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C06: Brain mechanisms differentiating aggressive vs. non-aggressive psychopathology as sequelae of early life maltreatment

Identify specific neuronal mechanisms related to the NVS and CS in female and male clinical samples with a history of early-life maltreatment (ELM) who exhibit externalizing, aggressive psychopathologies as opposed to internalizing, non-aggressive psychopathologies. We will therefore explore the interaction of the NVS and CS as well as the modulating effects of theory-of-mind (ToM) on the NVS and CS using a series of fMRI and behavioral tasks. Furthermore, we will investigate the role of hormonal stress responses and will use EMA to assess anger and aggression in everyday life. Thus, we will be able to combine behavioral phenotyping in natural conditions of everyday life and neurobiological correlates of psychopathology in order to detect clinically relevant biosignatures for AMD.

Contributors

Sabine Herpertz

A02: Context effects on threat processing in dependence of testosterone levels C06: Brain mechanisms differentiating aggressive vs. non-aggressive psychopathology as sequelae of early life maltreatment Q01: Recruitment and biotyping transdiagnostic risk mechanisms for aggressive behaviors in mental disorders across the life span Principal investigator Deputy Spokesperson Steering committee member Management board member Equal opportunity committee member Heidelberg University

Prof Dr Sabine C Herpertz studied human medicine in Bonn, obtained her doctorate in Frankfurt aM and habilitated in psychiatry and psychotherapy at RWTH Aachen University. Between 2002 and 2003, she held a professorship for Experimental Psychopathology at RWTH Aachen University before taking over the Chair of Psychiatry and Psychotherapy at the University of Rostock between 2003 and 2009. Since 2009, she has been Chair of General Psychiatry at Heidelberg University Hospital, Medical Director of the clinic of the same name and spokesperson for the Centre for Psychosocial Medicine. Her research focuses on the investigation of emotions and social functions in patients with personality disorders and trauma-associated disorders using experimental psychopathology and neuroscientific methods, in particular functional imaging. Reactive aggression is another focus of her research in personality disorders. She is Past President of the International Society for the Study of Personality Disorders (ISSPD) and has published many book chapters and journal articles on personality disorders. A second focus of her research is the development and evaluation of psychotherapeutic interventions.

Publications

A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial

A02: Context effects on threat processing in dependence of testosterone levels A07: The intestinal microbiota as a regulator of aggressive and impulsive behavior A08: The metabolic lung-brain axis in aggressive behavior in patients with AMD B01: Neurobehavioral effects of repetitive prefrontal transcranial direct current stimulation (tDCS) on pathological aggression B04: Investigating psychological and neural correlates of intimate partner violence C06: Brain mechanisms differentiating aggressive vs. non-aggressive psychopathology as sequelae of early life maltreatment Interaction of negative valence system and cognitive system

High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden on individuals and their social environment, there are no specific, cost-effective treatments to reduce aggression in BPD. In previous studies, we and others have been able to infer specific biobehavioral mechanisms underlying patterns of reactive aggression in BPD that can be used as potential treatment targets. To address this, we developed a mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets the biobehavioral mechanisms underlying outward-directed aggression in BPD. A previously conducted proof-of-concept study had suggested beneficial effects for this neglected group of patients. In this multicenter, confirmatory, randomized-controlled-clinical-trial, MAAP, which consists of multifaceted, evidence-based treatment elements adapted from other sophisticated treatment programs such as Dialectical Behavior Therapy and Mentalization-Based Treatment, is tested for efficacy against a non-specific supportive psychotherapy (NSSP) program focusing on non-specific general factors of psychotherapy at seven different sites in Germany. Both treatment arms, based on one individual and 13 group therapeutic sessions (1.5 h per session, twice a week), are delivered over a period of 7–10 weeks. A total of N = 186 patients will be recruited, half of whom will be cluster-randomized to MAAP. Outcomes are assessed at baseline, immediately, and 4, 12, 20, and 24 weeks post-treatment using ecological momentary assessment, clinical interviews, questionnaires, and online tasks. If proven superior, MAAP can be incorporated into standard psychiatric care, filling a critical gap in the current therapeutic landscape by offering a structured, cost-effective, and evidence-based treatment that directly targets the biobehavioral mechanisms underlying reactive aggression in BPD. By potentially improving clinical outcomes and reducing the burden of reactive aggression in BPD, MAAP could be beneficial for both individuals and their social environments. The study’s large, multicenter design enhances the generalizability of the results, making them more relevant for broader clinical applications.