Elsevier

Biological Psychiatry

Volume 82, Issue 4, 15 August 2017, Pages 257-266
Biological Psychiatry

Archival Report
Brain Mechanisms Underlying Reactive Aggression in Borderline Personality Disorder—Sex Matters

https://doi.org/10.1016/j.biopsych.2017.02.1175Get rights and content

Abstract

Background

Aggression in borderline personality disorder (BPD) is thought to be mediated through emotion dysregulation via high trait anger. Until now, data comparing anger and aggression in female and male patients with BPD have been widely missing on the behavioral and particularly the brain levels.

Methods

Thirty-three female and 23 male patients with BPD and 30 healthy women and 26 healthy men participated in this functional magnetic resonance imaging study. We used a script-driven imagery task consisting of narratives of both interpersonal rejection and directing physical aggression toward others.

Results

While imagining both interpersonal rejection and acting out aggressively, a sex × group interaction was found in which male BPD patients revealed higher activity in the left amygdala than female patients. In the aggression phase, men with BPD exhibited higher activity in the lateral orbitofrontal and dorsolateral prefrontal cortices compared with healthy men and female patients. Positive connectivity between amygdala and posterior middle cingulate cortex was found in female patients but negative connectivity was found in male patients with BPD. Negative modulatory effects of trait anger on amygdala–dorsolateral prefrontal cortex and amygdala–lateral orbitofrontal cortex coupling were shown in male BPD patients, while in female patients trait anger positively modulated dorsolateral prefrontal cortex–amygdala coupling. Trait aggression was found to positively modulate connectivity of the left amygdala to the posterior thalamus in male but not female patients.

Conclusions

Data suggest poor top-down adjustment of behavior in male patients with BPD despite their efforts at control. Female patients appear to be less aroused through rejection and to successfully dampen aggressive tension during the imagination of aggressive behavior.

Section snippets

Participants

Groups comprised 33 women and 23 unmedicated men with a current diagnosis of BPD (18 to 45 years of age) and 30 age-matched healthy women and 26 healthy men who had never received a psychiatric diagnosis or undergone any psychological and/or psychopharmacological treatment (Table 1). Recruitment was done by the central project of the KFO 256 (24), a clinical research unit funded by the German Research Foundation dedicated to investigating mechanisms of disturbed emotion processing in BPD (24).

Self-Reported Data

Female and male BPD patients, compared with sex-matched HC subjects, reported significantly higher levels of aggression (per BPAQ), emotion dysregulation (per Difficulties in Emotion Regulation Scale), trait anger (STAXI), dissociation (per the Dissociative Experiences Scale) and impulsivity (per Barratt Impulsiveness Scale 11), but lower levels of anger control (STAXI) (all p < .05). Male patients reported higher levels of aggression (BPAQ; p < .001) and tended to report higher levels of trait

Discussion

To the best of our knowledge, this is the first study to investigate brain circuits, which mediate the emotion of anger and anger-based reactive aggression in female and male BPD patients. According to self-report, male BPD patients turned out to be more aggressive that female BPD patients. Consistent with self-report, male, compared with female, patients revealed higher activity of the left amygdala in both the anger induction and aggression phases with the amygdala playing a central role in

Acknowledgments and Disclosures

This study was part of the Clinical Research Unit KFO 256 supported by the German Research Foundation [(24); www.kfo256.de, Grant No. HE 2660/12-1 to SCH and CS].

Dr. Herpertz and Dr. Schmahl report having received funding for this project from the German Research Foundation (Grant No. HE 2660/12-1) with this project being part of the German Research Foundation Clinical Research Unit (KFO 256, spokesperson: Dr. Schmahl) on the “Mechanisms of Disturbed Emotion Processing in Borderline Personality

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    SCH and KN contributed equally to this work.

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