Borderline Personality Disorder With Cocaine Dependence: Impulsivity, Emotional Dysregulation and Amygdala Functional Connectivity

Thania Balducci,Eduardo A Garza-Villarreal,Diego Angeles-Valdez,Isabel Espinoza-Luna,Jorge J González-Olvera

doi:10.3389/fpsyt.2018.00328

Abstract

Background: Borderline personality disorder is present in 19% of cocaine dependence cases; however, this dual pathology is poorly understood. We wished to characterize the dual pathology and find its functional connectivity correlates to better understand it.Methods: We recruited 69 participants divided into 4 groups: dual pathology (n = 20), cocaine dependence without borderline personality disorder (n = 19), borderline personality without cocaine dependence (n = 10) and healthy controls (n = 20). We used self-reported instruments to measure impulsivity and emotional dysregulation. We acquired resting state fMRI and performed seed-based analyses of the functional connectivity of bilateral amygdala.Results: Borderline personality disorder and cocaine dependence as factors had opposing effects in impulsivity and emotional dysregulation, as well as on functional connectivity between left amygdala and medial prefrontal cortex. On the other hand, in the functional connectivity between right amygdala and left insula, the effect of having both disorders was instead additive, reducing functional connectivity strength. The significant functional connectivity clusters were correlated with impulsivity and emotional dysregulation.Conclusions: In this study, we found that clinical scores of dual pathology patients were closer to those of borderline personality disorder without cocaine dependence than to those of cocaine dependence without borderline personality disorder, while amygdala-medial prefrontal cortex functional connectivity patterns in dual pathology patients were closer to healthy controls than expected.

Highlights

Psychiatric comorbidities are present in 85–95% of cases of substance use disorders [1], and this entity is defined as dual pathology [2]
We found that the dual pathology group (BPD+CD+) resembled the only borderline personality disorder group (BPD+CD−) in impulsivity and emotional dysregulation scores more than the only cocaine dependence group (BPD−CD+)
Our clinical and functional connectivity results are related to each other, and we suggest that cocaine dependence in this case may be an empirical method of self-regulating the amygdala—medial prefrontal cortex (mPFC) connectivity in BPD that, at the same time, may negatively affect other circuits such as amygdala—insula connectivity, and enhancing attentional bias to cocaine cues in dual pathology patients

Summary

Introduction

Psychiatric comorbidities are present in 85–95% of cases of substance use disorders [1], and this entity is defined as dual pathology [2]. Cocaine is a stimulant amine and it is the second most used illicit drug in Mexico, Central America, Western Europe and South Africa It has been estimated that 5–6% of those who consume cocaine develop dependence within the first year of use [7]. This dependence is characterized by substance misuse with tolerance, abstinence syndrome, difficulties controlling consumption and clinical impairment or distress [4]. Borderline personality disorder is present in 19% of cocaine dependence cases; this dual pathology is poorly understood. We acquired resting state fMRI and performed seed-based analyses of the functional connectivity of bilateral amygdala

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