Elsevier

Biological Psychiatry

Volume 55, Issue 6, 15 March 2004, Pages 603-611
Biological Psychiatry

Original article
Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder

https://doi.org/10.1016/j.biopsych.2003.08.018Get rights and content

Abstract

Background

Early traumatization and additional posttraumatic stress disorder are frequent in patients with borderline personality disorder (BPD). The purpose of this study was to investigate neural correlates of traumatic memory in BPD with and without posttraumatic stress disorder (PTSD) using functional magnetic resonance imaging (fMRI).

Methods

We studied 12 traumatized female patients BPD, 6 of them with and 6 without PTSD. According to an autobiographical interview key words (cues) were defined for traumatic and for negative but nontraumatic episodes. In a block-designed fMRI task patients recalled these episodes. Contrasts between trauma condition and nontrauma condition were analyzed.

Results

Analyses for all subjects revealed activation of orbitofrontal cortex areas in both hemispheres, anterior temporal lobes, and occipital areas. In the subgroup without PTSD, activation of orbitofrontal cortex on both sides and Broca’s area predominated. In the subgroup with additional PTSD, we observed right more than left activation of anterior temporal lobes, mesiotemporal areas, amygdala, posterior cingulate gyrus, occipital areas, and cerebellum.

Conclusions

Dependent on absence or presence of additional PTSD different neural networks seem to be involved in the traumatic memory of patients with BPD.

Section snippets

Subjects

Twelve Caucasian, 21-year-old to 40-year-old, female traumatized BPD patients were included in the study. All of them were treated for BPD as inpatients in the Gilead Hospital or in the Ev. Johannes Hospital, Bielefeld, Germany, during 2001 and 2002. All patients met DSM-IV criteria of BPD, assessed by the treating psychotherapists within the first week after admission. Participants were neither pregnant nor had any of the following current or previous medical conditions, which were assessed by

Clinical assessment and memory testing

The clinical assessment was similar to that in a previous study (Driessen et al 2000), but participants completed the full Structured Clinical Interview for DSM-IV (SCID) (Wittchen et al 1997). Current psychopathology was assessed by the Beck Depression Inventory (BDI) (Beck and Steer 1994), the Symptom Checklist (SCL-90-R) (Franke 1995), and the Dissociative Experiences Scale (DES) (Bernstein and Putnam 1986; German version by Freyberger et al 1999). Traumatization history was assessed by the

Autobiographical interview and traumatic memories

The method of script-driven stimulation has been applied not only in neuroimaging studies of traumatized subjects Bremner et al., 1999a, Lanius et al., 2002, Lanius et al., 2003 but also in those of other psychiatric and neurologic conditions like addictive disorders (Kilts et al 2001) and epilepsy (Jokeit et al 2001). Basing on these experiences, we applied a semistructured autobiographical research interview Fischer-Rosenthal, 1991, Hopf, 1991, Witzel, 1985 1 week before fMRI acquisition. The

Case report

Patient 2 was sexually abused by her teacher in the hall of the residence. The key words (cues) for this traumatic episode were teacher, hall of residence, and touch. She also reported a severe sunburn with medical consequences for 2 days during a hiking tour on the island of Malta. The key words (cues) for this nontraumatic episode were sun, Malta, and hiking.

The key words were agreed upon with the patients as cue stimuli for the active recall of the episode during fMRI (cue-driven method).

Stimulus presentation and design

Structural scanning was obtained in the days before fMRI to exclude brain damage, and all technical and study details were explained. On the day of fMRI acquisition, we started the protocol with a self-rating scale (see below) before patients entered the tomograph. We chose a boxcar design with presentation of two activation conditions (trauma condition and nontrauma condition) in a between-subjects randomly balanced order and with the presentation of a baseline condition (BC). The design

MRI acquisition

Magnetic resonance imaging scanning was performed on a 1.5 Tesla scanner (Siemens Magnetom Symphony, Erlangen, Germany) equipped with a standard head coil. On the day of fMRI, scout images were obtained. Sagittal T1-weighted images were obtained in each subject, scanning to position the axial T2*-weighted images along the anterior commissure-posterior commissure (AC-PC) line. For fMRI, 16 contiguous axial T2*-weighted images covering the brain with a slice thickness of 7 mm were obtained using

