Borderline personality disorder with cocaine dependence: impulsivity, emotional dysregulation and amygdala functional connectivity

Objective: Borderline personality disorder (BPD) is present in 19% of cocaine dependence (CD) cases; however, this dual pathology (DP) is poorly understood. We assessed impulsivity, emotional dysregulation (ED) and amygdala functional connectivity in this DP.Methods. We recruited 69 participants divided into 4 groups: DP (n = 20), CD without BPD (n = 19), BPD without CD (n = 10) and healthy controls (HC, n = 20). We used self-reported instruments to measure impulsivity and ED. We acquired resting state fMRI and performed seed-based analyses of functional connectivity (FC) of bilateral amygdalas.Results. BPD and CD factors had opposing effects in impulsivity and ED, as well as on FC between left amygdala and medial prefrontal cortex. For the FC between right amygdala and left insula, the effect of having both disorders was additive, reducing FC strength. Significant FC clusters were correlated with impulsivity and ED.Conclusions. In this preliminary study, we found that clinical scores of DP patients were closer to those of BPD without CD than to those of CD without BPD, while amygdala to medial prefrontal cortex FC patterns in DP patients were closer to HC than expected.