Borderline personality disorder classification based on brain network measures during emotion regulation

Henk Cremers,Lourens Waldorp,Sascha Duken,Arnoud Arntz,Linda van Zutphen,Gregor Domes,Andreas Sprenger

doi:10.1007/s00406-020-01201-3

Abstract

Borderline Personality Disorder (BPD) is characterized by an increased emotional sensitivity and dysfunctional capacity to regulate emotions. While amygdala and prefrontal cortex interactions are regarded as the critical neural mechanisms underlying these problems, the empirical evidence hereof is inconsistent. In the current study, we aimed to systematically test different properties of brain connectivity and evaluate the predictive power to detect borderline personality disorder. Patients with borderline personality disorder (n = 51), cluster C personality disorder (n = 26) and non-patient controls (n = 44), performed an fMRI emotion regulation task. Brain network analyses focused on two properties of task-related connectivity: phasic refers to task-event dependent changes in connectivity, while tonic was defined as task-stable background connectivity. Three different network measures were estimated (strength, local efficiency, and participation coefficient) and entered as separate models in a nested cross-validated linear support vector machine classification analysis. Borderline personality disorder vs. non-patient controls classification showed a balanced accuracy of 55%, which was not significant under a permutation null-model, p = 0.23. Exploratory analyses did indicate that the tonic strength model was the highest performing model (balanced accuracy 62%), and the amygdala was one of the most important features. Despite being one of the largest data-sets in the field of BPD fMRI research, the sample size may have been limited for this type of classification analysis. The results and analytic procedures do provide starting points for future research, focusing on network measures of tonic connectivity, and potentially focusing on subgroups of BPD.

Highlights

Borderline Personality Disorder (BPD) is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, affect, and impulse control [1]
We further examined which brain regions were most important in the classification, the critical functional subnetwork modules related to psychiatric disorders: the emotion, motivation, cognitive control, and default mode modules of the brain [19]
It is of note that the left amygdala was one of the 5 highest-ranking features and showed an increased strength in the BPD group than the Non-patient controls (NPC) group

Summary

Introduction

Borderline Personality Disorder (BPD) is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, affect, and impulse control [1]. An increased sensitivity to emotions and a dysfunctional capacity to regulate emotions is considered to be one of the hallmark features of BPD [2]. Research generally focuses on increased amygdala and reduced prefrontal activity as the neural mechanism underlying these processes [3]. While some research findings fit this pattern, the inconsistency of results on this topic is perhaps even more notable [3]. There is a large discrepancy between studies on the involvement of lateral and medial prefrontal regions in BPD during emotion regulation [3]

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Discussion

Conclusion