Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder

• Published in: Biological psychiatry (1969) Vol. 65; no. 9; pp. 819 - 822
• Main Authors: Kraus, Anja, Esposito, Fabrizio, Seifritz, Erich, Di Salle, Francesco, Ruf, Matthias, Valerius, Gabriele, Ludaescher, Petra, Bohus, Martin, Schmahl, Christian
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2009; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Amygdala; Amygdala - physiopathology; Anxiety disorders. Neuroses; Biological and medical sciences; borderline personality disorder; Borderline Personality Disorder - complications; Borderline Personality Disorder - diagnosis; Borderline Personality Disorder - physiopathology; Emotions; Female; functional magnetic resonance imaging; Humans; Magnetic Resonance Imaging; Medical sciences; pain; Pain - physiopathology; Pain Measurement; Personality disorders; Post-traumatic stress disorder; posttraumatic stress disorder; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - physiopathology; pain; Amygdala; functional magnetic resonance imaging; borderline personality disorder; posttraumatic stress disorder; Human; Deactivation; Borderline; Central nervous system; Anxiety disorder; Basal ganglion; Posttraumatic stress disorder; Nuclear magnetic resonance imaging; Personality disorder; Stress; Encephalon; Pain; Medical imagery; Amygdaloid nucleus; Functional imaging
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2008.10.028

Background Previous studies have revealed altered affective pain processing in patients with borderline personality disorder (BPD) as well as in patients with posttraumatic stress disorder (PTSD). Reduced levels of activation in the amygdala might be related to antinociceptive mechanisms pertinent to both disorders. This study aimed at clarifying whether central antinoceptive mechanisms discriminate BPD patients with and without co-occurrent PTSD. Methods We investigated 29 medication-free female outpatients with BPD, 12 with and 17 without co-occurrent PTSD. Psychophysical characteristics were assessed, and functional magnetic resonance imaging was performed during heat stimulation with stimuli adjusted for equal subjective painfulness. Results No difference in pain sensitivity was found between both groups of patients. Amygdala deactivation, however, was more pronounced in BPD patients with co-occurrent PTSD compared with those without PTSD. Amygdala deactivation was independent of BPD symptom severity and dissociation. Conclusions Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD. On the basis of these preliminary findings it might be speculated that reduced pain sensitivity or at least the emotional component of it is associated with amygdala deactivation in patients with both disorders, whereas BPD patients without PTSD use different yet unknown antinociceptive mechanisms.