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Incision and stress regulation in borderline personality disorder: Neurobiological mechanisms of self-injurious behaviour

  • Sarah Reitz (a1), Rosemarie Kluetsch (a1), Inga Niedtfeld (a1), Teresa Knorz (a1), Stefanie Lis (a1), Christian Paret (a2), Peter Kirsch (a3), Andreas Meyer-Lindenberg (a4), Rolf-Detlef Treede (a5), Ulf Baumgärtner (a5), Martin Bohus (a1) and Christian Schmahl (a1)...

Abstract

Background

Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress.

Aims

Investigation of neurobiological mechanisms of NSSI in borderline personality disorder

Method

In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed.

Results

We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group.

Conclusions

Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.

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Copyright

Corresponding author

Christian Schmahl, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany. Email: christian.schmahl@zi-mannheim.de

Footnotes

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These authors contributed equally to this work.

Declaration of interest

A.M.-L. has received fees for consultancy from AstraZeneca, Bristol Myers Squibb, Defined Health, Desitin Arzneimittel, Elsevier, F. Hoffmann-La Roche, Gerson Lehrman Group, Lundbeck, Outcome Europe Sárl, Outcome Sciences, Pricespective, Roche Pharma, Servier International and Thieme Verlag; for lectures, including travel fees from Abbott, Alexza Pharmaceuticals, AstraZeneca, Aula Médica Congresos, BASF, Groupo Ferrer International, Janssen-Cilag, Lilly Deutschland, LVR Klinikum Düsseldorf, Pfizer Pharma and Servier Deutschland; and also grants from the Hans-Jörg Weitbrecht Award and ECNP Neuropsychopharmacology Award. C.S. has received fees for lectures, including travel fees, from Pfizer Germany. R.-D.T. has received fees for consultancy from Astellas, AstraZeneca, Boehringer Ingelheim, Galderma, Glaxo Smith Kline, Grünenthal, Lilly, Merz, Merck-Sharpe & Dohme, Pfizer, Sanofi and Schwarz-Pharma/UCB; and for lectures from Astellas, AWD, Boehringer Ingelheim, Dr Kade, Nycomed, Grünenthal, Lilly, Mundipharma, Pfizer and Schwarz-Pharma/UCB; and also grants from Dr Kade, Boehringer Ingelheim, Astellas and AbbVie.

Footnotes

References

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Incision and stress regulation in borderline personality disorder: Neurobiological mechanisms of self-injurious behaviour

  • Sarah Reitz (a1), Rosemarie Kluetsch (a1), Inga Niedtfeld (a1), Teresa Knorz (a1), Stefanie Lis (a1), Christian Paret (a2), Peter Kirsch (a3), Andreas Meyer-Lindenberg (a4), Rolf-Detlef Treede (a5), Ulf Baumgärtner (a5), Martin Bohus (a1) and Christian Schmahl (a1)...

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Incision and stress regulation in borderline personality disorder: Neurobiological mechanisms of self-injurious behaviour

  • Sarah Reitz (a1), Rosemarie Kluetsch (a1), Inga Niedtfeld (a1), Teresa Knorz (a1), Stefanie Lis (a1), Christian Paret (a2), Peter Kirsch (a3), Andreas Meyer-Lindenberg (a4), Rolf-Detlef Treede (a5), Ulf Baumgärtner (a5), Martin Bohus (a1) and Christian Schmahl (a1)...
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