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Cited by 91Functional Brain Connectivity StudiesPersonality Disorders and PsychopathologyPsychosomatic Disorders and Their Treatments

Alterations in Default Mode Network Connectivity During Pain Processing in Borderline Personality Disorder

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Kluetsch, Rosemarie C., Schmahl, Christian, Niedtfeld, Inga, Densmore, Maria, Calhoun, Vince D., Daniels, Judith, Kraus, Anja, Ludaescher, Petra +2 more·2012·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2012.476PMC PMC4429518
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Abstract

CONTEXT: Recent neuroimaging studies have associated activity in the default mode network (DMN) with self-referential and pain processing, both of which are altered in borderline personality disorder (BPD). In patients with BPD, antinociception has been linked to altered activity in brain regions involved in the cognitive and affective evaluation of pain. Findings in healthy subjects indicate that painful stimulation leads to blood oxygenation level-dependent signal decreases and changes in the functional architecture of the DMN. OBJECTIVES: To connect the previously separate research areas of DMN connectivity and altered pain perception in BPD and to explore DMN connectivity during pain processing in patients with BPD. DESIGN: Case-control study. SETTING: University hospital. PARTICIPANTS: Twenty-five women with BPD, including 23 (92%) with a history of self-harm, and 22 age-matched control subjects. INTERVENTIONS: Psychophysical assessment and functional magnetic resonance imaging during painful heat vs neutral temperature stimulation. MAIN OUTCOME MEASURE: Connectivity of DMN as assessed via independent component analysis and psychophysiological interaction analysis. RESULTS: Compared with control subjects, patients with BPD showed less integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN. Higher BPD symptom severity and trait dissociation were associated with an attenuated signal decrease of the DMN in response to painful stimulation. During pain vs neutral, patients with BPD exhibited less posterior cingulate cortex seed region connectivity with the left dorsolateral prefrontal cortex. CONCLUSIONS: Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics. These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive as well as a deficiency in the switching between baseline and task-related processing. This deficiency may be related to everyday difficulties of patients with BPD in regulating their emotions, focusing mindfully on 1 task at a time, and efficiently shifting their attention from one task to another.

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Written from the paper’s full text.

TL;DR

This case-control fMRI study examined default mode network (DMN) connectivity during painful heat versus neutral temperature in women with borderline personality disorder (BPD) and healthy controls. BPD patients showed altered DMN spatial integration and pain-related connectivity, including less posterior cingulate cortex–dorsolateral prefrontal cortex coupling during pain, with symptom severity and trait dissociation linked to attenuated DMN signal decrease.

Key findings

  • Compared with controls, BPD patients showed less integration of the left retrosplenial cortex into component 28 [−12, −39, 3; t(44)=4.16] and of the right inferior temporal gyrus [60, −9, −33; t(44)=3.79] and left superior frontal gyrus [−21, 30, 51; t(44)=3.40] into component 27; no significant group differences were found for component 13.
  • Among BPD patients, pain-related connectivity change of component 28 was positively correlated with Borderline Symptom List scores (r=0.63) and Dissociative Experience Scale scores (r=0.59), indicating worse symptom severity and higher trait dissociation were associated with less signal decrease of the “posterior DMN” during painful thermal stimulation.
  • During “pain” greater “neutral,” controls showed significantly stronger posterior cingulate cortex connectivity with the left dorsolateral prefrontal cortex than BPD patients [−24, 54, 18; t(43)=3.40; SVC-corrected].
  • Psychophysical results: mean individual temperatures were 45.86°C ± 1.31°C for patients versus 44.60°C ± 1.22°C for controls [t(45)=−3.40, p=.001], and fMRI pain intensity ratings were 47.3 ± 13.78 for patients versus 63.93 ± 19.0 for controls [t(45)=3.464, p=0.001].

Methods

  • Case-control study at a university hospital including 25 women with BPD, 92% with a history of self-injurious behavior, and 22 age-matched healthy women; diagnoses used SCID-I and IPDE, with FDS, DSS, BSL, and DSM-IV criteria measures.
  • Participants underwent psychophysical assessment and fMRI during painful heat individually adjusted to a subjective pain intensity rating of 40 on a 0–100 NRS versus neutral temperature (35°C), using a block design on a 1.5-T scanner with five 30-second pain blocks and 60-second neutral intervals.
  • Analyses used group spatial ICA (infomax in GIFT, 29 components, ICASSO with 20 repeats) and psychophysiological interaction analysis with PCC (0, −57, 30) and mPFC (0, 51, 0) seeds; second-level tests used SPM8/SPSS, p<0.005 uncorrected plus cluster-extent correction, with ROI small-volume correction for DLPFC, insula, and cuneus and pain intensity as a covariate.

Limitations

  • The authors state that because most patients had a history of self-injurious behavior, it cannot be determined whether findings relate to self-injury per se or BPD psychopathology in general; longitudinal studies comparing BPD patients with and without self-injury are needed.
  • The authors note that controls and patients differed significantly in average pain intensity ratings during fMRI versus pre-scan psychophysical assessment, and actual temperatures were higher for BPD patients, so group differences could represent stimulus intensity rather than basic connectivity differences, although they argue this is unlikely; they controlled only for subjective pain intensity.
  • The authors also state that comorbid psychiatric conditions such as depression, PTSD, and social anxiety may limit interpretation, that ICA and PPI carry investigator-specific biases, that PPI modeled only two seed regions, and that generalizability to other tasks is unknown; evident additional limitations include the small sample and inclusion of only women.

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Integrity signals

Registry

Crossref · 10.1001/archgenpsychiatry.2012.476

Cites

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Claims the paper makes

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  • Findingown data

    For 'neutral' greater 'pain', controls showed significantly stronger mPFC connectivity with the left putamen.

    “For “neutral” greater “pain”, controls showed significantly stronger mPFC connectivity with the left putamen (Figure 4).”
    Quote in the paperSubstantial claim
  • Findingown data

    Component 27 received its strongest contributions from the mPFC and surrounding frontal areas ('anterior DMN').

