Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder

https://doi.org/10.1016/j.pscychresns.2007.08.007Get rights and content

Abstract

It is not known whether the fronto-limbic volume reductions found in adults with established borderline personality disorder (BPD) are present early in the disorder. The aim of the study was to investigate orbitofrontal cortex (OFC), hippocampal and amygdala volumes in a first-presentation teenage BPD sample with minimal exposure to treatment. Groups of 20 BPD patients and 20 healthy control participants underwent magnetic resonance imaging. Hippocampal, amygdala, OFC and whole brain volumes were estimated and compared between the two groups. Analysis of variance revealed reversal of the normal (right > left) asymmetry of OFC grey matter volume in the BPD group, reflecting right-sided OFC grey matter loss in the BPD group compared with control participants. No significant differences were found for amygdala or hippocampal volumes comparing BPD with control participants. We identified OFC but not hippocampal or amygdala volumetric differences early in the course of BPD. Hippocampal and amygdala volume reductions observed in adult BPD samples might develop during the course of the disorder, although longitudinal studies are needed to examine this.

Introduction

Structural magnetic resonance imaging (MRI) findings in adults with borderline personality disorder (BPD (reviewed in Schmahl and Bremner, 2006) include volume reductions in the amygdala (Driessen et al., 2000, Rusch et al., 2003, Schmahl et al., 2003, Tebartz van Elst et al., 2003), hippocampus (Driessen et al., 2000, Schmahl et al., 2003, Tebartz van Elst et al., 2003, Brambilla et al., 2004, Irle et al., 2005), orbitofrontal cortex (OFC) (Tebartz van Elst et al., 2003), frontal lobes (Lyoo et al., 1998) and cingulate cortex (Tebartz van Elst et al., 2003, Hazlett et al., 2005). However, it is unclear whether these findings are associated with a vulnerability to BPD itself, severity or duration of BPD, treatment or other factors, such as cumulative traumatic events, associated lifestyle factors or the co-occurrence or duration of common mental disorders. Studies of samples earlier in the course of BPD reduce the effects of duration of illness factors upon brain morphology. This is the first study to measure hippocampal, amygdala and OFC volumes in teenagers with first-presentation BPD in order to ascertain whether the changes found in previous studies of adults pre-date the full expression of BPD. In addition, we explored how co-occurring clinical characteristics were associated with brain morphology.

Section snippets

Participants

Twenty patients meeting Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) (First et al., 1997) criteria for BPD were recruited from a specialized early intervention program for BPD at ORYGEN Youth Health in Melbourne, Australia. They had minimal exposure to psychiatric interventions and had never received specific treatment for BPD. Sixteen patients (80%) had a lifetime history of non-specialized prior counseling or psychotherapy (median = 6 sessions, range = 1–140). One (5%)

Volumetric findings

The raw data for all structural volume measures are displayed in Table 3. Analysis of covariance, using height as the covariate, did not reveal any significant differences between the BPD and healthy control groups on measures of WBV or ICV (all P > 0.5).

MANOVA on the four OFC volume measures revealed a significant group by side by region interaction (F1,36 = 4.68, P = 0.037). Further pairwise tests (see Table 4) revealed a significant difference between left and right OFC grey matter for normal

Discussion

Three main findings emerge from this unique study of teenagers with first-presentation BPD. Firstly, there is a reversal of the normal (right > left) asymmetry of OFC grey matter in the BPD group, reflecting right-sided OFC grey matter loss in the BPD group that is not related to gender, the clinical features of BPD or other mental state phenomena. Secondly, hippocampal and amygdala volumes are not reduced in BPD participants compared with healthy controls. Thirdly, in females with BPD, large and

Acknowledgements

The authors thank the patients and staff of the HYPE Clinic at ORYGEN Youth Health. Thanks are also due to Ms Caroline Weinstein, A/Prof. Warrick Brewer and Ms Deidre Smith for assistance with data collection and to Dr Jem Riffkin for assistance with imaging analysis.

Funding/support: This work was supported in part by grants 98-0198 from the Victorian Health Promotion Foundation, Melbourne, Australia and grant 990748 from the National Health and Medical Research Council (NHMRC), Canberra,

References (43)

  • J. Pujol et al.

    The lateral asymmetry of the human brain studied by volumetric magnetic resonance imaging

    Neuroimage

    (2002)
  • J. Riffkin et al.

    A manual and automated MRI study of anterior cingulate and orbito-frontal cortices, and caudate nucleus in obsessive–compulsive disorder: comparison with healthy controls and patients with schizophrenia

    Psychiatry Research. Neuroimaging

    (2005)
  • I.M. Rosso et al.

    Amygdala and hippocampus volumes in pediatric major depression

    Biological Psychiatry

    (2005)
  • N. Rusch et al.

    A voxel-based morphometric MRI study in female patients with borderline personality disorder

    Neuroimage

    (2003)
  • C.G. Schmahl et al.

    Neuroimaging in borderline personality disorder

    Journal of Psychiatric Research

    (2006)
  • C.G. Schmahl et al.

    Magnetic resonance imaging of hippocampal and amygdala volume in women with childhood abuse and borderline personality disorder

    Psychiatry Research. Neuroimaging

    (2003)
  • C.G. Schmahl et al.

    A positron emission tomography study of memories of childhood abuse in borderline personality disorder

    Biological Psychiatry

    (2004)
  • L.J. Siever et al.

    The borderline diagnosis III: identifying endophenotypes for genetic studies

    Biological Psychiatry

    (2002)
  • P.H. Soloff et al.

    A fenfluramine-activated FDG-PET study of borderline personality disorder

    Biological Psychiatry

    (2000)
  • P.H. Soloff et al.

    Impulsivity and prefrontal hypometabolism in borderline personality disorder

    Psychiatry Research. Neuroimaging

    (2003)
  • L. Tebartz van Elst et al.

    Frontolimbic brain abnormalities in patients with borderline personality disorder — a volumetric magnetic resonance imaging study

    Biological Psychiatry

    (2003)
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