Taha, NA; (2015) Exploring Functional Connectivity Across Borderline Personality Disorder, Post Traumatic Stress Disorder and Dissociative Disorder. Doctoral thesis , UCL (University College London).

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Abstract

The overall focus of this thesis relates to resting state functional connectivity (RSFC) of the default mode network (DMN) in borderline personality disorder (BPD), post traumatic stress disorder (PTSD) and dissociative disorders. Part one of the thesis systematically reviewed 19 studies investigating RSFC of the DMN in PTSD, BPD and dissociative disorders to establish the value of DMN in understanding the three psychopathology. Current research suggests that RSFC of the DMN is distinct when comparing participants with PTSD, participants with PTSD co-morbid with MDD, and healthy controls. In addition, studies also showed that RSFC of the DMN was associated with PTSD severity and trauma experiences. In terms of BPD, findings seem to indicate the presence of aberrant RSFC of the DMN when compared to healthy controls and bipolar disorder. However, in order to interpret these results, it is essential to consider the potential influence of co-morbid MDD. As there was only one research investigating dissociative disorder, it is premature to conclude if RSFC of the DMN is atypical in this disorder. Overall, the reviewed studies seems to indicate that the value of the DMN in understanding psychopathology is strongest in PTSD but lacking in BPD and dissociative disorder. Part one concludes by addressing current limitations and implications for future research. Part two presents an empirical study investigating RSFC of the DMN in participants with BPD and healthy controls. In order to further elucidate the associations with indices of core symptomatology, self-reports measures pertaining to dissociation, trauma, emotional dysregulation, general clinical symptomatology and personality psychopathology were also administered. The findings suggest that BPD participants display higher RSFC between core brain regions. However, as only one of the obtained finding remained significant after correcting for multiple comparisons, the results should be interpreted cautiously. Additionally, higher RSFC in BPD participants were also associated with higher self-reported trauma experiences, dissociation and general clinical symptomatology. Similarly, these results did not survive correction for multiple comparisons and hence should be further investigated in future studies. This section concluded by discussing implications of these findings and limitations of the current study. Part three provided a critical appraisal of the entire research process. Firstly, it considers the implications of the current study, namely the influence on therapeutic approaches, our understanding of BPD, PTSD and dissociation, reflections on the wider issues in neuroimaging studies and in BPD research. This is then followed by a discussion of the challenges and opportunities in research investigating multiple constructs. Lastly, whilst acknowledging the limitations of neuroimaging, the critical appraisal also put forth suggestions aimed at maximizing clinical utility of neuroimaging findings.

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