    “Component 27 received its strongest contributions from the mPFC and surrounding frontal areas (“anterior DMN”).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Component 28 included mainly the PCC/RSC/PrC, lateral parietal areas and superior/middle temporal gyri, but also smaller clusters within the mPFC, superior/middle frontal gyrus, insula and cerebellum ('posterior DMN').

    “Component 28 included mainly the PCC/RSC/PrC, lateral parietal areas and superior/middle temporal gyri, but also smaller clusters within the mPFC, superior/middle frontal gyrus, insula and cerebellum (“posterior DMN”).”
    Quote in the paperNot a substantial claim
  • Findingown data

    For 'pain' greater 'neutral', only the patient group revealed enhanced connectivity of the PCC mPFC with the right inferior parietal lobule.

    “For “pain” greater “neutral”, only the patient group revealed enhanced connectivity of the PCC mPFC with the right inferior parietal lobule.”
    Quote in the paperSubstantial claim
  • Findingown data

    Two-sample t-tests yielded significant group differences in the integration of the left superior frontal gyrus (SFG) into component 27.

    “and of the right inferior temporal gyrus (ITG) [60, −9, −33; t (44) = 3.79] and left superior frontal gyrus (SFG) [−21, 30, 51; t (44) = 3.40] into component 27.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 42
  • May combine two claims. 33

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Component 13 failed to show significant signal change in response to 'pain' and was excluded from further analyses.

    “Component 13 was excluded from further analyses, since it failed to show significant signal change in response to “pain”.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Component 13 included the PrC and a large cluster extending from the PCC along the cingulate gyrus, with dominant contributions of posterior DMN regions.

    “Contributions of posterior DMN regions were also dominant in component 13, which included the PrC and a large cluster extending from the PCC along the cingulate gyrus.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the left RSC, right ITG, and left SFG, patients showed less integration (decreased connectivity strength with other DMN areas) than healthy controls.

    “For those brain regions, patients showed less integration, i.e. decreased connectivity strength with other DMN areas,52 than HC (Figure 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The ICA selection process revealed three components that closely resembled the DMN mask and included brain areas previously implicated in the network.

    “The selection process revealed three components that closely resembled our DMN mask and included brain areas previously implicated in the network20: Component 28 (r = 0.55), component 13 (r = 0.43), and component 27 (r = 0.29) (Figure 1 and eTable 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The present evidence suggests that patients with BPD show significant alterations in DMN connectivity with differences in spatial integrity and temporal characteristics.

    “the present evidence suggests that patients with BPD show significant alterations in DMN connectivity with differences in spatial integrity and temporal characteristics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive, and a deficiency in the switching between baseline and task-related processing.

    “These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive, and a deficiency in the switching between baseline and task-related processing.”
    • Also stated in: § Conclusion · hedged
      “These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive, and a deficiency in the switching between baseline and task-related processing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics.

    “Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Worse symptom severity and higher trait dissociation are associated with less signal decrease of the 'posterior DMN' in response to painful thermal stimulation.

    “This indicates that worse symptom severity and higher trait dissociation are associated with less signal decrease of the “posterior DMN” in response to painful thermal stimulation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This deficiency may be related to everyday difficulties of BPD patients to regulate their emotions, focus mindfully on one task at a time, and efficiently shift their attention from one task to another.

    “This deficiency may be related to everyday difficulties of BPD patients to regulate their emotions, focus mindfully on one task at a time, and efficiently shift their attention from one task to another.”
    • Also stated in: § Conclusion · hedged
      “This deficiency may, in turn, be related to everyday difficulties of BPD patients to regulate their emotions, focus mindfully on one task at a time, and efficiently shift their attention from one task to another.98,99”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [98] Levy KN Beeney JE Wasserman RH Clarkin JF Conflict begets conflict: Executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder Psychother Res 15 6 2010 1 10 20552536

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    • cites [99] Sachse S Keville S Feigenbaum J A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder Psychol Psychother 10 8 2010 22903856

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  • Classified as probably not a substantial claim.

    Premisecitation

    Due to its connections with the thalamus and the medial temporal lobe memory system, the RSC/PCC have been considered a critical hub for the integration of responses and the 'switching' between different modes of processing.

    “Due to its connections with the thalamus and the medial temporal lobe memory system, the RSC/PCC have been considered a critical hub for the integration of responses and the “switching” between different modes of processing.20,69,70”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Buckner RL Andrews-Hanna JR Schacter DL The brain’s default network: anatomy, function, and relevance to disease Ann. N. Y. Acad. Sci 3 2008 1124 1 38 18400922

      Not checked in the free run.

    • cites [69] Fransson P Marrelec G The precuneus/posterior cingulate cortex plays a pivotal role in the default mode network: Evidence from a partial correlation network analysis Neuroimage 1 9 2008 42 3 1178 1184 18598773

      Not checked in the free run.

    • cites [70] Daniels JK McFarlane AC Bluhm RL Moores KA Clark CR Shaw ME Williamson PC Densmore M Lanius RA Switching between executive and default mode networks in posttraumatic stress disorder: alterations in functional connectivity J. Psychiatry Neurosci 7 2010 35 4 258 266 20569651 PMC2895156

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Experimental studies confirm reduced pain sensitivity in patients with BPD under stress and non-stress conditions, which cannot be explained by sensory-discriminative or attentional factors.

    “Experimental studies confirm reduced pain sensitivity in patients with BPD under stress and non-stress conditions, which cannot be explained by sensory-discriminative or attentional factors.8-10”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Bohus M Limberger M Ebner U Glocker FX Schwarz B Wernz M Lieb K Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior Psychiatry Res 11 9 2000 95 3 251 260 10974364

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    • cites [9] Russ MJ Roth SD Lerman A Kakuma T Harrison K Shindledecker RD Hull J Mattis S Pain perception in self-injurious patients with borderline personality disorder Biol Psychiatry 15 9 1992 32 6 501 511 1445967

      Not checked in the free run.

