Psychological Medicine



Original Article

Functional MRI correlates of the recall of unresolved life events in borderline personality disorder


THOMAS BEBLO a1c1, MARTIN DRIESSEN a1a2a3, MARKUS MERTENS a4, KATJA WINGENFELD a1, MARTINA PIEFKE a5a7, NINA RULLKOETTER a1a3, ANAMARIA SILVA-SAAVEDRA a1, CHRISTOPH MENSEBACH a1a3, LUISE REDDEMANN a6, HARALD RAU a1a3, HANS J. MARKOWITSCH a3, HELLA WULFF a1, WOLFGANG LANGE a1, CRISTINA BEREA a1, ISABELLA OLLECH a4 and FRIEDRICH G. WOERMANN a4
a1 Department of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Germany
a2 Luebeck School of Medicine, Luebeck, Germany
a3 Department of Psychology, University of Bielefeld, Germany
a4 MRI Unit, Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany
a5 Institute of Medicine, Research Center Juelich, Germany
a6 Clinic of Psychotherapy and Psychosomatic Medicine, Ev. Hospital Bielefeld, Germany
a7 University Hospital of the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany

Article author query
beblo t   [PubMed][Google Scholar] 
driessen m   [PubMed][Google Scholar] 
mertens m   [PubMed][Google Scholar] 
wingenfeld k   [PubMed][Google Scholar] 
piefke m   [PubMed][Google Scholar] 
rullkoetter n   [PubMed][Google Scholar] 
silva-saavedra a   [PubMed][Google Scholar] 
mensebach c   [PubMed][Google Scholar] 
reddemann l   [PubMed][Google Scholar] 
rau h   [PubMed][Google Scholar] 
markowitsch hj   [PubMed][Google Scholar] 
wulff h   [PubMed][Google Scholar] 
lange w   [PubMed][Google Scholar] 
berea c   [PubMed][Google Scholar] 
ollech i   [PubMed][Google Scholar] 
woermann fg   [PubMed][Google Scholar] 

Abstract

Background. Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls.

Method. Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories.

Results. When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2×2 factorial analysis (ΔBPD−Δcontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition.

Conclusions. The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.


Correspondence:
c1 Department of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Remterweg 69-71, D-33617 Bielefeld, Germany. (Email: thomas.beblo@evkb.de)


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