Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

BACKGROUND Inferior frontal white matter circuits are likely to be relevant to dysfunctional affect regulation, aggression, dissociative symptoms, neuropsychological functioning and psychopathology in women with borderline personality disorder (BPD) and comorbid attention-deficit hyperactivity disorder (ADHD). METHODS 20 women with BPD and comorbid ADHD and 20 healthy women were investigated, and groups were matched for age, education and premorbid intelligence. Mean diffusivity and fractional anisotropy were measured bilaterally in the inferior frontal white matter by diffusion tensor imaging (DTI). Conflict resolution was assessed by the Attention Network Test, sustained vigilance by the Degraded-Stimulus Continuous Performance Test. RESULTS Among women with BPD and comorbid ADHD, increased mean diffusivity in inferior frontal white matter was associated with higher levels of dysfunctional affect regulation, anger-hostility, dissociative symptoms, and general psychopathology (p<.05, uncorrected). Poor conflict resolution during the attention task was positively associated with anger-hostility, psychopathology, dissociation and the number of ADHD-symptoms, but not related to DTI variables. Both groups did not differ significantly with respect to DTI variables or neuropsychological performance. In the BPD group, a lifetime history of major depression or a current eating disorder were associated with impaired inferior frontal white matter integrity, while a history of sexual abuse or a current posttraumatic stress disorder were not. CONCLUSIONS Inferior frontal white matter microstructural abnormalities may be linked to key aspects of psychopathology in women with BPD and comorbid ADHD and add to alterations in orbitofrontal and limbic areas. The relationship between neuropsychological functioning and white matter structure remains unclear.

[1]  R. C. Oldfield.  The assessment and analysis of handedness: the Edinburgh inventory. , 1971, Neuropsychologia.

[2]  Derek K. Jones.  Fundamentals of diffusion MR imaging , 2004 .

[3]  Ravi S. Menon,et al.  Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation , 2002, Biological Psychiatry.

[4]  Alexander L. Chapman,et al.  Psychometric Properties of the Borderline Symptom List (BSL) , 2007, Psychopathology.

[5]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[6]  P. Wender,et al.  The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. , 1993, The American journal of psychiatry.

[7]  Jin Fan,et al.  The activation of attentional networks , 2005, NeuroImage.

[8]  A. Fossati,et al.  History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. , 2002, Comprehensive psychiatry.

[9]  M. Bohus,et al.  A voxel-based morphometric MRI study in female patients with borderline personality disorder , 2003, NeuroImage.

[10]  C. Spitzer,et al.  Adaptation and Psychometric Properties of the German Version of the Dissociative Experience Scale , 1998, Journal of traumatic stress.

[11]  K. Krishnan,et al.  Diffusion tensor imaging: background, potential, and utility in psychiatric research , 2003, Biological Psychiatry.

[12]  E. Bullmore,et al.  Functional dysconnectivity in schizophrenia associated with attentional modulation of motor function. , 2005, Brain : a journal of neurology.

[13]  J. Grafman,et al.  Frontal lobe injuries, violence, and aggression , 1996, Neurology.

[14]  E T Rolls,et al.  Impulsivity, time perception, emotion and reinforcement sensitivity in patients with orbitofrontal cortex lesions. , 2004, Brain : a journal of neurology.

[15]  J. Guzder,et al.  Neuropsychological factors associated with borderline pathology in children. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[16]  M. Rössler,et al.  Wender Utah Rating Scale (WURS-k) Die deutsche Kurzform zur retrospektiven Erfassung des hyperkinetischen Syndroms bei Erwachsenen , 2002, Der Nervenarzt.

[17]  J. Gruzelier,et al.  Neuropsychology, Psychophysiology And Information Processing , 1991 .

[18]  M S Mega,et al.  Frontal-subcortical circuits and neuropsychiatric disorders. , 1994, The Journal of neuropsychiatry and clinical neurosciences.

[19]  M. Gastpar,et al.  Attention deficit hyperactivity disorder and borderline personality disorder , 2005, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[20]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[21]  M. Holz,et al.  Temperature-dependent self-diffusion coefficients of water and six selected molecular liquids for calibration in accurate 1H NMR PFG measurements , 2000 .

[22]  J Douglas Bremner,et al.  Neuroimaging in borderline personality disorder. , 2006, Journal of psychiatric research.

[23]  Bruce D. McCandliss,et al.  Testing the Efficiency and Independence of Attentional Networks , 2002, Journal of Cognitive Neuroscience.

[24]  G. Teuchert-Noodt,et al.  Influence of methylphenidate on brain development – an update of recent animal experiments , 2006, Behavioral and Brain Functions.

