Reduced amygdala reactivity and impaired working memory during dissociation in borderline personality disorder

Publication Type:

Journal Article

Source:

European Archives of Psychiatry and Clinical Neuroscience (2017)

DOI:

10.1007/s00406-017-0806-x

Keywords:

Borderline personality disorder; Working memory; Memory; Neuroimaging · Stress

Abstract:

Affective hyper-reactivity and impaired cognitive
control of emotional material are core features of borderline
personality disorder (BPD). A high percentage of individuals
with BPD experience stress-related dissociation,
including emotional numbing and memory disruptions.
So far little is known about how dissociation influences
the neural processing of emotional material in the context
of a working memory task in BPD. We aimed to investigate
whole-brain activity and amygdala functional connectivity
(FC) during an Emotional Working Memory Task
(EWMT) after dissociation induction in un-medicated BPD
patients compared to healthy controls (HC). Using scriptdriven
imagery, dissociation was induced in 17 patients
(‘BPD_D’), while 12 patients (‘BPD_N’) and 18 HC were
exposed to neutral scripts during fMRI. Afterwards, participants
performed the EWMT with neutral vs. negative
IAPS pictures vs. no distractors. Main outcome measureswere behavioral performance (reaction times, errors) and
whole-brain activity during the EWMT. Psychophysiological
interaction analysis was used to examine amygdala connectivity
during emotional distraction. BPD patients after
dissociation induction showed overall WM impairments,
a deactivation in bilateral amygdala, and lower activity
in left cuneus, lingual gyrus, and posterior cingulate than
BPD_N, along with stronger left inferior frontal gyrus
activity than HC. Furthermore, reduced amygdala FC with
fusiform gyrus and stronger amygdala FC with right middle/
superior temporal gyrus and left inferior parietal lobule
was observed in BPD_D. Findings suggest that dissociation
affects reactivity to emotionally salient material and WM.
Altered activity in areas associated with emotion processing,
memory, and self-referential processes may contribute
to dissociative states in BPD.