Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.

中文翻译：

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边缘性人格障碍女性羞耻和内疚体验的神经基础。

边缘型人格障碍（BPD）的特点是情感不稳定、情绪失调和人际功能障碍。尤其是羞耻和内疚，即所谓的自我意识情绪，与 BPD 具有重要的临床相关性。然而，只有少数实验研究关注 BPD 中的羞耻或内疚，并且没有研究研究其神经生物学基础。在目前的功能磁共振成像研究中，我们采用基于场景的方法，以中性场景作为控制条件，通过实验诱导羞耻感、内疚感和厌恶感。我们纳入了 19 名 BPD 女性（年龄 26.4 ± 5.8 岁；经 DSM-IV 诊断；接受药物治疗）和 22 名健康女性对照受试者（年龄 26.4 ± 4.6 岁；年龄和语言智商匹配）。与对照组相比，患有边缘性人格障碍的女性在面对情感情景时表现出更强烈的感受，尤其是更高程度的羞耻、内疚和恐惧。我们发现，与羞耻和内疚的对照相比，BPD 中杏仁核的反应性有所增加，但厌恶场景的反应性却没有增加（p = 0.05 FWE 在集群级别进行了校正；p < 0.0001 集群定义阈值）。探索性分析表明，这是由于边缘性人格障碍女性相对于对照组参与者的习惯性降低所致。这种效应是特定于内疚和羞耻场景的，因为两组人的杏仁核都表现出对厌恶场景的习惯。我们的研究表明，边缘性人格障碍患者的羞耻感和内疚感加剧与杏仁核活动本身的增加无关，而是与自我意识情绪的习惯减少有关。这解释了先前关于 BPD 中杏仁核参与的影像学工作的不一致，以及该患者群体中功能​​失调的自我意识情绪的心理治疗通常进展缓慢。