Media Recognition

Does impaired prefrontal inhibition lead to the diminished emotional self-regulation characteristic of this disorder? Borderline personality disorder, characterized by preponderantly negative affective states, high reactivity, and diminished ability to regulate one’s emotions, has challenged researchers for decades. Previous neuropsychological studies have suggested that impulsivity and negative affectivity may be related to orbitofrontal dysfunction. Now, neurobiological and psychoanalytic investigators join in an elegant examination of the hypothesis that during negative emotional states, patients with borderline personality disorder would show deficient inhibitory function of the prefrontal cortex. Sixteen patients with borderline personality disorder and 14 healthy controls were subjected to a test requiring motor inhibition during negative emotion. No patients had current substance dependence, but many had past or current psychiatric comorbidities.

Subjects underwent functional MRI scanning while silently reading a series of negative, positive, or neutral words; they were asked to press a button while reading each word but to inhibit pressing it when the word was italicized. When confronted with negative stimuli and asked to exert behavioral inhibition, patients showed less activation of the subgenual anterior cingulate cortex and the posterior medial orbitofrontal cortex than controls did, and more activity in the left and right extended amygdala and ventral striatum. The brain-activation pattern differences persisted in all analyses that adjusted for psychiatric comorbidities and psychotropic drug use (by 11 patients) — except in an analysis for avoidant personality disorder.