Sex differences in emotional responding have been repeatedly postulated but less consistently shown in empirical studies. Because emotional reactions are modulated by cognitive appraisal, sex differences in emotional responding might depend on differences in emotion regulation. In this study, we investigated sex differences in emotional reactivity and emotion regulation using a delayed cognitive reappraisal paradigm and measured whole-brain BOLD signal in 17 men and 16 women. During fMRI, participants were instructed to increase, decrease, or maintain their emotional reactions evoked by negative pictures in terms of cognitive reappraisal. We analyzed BOLD responses to aversive compared to neutral pictures in the initial viewing phase and the effect of cognitive reappraisal in the subsequent regulation phase. Women showed enhanced amygdala responding to aversive stimuli in the initial viewing phase, together with increased activity in small clusters within the prefrontal cortex and the temporal cortex. During cognitively decreasing emotional reactions, women recruited parts of the orbitofrontal cortex, the anterior cingulate, and the dorsolateral prefrontal cortex to a lesser extent than men, while there was no sex effect on amygdala activity. In contrast, compared to women, men showed an increased recruitment of regulatory cortical areas during cognitively increasing initial emotional reactions, which was associated with an increase in amygdala activity. Clinical implications of these findings are discussed.
Borderline personality disorder (BPD) is characterized by distinct impairments in emotion regulation, resulting in affective instability especially in the social context. It has been suggested that impaired social cognitive functioning such as impaired facial emotion recognition contributes to the social disturbances in BPD. In accordance with this notion, a number of behavioral studies have revealed a pattern of alterations in facial emotion recognition associated with BPD: subtle impairments in basic emotion recognition, a negativity or anger bias, and a heightened sensitivity to the detection of negative emotions. Furthermore, there is increasing evidence for structural and functional changes in the neural networks underlying affective dysregulation and emotional hyperreactivity in BPD. Merging these lines of evidence, we propose that emotional hyperreactivity interferes with the cognitive processes of facial emotion recognition, thereby contributing to the specific pattern of altered emotion recognition in BPD. Suggestions for future research and clinical implications are discussed.Borderline personality disorder (BPD) is characterized by a pervasive pattern of emotional instability, unstable interpersonal relations, and impaired impulse control. The most prominent clinical symptoms are recurrent self-injury, impulsive aggression and chronic suicidal tendencies, severely affecting patients and their social environment
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