Neural Underpinnings of Cognitive Reappraisal and Emotion Suppression in Response to Disorder-Specific Stimuli in Women With Borderline Personality Disorder and Women With Restrictive Anorexia Nervosa: An fMRI Study.

Background: Maladaptive emotion regulation (ER) is central to both borderline personality disorder (BPD) and anorexia nervosa (AN). However, neural mechanisms underlying cognitive reappraisal and emotion suppression in response to disorder-specific stimuli remain understudied in these groups-especially for suppression in AN.

Method: Women with BPD (N = 44), AN restrictive type (N = 38), and healthy control women (HCs; N = 40) completed self-report measures and an fMRI task involving cognitive reappraisal and emotion suppression using disorder-specific stimuli.

Results: In response to disorder-specific stimuli, BPD individuals showed heightened activation in the anterior orbitofrontal cortex (aOFC) and dorsal anterior cingulate cortex (dACC) compared to HCs. In AN, whole-brain analysis revealed increased activity in the right angular gyrus and cingulate gyrus/precuneus, and reduced activation in the left central operculum and inferior frontal gyrus (IFG) during cognitive reappraisal compared to HCs. Across all groups, emotional state worsened after the fMRI task, with BPD and AN groups reporting more negative affect than controls, possibly reflecting increased emotional burden.

Discussion: The study reveals distinct neural patterns of ER in BPD and AN. Using disorder-relevant stimuli enhances ecological validity and provides novel insights into ER in these clinical populations.