    • cites [10] Schmahl C Greffrath W Baumgartner U Schlereth T Magerl W Philipsen A Lieb K Bohus M Treede RD Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings Pain 7 2004 110 1-2 470 479 15275800

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    ICA and PPI revealed different, but complementary aspects of DMN dysfunction and under-connectivity in BPD patients.

    “With regard to pain-related connectivity changes, ICA and PPI revealed different, but complementary aspects of DMN dysfunction and under-connectivity in BPD patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SFG has shown increased coupling with the dorsal and ventral mPFC during self-relevant processing.

    “Although the SFG is not commonly associated with the DMN, a recent study has shown increased coupling of this region with the dorsal and ventral mPFC during self-relevant processing.28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] van Buuren M Gladwin TE Zandbelt BB Kahn RS Vink M Reduced functional coupling in the default-mode network during self-referential processing Hum Brain Mapp 8 2010 31 8 1117 1127 20108218 PMC6870730

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In that study, BPD patients showed increased DMN connectivity during rest with the left DLPFC and the left insula as well as decreased connectivity with the left cuneus compared to healthy controls.

    “In this study, BPD patients showed increased DMN connectivity during rest with the left DLPFC and the left insula as well as decreased connectivity with the left cuneus compared to HC.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Wolf RC Sambataro F Vasic N Schmid M Thomann PA Bienentreu SD Wolf ND Aberrant connectivity of resting-state networks in borderline personality disorder J Psychiatry Neurosci 1 3 2011 36 2 100150 PMC3201994 21406160

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ITG has been linked to visual processing, multisensory integration and dissociative pathology.

    “while the ITG has been linked to visual processing, multisensory integration and dissociative pathology.66-68”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [66] Herath P Kinomura S Roland PE Visual recognition: evidence for two distinctive mechanisms from a PET study Hum Brain Mapp 2 2001 12 2 110 119 11169875 PMC6871813

      Not checked in the free run.

    • cites [67] Ludascher P Valerius G Stiglmayr C Mauchnik J Lanius RA Bohus M Schmahl C Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study J Psychiatry Neurosci 5 2010 35 3 177 184 20420768 PMC2861134

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    • cites [68] Mesulam MM From sensation to cognition Brain 6 1998 121 Pt 6 1013 1052 9648540

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  • Classified as probably not a substantial claim.

    Premisecitation

    The RSC and neighboring PCC have previously been implicated in assessing the (emotional) salience and self-relevance of experimental stimuli.

    “The RSC and neighboring PCC have previously been implicated in assessing the (emotional) salience and self-relevance of experimental stimuli,62-65”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [62] Maddock RJ The retrosplenial cortex and emotion: new insights from functional neuroimaging of the human brain Trends Neurosci 7 1999 22 7 310 316 10370255

      Not checked in the free run.

    • cites [63] Nielsen FA Balslev D Hansen LK Mining the posterior cingulate: segregation between memory and pain components Neuroimage 9 2005 27 3 520 532 15946864

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    • cites [64] Vogt BA Pain and emotion interactions in subregions of the cingulate gyrus Nat Rev Neurosci 7 2005 6 7 533 544 15995724 PMC2659949

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    • cites [65] Vann SD Aggleton JP Maguire EA What does the retrosplenial cortex do? Nat Rev Neurosci 11 2009 10 11 792 802 19812579

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  • May combine two claims.

    Interpretationown data

    The analysis of ICA time courses indicates that switching might be compromised in BPD, and that the extent of the deficiency reflects clinical measures of BPD.

    “Our analysis of ICA time courses further indicates that this switching might be compromised in BPD, and that the extent of the deficiency reflects clinical measures of BPD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Compared to healthy controls, BPD patients displayed increased activation in the dorsolateral prefrontal cortex coupled with deactivation in the anterior cingulate cortex and the amygdala in response to heat stimuli individually adjusted for equal subjective painfulness.

    “Compared to healthy controls (HC), BPD patients displayed increased activation in the dorsolateral prefrontal cortex (DLPFC) coupled with deactivation in the anterior cingulate cortex (ACC) and the amygdala in response to heat stimuli individually adjusted for equal subjective painfulness.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Schmahl C Bohus M Esposito F Treede RD Di Salle F Greffrath W Ludaescher P Jochims A Lieb K Scheffler K Hennig J Seifritz E Neural correlates of antinociception in borderline personality disorder Arch Gen Psychiatry 6 2006 63 6 659 667 16754839

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Painful electrical stimulation led to a significant recruitment of areas associated with cognitive and affective pain modulation, such as the ACC and middle frontal gyrus, into the DMN.

    “Painful electrical stimulation, for example, led to a significant recruitment of areas associated with cognitive and affective pain modulation, such as the ACC and middle frontal gyrus, into the DMN.19,35”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Mantini D Caulo M Ferretti A Romani GL Tartaro A Noxious somatosensory stimulation affects the default mode of brain function: evidence from functional MR imaging Radiology 12 2009 253 3 797 804 19789220

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    • cites [35] Rainville P Duncan GH Price DD Carrier B Bushnell MC Pain affect encoded in human anterior cingulate but not somatosensory cortex Science 15 8 1997 277 5328 968 971 9252330

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Activity within the DMN has been observed when individuals are at rest or engaged in stimulus-unrelated thought, presumably facilitating a state of readiness to respond to environmental changes.

    “Activity within the DMN has been observed when individuals are at rest or engaged in stimulus-unrelated thought – presumably facilitating a state of readiness to respond to environmental changes.20,23,24,25”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [20] Buckner RL Andrews-Hanna JR Schacter DL The brain’s default network: anatomy, function, and relevance to disease Ann. N. Y. Acad. Sci 3 2008 1124 1 38 18400922

      Not checked in the free run.

    • cites [23] Mason MF Norton MI Van Horn JD Wegner DM Grafton ST Macrae CN Wandering minds: the default network and stimulus-independent thought Science 19 1 2007 315 5810 393 395 17234951 PMC1821121

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    • cites [24] Raichle ME Gusnard DA Intrinsic brain activity sets the stage for expression of motivated behavior J Comp Neurol 5 12 2005 493 1 167 176 16254998

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    • cites [25] Raichle ME Two views of brain function Trends Cogn Sci 4 2010 14 4 180 190 20206576

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DMN comprises the medial prefrontal cortex, posterior cingulate/retrosplenial cortex including the precuneus, inferior parietal lobule, lateral temporal cortex, and hippocampal formation.

