Emotional modulation of motor response inhibition in women with borderline personality disorder: an fMRI study

Abstract

Background: Both emotion regulation and impulsivity are core aspects of borderline personality disorder (BPD) pathology. Although both problems may be combined specifically in BPD, few studies to date have investigated the emotional modulation of impulsivity in BPD.

Methods: Women with BPD and matched healthy controls performed go/no-go tasks after induction of anger, joy or a neutral mood by vocally presented short stories. Dependent variables were the behavioural results and functional magnetic resonance imaging data.

Results: We included 17 women with BPD and 18 controls in our study. No behavioural group differences were found. However, patients with BPD showed stronger activation of the left amygdala and weaker activation of the subgenual anterior cingulate during anger induction than controls. Inhibition in the go/no-go task after anger induction increased activity in the left inferior frontal cortex in controls, but not in women with BPD, who, in turn, showed increased activation in the subthalamic nucleus.

Limitations: Findings cannot be generalized to men, and 4 patients were taking antidepressant medication (selective serotonin reuptake inhibitors). In addition, no patient control group was investigated, thus we do not know whether findings are specific to BPD compared with other disorders.

Conclusion: Our findings are consistent with the view that a disturbed amygdala-prefrontal network in patients with BPD is compensated by a subcortical loop involving the subthalamic nucleus, leading to normal behavioural inhibition in these patients.

Fig. 1

Ratings of joy and anger (mean and standard error of the mean) in 17 patients with borderline personality disorder (BPD) and 18 healthy controls before (t1) and after (t2) different emotional conditions and after the go/no-go task (t3)

Fig. 2

Group differences during anger induction. (A) Stronger activation of the right amygdala (p_FWE = 0.033; the left amygdala showed a trend: SVC p_FWE = 0.08) in 17 patients with borderline personality disorder (BPD) compared to 18 healthy controls when participants listened to an anger-inducing story compared to a neutral story. Colour bars indicate t values. (B) Stronger activation of the right amygdala (SVC p_FWE = 0.035; the left amygdala showed a trend: Montreal Neurological Institute space x, y, z = −24, −6, −12, SVC p_FWE = 0.06) in 17 patients with BPD in correlation to symptom severity (Borderline Personality Disorder Severity Index33) when participants listened to an anger-inducing story compared to a neutral story. (C) Stronger activation of the subgenual anterior cingulate (SVC p_FWE = 0.044) in 18 healthy controls compared to 17 patients with BPD when participants listented to an anger-inducing story compared to a neutral story. FWE = family-wise error; SVC = small volume correction.

Fig. 3

Group differences during the go/no-go task after anger induction. (A) Reducted left inferior frontal cortex activation (SVC p_FWE = 0.026) in 17 patients with borderline personality disorder (BPD) compared to 18 healthy controls during go/no-go blocks after an anger condition compared to a neutral condition. Colour bar indicates t values. (B) Bar plot (mean and standard error of the mean) of the left inferior frontal cortex activity in the no-go tasks for the anger and neutral conditions in 17 patients with BPD compared to 18 healthy controls. FWE = family-wise error; SVC = small volume correction. The x, y, z coordinates refer to Montreal Neuroligical Institute space.

Fig. 4

Relative hyperactivation of the nucleus subthalamicus (SVC p_FWE = 0.05) in the interaction contrast (no-go – go × anger – neutral) in the go/no-go task after anger induction in 17 patients with borderline personality disorder compared to 18 healthy controls during go/no-go blocks after an anger condition compared to a neutral condition. Colour bar indicates t values. FWE = family-wise error; SVC = small volume correction.