Neural basis of shame and guilt experience in women with borderline personality disorder.

Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.

[Rehabilitation Program for Persons with Relatives Suffering from Dementia: Results of a Longitudinal Observational Study]. / Rehabilitation mit einem demenzkranken Angehörigen: Ergebnisse einer längsschnittlichen Beobachtungstudie.

BACKGROUND: Caregiving relatives of dementia patients are exposed to considerable burdens. A multimodal rehabilitation concept which enables the inpatient treatment of caregiving relatives together with the dementia patients was evaluated. METHODS: Questionnaire survey including 121 caring relatives at 3 times of measurement. Indicators of subjective health and the use of nursing and psychosocial support services were measured during the course of the study. RESULTS: Relevant improvements in health can be seen after rehabilitation. Six months after rehabilitation, the effects decrease, but do not reach the baseline value before rehabilitation for any of the variables measured. CONCLUSION: The multimodal rehabilitation concept shows sustainable effects, at least in some variables. In connection with the high level of satisfaction of the participants, the results indicate that the rehabilitation concept is successful and is associated with a large health benefit.