    “The DMN comprises the medial prefrontal cortex (mPFC), posterior cingulate/retrosplenial cortex (PCC/RSC) including the precuneus (PrC), inferior parietal lobule, lateral temporal cortex, and hippocampal formation.20-22”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [20] Buckner RL Andrews-Hanna JR Schacter DL The brain’s default network: anatomy, function, and relevance to disease Ann. N. Y. Acad. Sci 3 2008 1124 1 38 18400922

      Not checked in the free run.

    • cites [21] Zhang D Raichle ME Disease and the brain’s dark energy Nat Rev Neurol 1 2010 6 1 15 28 20057496

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    • cites [22] Bluhm RL Osuch EA Lanius RA Boksman K Neufeld RW Theberge J Williamson P Default mode network connectivity: effects of age, sex, and analytic approach Neuroreport 28 5 2008 19 8 887 891 18463507

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  • May combine two claims.

    Premisecitation

    Many patients with BPD engage in self-injurious behavior to regulate affect, decrease dissociation and regain awareness of physical sensations.

    “Specifically, many patients with BPD engage in SIB to regulate affect, decrease dissociation and regain awareness of physical sensations.5-7”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Shearer SL Phenomenology of self-injury among inpatient women with borderline personality disorder J Nerv Ment Dis 9 1994 182 9 524 526 8083682

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    • cites [6] Kleindienst N Bohus M Ludascher P Limberger MF Kuenkele K Ebner-Priemer UW Chapman AL Reicherzer M Stieglitz RD Schmahl C Motives for nonsuicidal self-injury among women with borderline personality disorder J Nerv Ment Dis 3 2008 196 3 230 236 18340259

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    • cites [7] Niedtfeld I Schulze L Kirsch P Herpertz SC Bohus M Schmahl C Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury Biol Psychiatry 15 8 2010 68 4 383 391 20537612

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Beyond pain processing, patients with BPD have shown altered metabolic activity of prefrontal and limbic brain regions during rest and in the contexts of emotion regulation and inhibitory control.

    “Beyond pain processing, patients with BPD have shown altered metabolic activity of prefrontal and limbic brain regions during rest and in the contexts of emotion regulation and inhibitory control.13-15”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [13] New AS Hazlett EA Buchsbaum MS Goodman M Mitelman SA Newmark R Trisdorfer R Haznedar MM Koenigsberg HW Flory J Siever LJ Amygdala-prefrontal disconnection in borderline personality disorder Neuropsychopharmacology 7 2007 32 7 1629 1640 17203018

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    • cites [14] Silbersweig D Clarkin JF Goldstein M Kernberg OF Tuescher O Levy KN Brendel G Pan H Beutel M Pavony MT Epstein J Lenzenweger MF Thomas KM Posner MI Stern E Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder Am J Psychiatry 12 2007 164 12 1832 1841 18056238

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    • cites [15] Koenigsberg HW Fan J Ochsner KN Liu X Guise KG Pizzarello S Dorantes C Guerreri S Tecuta L Goodman M New A Siever LJ Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder Biol Psychiatry 1 11 2009 66 9 854 863 19651401 PMC2821188

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The finding of enhanced mPFC connectivity with the left putamen during 'neutral' greater 'pain' in controls versus patients may reflect underlying differences in the ability to regulate/inhibit motor responses.

    “Our finding of enhanced mPFC connectivity with this region during “neutral” greater “pain” in controls versus patients may reflect underlying differences in the ability to regulate/inhibit motor responses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Recent neuroimaging studies have associated activity in the DMN with self-referential and pain processing, both of which are altered in BPD.

    “The so-called default mode network (DMN) has recently been studied in the contexts of both self-referential and pain processing.16-19”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [16] Gusnard DA Akbudak E Shulman GL Raichle ME Medial prefrontal cortex and self-referential mental activity: relation to a default mode of brain function Proc Natl Acad Sci U S A 27 3 2001 98 7 4259 4264 11259662 PMC31213

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    • cites [17] Northoff G Heinzel A de Greck M Bermpohl F Dobrowolny H Panksepp J Self-referential processing in our brain--a meta-analysis of imaging studies on the self Neuroimage 15 5 2006 31 1 440 457 16466680

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    • cites [18] Schneider F Bermpohl F Heinzel A Rotte M Walter M Tempelmann C Wiebking C Dobrowolny H Heinze HJ Northoff G The resting brain and our self: self-relatedness modulates resting state neural activity in cortical midline structures Neuroscience 11 11 2008 157 1 120 131 18793699

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    • cites [19] Mantini D Caulo M Ferretti A Romani GL Tartaro A Noxious somatosensory stimulation affects the default mode of brain function: evidence from functional MR imaging Radiology 12 2009 253 3 797 804 19789220

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with BPD frequently experience stress-induced aversive states of inner tension and dissociation, which are often associated with analgesia and self-injurious behavior.

    “Patients with borderline personality disorder (BPD) frequently experience stress-induced aversive states of inner tension and dissociation,1,2 which are often associated with analgesia and self-injurious behavior (SIB).3,4”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [1] Stiglmayr CE Shapiro DA Stieglitz RD Limberger MF Bohus M Experience of aversive tension and dissociation in female patients with borderline personality disorder -- a controlled study J Psychiatr Res Mar-Apr 2001 35 2 111 118 11377440

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    • cites [2] Stiglmayr CE Grathwol T Linehan MM Ihorst G Fahrenberg J Bohus M Aversive tension in patients with borderline personality disorder: a computer-based controlled field study Acta Psychiatr Scand 5 2005 111 5 372 379 15819731

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    • cites [3] Lieb K Zanarini MC Schmahl C Linehan MM Bohus M Borderline personality disorder Lancet 31 6 7 8 2004 364 9432 453 461 15288745

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    • cites [4] Ludascher P Bohus M Lieb K Philipsen A Jochims A Schmahl C Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder Psychiatry Res 15 1 2007 149 1-3 291 296 17126914

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  • May combine two claims.

