How clinicians respond to borderline personality disorder
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The current study used functional magnetic resonance imaging (fMRI) to evaluate clinicians’ brain activity associated with their attitudes toward borderline personality disorder (BPD). Nine clinicians were surveyed about their experience with BPD patients and then were scanned while they read vignettes describing clients with BPD and clients without any mental disorder in alternating blocks. For each vignette, a score was provided by the participants to evaluate their efficacy to treat the client described in the vignette. Each vignette was presented in a series of three screens, the first screen providing gender and diagnosis of the client (diagnosis screen), the 2nd and 3rd screen describing three salient symptoms from that diagnosis (symptom screen I and II). Reading the word borderline (in the diagnosis screen) resulted in increased activity in the left amygdala, left thalamus, bilaterally in putamen, caudate, substantia nigra, insula, in the left superior and middle temporal gyri, left fusiform, left parahippocampal gyrus, left inferior parietal lobule, left angular cortex, and in the bilateral superior frontal gyrus. Reading BPD symptoms in symptom I screen was associated with increased activity in the left caudate, cerebellum, bilaterally in visual cortex and posterior cingulate gyrus. One area of deactivation was also found in the right postcentral gyrus. In the symptom II screen, reading BPD related content resulted in increased activity in the right fusiform, parahippocampal gyrus, bilaterally in posterior cingulate gyrus, inferior parietal gyrus, angular gyrus, cerebellum, insula, and inferior frontal gyrus. I also found five of regions of interest activated when reading the symptom II screen where activation correlated linearly with the self-reported efficacy score, the bilateral insula, bilateral angular gyrus and right middle frontal gyrus. Deactivations were also found in right postcentral gyurs, right precentral gyrus, left visual cortex and left superior frontal gyurs. This study thus showed that BPD related stimuli had emotional charge to experienced clinicians.