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Tijdschrift voor Psychiatrie 61 (2019) 4, 267 - 275


Neural mechanisms of dissociation: implication for borderline personality disorder

A.D. Krause-Utz, B.M. Elzinga

background Dissociation is a prevalent symptom in borderline personality disorder (bpd), which can have detrimental effects on everyday functioning and treatment. Until now, little is known about the brain networks implicated in dissociation in bpd. Research on dissociative disorders and posttraumatic stress disorder found alterations in networks implicated in cognitive control and arousal modulation. However, it is unknown whether these alterations are also affected in bpd.
aim To provide an overview of the definitions, neurobiological models, and neuroimaging research on dissociation in bpd.
method Review of the literature.
results During dissociation in bpd, there is evidence for an altered recruitment and interplay of brain regions implicated in the regulation of stress responses and emotions, attention, memory, and self-referential processing (amygdala, anterior cingulate cortex, inferior frontal gyrus, medial prefrontal cortex, superior temporal gyrus, and inferior parietal lobule).
conclusion Dissociation is associated with alterations in brain networks that regulate affect-cognitive processing in bpd. Given the substantial impact of dissociation on treatment and neural processing, dissociative symptoms should be taken into account in future research and treatment of bpd, even if they are not the primary focus.

keywords borderline personality disorder, depersonalisation, dissociation, neuroimaging, trauma