Interactive behavior in mothers with and without borderline personality disorder: non-hostile behavior is associated with stronger neural activation of the Theory of Mind network in response to sad faces of the own child

Kristina Meyer^1,2*Catherine Hindi Attar^3,4Christian Banzhaf³Katja Bödeker⁵Ines Boegen^3,4Katja Dittrich⁵Christine Heim^6,7Sabine Herpertz⁸Charlotte Jaite^5,9Dorothea Kluczniok^3,4Corinne Neukel^10,8Sina Poppinga^3,4Salomé Porten^3,5Stefan Roepke^11,12Nikola Schoofs^3,4Felix Bermpohl^3,4

• ¹Charité University Medicine Berlin, Berlin, Germany
• ²Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Luisenstraße 57, 10117 Berlin, Germany, Berlin, Germany
• ³Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Campus Charité Mitte, Berlin, Germany
• ⁴Charité Universitätsmedizin – Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Campus St. Hedwig Hospital, Berlin, Germany
• ⁵Charité Universitätsmedizin – Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
• ⁶Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
• ⁷Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
• ⁸Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
• ⁹Department of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Hildesheim, Hildesheim, Germany
• ¹⁰German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Heidelberg, Germany
• ¹¹Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin-Franklin, Berlin, Germany
• ¹²Oberberg Fachkliniken for Psychiatry, Psychosomatics and Psychotherapy, Berlin and Brandenburg, Berlin, Germany

Objective: Borderline personality disorder (BPD) affects many facets of interpersonal functioning, including maternal caregiving. Deficits in theory of mind (ToM) may put mothers with BPD at risk of showing dysfunctional parenting behavior. The present study investigated the association between the ToM brain network activation and parental behavior using functional magnetic resonance imaging (fMRI). Method: In the present study conducted within the UBICA project (Understanding and Breaking the Intergenerational Cycle of Abuse), mothers with BPD (n=19) and healthy controls (HCs, n=30) completed an affect recognition task where they viewed sad, happy, and neutral faces of their own vs. unknown children during fMRI. Additionally, maternal non-hostility, the degree of maternal angry or irritable negative affect during mother-child-interactions, was assessed with the emotional availability scales. Results: Mothers with BPD compared to HCs showed lower performance in recognizing child facial expressions across emotions. Further, maternal non-hostility across groups was associated with higher activation of the ToM neural network including the temporoparietal junction (left TPJ; T = 4.52, pFWE = .03; right TPJ: T = 4.44, pFWE = .04) and the dorsomedial prefrontal cortex (dmPFC; T = 4.39, pFWE = .05) in response to sad faces of mother’s own vs. unknown children. Conclusion: The results indicate reduced child affect recognition in mothers with BPD. Further, mothers showing stronger neural activation of the TPJ and dmPFC while seeing their own sad children were more non-hostile, pointing towards an important role of affective ToM in maternal care, which might be a viable therapeutic target in future studies.