Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder
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Background Previous studies have revealed altered affective pain processing in patients with borderline personality disorder (BPD) as well as in patients with posttraumatic stress disorder (PTSD). Reduced levels of activation in the amygdala might be related to antinociceptive mechanisms pertinent to both disorders. This study aimed at clarifying whether central antinoceptive mechanisms discriminate BPD patients with and without co-occurrent PTSD.Methods We investigated 29 medication-free female outpatients with BPD, 12 with and 17 without co-occurrent PTSD. Psychophysical characteristics were assessed, and functional magnetic resonance imaging was performed during heat stimulation with stimuli adjusted for equal subjective painfulness.Results No difference in pain sensitivity was found between both groups of patients. Amygdala deactivation, however, was more pronounced in BPD patients with co-occurrent PTSD compared with those without PTSD. Amygdala deactivation was independent of BPD symptom severity and dissociation.Conclusions Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD. On the basis of these preliminary findings it might be speculated that reduced pain sensitivity or at least the emotional component of it is associated with amygdala deactivation in patients with both disorders, whereas BPD patients without PTSD use different yet unknown antinociceptive mechanisms.
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Kraus et al. (2009) found no significant group differences in pain sensitivity, and amygdala deactivation during pain processing was more pronounced in BPD patients with comorbid PTSD than in those without PTSD, but this was not significantly correlated with DSS scores.
“No significant group differences in pain sensitivity were observed. A deactivation of the amygdala during pain processing was found to be more pronounced in BPD patients with comorbid PTSD than in those without PTSD, while this was not significantly correlated with DSS scores.”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [137]
Naturally occurring dissociative states (DSS4 ratings) were relatively low in some studies compared to script-driven imagery studies inducing dissociation.
“Naturally occurring dissociative states (DSS4 ratings: mean ± standard deviation (M ± SD)) were relatively low ([137]: BPD 1.16 ± 0.28; [138] 2.14 ± 1.67) as compared to script-driven imagery studies inducing dissociation (e.g., [55]: BPDd 6.85 ± 2.03; 9-point Likert scale, 9 indicating extreme symptoms).”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [137]
Discrepancies in amygdala findings may partly be related to differences in study design: studies observing negative correlations studied amygdala reactivity to highly aversive (trauma-related) pictures, while Kraus et al. studied amygdala activation during pain stimulation and Winter et al. used emotional words, which might have been less distressing.
“These discrepancies may partly be related to differences in study design: studies observing negative correlations studied amygdala reactivity to highly aversive (trauma-related) pictures [55, 135, 139], while Kraus and colleagues [137] studied amygdala activation during pain stimulation and Winter et al. [60•] used emotional words, which might have been less distressing than aversive pictures (not”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [137]
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References 17 · Cited by 83
- Authors
- Kraus, A., Esposito, F., Seifritz, E., Di Salle, F., Ruf, M., Valerius, G., Ludaescher, P., Bohus, M., & Schmahl, C.
- Affiliations
- Central Institute of Mental Health (DE)
- University of Naples Federico II (IT)
- University Hospital of Bern (CH)
- Corresponding author
- Schmahl, Christian
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-05
- Volume
- 65
- Issue
- 9
- Pages
- 819-822
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2101184387
- Cited by
- 83
- References
- 17
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 12 · 2014: 6 · 2013: 6 · 2012: 12
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- pain processing, borderline personality disorder, post-traumatic stress disorder, comorbidities, affective pain, pain sensitivity, thermal pain, emotional pain, dissociation
- MeSH terms
- Adult, Amygdala, Borderline Personality Disorder, Emotions, Female, Humans, Magnetic Resonance Imaging, Pain, Pain Measurement, Severity of Illness Index, Stress Disorders, Post-Traumatic
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