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Cited by 186Personality Disorders and PsychopathologyNeural and Behavioral Psychology StudiesBipolar Disorder and Treatment

Potentiated amygdala response to repeated emotional pictures in borderline personality disorder

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Hazlett, Erin A., Zhang, Jing, New, Antonia S., Zelmanova, Yuliya, Goldstein, Kim E., Haznedar, M. Mehmet, Meyerson, David, Goodman, Marianne +2 more·2012·Biological Psychiatry
DOI 10.1016/j.biopsych.2012.03.027PMC PMC3415575
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Abstract

Background Borderline personality disorder (BPD) is characterized by an inability to regulate emotional responses. The amygdala is important in learning about the valence (goodness and badness) of stimuli and functions abnormally in BPD.Methods Event-related functional magnetic resonance imaging (MRI) was employed in three groups: unmedicated BPD (n = 33) and schizotypal personality disorder (n = 28) participants and healthy control subjects (n = 32) during a task involving an intermixed series of unpleasant, neutral, and pleasant pictures each presented twice within their respective trial block/run. The amygdala was hand-traced on each participant's structural MRI scan and co-registered to their MRI scan. Amygdala responses were examined with a mixed-model multivariate analysis of variance.Results Compared with both control groups, BPD patients showed greater amygdala activation, particularly to the repeated emotional but not neutral pictures, and a prolonged return to baseline for the overall blood oxygen level-dependent response averaged across all pictures. Despite amygdala overactivation, BPD patients showed blunted self-report ratings of emotional but not neutral pictures. Fewer dissociative symptoms in both patient groups were associated with greater amygdala activation to repeated unpleasant pictures.Conclusions The increased amygdala response to the repeated emotional pictures observed in BPD was not observed in schizotypal patients, suggesting diagnostic specificity. This BPD-related abnormality is consistent with the well-documented clinical feature of high sensitivity to emotional stimuli with unusually strong and long-lasting reactions. The finding of a mismatch between physiological and self-report measures of emotion reactivity in BPD patients suggests they may benefit from treatments targeting emotion recognition.

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  • Adults with BPD showed greater amygdala activation to emotional but not neutral pictures than non-clinical and matched schizotypal controls.

    “when compared to non-clinical controls and matched schizotypal personality disorder controls, adults diagnosed with BPD showed greater activation in the amygdala (an area related to emotional reactivity) when being shown emotional but not neutral pictures”

    From Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (2014) · cites this paper as Hazlett et al., 2012

    The Results (‘Amygdala activation during picture processing’) report greater amygdala activation in BPD than in healthy and schizotypal controls for emotional, but not neutral, pictures when the pictures were repeated. The claim omits that repetition condition; the same passage reports greater activation in healthy controls than in BPD patients for novel pleasant pictures. (LLM, conf=0.88)

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  • Hazlett et al. (2012) found that BPD patients demonstrated increased amygdala reactivity to repeated emotional, but not neutral pictures, and a prolonged return to baseline of amygdala activity across all conditions, despite blunted arousal ratings of emotional pictures.

    “BPD patients demonstrated increased amygdala reactivity to repeated emotional, but not neutral pictures, and a prolonged return to baseline of amygdala activity across all conditions. Despite amygdala overactivation, BPD patients showed blunted arousal ratings of emotional, but not neutral pictures.”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [135]

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  • 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 [135]

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  • Amygdala activation returned to baseline more slowly in the BPD group.

    “In addition, the activation in the amygdala took longer to return to baseline in the BPD group”

    From Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (2014) · cites this paper as Hazlett, et al., 2012

  • In Krause-Utz et al. (2014), patients who reported a stronger increase of state dissociation (DSS) showed significantly lower amygdala reactivity to negative distractors.

    “Patients who reported a stronger increase of state dissociation (DSS) showed significantly lower amygdala reactivity to negative distractors [139], in line with aforementioned findings by Hazlett and colleagues [135] and theoretical models [10].”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [135]

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2 of the 79 references couldn’t be matched to a known paper.

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  1. [74]First MB Spitzer R Gibbon M Williams J Structured clinical interview for Axis I disorders-patient edition New York Biometrics Research, New York State Psychiatric Institute 1996
  2. [75]Pfohl B Blum N Zimmerman M Structured clinical interview for DSM-IV personality (SIDP-IV) Washington, DC American Psychiatric Press 1997

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Authors
Hazlett, E. A., Zhang, J., New, A. S., Zelmanova, Y., Goldstein, K. E., Haznedar, M. M., Meyerson, D., Goodman, M., Siever, L. J., & Chu, K.-W.
Affiliations
  • New York/New Jersey VA Health Care Network (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • James J. Peters VA Medical Center (US)
Corresponding author
Hazlett, Erin A.
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2012-09
Volume
72
Issue
6
Pages
448-456
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2012.03.027
PMC
PMC3415575
OpenAlex
W1984839944
Cited by
186
References
79
Citations by year
2026: 2 · 2025: 5 · 2024: 10 · 2023: 2 · 2022: 4 · 2021: 16 · 2020: 12 · 2019: 21 · 2018: 14 · 2017: 17 · 2016: 20 · 2015: 26 · 2014: 14 · 2013: 18 · 2012: 4
FWCI
22.45
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01MH073911)
  • National Center for Research Resources (UL1RR029887)
  • National Institutes of Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
borderline personality disorder, amygdala, emotional pictures, emotional reactivity, schizotypal personality disorder, dissociation, emotion regulation
MeSH terms
Adolescent, Adult, Amygdala, Analysis of Variance, Arousal, Borderline Personality Disorder, Brain Mapping, Emotions, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Photic Stimulation, Schizotypal Personality Disorder, Linear Models, Case-Control Studies

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