PDF(Pubmed)
Abstract：
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.
摘要：
精神疾病诊断和统计手册（DSM-5）的第五版，2013年出版，包括人格障碍（AMPD）的替代模型，重点是用于诊断几种人格障碍的适应不良特征模型。边缘性人格障碍（BPD）和反社会人格障碍（ASPD）是AMPD分类的两种疾病，表现出很高的暴力和侵略率。AMPD中概述的几个特征，包括敌意,冲动,冒险,和无情，以前曾与BPD和ASPD的侵略有关。然而,据我们所知,在BPD和ASPD中,从来没有一项神经影像学综合研究调查了这些特征与攻击性之间的联系.为了克服这个差距，我们在PRISMA框架下进行了系统评价，以定位自AMPD发布以来发表的神经影像学文章，冲动,冒险,以及对BPD和ASPD侵略的冷酷无情。主要发现包括以下内容：i)愤怒/敌意，与前额叶和皮质下区域（主要是杏仁核）之间相互作用的改变有关，可能是解释对人际威胁或挑衅的积极反应的共同因素;ii)额-颞区和5-羟色胺能和内源性大麻素信号系统的改变可能将冲动与BPD和ASPD的侵略联系起来;iii)皮质-纹状体连通性较弱可能与更大的风险承担和更大的暴力倾向有关。从神经影像学文章中没有足够的证据来描述冷酷与侵略之间的关系。总的来说,这篇综述的结果揭示了神经影像学研究的相对缺乏，这些研究检查了与BPD和ASPD中的攻击性相关的AMPD特征。除了鼓励进一步研究与侵略有关的AMPD特征的神经影像学标记外，我们推荐多方法设计，包括其他生物标志物的掺入，如激素和生理唤醒指数，以充分扩展我们对BPD和ASPD侵略的理解。
