Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates

TL;DR

The study explores how people with borderline personality disorder experience and process emotions like guilt and shame compared to healthy individuals, using brain scans and self-reports.

Contribution

The study reveals distinct neural correlates of shame and guilt in BPD patients despite similar subjective emotional intensity compared to healthy controls.

Findings

BPD patients showed stronger brain activation in regions like the cingulate and fusiform gyrus during shame scenarios.

In guilt scenarios, BPD patients had increased activation in the caudate nucleus and posterior cingulate cortex compared to healthy controls.

Healthy controls exhibited stronger activation in the cuneus and lingual gyrus during both shame and guilt conditions.

Abstract

Objective: Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. Methods: Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. Results: BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. Conclusions: Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.

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