Background
Borderline personality disorder (BPD) is often associated with symptoms of impulsive
aggression, which poses a threat to patients themselves and to others. Preclinical
studies show that orbital frontal cortex (OFC) plays a role in regulating impulsive
aggression. Prior work has found OFC dysfunction in BPD.
Methods
We employed a task to provoke aggressive behavior, the Point Subtraction Aggression
Paradigm (PSAP), which has never previously been used during functional brain imaging.
Thirty-eight BPD patients with intermittent explosive disorder (BPD-IED) and 36 age-matched
healthy control subjects (HCs) received 18fluoro-deoxyglucose positron emission tomography (18FDG-PET) on two occasions with a provocation and nonprovocation version of the PSAP.
Mean relative glucose metabolism was measured throughout the cortex, and difference
scores (provoked − nonprovoked) were calculated. A whole brain exploratory analysis
for the double difference of BPD-IED − HC for provoked − nonprovoked was also conducted.
Results
BPD-IED patients were significantly more aggressive than HCs on the PSAP. BPD-IED
patients also increased relative glucose metabolic rate (rGMR) in OFC and amygdala
when provoked, while HCs decreased rGMR in these areas. However, HCs increased rGMR
in anterior, medial, and dorsolateral prefrontal regions during provocation more than
BPD-IED patients.
Conclusions
Patients responded aggressively and showed heightened rGMR in emotional brain areas,
including amygdala and OFC, in response to provocation but not in more dorsal brain
regions associated with cognitive control of aggression. In contrast, HCs increased
rGMR in dorsal regions of PFC during aggression provocation, brain regions involved
in top-down cognitive control of aggression, and, more broadly, of emotion.
Key Words
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Article info
Publication history
Published online: September 14, 2009
Accepted:
July 10,
2009
Received in revised form:
July 10,
2009
Received:
March 2,
2009
Identification
Copyright
Published by Elsevier Inc.