[25]  N. Makris,et al.  Structural Brain Imaging of Attention-Deficit/Hyperactivity Disorder , 2005, Biological Psychiatry.

[26]  T. McGlashan,et al.  The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. , 2005, Journal of personality disorders.

[27]  E. Bernstein,et al.  Development, reliability, and validity of a dissociation scale. , 1986, The Journal of nervous and mental disease.

[28]  Nathalie Vizueta,et al.  Attentional mechanisms of borderline personality disorder , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[29]  V. Wedeen,et al.  Reduction of eddy‐current‐induced distortion in diffusion MRI using a twice‐refocused spin echo , 2003, Magnetic resonance in medicine.

[30]  Michael S. Gaffrey,et al.  Activity and functional connectivity of inferior frontal cortex associated with response conflict. , 2005, Brain research. Cognitive brain research.

[31]  C. Frith,et al.  A fronto-parietal network for rapid visual information processing: a PET study of sustained attention and working memory , 1996, Neuropsychologia.

[32]  Natalia Ojeda,et al.  Functional neuroanatomy of sustained attention in schizophrenia: Contribution of parietal cortices , 2002, Human brain mapping.

[33]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[34]  R. Stieglitz,et al.  Entwicklung der Borderline- Symptom-Liste , 2001 .

[35]  G. Bush,et al.  Dorsolateral Prefrontal and Anterior Cingulate Cortex Volumetric Abnormalities in Adults with Attention-Deficit/Hyperactivity Disorder Identified by Magnetic Resonance Imaging , 2006, Biological Psychiatry.

[36]  G. Triebig,et al.  Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence , 1995, Acta neurologica Scandinavica.

[37]  E. Rolls,et al.  Borderline personality disorder, impulsivity, and the orbitofrontal cortex. , 2005, The American journal of psychiatry.

[38]  C. Beaulieu,et al.  The basis of anisotropic water diffusion in the nervous system – a technical review , 2002, NMR in biomedicine.

[39]  M. Hoptman,et al.  Frontal white matter microstructure, aggression, and impulsivity in men with schizophrenia: a preliminary study , 2002, Biological Psychiatry.

[40]  T. Thiel,et al.  Frontoorbital volume reductions in adult patients with attention deficit hyperactivity disorder , 2002, Neuroscience Letters.

[41]  M. First,et al.  Structured clinical interview for DSM-IV axis II personality disorders : SCID-II , 1997 .

[42]  Shannan Henry,et al.  Neuroimaging Studies in Eating Disorders , 2004, CNS Spectrums.

[43]  E. Rolls,et al.  Changes in emotion after circumscribed surgical lesions of the orbitofrontal and cingulate cortices. , 2003, Brain : a journal of neurology.

[44]  Klaus Lieb,et al.  Borderline personality disorder , 2004, The Lancet.

[45]  K. Phan,et al.  Neuroimaging and personality disorders , 2005, Current psychiatry reports.

[46]  James R. MacFall,et al.  Dorsolateral Prefrontal Cortex and Anterior Cingulate Cortex White Matter Alterations in Late-Life Depression , 2006, Biological Psychiatry.

[47]  Tobias Egner,et al.  Hypnosis decouples cognitive control from conflict monitoring processes of the frontal lobe , 2005, NeuroImage.

[48]  Lr Derogatis,et al.  SCL-90-R, Administration, Scoring, and Procedures Manual-II for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series , 1983 .

[49]  G. Bush,et al.  Cortical thinning of the attention and executive function networks in adults with attention-deficit/hyperactivity disorder. , 2007, Cerebral cortex.

[50]  K. Nuechterlein.  Vigilance of schizophrenia and related disorders , 1991 .

[51]  Single‐shot diffusion‐weighted RARE sequence: Application for temperature monitoring during hyperthermia session , 1998 .

[52]  Louis Lemieux,et al.  Frontolimbic brain abnormalities in patients with borderline personality disorder a volumetric magnetic resonance imaging study , 2003, Biological Psychiatry.

[53]  E. Rolls.  The functions of the orbitofrontal cortex , 1999, Brain and Cognition.

[54]  R. Davidson,et al.  Dysfunction in the neural circuitry of emotion regulation--a possible prelude to violence. , 2000, Science.

[55]  J. Paris.  The diagnosis of borderline personality disorder: problematic but better than the alternatives. , 2005, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[56]  T. Dietrich,et al.  Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study , 2001, Biological Psychiatry.

[57]  M. Holz,et al.  Biological applications of scanning tunnelling microscopy , 1993 .