Influence of dissociation on the neural correlates of Emotional Working Memory in Borderline Personality Disorder
How do dissociative states affect the ability to suppress emotional distraction (in the context of a working memory task) in patients with Borderline Personality Disorder?
- Anne Krause-Utz
This project is part of a collaboration between Leiden University and the Central Institute of Mental Health in Mannheim, Germany.
Emotion dysregulation and stress-related dissociation are key features of Borderline Personality Disorder (BPD). Previous research suggests that emotion dysregulation (hypersensitivity to emotional stimuli, affective hyper-arousal) in BPD involves an insufficient cognitive inhibition of emotional stimuli. For example, individuals with this disorder showed pronounced difficulties in shifting attention away from emotional pictures, which were presented as distractors in the context of a working memory task. In patients with BPD, impaired working memory performance (i.e. prolonged reaction times) during emotional distraction has further been associated with a hyper-reactivity of brain regions that play a key role in emotion processing such as the amygdala, and with diminished recruitment of prefrontal brain areas implicated in regulatory control. However, a high percentage of patients with BPD report stress-related dissociation, which may modulate (the neural correlates of) emotional distractibility in BPD. Dissociation involves disruptions of usually integrated functions of perception, consciousness, and affect (e.g., states of emotional numbing) and has been etiologically and trans-diagnostically related to a history of complex trauma (e.g. emotional, physical, sexual abuse and neglect). Current conceptualizations propose that dissociation may represent an over-modulation of emotions associated with dampened amygdala activity and increased prefrontal control. However, neuroimaging studies investigating activity and connectivity of the amygdala during the presentation of emotional distractors during a working memory task in BPD have been lacking. The aim of the present project is to investigate the effect of experimentally induced dissociation on brain activity and behavioral performance of an Emotional Working Memory Task in BPD patients with a history of interpersonal trauma (childhood abuse). During functional magnetic imaging (fMRI), un-medicated patients with BPD and healthy controls (matched for age and education) perform a working memory task while emotional versus neutral pictures are presented as distractors(Emotional Working Memory Task, EWMT). Beforehand, patients are exposed to a personalized script describing either a neutral situation or a situation that induced dissociation (Script driven imagery). Working memory performance (reaction times, errors) and percent signal change in the amygdala during the EWMT are compared between groups. In addition, psychophysiological Interactions (PPI) analysis is applied to investigate task-related changes in functional connectivity of the amygdala (seed region) with other areas across the whole brain.