Mapping the brain correlates of borderline personality disorder: A functional neuroimaging meta-analysis of resting state studies

Background: Altered intrinsic function of the brain has been implicated in Borderline Personality Disorder (BPD). Nonetheless, imaging studies have yielded inconsistent alterations of brain function. To investigate the neural activity at rest in BPD, we conducted a set of meta-analyses of brain imaging studies performed at rest. Methods: A total of seven functional imaging studies (152 patients with BPD and 147 control subjects) were combined using whole-brain Signed Differential Mapping meta-analyses. Furthermore, two conjunction meta-analyses of neural activity at rest were also performed: with neural activity changes during emotional processing, and with structural differences, respectively. Results: We found altered neural activity in the regions of the default mode network (DMN) in BPD. Within the regions of the midline core DMN, patients with BPD showed greater activity in the anterior as well as in the posterior midline hubs relative to controls. Conversely, in the regions of the dorsal DMN they showed reduced activity compared to controls in the right lateral temporal complex and bilaterally in the orbitofrontal cortex. Increased activity in the precuneus was observed both at rest and during emotional processing. Reduced neural activity at rest in lateral temporal complex was associated with smaller volume of this area. Limitations: Heterogeneity across imaging studies. Conclusions: Altered activity in the regions of the midline core as well as of the dorsal subsystem of the DMN may reflect difficulties with interpersonal and affective regulation in BPD. These findings suggest that changes in spontaneous neural activity could underlie core symptoms in BPD