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. 2023;14(1):2163768.
doi: 10.1080/20008066.2022.2163768.

Altered cortical thickness and emotional dysregulation in adolescents with borderline personality disorder

Qian Xiao  1   2 , Yan Fu  2   3 , Xiaoping Yi  3   4   5   6   7 , Jun Ding  8 , Zaide Han  3 , Zhejia Zhang  9 , Zeming Tan  10 , Jing Wang  11 , Zijun Wu  3 , Jingying Pi  3 , Bihong T Chen  12
Affiliations

Altered cortical thickness and emotional dysregulation in adolescents with borderline personality disorder

Qian Xiao et al. Eur J Psychotraumatol. 2023.

Abstract
in English, Spanish, Chinese

Background: Emotional dysregulation is a core feature of borderline personality disorder (BPD). Previous studies have reported that abnormal grey matter volume is associated with the limbic-cortical circuit and default mode network (DMN) in patients with BPD. However, alterations of cortical thickness in adolescents with BPD have not been well evaluated.Objective: The aim of this study was to assess cortical thickness and its association with emotional dysregulation in adolescents with BPD.Method: This prospective study enrolled 52 adolescents with BPD and 39 age- and sex-matched healthy controls (HCs). Assessments included brain magnetic resonance imaging (MRI) acquisition with structural and resting-state functional MRI data, and clinical assessment for emotional dysregulation using the Difficulties in Emotion Regulation Scale (DERS). Cortical thickness and seed-based functional connectivity were analysed with FreeSurfer 7.2 software. Correlation analysis between cortical thickness and the scores from emotional assessment was performed with Spearman analysis.Results: Compared to HCs, there was altered cortical thickness in the DMN and limbic-cortical circuit in adolescents with BPD (Monte Carlo correction, all p < .05). These regions with altered cortical thickness were significantly associated with emotional dysregulation (all p < .05). There were also alterations of functional connectivity, i.e. with increased connectivity of the right prefrontal cortex with bilateral occipital lobes, or with the limbic system, and with decreased connectivity among the DMN regions (voxel p < .001, cluster p < .05, family-wise error corrected).Conclusions: Our results suggest that the altered cortical thickness and altered functional connectivity in the limbic-cortical circuit and DMN may be involved in emotional dysregulation in adolescents with BPD.

Antecedentes: La desregulación emocional es una característica central del trastorno de personalidad limítrofe (TLP). Estudios previos han reportado que el volumen anormal de sustancia gris esta asociado con el circuito límbico-cortical y la red de modo predeterminado (DMN) en pacientes con TLP. Sin embargo, las alteraciones del grosor cortical en adolescentes con TLP no han sido bien evaluadas.

Objetivo: El objetivo de este estudio fue evaluar el grosor cortical y su asociación con la desregulación emocional en adolescentes con TLP.

Método: Este estudio prospectivo recluto 52 adolescentes con TLP y 39 controles sanos (CSs) emparejados por edad y sexo. La evaluación del estudio incluyo la realización de RNM cerebral con datos de RNM estructural y funcional en estado de reposo (RNMf) y evaluaciones clínicas para la desregulación emocional utilizando la Escala de Dificultades en la Regulación Emocional (DERS). El grosor cortical y la conectividad funcional basadas en semillas se analizaron con el software FreeSurfer 7.2. El análisis correlativo entre el grosor cortical y los puntajes de la evaluación emocional se realizó con el análisis de Spearman.

Resultados: En comparación con los CSs, hubo un grosor cortical alterado en la DMN y el circuito límbico-cortical en los adolescentes con TLP (corrección de Monte Carlo, todos p < .05). Estas regiones con el grosor cortical alterado se asociaron significativamente con desregulación emocional (todos p < .05). Tambien hubo alteraciones en la conectividad funcional, es decir, con conectividad aumentada de la corteza prefrontal derecha con los lóbulos occipitales bilaterales, o con el sistema límbico y con conectividad disminuida entre las regiones DMN (p de voxel < .001, cluster p < .05, FWE corregido).

Conclusiones: Nuestro resultados sugieren que el grosor cortical alterado y la conectividad funcional alterada en el sistema límbico-cortical y DMN pueden estar involucrados en la desregulación emocional en adolescentes con TLP.

