Alterations in Default Mode Network Connectivity During Pain Processing in Borderline Personality Disorder

Abstract

Context Recent neuroimaging studies have associated activity in the default mode network (DMN) with self-referential and pain processing, both of which are altered in borderline personality disorder (BPD). In patients with BPD, antinociception has been linked to altered activity in brain regions involved in the cognitive and affective evaluation of pain. Findings in healthy subjects indicate that painful stimulation leads to blood oxygenation level-dependent (BOLD) signal decreases and changes in the functional architecture of the DMN. Objective To connect the previously separate research areas of DMN connectivity and altered pain perception in BPD and explore DMN connectivity during pain processing in patients with BPD. Design Case-control study Setting A university hospital Participants Twenty-five women with BPD, 92 percent with a history of self-harm, and 22 age-matched controls. Interventions Psychophysical assessment and functional MRI (fMRI) during painful heat versus neutral temperature stimulation. Main Outcome Measure DMN connectivity as assessed via independent component analysis and psychophysiological interaction analysis. Results Compared to controls, patients with BPD showed less integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN. Higher BPD symptom severity and trait dissociation were associated with an attenuated signal decrease of the DMN in response to painful stimulation. During “pain” versus “neutral”, BPD patients exhibited less posterior cingulate cortex seed region connectivity with the left dorsolateral prefrontal cortex. Conclusion Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics. These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive, and a deficiency in the switching between baseline and task-related processing. This deficiency may be related to everyday difficulties of BPD patients to regulate their emotions, focus mindfully on one task at a time, and efficiently shift their attention from one task to another.

Dysregulation between emotion and theory of mind networks in borderline personality disorder

“…Of the research that exists, one study explored alterations in the functional connectivity of the DMN in patients with BPD during pain processing. This particular study observed less integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN in the BPD group than in the controls during pain appraisal (Kluetsch et al, 2012). An earlier study explored prefrontal and limbic resting state networks in BPD patients without any external stimulus.…”

Mapping the brain correlates of borderline personality disorder: A functional neuroimaging meta-analysis of resting state studies

“…In patients with BPD, increased activity in the precuneus and posterior cingulate has been associated with processing affectively charged scenes (Koenigsberg et al, 2009) as well as social exclusion clues (Domsalla et al, 2014) and altered functional connectivity in these areas has been linked with disturbances in self-referential and emotional processing of pain (Kluetsch et al, 2012;. A relative functional hyperactivity in posterior cingulate during emotion processing has been reported in BPD, possibly suggesting an increased selfrelevance of negative stimuli (Schulze et al, 2016).…”

“…This finding can suggest an intrinsic rather than a processdependent alteration of the neural activity in these regions. Specifically, a persistent activity of precuneus/posterior cingulate may reflect an altered ability to allocating attention;; BPD patients may focus too much on autobiographical/self-referential cues (Scherpiet et al, 2014) and may have problems with switching attention from this "baseline" state to external, task-related demands (Kluetsch et al, 2012;; Schulze et al, 2016). For instance, BPD patients show altered self-referential processing of social events ("hypermentalization", (Sharp et al, 2013), which can affect both the evaluation and memory of social events and contribute to their interpersonal dysfunction;; thus, they may benefit from interventions aimed toward redirecting attention from the self to others (Winter et al, 2015).…”

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…These findings possibly point to a shared vulnerability for two symptoms of BPD (unstable sense of self, unstable interpersonal relationships). Evidence from the BPD literature suggests that other symptoms, such as dissociation, may also be related to functional connectivity in the DMN [92,93]. These findings suggest that further exploring these networks (e.g., the DMN, MNS, or E-network) may provide novel avenues for understanding multiple symptoms in BPD.…”

“…As we argue in this project, a networkbased approach, focusing on the broader circuits at play such as the DMN, SN, and CEN is an important direction for BPD neuroimaging research and may help overcome the limitations of such a piecemeal literature. A few studies have already begun this work and find compelling evidence for the role that altered activation in these networks (measured using rs-fMRI, while the brain is not performing a specific task and is therefore considered at rest) plays in BPD pathology [72,92,185]. Additionally, we know that these neural regions and networks interplay in complex patterns in order to execute the processes associated with affect, cognition, and behavior and altered interactions between networks and regions likely underlies pathology.…”