The Neural Correlates of Anomalous Habituation to Negative Emotional Pictures in Borderline and Avoidant Personality Disorder Patients
The Neural Correlates of Anomalous Habituation to Negative Emotional Pictures in Borderline and Avoidant Personality Disorder Patients
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DOI：
10.1176/appi.ajp.2013.13070852
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发表时间：
2014-01-01
影响因子：
17.7
通讯作者：
Siever, Larry J.
中科院分区：
文献类型：
--
作者：
Koenigsberg, Harold W.;Denny, Bryan T.;Siever, Larry J.
目的：极端情绪反应是交界性人格障碍的一个明显特征，但这种情绪不稳定背后的神经行为机制却知之甚少。一个可能的因素是参与情绪习惯化机制的能力减弱。作者通过检测边缘患者、健康对照对象和回避型人格障碍患者的心理病理对照组中习惯化的行为和神经相关性来检验这一假设。方法：在fMRI扫描中，边缘患者、健康受试者和回避型人格障碍患者观看新奇和重复的图片，并在每次呈现时提供价格评级。比较两组间重复观看负性图片与首次观看负性图片时激活对比的统计参数图。结果：与健康受试者不同，边缘型和回避型人格障碍患者在观看重复图片和新奇图片时，背侧前扣带回皮质的活动均不增加。在交界性患者中，这种背侧前扣带回活动缺乏增加与更大的情感不稳定有关。此外，与健康受试者相比，边缘患者和回避型患者在脑岛-杏仁核功能连接性方面的增加较小，而且与健康受试者不同，他们在图像的情绪强度评级上没有表现出习惯性。结论：与健康受试者不同，边缘受试者在习惯化过程中的神经活动不同于健康受试者和回避受试者。未能有效地参与情绪习惯过程可能会导致临界性患者的情绪不稳定。
Objective: Extreme emotional reactivity is a defining feature of borderline personality disorder, yet the neural-behavioral mechanisms underlying this affective instability are poorly understood. One possible contributor is diminished ability to engage the mechanism of emotional habituation. The authors tested this hypothesis by examining behavioral and neural correlates of habituation in borderline patients, healthy comparison subjects, and a psychopathological comparison group of patients with avoidant personality disorder.Method: During fMRI scanning, borderline patients, healthy subjects, and avoidant personality disorder patients viewed novel and repeated pictures, providing valence ratings at each presentation. Statistical parametric maps of the contrasts of activation during repeated versus novel negative picture viewing were compared between groups. Psychophysiological interaction analysis was employed to examine functional connectivity differences between groups.Results: Unlike healthy subjects, neither borderline nor avoidant personality disorder patients exhibited increased activity in the dorsal anterior cingulate cortex when viewing repeated Versus novel pictures. This lack of an increase in dorsal anterior cingulate activity was associated with greater affective instability in borderline patients. In addition, borderline and avoidant patients exhibited smaller increases in insula-amygdala functional connectivity than healthy subjects and, unlike healthy subjects, did not show habituation in ratings of the emotional intensity of the images. Borderline patients differed from avoidant patients in insula-ventral anterior cingulate functional connectivity during habituation.Conclusions: Unlike healthy subjects, borderline patients fail to habituate to negative pictures, and they differ from both healthy subjects and avoidant patients in neural activity during habituation. A failure to effectively engage emotional habituation processes may contribute to affective instability in borderline patients.