Neural correlates of emotional action control in anger-prone women with borderline personality disorder

Background: Difficulty in controlling emotional impulses is a crucial component of borderline personality disorder (BPD) that often leads to destructive, impulsive behaviors against others. In analogue to recent findings in aggressive samples, deficits in prefrontalamygdala coupling during emotional action control may account for these symptoms. Methods: To study the neurobiological correlates of altered emotional action control in BPD, 30 medication-free, anger-prone, female BPD-patients and 28 age- and intelligence-matched healthy women took part in an Approach-Avoidance task while lying in the MR-scanner. The task required controlling fast behavioral tendencies to approach happy and avoid angry faces. Additionally, saliva testosterone and self-report tendencies to act out anger were collected before the task and correlated with behavioral and fMRI data. Results: BPD-patients reported increased tendencies to act out anger and were faster in approaching than avoiding angry faces compared to healthy women, suggesting deficits in emotional action control in BPD. On a neural level, controlling fast emotional action tendencies was related to enhanced activation in the antero- and dorsolateral prefrontal cortex across groups. Healthy volunteers showed a negative coupling between the left dorsolateral prefrontal cortex and right amygdala, whereas this was absent in BPD-patients. Limitations: Specificity of results for BPD and sex differences remain unknown due to lack of clinical control groups and male participants. Conclusion: The results indicate reduced lateral prefrontal-amygdala communication during emotional action control in anger-prone BPD-patients. The findings provide a possible neural mechanism underlying difficulties with controlling emotional impulses in BPD