    Premisecitation

    Findings in healthy subjects indicate that painful stimulation leads to BOLD signal decreases and changes in the functional architecture of the DMN.

    “Findings in healthy subjects indicate that painful stimulation leads to BOLD signal decreases and changes in brain regions known to be part of the functional architecture of the DMN.19,32-34”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [19] Mantini D Caulo M Ferretti A Romani GL Tartaro A Noxious somatosensory stimulation affects the default mode of brain function: evidence from functional MR imaging Radiology 12 2009 253 3 797 804 19789220

      Not checked in the free run.

    • cites [32] Kong J Loggia ML Zyloney C Tu P Laviolette P Gollub RL Exploring the brain in pain: activations, deactivations and their relation Pain 2 2010 148 2 257 267 20005043 PMC2815185

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    • cites [33] Coghill RC Sang CN Maisog JM Iadarola MJ Pain intensity processing within the human brain: a bilateral, distributed mechanism J Neurophysiol 10 1999 82 4 1934 1943 10515983

      Not checked in the free run.

    • cites [34] Vogt BA Derbyshire S Jones AK Pain processing in four regions of human cingulate cortex localized with co-registered PET and MR imaging Eur J Neurosci 7 1996 8 7 1461 1473 8758953

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The DMN comprises at least two interacting subsystems, the mPFC network and the PCC network, that serve specific, dissociable functions and may differentially modulate activity in task-positive networks.

    “Accumulating evidence suggests that the DMN comprises at least two interacting subsystems, the mPFC network and the PCC network, that serve specific, dissociable functions and may differentially modulate activity in so-called task-positive networks.26-29”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [26] Uddin LQ Kelly AM Biswal BB Xavier Castellanos F Milham MP Functional connectivity of default mode network components: correlation, anticorrelation, and causality Hum Brain Mapp 2 2009 30 2 625 637 18219617 PMC3654104

      Not checked in the free run.

    • cites [27] Fox MD Snyder AZ Vincent JL Corbetta M Van Essen DC Raichle ME The human brain is intrinsically organized into dynamic, anticorrelated functional networks Proc Natl Acad Sci U S A 5 7 2005 102 27 9673 9678 15976020 PMC1157105

      Not checked in the free run.

    • cites [28] van Buuren M Gladwin TE Zandbelt BB Kahn RS Vink M Reduced functional coupling in the default-mode network during self-referential processing Hum Brain Mapp 8 2010 31 8 1117 1127 20108218 PMC6870730

      Not checked in the free run.

    • cites [29] Andrews-Hanna JR Reidler JS Sepulcre J Poulin R Buckner RL Functional-anatomic fractionation of the brain’s default network Neuron 25 2 2010 65 4 550 562 20188659 PMC2848443

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The default mode network plays a role in self-related processing.

    “the role of the DMN in self-related processing”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Kleindienst N Bohus M Ludascher P Limberger MF Kuenkele K Ebner-Priemer UW Chapman AL Reicherzer M Stieglitz RD Schmahl C Motives for nonsuicidal self-injury among women with borderline personality disorder J Nerv Ment Dis 3 2008 196 3 230 236 18340259

      Not checked in the free run.

    • cites [89] Kraus A Valerius G Seifritz E Ruf M Bremner JD Bohus M Schmahl C Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study Acta Psychiatr Scand 1 2010 121 1 41 51 19522883 PMC3233769

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Region-of-interest analyses for the DLPFC, insula and cuneus applied a more liberal height threshold of p < 0.01 (uncorrected), with correction for multiple comparisons using a small volume correction (p < 0.05, SVC-corrected).

    “To identify whether these regions, showed a different pain-related coupling with the two seed regions in BPD patients compared to HC, we applied a more liberal height threshold of p < 0.01 (uncorrected). Correction for multiple comparisons was carried out using a small volume correction for these ROIs (p < 0.05, SVC-corrected).60,67”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [60] Ethofer T Gschwind M Vuilleumier P Processing social aspects of human gaze: a combined fMRI-DTI study Neuroimage 1 3 2011 55 1 411 419 21095230

      Not checked in the free run.

    • cites [67] Ludascher P Valerius G Stiglmayr C Mauchnik J Lanius RA Bohus M Schmahl C Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study J Psychiatry Neurosci 5 2010 35 3 177 184 20420768 PMC2861134

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Activity in the DLPFC has been linked to response selection/inhibition, executive function, and cognitive control in the realms of emotion regulation, pain processing and (working) memory - all of which are affected in BPD.

    “Activity in the DLPFC has been linked to response selection/inhibition, executive function, and cognitive control in the realms of emotion regulation, pain processing83 and (working) memory84-86 – all of which are affected in BPD.11,14,87,88”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [83] Lorenz J Minoshima S Casey KL Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation Brain 5 2003 126 Pt 5 1079 1091 12690048

      Not checked in the free run.

    • cites [84] Veen Vv Carter CS Conflict and Cognitive Control in the Brain Current Directions in Psychological Science 1 10 2006 15 5 237 240 2006

      Not checked in the free run.

    • cites [85] Ochsner KN Bunge SA Gross JJ Gabrieli JD Rethinking feelings: an FMRI study of the cognitive regulation of emotion J Cogn Neurosci 15 11 2002 14 8 1215 1229 12495527

      Not checked in the free run.

    • cites [86] D’Esposito M Detre JA Alsop DC Shin RK Atlas S Grossman M The neural basis of the central executive system of working memory Nature 16 11 1995 378 6554 279 281 7477346

      Not checked in the free run.

    • cites [11] Schmahl C Bohus M Esposito F Treede RD Di Salle F Greffrath W Ludaescher P Jochims A Lieb K Scheffler K Hennig J Seifritz E Neural correlates of antinociception in borderline personality disorder Arch Gen Psychiatry 6 2006 63 6 659 667 16754839

      Not checked in the free run.

