Impulse control under emotion processing: an fMRI investigation in borderline personality disorder compared to non-patients and cluster-C personality disorder patients

Linda Van Zutphen,Nicolette Siep,Gitta A Jacob,Arnoud Arntz,Gregor Domes,Oliver Tüscher,Rainer Goebel,Andreas Sprenger,Bastian Willenborg

doi:10.1007/s11682-019-00161-0

Abstract

Impulsivity is a characteristic syndromal and neurobehavioral feature of borderline personality disorder (BPD). Research suggests an important interaction between high negative emotions and low behavioral inhibition in BPD. However, knowledge about the generalizability across stimulus categories and diagnosis specificity is limited. We investigated neural correlates of hypothesized impaired response inhibition of BPD patients to negative, positive and erotic stimuli, by comparing them to non-patients and cluster-C personality disorder patients. During fMRI scanning, 53 BPD patients, 34 non-patients and 20 cluster-C personality disorder patients completed an affective go/no-go task, including social pictures. BPD patients showed more omission errors than non-patients, independent of the stimulus category. Furthermore, BPD patients showed higher activity in the inferior parietal lobule and frontal eye fields when inhibiting negative versus neutral stimuli. Activity of the inferior parietal lobule correlated positively with the BPD checklist subscale impulsivity. When inhibiting emotional stimuli, BPD patients showed an altered brain activity in the inferior parietal lobe and frontal eye fields, whereas previously shown dysfunctional prefrontal activity was not replicated. BPD patients showed a general responsivity across stimulus categories in the frontal eye fields, whereas effects in the inferior parietal lobe were specific for negative stimuli. Results of diagnosis specificity support a dimensional rather than a categorical differentiation between BPD and cluster-C patients during inhibition of social emotional stimuli. Supported by behavioral results, BPD patients showed no deficiencies in emotionally modulated response inhibition per se but the present findings rather hint at attentional difficulties for emotional information.

Highlights

One of the hallmarks of borderline personality disorder (BPD) is impulsivity; commonly associated with self-injury, anger outbursts, substance abuse, unprotected sex, excessive spending, reckless driving, and uncontrolled eating (American Psychiatric Association 2013; Sebastian et al 2013a)
Some studies did not report differences between BPD and non-patients (NPC) (Vollm et al 2004; van Eijk et al 2015; Soloff et al 2015), while others showed that BPD patients make significantly more commission errors, supporting that they are worse in response inhibition (Leyton et al 2001; Rentrop et al 2008; Mortensen et al 2010)
The number of omissions showed a main effect of group (F2,68.24 = 4.73, p = 0.012), in which BPD patients committed more omissions than Non-patient controls (NPC) (B = 0.138, standard errors (SE) = 0.049, p = 0.014) and clinical control group (CCP) (B = 0.124, SE = 0.053, p = 0.039). (Neural correlates of group differences regarding response inhibition are reported in the Online Resource.) we tested whether the number of commissions and omissions were related to the length of the session

Summary

Introduction

One of the hallmarks of borderline personality disorder (BPD) is impulsivity; commonly associated with self-injury, anger outbursts, substance abuse, unprotected sex, excessive spending, reckless driving, and uncontrolled eating (American Psychiatric Association 2013; Sebastian et al 2013a). Some studies did not report differences between BPD and non-patients (NPC) (Vollm et al 2004; van Eijk et al 2015; Soloff et al 2015), while others showed that BPD patients make significantly more commission errors, supporting that they are worse in response inhibition (Leyton et al 2001; Rentrop et al 2008; Mortensen et al 2010). An fMRI study in BPD patients compared to NPC showed a negative correlation between the number of commission errors and activation in the medial frontal gyrus, anterior cingulate cortex (ACC), temporal gyrus and striatum (Leyton et al 2001). Two other fMRI studies did not show any differences in brain activity between BPD and NPC (Mortensen et al 2010; van Eijk et al 2015)

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