title: Medial prefrontal dysfunction and prolonged amygdala response during instructed fear processing in borderline personality disorder.
abstract: OBJECTIVE
  Affective dysregulation is a clinical hallmark of borderline personality disorder (BPD). This study used an instructed fear task combined with functional MRI (fMRI) and skin conductance response (SCR) to test hypotheses about mechanisms of disturbed fronto-limbic neural circuitry underlying dysfunctional emotional processing in BPD.
  
  
  METHODS
  Female BPD patients and matched control subjects were exposed to two visual stimuli during fMRI scanning and SCR recording. Subjects were instructed shortly before scanning that one stimulus (Threat) potentially represents an aversive event whereas another stimulus (Safe) represents safety. The aversive event (electrodermal stimulation) itself was only experienced before this instruction and never occurred during fMRI scanning.
  
  
  RESULTS
  Both groups showed stronger SCR to Threat compared to Safe indicating differential fear response which habituated over time. BPD compared to control subjects did not show fMRI signal decrease of amygdala activity or relative ventromedial prefrontal cortex (vmPFC) activity increase over time. Moreover, BPD patients showed increased connectivity of the amygdala with vmPFC but decreased connectivity of subgenual ACC with dorsal ACC compared to control subjects.
  
  
  CONCLUSIONS
  Prolonged amygdala response and a functional disconnection between ventral and dorsal mPFC regions may be part of the neural mechanisms underlying emotional dysregulation in BPD patients.
authors.affiliation: Departments of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kamphausen
authors.forename: Patricia
authors.initials: P
authors.lastname: Schröder
authors.forename: Simon
authors.initials: S
authors.lastname: Maier
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bader
authors.forename: Bernd
authors.initials: B
authors.lastname: Feige
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Kaller
authors.forename: Volkmar
authors.initials: V
authors.lastname: Glauche
authors.forename: Sabine
authors.initials: S
authors.lastname: Ohlendorf
authors.forename: Ludger
authors.initials: L
authors.lastname: Tebartz van Elst
authors.forename: Stefan
authors.initials: S
authors.lastname: Klöppel
authors.forename: Gitta A
authors.initials: GA
authors.lastname: Jacob
authors.forename: David
authors.initials: D
authors.lastname: Silbersweig
authors.forename: Klaus
authors.initials: K
authors.lastname: Lieb
authors.forename: Oliver
authors.initials: O
authors.lastname: Tüscher
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology*; D001883:Borderline Personality Disorder / Q000503:physiopathology*; D001921:Brain / Q000503:physiopathology; D016022:Case-Control Studies; D005239:Fear / Q000502:physiology*; D005260:Female; D059907:Functional Neuroimaging; D005712:Galvanic Skin Response; D006801:Humans; D008279:Magnetic Resonance Imaging; D009434:Neural Pathways / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D055815:Young Adult