Social and emotional processing in borderline personality disorder
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Objective Borderline Personality Disorder (BPD) is a common and serious mental illness, associated with severe emotional dysregulation, a high risk of suicide and self-harm. Those with a diagnosis of BPD often display difficulties with social interaction, making daily life problematic, and sufferers can struggle to form and maintain interpersonal relationships. Childhood trauma is believed to contribute to the development of BPD, however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we investigate the ability of participants with a diagnosis of BPD to make social judgements and recognise emotions from facial stimuli. We also explore the relationship between childhood trauma, brain structure, and brain activation in response to emotional stimuli. Methods Individuals with a diagnosis of borderline personality disorder, as well as matched healthy controls, were recruited to take part in a neuropsychology study of emotion recognition and social judgement from faces. Participants also underwent a magnetic resonance imaging (MRI) scan, during which data was collected for analysis of brain structure, and brain function in response to emotional faces. In addition, all participants completed a structured clinical interview and the Childhood Trauma Questionnaire (CTQ). Results Individuals with a diagnosis of BPD were less well able to correctly identify facial emotions than healthy control participants (p < 0.001), with a particular deficit in the recognition of disgust (p = 0.001). Those with BPD also had difficulty making appropriate social judgements about others from their faces, and between group differences were greatest for judgements of approachability (p = 0.004) and trustworthiness (p = 0.014). Significant correlations were identified between CTQ scores and performance on both tasks in the BPD group. Although no structural brain differences were noted between the BPD group and healthy controls, we found that brain activation correlated to childhood trauma in midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. There was a significant association between incidence of abuse in childhood and psychotic symptoms in adulthood. In addition, there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group, suggesting a potential relationship between childhood trauma, midbrain activity and the development of psychotic symptoms in those with a diagnosis of BPD. Conclusion Abuse in childhood is associated with impaired social and emotional function, as well as increased activation of a network of brain regions in response to emotional stimuli in BPD. Brain abnormalities in BPD appear to be confined to functional activation changes, rather than structural changes, in regions associated with emotional and social information processing. In addition, childhood trauma is correlated with increased psychotic symptoms in adulthood. These results provide striking evidence for the involvement of childhood adversity in the development of symptoms of BPD, and suggest a possible mechanism by which psychotic symptoms may occur.