Dysfunctional emotion regulation is often reported in affective disorders, but it is unclear whether this dysfunction concerns initial processing of emotional input or regulation of resulting emotion. The present study addressed these aspects in 27 depressive and 15 borderline personality disorder patients and 28 healthy controls who were instructed to either passively view unpleasant and neutral pictures or downregulate emotional responses by reappraisal, while neuromagnetic brain activity was measured. All three groups showed more early response to unpleasant than to neutral pictures, whereas patients failed to show subsequent activity suppression under instructions to down-regulate. This deficient emotion regulation was evident primarily in those subjects reporting high childhood adversity. Results support intact emotional input processing but impaired emotion regulation in affective disorders and indicate a moderating influence of early life stress. 1. Introduction Impaired emotion regulation is often discussed as characteristic of disorders of affect. It is reported for major depressive disorder (MDD, [1–4]) and has been described as a core feature in borderline personality disorder (BPD, [5–8]). Dysfunctional emotion regulation could result from impaired initial processing of emotional input or from impaired regulation of physiological and behavioral aspects of resulting emotion. A widely cited model [9, 10] distinguishes perceptual input-oriented processes of monitoring, appraisal, or evaluation of an emotional stimulus and response- or output-oriented regulation processes that may include cognitive reappraisal or response suppression. Similarly, a prominent earlier model [11] centrally distinguished stimulus and response aspects of emotional processing. Research on neural mechanisms associated with this distinction has related input-oriented processes to amygdala and anterior cingulated gyrus (ACC, [10, 12]) and output-oriented regulation processes to ventromedial prefrontal cortex (VMPFC; [10, 13–17]). The interplay of these processes seems crucial for efficient regulation [9, 11]. Emotion dysregulation has been inferred from hemodynamic neuroimaging findings of reduced ventromedial frontal activity during reappraisal, affect discrimination, and emotional Stroop tasks in patients with MDD [1–3] and from augmented limbic activity and reduced orbitofrontal activity in patients with BPD [7]. Moreover, a limbic-prefrontal activity pattern under downregulation instructions opposite to the one characteristic of healthy subjects [2, 18] suggests that
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