    • cites [14] Silbersweig D Clarkin JF Goldstein M Kernberg OF Tuescher O Levy KN Brendel G Pan H Beutel M Pavony MT Epstein J Lenzenweger MF Thomas KM Posner MI Stern E Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder Am J Psychiatry 12 2007 164 12 1832 1841 18056238

      Not checked in the free run.

    • cites [87] Beblo T Saavedra AS Mensebach C Lange W Markowitsch HJ Rau H Woermann FG Driessen M Deficits in visual functions and neuropsychological inconsistency in Borderline Personality Disorder Psychiatry Res 7 12 2006 145 2-3 127 135 17070927

      Not checked in the free run.

    • cites [88] Koenigsberg HW Siever LJ Lee H Pizzarello S New AS Goodman M Cheng H Flory J Prohovnik I Neural correlates of emotion processing in borderline personality disorder Psychiatry Res 30 6 2009 172 3 192 199 19394205 PMC4153735

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Kraus et al. reported a significant BOLD signal increase in the DLPFC and PCC in BPD patients while they were imagining the emotional and cognitive reactions to a stressful situation.

    “Kraus et al. who reported a significant BOLD signal increase in the DLPFC and PCC in BPD patients, while they were imagining the emotional and cognitive reactions to a stressful situation.89”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kraus et al.

      Not checked in the free run.

    • cites [89] Kraus A Valerius G Seifritz E Ruf M Bremner JD Bohus M Schmahl C Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study Acta Psychiatr Scand 1 2010 121 1 41 51 19522883 PMC3233769

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Results of the image analyses are reported at a statistical height threshold of p < 0.005 (uncorrected) at the voxel-level, with cluster extent correction to correct for multiple comparisons across the whole brain.

    “Given the novelty of our approach and the lack of previous studies examining DMN connectivity during pain in BPD, the results of these analyses are reported at a statistical height threshold of p < 0.005 (uncorrected) at the voxel-level. Additionally, to correct for multiple comparisons across the whole brain, we used a cluster extent correction procedure to compute the number of expected voxels”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Hayasaka S Nichols TE Combining voxel intensity and cluster extent with permutation test framework Neuroimage 9 2004 23 1 54 63 15325352

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To control for differences in subjective pain intensity during the fMRI acquisition, each subject's average rating for the five 'pain' blocks was entered as a covariate of no interest into the two-sample t-tests comparing the component images of BPD patients and HC.

    “To control for differences in subjective pain intensity during the fMRI acquisition, we entered each subject’s average rating for the five “pain” blocks as a covariate of no interest into the two-sample t-tests comparing the component images of BPD patients and HC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Alterations in DMN connectivity and/or pain processing have also been reported in other psychiatric disorders, such as depression, PTSD related to early life trauma, and social anxiety disorder.

    “alterations in DMN connectivity and/or pain processing have also been reported in other psychiatric disorders,91 such as depression,92,93 PTSD related to early life trauma,94 and social anxiety disorder,95”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [91] Lautenbacher S Krieg J-C Pain perception in psychiatric disorders: A review of the literature Journal of Psychiatric Research 1994 28 2 109 122 7932274

      Not checked in the free run.

    • cites [92] Grimm S Boesiger P Beck J Schuepbach D Bermpohl F Walter M Ernst J Hell D Boeker H Northoff G Altered negative BOLD responses in the default-mode network during emotion processing in depressed subjects Neuropsychopharmacology 3 2009 34 4 932 843 18536699

      Not checked in the free run.

    • cites [93] Bluhm R Williamson P Lanius R Theberge J Densmore M Bartha R Neufeld R Osuch E Resting state default-mode network connectivity in early depression using a seed region-of-interest analysis: decreased connectivity with caudate nucleus Psychiatry Clin Neurosci 12 2009 63 6 754 761 20021629

      Not checked in the free run.

    • cites [94] Bluhm RL Williamson PC Osuch EA Frewen PA Stevens TK Boksman K Neufeld RW Theberge J Lanius RA Alterations in default network connectivity in posttraumatic stress disorder related to early-life trauma J. Psychiatry Neurosci 5 2009 34 3 187 194 19448848 PMC2674971

      Not checked in the free run.

    • cites [95] Liao W Chen H Feng Y Mantini D Gentili C Pan Z Ding J Duan X Qiu C Lui S Gong Q Zhang W Selective aberrant functional connectivity of resting state networks in social anxiety disorder Neuroimage 1 10 2010 52 4 1549 1558 20470894

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    We launched the ICASSO algorithm to increase the robustness of our independent components to initial algorithm conditions by repeating the ICA estimation 20 times.

    “We launched the ICASSO algorithm,47 implemented in GIFT, to increase the robustness of our independent components to initial algorithm conditions by repeating the ICA estimation 20 times.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Himberg J Hyvarinen A Esposito F Validating the independent components of neuroimaging time series via clustering and visualization Neuroimage 7 2004 22 3 1214 1222 15219593

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    PPI results are reported at a statistical height threshold of p < 0.005 (uncorrected) at the voxel-level, in addition to the cluster-extent correction.

    “PPI results are reported at a statistical height threshold of p < 0.005 (uncorrected) at the voxel-level, in addition to the cluster-extent correction described above.54”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Hayasaka S Nichols TE Combining voxel intensity and cluster extent with permutation test framework Neuroimage 9 2004 23 1 54 63 15325352

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Controls were excluded if they had a lifetime diagnosis of BPD as assessed by the IPDE or a current axis I diagnosis as assessed by the SCID-I.

    “Controls were excluded if they had a lifetime diagnosis of BPD as assessed by the IPDE or a current axis I diagnosis as assessed by the SCID-I.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Extant data link frontolimbic dysfunction to emotional instability in BPD.

    “The former interpretation receives support from extant data linking frontolimbic dysfunction to emotional instability in BPD.14,88”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] Silbersweig D Clarkin JF Goldstein M Kernberg OF Tuescher O Levy KN Brendel G Pan H Beutel M Pavony MT Epstein J Lenzenweger MF Thomas KM Posner MI Stern E Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder Am J Psychiatry 12 2007 164 12 1832 1841 18056238

      Not checked in the free run.