Image and statistical analyses

Functional MRI data were analyzed using SPM99 (Wellcome Department of Imaging Neuroscience, London, United Kingdom; http://www.fil.ion.ucl.ac.uk/spm99, accessed September 26, 2003) for all image preprocessing and voxel-based statistical analyses within the context of the general linear model. Image realignment corrected for head movement using the SPM99 default algorithm. Spatial normalization reduced anatomical differences before group comparisons, again using default settings and the standard

Sample characteristics and traumatization history

The mean age of our sample was 32.7 ± 9.3 years, and five patients (41.7%) lived in a partnership. The mean time of education was 11.2 ± 1.6 years with five patients (41.7%) having reached a high school degree (the German “Abitur”). All patients were right-handed. There were no significant differences between the patients with and without additional current PTSD (each subgroup n = 6) with regard to comorbid psychiatric diagnoses, psychopathology, traumatization history, and prescribed

Discussion

In this fMRI study of severely traumatized women with BPD, we compared the autobiographical memory of traumatic episodes (TC) with that of aversive but nontraumatic episodes (NTC). Patients reported higher levels of anxiety, helplessness, and tactile sensations, as well as stronger feelings of unreality, in the TC compared with the NTC. Although we did not measure additional physiologic parameters (like heart rate and blood pressure), these results indicate the subjects' actual engagement in

Acknowledgements

Parts of this study were supported by the Deutsche Forschungsgemeinschaft (DFG) Grant Dr 358/5–1. We thank our patients for their readiness to engage in this study, and the Society of Epilepsy Research Bethel for providing scan time.

References (61)

  • W.D. Taylor et al.

    Smaller orbital frontal cortex volumes associated with functional disability in depressed elders

    Biol Psychiatry

    (2003)
  • B.A. van der Kolk et al.

    Trauma and the development of borderline personality disorder

    Psychiatr Clin North Am

    (1994)
  • A.T. Beck et al.

    Beck-Depressions-Inventar: (BDI); Testhandbuch

    (1994)
  • D.P. Bernstein et al.

    CTQ Childhood Trauma Questionnaire. A Retrospective Self –Report. Manual

    (1998)
  • E.M. Bernstein et al.

    Development, reliability, and validity of a dissociation scale

    J Nerv Ment Dis

    (1986)
  • J.R. Binder et al.

    Determination of language dominance using functional MRIA comparison with the Wada test

    Neurology

    (1996)
  • J.D. Bremner et al.

    Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder

    Am J Psychiatry

    (1999)
  • Brett M (1999): The MNI brain and the Talairach atlas. Available online at...
  • C. Brewin

    Memory processes in post-traumatic disorder

    Int Rev Psychiatry

    (2001)
  • C.R. Brewin et al.

    A dual representation theory of posttraumatic stress disorder

    Psychol Rev

    (1996)
  • R. Cabeza et al.

    Age-related differences in neural activity during memory encoding and retrievalA positron emission tomography study

    J Neurosci

    (1997)
  • R.J. Davidson et al.

    DepressionPerspectives from affective neuroscience

    Annu Rev Psychol

    (2002)
  • W.C. Drevets

    Functional neuroimaging studies of depressionThe anatomy of melancholia

    Annu Rev Med

    (1998)
  • M. Driessen et al.

    Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization

    Arch Gen Psychiatry

    (2000)
  • G.R. Fink et al.

    Cerebral representation of one's own pastNeural networks involved in autobiographical memory

    J Neurosci

    (1996)
  • W.B. Fischer-Rosenthal

    iographische Methoden in der Soziologie

  • G. Franke

    Die Symptom-Checkliste von Degoratis - Deutsche Version

    (1995)
  • H.J. Freyberger et al.

    Fragebogen zu dissoziativen Symptomen

    (1999)
  • C. Härting et al.

    Wechsler Gedächtnistest—Revidierte Fassung

    (2000)
  • R.N. Henson et al.

    Right prefrontal cortex and episodic memory retrievalA functional MRI test of the monitoring hypothesis

    Brain

    (1999)
  • Cited by (144)

    • Stress, the brain, and trauma spectrum disorders

      2020, International Review of Neurobiology
    • The dynamic Duo: Combining noninvasive brain stimulation with cognitive interventions

      2019, Progress in Neuro-Psychopharmacology and Biological Psychiatry
    • The cerebellum in fear and anxiety-related disorders

      2018, Progress in Neuro-Psychopharmacology and Biological Psychiatry
    View all citing articles on Scopus
    View full text