Borderline Emotions

borderline emotionsOriginally, the label “borderline personality disorder” was applied to patients who were thought to somewhere  between patients with neurotic and psychotic disorders in terms of psychopathology.

Increasingly, though, this area of research has focused on the heightened emotional reactivity observed in patients carrying this diagnosis, as well as the high rates with which they also meet diagnostic criteria for posttraumatic stress disorder and mood disorders..

An article in  Biological Psychiatry by Dr. Anthony Ruocco at the University of Toronto and his colleagues suggests that there may be a biological basis for the strong dysregulation of emotions seen in people with borderline personality.

They reported increased activity in brain circuits involved in the experience of negative emotions and reduced activity in brain circuits that normally suppress negative emotion once it is generated.

Compared with healthy control subjects, BPD patients demonstrated greater activation within the insula and posterior cingulate cortex. The insular cortex is involved in the experience of visceral emotion. It has an important role in the experience of pain,  anger, fear, disgust, and sadness.

Conversely, they showed less activation than control subjects in a network of regions that extended from the amygdala to the subgenual anterior cingulate and dorsolateral prefrontal cortex.

The authors performed  a meta-analysis of previously published neuroimaging studies. They reviewed data from 11 studies and pooled the results so that they had data on 154 patients with borderline personality disorder and 150 healthy control subjects.

Ruocco said,

“We found compelling evidence pointing to two interconnected neural systems which may subserve symptoms of emotion dysregulation in this disorder: the first, centered on specific limbic structures, which may reflect a heightened subjective perception of the intensity of negative emotions, and the second, comprised primarily of frontal brain regions, which may be inadequately recruited to appropriately regulate emotions.”

The reduced activity in the subgenual anterior cingulate, may be unique to borderline personality disorder and could serve to differentiate it from other related conditions, such as recurrent major depression.

Dr. John Krystal, Editor of Biological Psychiatry said, 

“This new report adds to the impression that people with borderline personality disorder are ‘set-up’ by their brains to have stormy emotional lives, although not necessarily unhappy or unproductive lives.”

The article is “Neural Correlates of Negative Emotionality in Borderline Personality Disorder: An Activation-Likelihood-Estimation Meta-Analysis” by Anthony C. Ruocco, Sathya Amirthavasagam, Lois W. Choi-Kain, and Shelley F. McMain (doi: 10.1016/j.biopsych.2012.07.014). The article appears in Biological Psychiatry, Volume 73, Issue 2 (January 15, 2013), published by Elsevier.