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Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany, 2 Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany, 3 Bernstein Center for Computational
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Neuroscience, University of Heidelberg, Mannheim, Germany, 4 Department of Child and Adolescent Psychiatry, Center for
Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany, 5 University Hospital of Child and Adolescent
Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, 6 Department of Psychosomatic Medicine, Central
Institute of Mental Health, Mannheim, Germany
Background: Anger and aggression belong to the core symptoms of borderline
personality disorder. Although an early and specific treatment of BPD is highly relevant
to prevent chronification, still little is known about anger and aggression and their neural
underpinnings in adolescents with BPD.
Method: Twenty female adolescents with BPD (age 15–17 years) and 20 female healthy
adolescents (age 15–17 years) took part in this functional magnetic resonance imaging
(fMRI) study. A script-driven imagery paradigm was used to induce rejection-based
feelings of anger, which was followed by descriptions of self-directed and other-directed
aggressive reactions. To investigate the specificity of the neural activation patterns for
adolescent patients, results were compared with data from 34 female adults with BPD
(age 18–50 years) and 32 female healthy adults (age 18–50 years).
Results: Adolescents with BPD showed increased activations in the left posterior insula
and left dorsal striatum as well as in the left inferior frontal cortex and parts of the
mentalizing network during the rejection-based anger induction and the imagination of
aggressive reactions compared to healthy adolescents. For the other-directed aggression
phase, a significant diagnosis by age interaction confirmed that these results were
specific for adolescents.
Discussion: The results of this very first fMRI study on anger and aggression in
adolescents with BPD suggest an enhanced emotional reactivity to and higher effort
in controlling anger and aggression evoked by social rejection at an early developmental
stage of the disorder. Since emotion dysregulation is a known mediator for aggression in
BPD, the results point to the need of appropriate early interventions for adolescents with
BPD.
Keywords: anger, aggression, emotion regula
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