title: Functional connectivity of pain-mediated affect regulation in Borderline Personality Disorder.
abstract: Affective instability and self-injurious behavior are important features of Borderline Personality Disorder. Whereas affective instability may be caused by a pattern of limbic hyperreactivity paired with dysfunctional prefrontal regulation mechanisms, painful stimulation was found to reduce affective arousal at the neural level, possibly underlying the soothing effect of pain in BPD.We used psychophysiological interactions to analyze functional connectivity of (para-) limbic brain structures (i.e. amygdala, insula, anterior cingulate cortex) in Borderline Personality Disorder in response to painful stimulation. Therefore, we re-analyzed a dataset from 20 patients with Borderline Personality Disorder and 23 healthy controls who took part in an fMRI-task inducing negative (versus neutral) affect and subsequently applying heat pain (versus warmth perception).Results suggest an enhanced negative coupling between limbic as well as paralimbic regions and prefrontal regions, specifically with the medial and dorsolateral prefrontal cortex, when patients experienced pain in addition to emotional arousing pictures. When neutral pictures were combined with painful heat sensation, we found positive connectivity in Borderline Personality Disorder between (para-)limbic brain areas and parts of the basal ganglia (lentiform nucleus, putamen), as well areas involved in self-referential processing (precuneus and posterior cingulate).We found further evidence for alterations in the emotion regulation process in Borderline Personality Disorder, in the way that pain improves the inhibition of limbic activity by prefrontal areas. This study provides new insights in pain processing in BPD, including enhanced coupling of limbic structures and basal ganglia.
authors.affiliation: Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany. inga.niedtfeld@zi-mannheim.de
authors.forename: Inga
authors.initials: I
authors.lastname: Niedtfeld
authors.forename: Peter
authors.initials: P
authors.lastname: Kirsch
authors.forename: Lars
authors.initials: L
authors.lastname: Schulze
authors.forename: Sabine C
authors.initials: SC
authors.lastname: Herpertz
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000503:physiopathology*; D001479:Basal Ganglia / Q000503:physiopathology*; D001883:Borderline Personality Disorder / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D058748:Pain Perception / Q000502:physiology*; D010812:Physical Stimulation; D011594:Psychometrics