    • cites [88] Koenigsberg HW Siever LJ Lee H Pizzarello S New AS Goodman M Cheng H Flory J Prohovnik I Neural correlates of emotion processing in borderline personality disorder Psychiatry Res 30 6 2009 172 3 192 199 19394205 PMC4153735

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pain may be associated with reward or negative reinforcement among BPD patients who self-injure to end states of aversive inner tension and dissociation.

    “the idea that pain may be associated with reward/negative reinforcement among BPD patients who self-injure to end states of aversive inner tension and dissociation.6,89”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Kleindienst N Bohus M Ludascher P Limberger MF Kuenkele K Ebner-Priemer UW Chapman AL Reicherzer M Stieglitz RD Schmahl C Motives for nonsuicidal self-injury among women with borderline personality disorder J Nerv Ment Dis 3 2008 196 3 230 236 18340259

      Not checked in the free run.

    • cites [89] Kraus A Valerius G Seifritz E Ruf M Bremner JD Bohus M Schmahl C Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study Acta Psychiatr Scand 1 2010 121 1 41 51 19522883 PMC3233769

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Attenuated DMN signal decrease during task performance may underlie impaired attentional and inhibitory control, and may therefore interfere with task-specific attention and goal-directed action.

    “As recently discussed by Congdon et al.,71 attenuated DMN signal decrease during task performance may underlie impaired attentional and inhibitory control, and may therefore interfere with task-specific attention and goal-directed action.23,71”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Congdon E Mumford JA Cohen JR Galvan A Aron AR Xue G Miller E Poldrack RA Engagement of large-scale networks is related to individual differences in inhibitory control Neuroimage 1 11 2010 53 2 653 663 20600962 PMC2930099

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Dissociative States Scale (DSS) was used to measure state dissociation and aversive inner tension immediately before and after scanning.

    “The Dissociative States Scale (DSS)40 was used to measure state dissociation and aversive inner tension immediately before and after scanning.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Stiglmayr CE Braakmann D Haaf B Stieglitz RD Bohus M Development and characteristics of Dissociation-Tension-Scale acute (DSS-Akute) Psychother Psychosom Med Psychol 7 2003 53 7 287 294 12847662

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Axis I and II diagnoses were assessed by a trained psychologist using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the International Personality Disorder Examination (IPDE).

    “Axis I and II diagnoses were assessed by a trained psychologist using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I)37 and the International Personality Disorder Examination (IPDE).38”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for Axis I DSM-IV Disorders - Patient Edition (SCID-I/P) 1995 American Psychiatric Press New York

      Not checked in the free run.

    • cites [38] Loranger AW International Personality Disorder Examination (IPDE): DSM-IV and ICD-10 Modules 1999 Psychological Assessment Resources Odessa, Florida

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Trait dissociation was assessed in both groups with the German adaptation of the Dissociative Experience Scale (FDS).

    “Trait dissociation was assessed in both groups with the German adaptation of the Dissociative Experience Scale (FDS).39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Freyberger HJ Spitzer C Stieglitz RD Fragebogen zu Dissoziativen Symptomen (FDS): Deutsche Adaptation, Reliabilität und Validität der amerikanischen Dissociative Experience Scale (DES) [German adaptation, reliability and validity of the Dissociative Experience Scale (DES)] 1999 Huber Bern, Switzerland 9677826

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The relationship between DMN component time courses and patients' average BSL, DSS and FDS scores was determined using Pearson correlation analysis (p < 0.05, Bonferroni-corrected).

    “Using Pearson correlation analysis, we also determined the relationship between DMN component time courses and patients’ average BSL, DSS and FDS scores (p < 0.05, Bonferroni-corrected).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    BPD symptom severity was assessed with the Borderline Symptom List (BSL) and the number of DSM-IV criteria.

    “BPD symptom severity was assessed with the Borderline Symptom List (BSL)41,42 and the number of DSM-IV criteria.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Bohus M Limberger MF Frank U Sender I Gratwohl T Stieglitz RD Development of the Borderline Symptom List Psychother Psychosom Med Psychol 5 2001 51 5 201 211 11417358

      Not checked in the free run.

    • cites [42] Bohus M Limberger MF Frank U Chapman AL Kuhler T Stieglitz RD Psychometric properties of the Borderline Symptom List (BSL) Psychopathology 2007 40 2 126 132 17215599

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To control for differences in subjective pain intensity, each subject's average rating for the five 'pain' blocks was entered as a covariate of no interest into the two-sample t-tests for 'pain' greater 'neutral'.

    “To control for differences in subjective pain intensity, we entered each subject’s average rating for the five “pain” blocks as a covariate of no interest into the two-sample t-tests for “pain” greater “neutral”.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Subjects provided written informed consent for the experimental procedures, which were approved by the ethics committee of the University of Heidelberg, Germany.

    “Subjects provided written informed consent for the experimental procedures, which were approved by the ethics committee of the University of Heidelberg, Germany.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Exclusion criteria comprised a history of head trauma, chronic pain, serious medical or neurological illness, current major depression, alcohol or substance abuse or dependence in the last six months, lifetime bipolar disorder, schizophrenia, and pain disorders.

    “Exclusion criteria comprised a history of head trauma, chronic pain, serious medical or neurological illness, current major depression, alcohol or substance abuse or dependence in the last six months, lifetime bipolar disorder, schizophrenia, and pain disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The putamen has been implicated in motor control and various types of learning, e.g. reinforcement learning.

    “As part of the basal ganglia, the putamen has been implicated in motor control and various types of learning, e.g. reinforcement learning.80-82”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [80] Alexander GE Crutcher MD Preparation for movement: neural representations of intended direction in three motor areas of the monkey J Neurophysiol 7 1990 64 1 133 150 2388061

      Not checked in the free run.

    • cites [81] DeLong MR Alexander GE Georgopoulos AP Crutcher MD Mitchell SJ Richardson RT Role of basal ganglia in limb movements Hum Neurobiol 1984 2 4 235 244 6715208

      Not checked in the free run.

