Brain circuitries involved in emotional interference task in major depression and borderline personality disorders

Depression in the context of borderline personality disorder (BPD) predicts poor response to antidepressants. There is a paucity of knowledge with respect to the similarities and dissimilarities between BPD-related depression (MDD) and depression only at the neural level. Using functional MRI, 24 healthy control subjects, 21 patients with MDD only, and 14 patients with comorbid BPD and MDD were studied. The subjects were required to perform an emotional conflict task, which entailed categorizing facial affect while ignoring the affect label words. The performance of both patient groups was slower than that of the controls. The BPD group also performed less accurately during emotional recognition, revealing significantly smaller slowdown during incongruent trials compared to controls. In both patient groups, activation deficits were observed in the lateral prefrontal cortex/anterior insula region, the posterior medial frontal cortex and the parietal cortex, areas implicated in emotional conflict regulation. Collapsing across emotional face types, irrespective of the congruency type, we noticed that participants with BPD uniquely displayed much greater activation in the bilateral extrastriatal visual cortex. These data help corroborate the existence of a common abnormality pertaining to depressive symptoms in the cognitive control circuitry. Enhanced activation of the extrastriatal visual cortex is thought to reflect the intense and slowly subsiding emotions observed in BPD.