Increased Prefrontal Cortical Thickness Is Associated with Enhanced Abilities to Regulate Emotions in PTSD-Free Women with Borderline Personality Disorder

Hannah Bruehl,Sandra Preißler,Hauke R Heekeren,Stefan Roepke,Isabel Dziobek,Isabella Heuser,Antonio Verdejo García

doi:10.1371/journal.pone.0065584

Abstract

Previous studies suggest that amygdala, insula and prefrontal cortex (PFC) disintegrity play a crucial role in the failure to adequately regulate emotions in Borderline Personality Disorder (BPD). However, prior results are confounded by the high rate of comorbidity with Posttraumatic Stress Disorder (PTSD), which itself has been associated with changes in frontolimbic circuitry. We thus scrutinized the link between PFC, amygdala, insula, and the ability to regulate emotions, contrasting 17 women with BPD without comorbid PTSD to 27 non-clinical control women and in addition to those with BPD and PTSD (n = 14). BPD women without PTSD, but not those with comorbid PTSD, had increased cortical thickness in the dorsolateral PFC (DLPFC) in comparison to control women. Furthermore, cortical thickness in the DLPFC of BPD women without PTSD positively correlated with emotion regulation scores and furthermore was positively associated with amygdala volume, as well as cortical thickness of the insula. Our findings highlight the importance of disentangling the impact of BPD and PTSD on the brain and suggest possible compensatory mechanisms for the impaired emotion regulation in BPD women without PTSD.

Highlights

Borderline Personality Disorder (BPD) is a severe psychiatric disorder, characterized by abnormalities in interpersonal, behavioral and emotional functioning
After correcting for multiple comparisons using Monte Carlos simulation with a cluster-wise threshold of p,0.05, we found that selectively in a cluster located within the right RMFC, the ability to regulate emotions positively correlated with cortical thickness in BPD without Posttraumatic Stress Disorder (PTSD), but not in NC, showing that cortical thickness in this particular region was associated with emotion regulation abilities in BPD patients without PTSD (NC: r = 0.095, BPD without PTSD : r = 0.765, Fisher’s z = 22.69, p = 0.007, see figure 1, panel 1D for the cluster and figure 1 for a visualization of the correlation)
3.3 Brain-Brain Relationships Because the amygdala has been implicated in emotional dysregulation in BPD [27] and a functional prefrontal-amygdala disconnection has been described in BPD [15], we further explored the relationship between regional cortical thickening in the cluster that had been associated with emotion regulation in BPD without PTSD and amygdala volume in the group of BPD without PTSD [see [46] for a similar approach]

Summary

Introduction

Borderline Personality Disorder (BPD) is a severe psychiatric disorder, characterized by abnormalities in interpersonal, behavioral and emotional functioning. The current view regarding the neural correlates of emotion regulation holds that it involves a network of regions encompassing the hippocampus, amygdala and prefrontal cortex (PFC) [2,3,4,5,6,7]. In accordance with both this suggested network and the view of BPD as a disorder of emotion regulation, most neuroimaging studies with BPD patients have yielded structural and functional abnormalities in the hippocampus, amygdala and PFC [8], and in addition, in the insula [9]. This might be due to the heterogeneity of the BPD patient groups themselves

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