An fMRI Study of Emotional Dysregulation in Borderline Patients

描述（由申请人提供）：边缘型人格障碍（BPD）是一种普遍和持久的精神障碍，约占人口的2%和住院精神病患者的20%。它的特点是反复无常、冲动、自杀倾向和不稳定的人际关系，并且已被证明很难治疗。据报道，边缘患者的自杀率约为10%。BPD的一个核心潜在特征是极端的情绪不稳定，这已经被证明与自杀威胁、手势和行为、不适当的愤怒和身份障碍有关，这些对这些患者来说是非常危险和破坏性的。尽管情绪不稳定在BPD的病理中起着核心作用，但人们对其还没有很好的理解。本研究采用功能磁共振成像（fMRI）技术识别脑情绪处理系统的紊乱，这可能解释BPD患者的情绪控制障碍。当BPD患者有意识地试图控制他们对令人不安的图像的情绪反应时，当他们系统地重新接触这些图像时，它特别关注大脑区域的活动。识别与有意识情绪控制或习惯性反复暴露相关的大脑活动模式，可以开发新的药物治疗方法，开发新的更有针对性的认知/行为心理治疗策略，以及识别BPD的大脑活动标记物，这可能会指导未来的遗传研究。为了实现这些目标，我们将获得30名BPD患者的fMRI图像，以及30名非边缘型人格障碍患者（即回避型人格障碍患者）和30名健康志愿者的对照组(1)他们努力控制自己对情绪诱发图片的情绪反应，以及2)他们反复暴露于相同图片时的fMRI图像。这项研究的发现可能有助于BPD的新治疗策略的发展，这种疾病不仅对边缘患者及其亲人所经历的痛苦有巨大的情感成本，而且由于BPD患者的功能水平通常远低于具有同等智力的个体，而且他们消耗了不成比例的精神健康资源，因此社会成本也很高。因此，对这种疾病更有效的治疗将大大有利于公众健康。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) is a prevalent and enduring psychiatric disorder found in approximately 2% of the population and 20% of hospitalized psychiatric patients. It is characterized by great volatility, impulsivity, sucidality, and unstable interpersonal relationships, and has proved difficult to treat. Suicide rates of approximately 10% have been reported in borderline patients. A core underlying feature of BPD is extreme emotional instability and this has been shown to be associated with the suicide threats, gestures and acts, inappropriate anger, and identity disturbances which prove so dangerous and disruptive for these patients. Despite its central role in the pathology of BPD, emotional instability is not well understood. This study employs functional magnetic resonance imaging (fMRI) to identify the disturbances in brain emotion processing systems that may explain the impairments in emtional control in BPD. It looks in particular at regional brain activity when BPD patients are consciously trying to control their emotional reactions to disturbing images and as they are systematically re-exposed to these images. Identification of the patterns of brain activity that are associated with efforts at conscious emotional control or with habituation to repeated exposure can lead to the development of new pharmacological approaches to treatment, to the development of new and more appropriately targeted cognitive/behavoral psychotherapeutic strategies, and the identification of brain activity markers for BPD that may guide future genetic studies. To achieve these objectives, we will obtain fMRI images of 30 BPD patients, and of comparison groups of 30 non-borderline personality disorder patients (i.e. patients with Avoidant Personality Disorder) and 30 healthy volunteers 1) as they make efforts to control their emotional reactions to emotion- inducing pictures and 2) as they are exposed to repeated presentions of the same pictures. The findings of this study may help in the development of new treatment strategies for BPD, a disorder which has not only great emotional costs in terms of the suffering experienced by borderline patients and their loved ones, but also social costs since BPD patients typically function at a level substantially below that of individuals with comparable intellect and they consume a disproportionate share of metal health resources. A more effective treatment for this disorder would thus greatly benefit public health.