Neuronale Korrelate emotionaler Dysregulation bei Patienten mit Borderline-Persönlichkeitsstörung

Zusammenfassung

Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwerwiegende psychiatrische Erkrankung, die insbesondere durch eine Störung der Emotionsregulation gekennzeichnet ist. Gängige neuronale Modelle der Emotionsregulation gehen davon aus, dass zwei Prozesse in diesem Zusammenhang von Bedeutung sind: einerseits ein ventrales neuronales Netzwerk, welches für die Emotionsentstehung entscheidend ist (bottom-up) und andererseits präfrontale neuronale Strukturen, die mittels kognitiver Kontrollmechanismen der Emotionsregulation dienen (top-down). Neuere Forschung weist auf die Bedeutung impliziter Emotionsregulation unabhängig von exekutiven Funktionen hin. Untersuchungen zu neuronalen Korrelaten emotionaler Dysregulation bei der BPS finden vor allem eine Hyperreaktivität der Amygdala, die als erhöhte Sensibilität für emotionale Reize und Grundlage emotionaler Instabilität gedeutet werden kann. Psychotherapeutische Ansätze zeigen dazu passend eine Reduktion dieser erhöhten emotionalen Sensitivität im Sinne reduzierter Amygdalaaktivierung in Folge der Behandlung. In Bezug auf die Mechanismen einer veränderten Emotionsregulation bleiben die Befunde uneindeutig, was der geringen Stichprobengröße und großen Methodenvariabilität, aber auch einer notwendigen Erweiterung von Emotions-regulationsmodellen geschuldet sein kann.

Summary

Borderline personality disorder (BPD) is a severe psychiatric disorder particularly characterized by dysfunctional emotion regulation. Current neural models of emotion regulation have identified two relevant processes: a ventral neural network responsible for the appraisal of emotional stimuli and subsequent generation of an emotional response (bottom-up) on the one hand and prefrontal areas associated with cognitive control and emotion regulation (top-down) on the other hand. In addition present research highlighted the importance of implicit emotion regulation without recruitment of executive functions. The most consistent finding of studies regarding neural correlates of emotion dysregulation in BPD is an enhanced activity of the amygdala compared to controls which can be interpreted as heightened emotional sensitivity and probable source of emotional instability. Psychotherapeutic approaches result accordingly in reduced amygdala reactivity following treatment. Concerning altered emotion regulation findings are mixed which could be due to small sample sizes, variable methods or the need for a more complex model of emotion regulation.

Schlüsselwörter

Borderline-Persönlichkeitsstörung - Emotions-regulation - fMRT

Keywords

Borderline personality disorder - emotion regulation - fMRI

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