TY - JOUR
T1 - Laboratory Induced Aggression
T2 - A Positron Emission Tomography Study of Aggressive Individuals with Borderline Personality Disorder
AU - New, Antonia S.
AU - Hazlett, Erin A.
AU - Newmark, Randall E.
AU - Zhang, Jane
AU - Triebwasser, Joseph
AU - Meyerson, David
AU - Lazarus, Sophie
AU - Trisdorfer, Roanna
AU - Goldstein, Kim E.
AU - Goodman, Marianne
AU - Koenigsberg, Harold W.
AU - Flory, Janine D.
AU - Siever, Larry J.
AU - Buchsbaum, Monte S.
N1 - Funding Information:
This work was supported by the James J. Peters Veterans Affairs Medical Center and by a grant to ASN from the National Institutes of Health (NIH) (1-R01-MH067918-01) and to EAH (1-R01-MH07911) and by 5-M01 RR00071 for the Mount Sinai General Clinical Research Center from the National Center for Research Resources at the NIH.
PY - 2009/12/15
Y1 - 2009/12/15
N2 - Background: Borderline personality disorder (BPD) is often associated with symptoms of impulsive aggression, which poses a threat to patients themselves and to others. Preclinical studies show that orbital frontal cortex (OFC) plays a role in regulating impulsive aggression. Prior work has found OFC dysfunction in BPD. Methods: We employed a task to provoke aggressive behavior, the Point Subtraction Aggression Paradigm (PSAP), which has never previously been used during functional brain imaging. Thirty-eight BPD patients with intermittent explosive disorder (BPD-IED) and 36 age-matched healthy control subjects (HCs) received 18fluoro-deoxyglucose positron emission tomography (18FDG-PET) on two occasions with a provocation and nonprovocation version of the PSAP. Mean relative glucose metabolism was measured throughout the cortex, and difference scores (provoked - nonprovoked) were calculated. A whole brain exploratory analysis for the double difference of BPD-IED - HC for provoked - nonprovoked was also conducted. Results: BPD-IED patients were significantly more aggressive than HCs on the PSAP. BPD-IED patients also increased relative glucose metabolic rate (rGMR) in OFC and amygdala when provoked, while HCs decreased rGMR in these areas. However, HCs increased rGMR in anterior, medial, and dorsolateral prefrontal regions during provocation more than BPD-IED patients. Conclusions: Patients responded aggressively and showed heightened rGMR in emotional brain areas, including amygdala and OFC, in response to provocation but not in more dorsal brain regions associated with cognitive control of aggression. In contrast, HCs increased rGMR in dorsal regions of PFC during aggression provocation, brain regions involved in top-down cognitive control of aggression, and, more broadly, of emotion.
AB - Background: Borderline personality disorder (BPD) is often associated with symptoms of impulsive aggression, which poses a threat to patients themselves and to others. Preclinical studies show that orbital frontal cortex (OFC) plays a role in regulating impulsive aggression. Prior work has found OFC dysfunction in BPD. Methods: We employed a task to provoke aggressive behavior, the Point Subtraction Aggression Paradigm (PSAP), which has never previously been used during functional brain imaging. Thirty-eight BPD patients with intermittent explosive disorder (BPD-IED) and 36 age-matched healthy control subjects (HCs) received 18fluoro-deoxyglucose positron emission tomography (18FDG-PET) on two occasions with a provocation and nonprovocation version of the PSAP. Mean relative glucose metabolism was measured throughout the cortex, and difference scores (provoked - nonprovoked) were calculated. A whole brain exploratory analysis for the double difference of BPD-IED - HC for provoked - nonprovoked was also conducted. Results: BPD-IED patients were significantly more aggressive than HCs on the PSAP. BPD-IED patients also increased relative glucose metabolic rate (rGMR) in OFC and amygdala when provoked, while HCs decreased rGMR in these areas. However, HCs increased rGMR in anterior, medial, and dorsolateral prefrontal regions during provocation more than BPD-IED patients. Conclusions: Patients responded aggressively and showed heightened rGMR in emotional brain areas, including amygdala and OFC, in response to provocation but not in more dorsal brain regions associated with cognitive control of aggression. In contrast, HCs increased rGMR in dorsal regions of PFC during aggression provocation, brain regions involved in top-down cognitive control of aggression, and, more broadly, of emotion.
KW - Brain imaging
KW - PSAP
KW - Point Subtraction Aggression Paradigm
KW - emotion
UR - http://www.scopus.com/inward/record.url?scp=70450231533&partnerID=8YFLogxK
U2 - 10.1016/j.biopsych.2009.07.015
DO - 10.1016/j.biopsych.2009.07.015
M3 - Article
C2 - 19748078
AN - SCOPUS:70450231533
SN - 0006-3223
VL - 66
SP - 1107
EP - 1114
JO - Biological Psychiatry
JF - Biological Psychiatry
IS - 12
ER -