title: Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study.
abstract: Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients' inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
authors.affiliation: Institute of Psychology, University of Innsbruck Innsbruck, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Buchheim
authors.affiliation: Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Erk
authors.affiliation: Department of Psychology, Mills College Oakland, CA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: George
authors.affiliation: International Psychoanalytic University Berlin Berlin, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Kächele
authors.affiliation: Psychosomatic Hospital, Höhenried Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Martius
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany.
authors.forename: Dan
authors.initials: D
authors.lastname: Pokorny
authors.affiliation: Department of Psychiatry III, University of Ulm Ulm, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Spitzer
authors.affiliation: Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Walter
keywords: amygdala; attachment system; borderline personality disorder; emotional regulation; functional MRI