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Emotional instability—particularly within personal relationships—is a cardinal feature of borderline personality disorder (BPD). Little is known about the neurobiological underpinnings of emotional instability in BPD. To investigate this phenomenon, Koenigsberg and colleagues conducted an experiment using standardized social-affective pictures to characterize neural responses in borderline patients.
Nineteen nonmedicated individuals with BPD and seventeen healthy volunteers were recruited to participate in the study. Functional MRI measured blood oxygenation levels during passive perception of emotionally valenced (positive and negative) pictures; following the scan, subjective ratings of the stimuli were collected. Though no significant differences were found between groups in the subjective ratings of the stimuli, the neuroimaging data revealed divergent activation patterns between BPD subjects (e.g., greater activity in primary visual areas, left amygdala, and right fusiform gyrus for negative pictures; superior temporal and inferior frontal gyri, posterior cingulate, and premotor areas for positive pictures) and healthy volunteers (e.g., greater activity in middle temporal and frontal gyri and insula for negative pictures; bilateral caudate for positive pictures).
The authors propose that the divergent neural activation to the emotional pictures reflected a “dual-process model.” The BPD neural activation pattern corresponds to “reflexive” emotion processing. Reflexive processing engages more phylogenetically primitive regions that activate quickly and without conscious thought to avert potentially dangerous threats. In contrast, the healthy volunteer pattern of neural activation suggests more “reflective” processing of emotional stimuli and is characterized by slower response, conscious awareness, and abstract contextualization of the emotional environment.
These results suggest that treatments for BPD could focus on helping the patient convert from reflexive t