Neural Correlates of Affective Disturbances: A Comparative Meta-analysis of Negative Affect Processing in Borderline Personality Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder
Abstract
Background Borderline personality disorder (BPD), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) are prominent examples of mental disorders with affective disturbances. Notably, all three disorders share a generally heightened negative affect, which is presumably the result of shared neural abnormalities in affective processing. In this meta-analysis, we aimed to identify transdiagnostic and disorder-specific abnormalities during the processing of negative compared with neutral stimuli. Methods We synthesized neuroimaging findings of affect processing in BPD, MDD, and PTSD and calculated combined coordinate- and image-based meta-analyses. The analysis comprised 70 distinct study samples with a total of 31 unthresholded statistical parametric maps. Twenty-four studies had a focus on BPD (431 individuals with BPD, 436 healthy control subjects [HCs]), 32 studies on MDD (789 individuals with current MDD, 870 HCs), and 14 studies on PTSD (247 individuals with PTSD, 245 HCs). Results Findings showed limbic hyperactivations in BPD and PTSD compared with limbic activation of HCs. In contrast, patients with MDD showed blunted amygdala activation in comparison with that of HCs. Additionally, the calculation of overlapping brain abnormalities in BPD, MDD, and PTSD highlighted transdiagnostic hyperactivation of the right median cingulate gyri and hypoactivation of the right middle frontal gyrus and the right middle occipital gyrus. Finally, disorder-specific co…
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BPD and PTSD are distinguished from healthy controls and major depression by activation of the amygdala and hippocampus in reaction to stimuli eliciting negative emotion.
“Thus, BPD and PTSD were distinguished from healthy controls and major depression by activation of the amygdala and hippocampus in reaction to stimuli eliciting negative emotion”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
In BPD, brain activity in reaction to negative emotion appears to reflect conscious emotion processing (left amygdala), while in PTSD automatic emotion processing is implicated (right amygdala).
“although differing in that in BPD the brain activity appeared to reflect conscious emotion processing (i.e., left amygdala) while automatic emotion processing was implicated in PTSD (i.e., right amygdala) [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
BPD is associated with lesser inhibitory PfC activation in reaction to negative affective stimuli than PTSD.
“Potentially further contributing to difficulties in regulation of negative emotions, BPD also was associated with lesser inhibitory PfC activation in reaction to negative affective stimuli than PTSD.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
PTSD differs from BPD and major depression in showing reduced activation of the ventral premotor and right posterior parietal cortices.
“Additionally, PTSD differed from BPD (and major depression) in showing reduced activation of the ventral premotor and right posterior parietal cortices, which inhibit impulsivity and support attentional and cognitive processes regulating negative emotions [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
BPD is associated with hyperactivation of limbic (amygdala and hippocampus), posterior cingulate, temporal cortical, and medial PfC areas and hypoactivation of the postcentral gyrus in reaction to negatively-valenced versus neutral affective stimuli.
“a meta-analysis of neuroimaging studies testing reactions to affective stimuli that were negatively-valenced versus ones that were neutral found that BPD was associated with hyperactivation of limbic (i.e., amygdala and hippocampus), posterior cingulate, temporal cortical, and medial PfC areas and hypoactivation of the postcentral gyrus [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
PTSD differs from BPD and major depression in enhanced activation of the dorsolateral PfC and the striatum.
“PTSD was found to differ from BPD (and major depression) in enhanced activation of the dorsolateral PfC (which is implicated in cognitive coping) and the striatum (which is involved in identifying and preparing for threats, especially following unanticipated aversive outcomes) [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
Individuals with BPD have been shown to exhibit dorsolateral PfC hypo-activation and orbital PfC and amygdala hyperactivation and connectivity in response laboratory tasks that elicit negative emotions.
“Individuals with BPD have been shown to exhibit dorsolateral PfC hypo-activation and orbital PfC and amygdala hyperactivation and connectivity in response laboratory tasks that elicit negative emotions [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
This heightened prefrontal activation in cPTSD is associated with enhanced executive control and emotion regulation similar to that found in PTSD but opposite of the diminished PfC inhibition found with BPD.
“This heightened prefrontal activation is associated with enhanced executive control and emotion regulation similar to that found in PTSD but the opposite of the diminished PfC inhibition found with BPD [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
PTSD is associated with hyperactivation of the orbital PfC, amygdala, striatum, and temporal gyrus, and hypoactivation of the postcentral gyrus in reaction to negatively-valenced versus neutral affective stimuli.
“PTSD was associated with hyperactivation of the orbital PfC, amygdala, striatum, and temporal gyrus, and hypoactivation of the postcentral gyrus.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
Both BPD and PTSD share a tendency to activate the ventrolateral PfC in response to negatively-valenced affective stimuli.
“Both BPD and PTSD also shared a tendency to activate the ventrolateral PfC—an area associated with attempts to suppress excess emotion reactivity—in response to negatively-valenced affective stimuli [153].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
PTSD shows greater activation than BPD in the dorsolateral PfC, amygdala, temporal gyrus, posterior parietal gyrus, and premotor cortex.
“PTSD also showed greater levels of activation than BPD in the dorsolateral PfC, amygdala, temporal gyrus, posterior parietal gyrus, and premotor cortex”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
cPTSD was not assessed in the studies reviewed by Schulze et al.
“cPTSD was not assessed in the studies reviewed by Schulze et al. [153], raising the question of whether the deficits in amygdala inhibition and emotion regulation are associated with cPTSD/DSO rather than, or in addition to, BPD or PTSD per se.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [153]
Distinct fronto-limbic response patterns indicate deficient emotion regulation on the behavioral level and represent a key pathophysiological mechanism mediating the etiology and manifestation of PTSD.
“Accordingly, distinct fronto-limbic response patterns indicate deficient emotion regulation on the behavioral level and represent a key pathophysiological mechanism mediating the etiology and manifestation of the disorder (Schulze et al., 2019).”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as Schulze et al., 2019
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Complex PTSD and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00155-9 · Cited by 209 · see citing works
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Live from the “regulating brain”: harnessing the brain to change emotion
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- Authors
- Schulze, L., Schulze, A., Renneberg, B., Schmahl, C., & Niedtfeld, I.
- Affiliations
- Freie Universität Berlin (DE)
- Heidelberg University (DE)
- Corresponding author
- Schulze, Lars
- Venue
- Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 4
- Issue
- 3
- Pages
- 220-232
- ISSN
- 2451-9022 (ISSN-L)
- OpenAlex
- W2901437612
- Cited by
- 102
- References
- 140
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 14 · 2023: 15 · 2022: 12 · 2021: 22 · 2020: 13 · 2019: 7
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry Cognitive Neuroscience and Neuroimaging (publishedVersion)
- PubMed (publishedVersion)
- Funders
- German Research Foundation (DFG-SCHU 2961/2–1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- borderline personality disorder, major depressive disorder, post-traumatic stress disorder, mood disorders, amygdala activation, middle frontal gyrus, middle occipital gyrus
- MeSH terms
- Adult, Affect, Borderline Personality Disorder, Brain, Brain Mapping, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Stress Disorders, Post-Traumatic
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