Neurobiological background of borderline personality disorder, PTSD and ADHD

Excerpt

Deficits in emotional learning and memory are a core feature in borderline personality disorder (BPD). However, studies investigating the underlying neuronal substrates are lacking. In a functional magnetic resonance imaging (fMRI) study, Krause-Utz et al. [1] investigated 27 medication-free female patients with BPD and 26 female controls with fMRI during a differential delay aversive conditioning paradigm. Besides skin conductance response in subjective ratings, the authors also investigated valence and arousal. They found increased insula activity in BPD patients compared with healthy controls during early acquisition. During extinction, patients had more arousal and activated the amygdala in response to the conditioned stimulus. Amygdala habituation to this stimulus during acquisition was found in healthy controls but not in patients. Altered temporal response patterns with increased vigilance during early acquisition and delayed extinction processes may be a neurobiological background of emotional cognitive symptoms in BPD. In the disorder, genetic and environmental factors may interact and influence response of the hypothalamus–pituitary–adrenal (HPA) axis. In a case–control study, Martín-Blanco et al. [2] for the first time investigated 47 polymorphisms in 10 HPA axis genes and assessed the presence of childhood trauma in a group of 481 patients with BPD and 442 healthy controls. Two polymorphisms in the FKBP5 gene and haplotype combinations of the genes FKBP5 and CRHR1 showed significant associations with BPD. Interestingly, two FKBP5 alleles were more frequent in patients with history of physical abuse and emotional neglect and two CRHR2 variants in patients with sexual and physical abuse. Altogether, these results suggest the involvement of genes of the HPA axis and interaction with environmental factors in the pathophysiology of BPD. …