目的：情绪失调是边缘性人格障碍 (BPD) 的核心特征。 先前的研究报道了 BPD 患者的异常灰质体积与边缘-皮层回路和默认模式网络 (DMN) 相关。 然而，BPD 青少年的皮层厚度变化尚未得到很好的评估。 本研究旨在评估 BPD 青少年皮层厚度及其与情绪失调的关系。

方法：本前瞻性研究招募了 52 名 BPD 青少年和 39 名年龄和性别匹配的健康对照者 (HC)。 研究评估包括使用结构和静息状态功能 MRI (fMRI) 数据的脑部 MRI 采集，以及使用情绪调节困难量表 (DERS) 对情绪失调进行临床评估。 使用 FreeSurfer 7.2 软件分析皮层厚度和基于种子的功能连接。 使用斯皮尔曼分析进行皮层厚度与情绪评估分数之间的相关性分析。

结果：与HC相比，BPD青少年的DMN和边缘-皮层回路的皮层厚度发生改变（蒙特卡罗校正，均p < .05＝。 这些皮层厚度改变的区域与情绪失调显著相关（全部p < .05）。 功能连通性也发生了变化，即右前额叶皮层与双侧枕叶或边缘系统的连通性增加，DMN 区域之间的连通性降低（体素 p < .001，簇 p < .05，FWE 校正）。

结论：我们的结果表明，皮层厚度的改变以及边缘-皮层回路和 DMN 中功能连接的改变可能与 BPD 青少年的情绪失调有关。

Keywords: MRI; RNM; adolescent borderline personality disorder; adolescentes con trastorno de personalidad limítrofe; circuito límbico-cortical; conectividad funcional; cortical thickness; default mode network; desregulación emocional; emotional dysregulation; functional connectivity; grosor cortical; limbic–cortical circuit; red de modo predeterminado; 功能连接; 情绪失调; 皮层厚度; 边缘-皮层回路; 青少年边缘性人格障碍; 默认模式网络。.

Plain language summary

Emotional dysregulation is a core feature of borderline personality disorder, but the underlying neural correlates are not well known.There was altered cortical thickness and functional connectivity in the DMN and limbic–cortical circuit in adolescents with borderline personality disorder.Altered cortical thickness was associated with emotional dysregulation in adolescents with borderline personality disorder.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Flowchart illustrating the enrolment process for the adolescents with borderline personality disorder (BPD) and healthy controls (HCs). DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; IQ, intelligence quotient; MRI, magnetic resonance imaging.
Figure 2.
Figure 2.
Brain regions with increased (highlighted in orange) and decreased cortical thickness (highlighted in blue) in the limbic–cortical circuit and default mode network (DMN) of adolescents with borderline personality disorder (BPD) compared with healthy controls (HCs). (A) Cortical thickness alterations in bilateral hemispheres. (B) Cortical thickness alterations in the left hemisphere. (C) Cortical thickness alterations in the medial surface of the right hemisphere. (D) Cortical thickness alterations in the lateral surface of the right hemisphere.
Figure 3.
Figure 3.
Correlation analysis between cortical thickness and the scores on the Difficulties in Emotion Regulation Scale (DERS-A for lack of emotional awareness) in adolescents with borderline personality disorder (BPD). (A) Negative correlation between the cortical thickness of the right parahippocampal gyrus and the DERS-A score. (B) Negative correlation between the cortical thickness of the right precuneus gyrus and the DERS-A score.
Figure 4.
Figure 4.
Significant alterations of functional connectivity (FC) in adolescents with borderline personality disorder (BPD) compared with healthy controls (HCs), using the right lateral occipital and right inferior temporal regions as seed points. (A) Increased FC of the right lateral occipital gyrus with the right inferior orbitofrontal gyrus, right inferior frontal gyrus, and right anterior cingulate gyrus. (B) Increased FC of the right inferior temporal gyrus with the right inferior orbitofrontal gyrus and left inferior temporal gyrus. Voxel p < .001, cluster p < .05, family-wise error (FWE) corrected. The colour bar indicates the T score.
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