Magazine article Clinical Psychiatry News

Dissociation Alters Neural Activation Patterns in Borderline

Magazine article Clinical Psychiatry News

Dissociation Alters Neural Activation Patterns in Borderline

Article excerpt

SANTIAGO, CHILE -- People with borderline personality disorder show altered neural activation in response to aversive stress, Dr. Christian Schmahl said at an international congress sponsored by the World Federation of Societies of Biological Psychiatry.

Impulsivity, affective instability, and disturbed interpersonal relationships characterize borderline personality disorder. "Emotional dysregulation is the core feature of borderline personality disorder," said Dr. Schmahl of the Central Institute of Mental Health in Mannheim, Germany.

Marked emotional activation in those with borderline personality disorder is often combined with deficits in cognitive and sensory processing, producing a condition known as dissociation.

Dissociation is closely related to pain processing. People with borderline personality disorder have markedly reduced pain perception during dissociation. In states of emotional arousal and dissociation, a person with borderline personality disorder may engage in self-injurious behavior.

Dissociation may be a dysfunctional antistress mechanism that allows people with borderline personality disorder to reduce subjective stress. To study the neurobiology and neuroanatomy of emotional regulation in people with borderline personality disorder and healthy controls, Dr. Schmahl and his colleagues designed studies using script-driven imagery and functional MRI (fMRI). Pain processing is an ideal tool to investigate the interaction between sensory, emotional, and cognitive processes in borderline personality disorder, he said.

In a pilot study, Dr. Schmahl and his colleagues examined the response of people with borderline personality disorder to three consecutive presentations of 30-second scripts that were either neutral or designed to induce dissociation. Before and after the scripts, investigators assessed dissociation in the subjects, along with somatic markers of pain.

Psychological assessments showed a significantly higher degree of dissociation in patients with borderline personality disorder following the stress-associated script, compared with the neutral script. On the somatic level, there was significantly decreased sensitivity to pain following the stress-associated script, compared with the neutral script. …

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