Abstract
Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control, and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive vs. reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, patients with BPD exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial, and dorsolateral prefrontal regions, whereas patients with ADHD displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders.
Highlights
Taken together, while patients with BPD did not differ behaviorally from healthy controls, stimulus interference in BPD might be associated with hypoactivation in the ACC, especially in the dorsal, cognitive portion of the ACC (Bush et al, 2000)
DLPFC hypofunction was linked to stimulus interference only during event-related fMRI and might rather be involved in reactive stimulus interference
During emotionally modulated stimulus interference, patients with BPD displayed hypoactivation in neural networks typically associated with emotion regulation such as ACC and DLPFC, which have been shown to be less activated in patients with BPD during negative emotionality (Ruocco et al, 2013)
Summary
Reviewed by: Giuliana Lucci, IRCCS Fondazione Santa Lucia, Italy Anthony Charles Ruocco, University of Toronto, Canada Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Behavioral and neural dissociations are seen for proactive vs reactive inhibitory motor control.The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. We will focus on frontal dysfunctions in BPD and adult ADHD and their relation to different components of impulse control. The assessment of underlying neural dysfunctions is further complicated by multifaceted nature of impulse control (Dalley et al, 2011; Sebastian et al, 2013b; Stahl et al, 2014) that will be addressed
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