Structural brain abnormalities and suicidal behavior in borderline personality disorder

Abstract

Background: Structural brain abnormalities have been demonstrated in subjects with BPD in prefrontal and fronto-limbic regions involved in the regulation of emotion and impulsive behavior, executive cognitive function and episodic memory. Impairment in these cognitive functions is associated with increased vulnerability to suicidal behavior. We compared BPD suicide attempters and non-attempters, high and low lethality attempters to healthy controls to identify neural circuits associated with suicidal behavior in BPD.

Methods: Structural MRI scans were obtained on 68 BPD subjects (16 male, 52 female), defined by IPDE and DIB/R criteria, and 52 healthy controls (HC: 28 male, 24 female). Groups were compared by diagnosis, attempt status, and attempt lethality. ROIs were defined for areas reported to have structural or metabolic abnormalities in BPD, and included: mid-inf. orbitofrontal cortex, mid-sup temporal cortex, anterior cingulate, insula, hippocampus, amygdala, fusiform, lingual and parahippocampal gyri. Data were analyzed using optimized voxel-based morphometry implemented with DARTEL in SPM5, co-varied for age and gender, corrected for cluster extent (p < .001).

Results: Compared to HC, BPD attempters had significantly diminished gray matter concentrations in 8 of 9 ROIs, non-attempters in 5 of 9 ROIs. Within the BPD sample, attempters had diminished gray matter in Lt. insula compared to non-attempters. High lethality attempters had significant decreases in Rt. mid-sup. temporal gyrus, Rt. mid-inf. orbitofrontal gyrus, Rt. insular cortex, Lt. fusiform gyrus, Lt. lingual gyrus and Rt. parahippocampal gyrus compared to low lethality attempters.

Conclusions: Specific structural abnormalities discriminate BPD attempters from non-attempters and high from low lethality attempters.

Figure 1

The figure depicts reductions in gray matter volume in all BPD relative to controls assessed using DARTEL. Significant clusters (cluster level correction: p<.001) are projected to the cortical surface on bilateral lateral views (a), medial views (b) and ventral views (c). Collectively these ortho-projections convey volumetric reductions in brain regions relevant to BPD that are consistent with previous studies in independent samples. The regions with reductions including the insula, the middle and superior temporal cortex (Mid-Sup T), the fusiform gyrus (FG), the anterior cingulate cortex (ACC), the hippocampus and the parahippocampus and the amygdala (AMY).

Fig. 2

The figure depicts reductions in gray matter volume in BPD suicide attempters relative to controls assessed using DARTEL. Significant clusters (cluster level correction: p<.001) are projected to the cortical surface on bilateral lateral views (a), medial views (b) and ventral views (c) These ortho-projections convey robust volumetric reductions in BPD attempters in the insula, the middle and inferior orbito-frontal cortex (OFC), the fusiform gyrus (FG), the lingual gyrus, the anterior cingulate cortex (ACC), the mid.-sup. temporal cortex, the hippocampus and the parahippocampus.

Fig. 3

The figure depicts reductions in gray matter volume in high lethality suicide attempters relative to low lethality attempters assessed using DARTEL. Significant clusters (cluster level correction: p<.001) are projected to the cortical surface on bilateral lateral views (a), medial views (b) and ventral views (c). The naming schemes are consistent with Figure 1. High-lethality attempters show robust volumetric reductions in mid-sup. temporal cortex, mid-inf-OFC, insula, fusiform gyrus, lingual gyrus, and parahippocampus.