    • cites [82] Packard MG Knowlton BJ Learning and memory functions of the basal ganglia Annual Review of Neuroscience 2002 25 1 563 593 12052921

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    All participants were right-handed and free of psychotropic and pain medications for at least two weeks prior to scanning.

    “All participants were right-handed and free of psychotropic and pain medications for at least two weeks prior to scanning.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The posterior cingulate cortex interacts with the dorsolateral prefrontal cortex to regulate emotions.

    “The notion that the PCC interacts with the DLPFC to regulate emotions is also supported by Kraus et al.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kraus et al.

      Not checked in the free run.

    • cites [89] Kraus A Valerius G Seifritz E Ruf M Bremner JD Bohus M Schmahl C Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study Acta Psychiatr Scand 1 2010 121 1 41 51 19522883 PMC3233769

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BPD patients engaged these cognitive control regions to a lesser extent than controls did.

    “However, BPD patients engaged these cognitive control regions to a lesser extent than controls did,15 which is in line with our current findings.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Koenigsberg HW Fan J Ochsner KN Liu X Guise KG Pizzarello S Dorantes C Guerreri S Tecuta L Goodman M New A Siever LJ Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder Biol Psychiatry 1 11 2009 66 9 854 863 19651401 PMC2821188

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    ICA and PPI analyses are subject to different sources of investigator-specific bias and variability in their outcomes.

    “it is important to acknowledge different sources of investigator-specific bias and thus variability in their outcomes.21,96”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Zhang D Raichle ME Disease and the brain’s dark energy Nat Rev Neurol 1 2010 6 1 15 28 20057496

      Not checked in the free run.

    • cites [96] Cole DM Smith SM Beckmann CF Advances and pitfalls in the analysis and interpretation of resting-state FMRI data Front Syst Neurosci 4 2010 4 1 15 2010 20407579 PMC2854531

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The PPI results are limited by modeling the connections of only two seed regions.

    “our PPI results are limited by modeling the connections of only two seed regions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    ICA and PPI analyses are well-established and provide useful complements to traditional GLM subtraction analyses.

    “ICA and PPI analyses are well-established and provide useful complements to traditional GLM subtraction analyses”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Zhang D Raichle ME Disease and the brain’s dark energy Nat Rev Neurol 1 2010 6 1 15 28 20057496

      Not checked in the free run.

    • cites [96] Cole DM Smith SM Beckmann CF Advances and pitfalls in the analysis and interpretation of resting-state FMRI data Front Syst Neurosci 4 2010 4 1 15 2010 20407579 PMC2854531

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BPD patients tend to over-interpret neutral or ambiguous stimuli as self-referential.

    “BPD patients tend to over-interpret neutral or ambiguous stimuli as self-referential,92,103”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [92] Grimm S Boesiger P Beck J Schuepbach D Bermpohl F Walter M Ernst J Hell D Boeker H Northoff G Altered negative BOLD responses in the default-mode network during emotion processing in depressed subjects Neuropsychopharmacology 3 2009 34 4 932 843 18536699

      Not checked in the free run.

    • cites [103]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Potential biases result from the a priori selection of seed regions in PPI and the use of different model orders and spatial templates in ICA.

    “Potential biases result from the a priori selection of seed regions in PPI and the use of different model orders and spatial templates in ICA.”
    Quote in the paperNot a substantial claim
58 of 58

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In Kluetsch et al. (2014), higher trait dissociation (DES) was associated with an attenuated signal decrease of the DMN in response to painful stimulation.

    “Higher trait dissociation (DES) was associated with an attenuated signal decrease of the DMN in response to painful stimulation.”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [136]

  • Kluetsch et al. (2014) found that compared to controls, BPD patients showed reduced integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN, and during pain versus neutral temperature stimulation, patients exhibited less FC between the PCC and left dlPFC.

    “Compared to controls, patients showed a reduced integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN. During pain versus neutral temperature stimulation, patients further exhibited less FC between the PCC (seed region) and left dlPFC.”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [136]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(1, 45) = 10.05reported p = .003 · recomputed p = .003

    “F (1, 45) = 10.05, p = .003”

  • Consistentt(45) = -3.4reported p = .001 · recomputed p = .001

    “t (45) = −3.40, p = .001”

  • Consistentt(45) = 3.464reported p = .001 · recomputed p = .001

    “t (45) = 3.464, p = .001”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [37]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for Axis I DSM-IV Disorders - Patient Edition (SCID-I/P) 1995 American Psychiatric Press New York

Cited by

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Related

Authors
Kluetsch, R. C., Schmahl, C., Niedtfeld, I., Densmore, M., Calhoun, V. D., Daniels, J., Kraus, A., Ludaescher, P., Bohus, M., & Lanius, R. A.
Affiliations
  • Western University (CA)
  • Central Institute of Mental Health (DE)
  • Mind Research Network (US)
  • Charité – Universitätsmedizin Berlin (DE)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2012-10-01
Volume
69
Issue
10
Pages
993-1002
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2012.476
PMC
PMC4429518
OpenAlex
W2143630234
Semantic Scholar
ee319989d33c39e4a14827ba720f72f53baea478
Cited by
91
References
99
Citations by year
2026: 6 · 2025: 2 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 1 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 13 · 2015: 8 · 2014: 12 · 2013: 9
FWCI
4.75
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of General Medical Sciences (P20GM103472)
  • National Institute of Biomedical Imaging and Bioengineering (R01EB000840, R01EB020407, R01EB006841)
  • National Center for Research Resources (P20RR021938)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
borderline personality disorder, default mode network, pain processing, pain perception, self-referential processing, dissociation, self-harm, posterior cingulate cortex, dorsolateral prefrontal cortex, functional connectivity, emotion regulation, attentional shift, thermal pain
MeSH terms
Adult, Borderline Personality Disorder, Cerebral Cortex, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Nerve Net, Case-Control Studies, Self-Injurious Behavior, Prefrontal Cortex, Pain Perception

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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