Neural basis of shame and guilt experience in women with borderline personality disorder

Martin Göttlich,Marie Luise Bußmann,Anna Lisa Westermair,Ulrike M Krämer,Frederike Beyer,Ulrich Schweiger

doi:10.1007/s00406-020-01132-z

Abstract

Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.

Highlights

Borderline personality disorder (BPD) is defined by a pervasive pattern of instability in interpersonal relationships, selfimage, and affect, as well as markedly impulsive behavior [1]
Motivated by previous experimental evidence of a reduced decline in shame experience over time in BPD patients [22] and theoretical considerations of delayed habituation effects in BPD [34], we explored the temporal evolution of amygdala reactivity during repeated exposure to shame and guilt scenarios
We did not observe group differences specific to shame as compared to guilt, we found that women with BPD show generally enhanced amygdala reactivity when experiencing self-conscious emotions

Summary

Introduction

Borderline personality disorder (BPD) is defined by a pervasive pattern of instability in interpersonal relationships, selfimage, and affect, as well as markedly impulsive behavior [1]. It is associated with a high rate of comorbidity (above 80%), severe psychosocial impairment, intensive use of the health care system, and a high risk of suicide (5–10%) [2, 3]. The various conceptualizations of this complex disorder all include emotion dysregulation, interpersonal sensitivity, and difficulties with social cognition [5] As they touch on all these deficits, BPD patients show pronounced levels of the self-conscious emotions shame and guilt [6, 7]. Both are negative affective states following a shortcoming or transgression in an

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