Cognitive reappraisal in trauma-exposed women with borderline personality disorder

Borderline personality disorder (BPD) is characterized by emotional dysregulation and a high prevalence of traumatic stress. Recent estimates suggest that 2-6% of non-clinical populations suffer from BPD. Despite this relevance, this is the first study considering the neural mechanisms underlying trauma-history and temporal features of cognitive reappraisal in non-clinical BPD patients using script-driven stimuli. Using functional magnetic resonance imaging (fMRI), we examined subjective ratings of negative emotional experience and brain activity following up- and down-regulation of emotional responses to standardized negative scripts in 43 women: 14 trauma-exposed BPD patients (BPD), 14 trauma-exposed healthy subjects without posttraumatic stress disorder (non-PTSD), and 15 non-traumatized healthy subjects (HC). Behaviorally, all groups were able to use cognitive reappraisal to up- and down-regulate negative emotions. HC subjects showed increased early activation in the prefrontal cortex (PFC) and the amygdala following up-regulation of emotions to negative scripts, whereas BPD and non-PTSD subjects showed early deactivation in the PFC. Additionally, the anterior cingulate cortex was more activated in HC subjects than in BPD and non-PTSD subjects during up- and down-regulation. No significant group differences were found between BPD patients and non-PTSD. BPD patients and healthy individuals with trauma history do not engage the cognitive control regions to the extent than HC subjects do when employing down-regulation of negative emotions. They also do not activate the brain regions associated with emotional up-regulation. These findings may reflect compensatory changes associated with trauma-exposure.