title: Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour.
abstract: BACKGROUND
  Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress.
  
  
  OBJECTIVE
  Investigation of neurobiological mechanisms of NSSI in borderline personality disorder.
  
  
  METHODS
  In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed.
  
  
  RESULTS
  We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group.
  
  
  CONCLUSIONS
  Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Reitz
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Kluetsch
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Niedtfeld
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Knorz
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Lis
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Paret
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kirsch
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer-Lindenberg
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Baumgärtner
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
authors.affiliation: Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany christian.schmahl@zi-mannheim.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
mesh_terms: D000328:Adult; D000679:Amygdala / Q000502:physiology; D000704:Analysis of Variance; D001883:Borderline Personality Disorder / Q000503:physiopathology / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D005542:Forearm / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D017397:Prefrontal Cortex / Q000502:physiology; D016728:Self-Injurious Behavior / Q000503:physiopathology / Q000523:psychology*; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology