Reduced neural differentiation between self-referential cognitive and emotional processes in women with borderline personality disorder.

Borderline personality disorder (BPD) is associated with disturbed emotion regulation. Psychotherapeutic interventions using mindfulness elements have shown effectiveness in reducing clinical symptoms, yet little is known about their underlying neurobiology. In this functional magnetic resonance imaging (fMRI) study, 19 female BPD patients and 19 healthy controls were compared during mindful introspection, cognitive self-reflection and a neutral condition. The activation pattern in the right dorsomedial prefrontal cortex (DMPFC) in BPD patients was different from that in healthy subject when directing attention onto their emotions and bodily feelings in contrast to cognitively thinking about themselves. Mindful introspection compared with the neutral condition was associated with higher activations in bilateral motor/pre-motor regions, left inferior frontal gyrus (IFG), and left posterior cingulate cortex (PCC), while cognitive self-reflection activated the right motor and somatosensory cortex, extending into the right supramarginal gyrus (SMG) and superior temporal gyrus (STG) in BPD patients compared with the controls. Results indicate that self-referential cognitive and emotional processes are not clearly differentiated in BPD patients at the neurobiological level. In particular, altered neural mechanism underlying self-referential thinking may be related to some aspects of the typical emotion dysregulation in BPD. Current data support the finding that mindful self-focused attention is effective in regulating amygdala activity in BPD as well as in healthy subjects.

[An internet based discussion board for persons with borderline personality disorders moderated health care professionals]. / Fachlich moderiertes Internetforum für Menschen mit Borderline-Persönlichkeitsstörung.

OBJECTIVE: From a psychiatric viewpoint the internet as a communication medium bears some risks but also has some exceptional potential. The paper reports about an internet based discussion board that specifically addressed people with borderline personality disorder and that was continuously moderated by mental health professionals. METHODS: Discussion board participants were monitored over the course of the study with regard to the perceived helpfulness of the board discussion and psychological symptoms assessed with brief versions of the Symptom Checklist (SCL-10) and the Borderline Symptom List (BSL-15). RESULTS: With more than 16 000 log-ins during the last month the web board found wide acceptance. The majority of the users stated, that the internet can easily reach people with mental health problems and reported that the continuous support by mental health professionals was helpful. Over the course of the project the web board users reported reductions with regard to the severity and frequency of borderline symptoms. CONCLUSIONS: The results suggest that the internet might be helpful in the treatment of borderline patients, especially with regard to the coordination of therapeutical interventions or as an amendment of traditional face-to-face therapies.