forename: Richard
authors.initials: R
authors.lastname: White
authors.forename: Vaibhav A
authors.initials: VA
authors.lastname: Diwadkar
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000473:pathology* / Q000523:psychology*; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D011569:Psychiatric Status Rating Scales; D013405:Suicide / Q000523:psychology*; D055815:Young Adult