Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis

Abstract

Research on the biological basis of borderline personality disorder (BPD) has focused primarily on the serotonin model of impulsive aggression. However, there is evidence that dopamine (DA) dysfunction may also be associated with BPD. Pertinent research and review articles, identified by Medline searches of relevant topics, books, references from bibliographies, and conference proceedings from 1975 to 2003, were reviewed. Evidence of DA dysfunction in BPD derives from the efficacy of traditional and atypical antipsychotic agents in BPD, and from provocative challenges with amphetamine and methylphenidate of subjects with the disorder. In addition, human and animal studies indicate that DA activity plays an important role in emotion information processing, impulse control, and cognition. The results of this review suggest that DA dysfunction is associated with three dimensions of BPD, that is, emotional dysregulation, impulsivity, and cognitive-perceptual impairment. The main limitation of this hypothesis is that the evidence reviewed is circumstantial. There is no study that directly demonstrates DA dysfunction in BPD. In addition, the therapeutic effects of antipsychotic agents observed in BPD may be mediated by non-DA mechanisms of action. If the stated hypothesis is correct, DA dysfunction in BPD may result from genetic, developmental, or environmental factors directly affecting specific DA pathways. Alternatively, DA dysfunction in BPD may be a compensatory response to alterations in the primary neural systems that control emotion, impulse control, and cognition, and that are mediated by the brain's main neurotransmitters, glutamate, and GABA, or in one or more other neuromodulatory pathways such as serotonin, acetylcholine, and norepinephrine.

A dopamine transporter polymorphism is a risk factor for borderline personality disorder in depressed patients

“…The finding that the 9-repeat allele of DAT1 is a risk factor for BPD supports a dopamine dysfunction hypothesis of borderline personality disorder (Friedel, 2004). Such a possibility is consistent with the tendency for BPD patients to have brief psychotic episodes when under stress, and the possible role of antipsychotic drugs in the management of some BPD patients (Oldham et al 2001).…”

“…In most instances, BPD is usually co-morbid with other mental disorders, especially mood and anxiety disorders and substance abuse (Hyman, 2002 ;Skodol et al 2002 a). There is no satisfactory neurobiological model of BPD, but there are suggestions that abnormalities of impulsive aggression reflect abnormalities of reduced serotonergic function, that affective instability may reflect increased responsivity of cholinergic systems (Skodol et al 2002 b), although there are grounds for implicating dopamine dysfunction in emotional dysregulation, impulsivity and cognitive-perceptual impairment (Friedel, 2004). Furthermore, traits such as high noveltyseeking which are associated with BPD may reflect altered dopaminergic function (Cloninger, 2000).…”

Impulsivity: current and future trends in pharmacological treatment

“…Dopamine (DA) and noradrenaline are also said to intervene by affecting the activity of prefrontal lobe cortical regions [13]. Evidence of DA dysfunction in the treatment of impulsivity derives from the efficacy of traditional and atypical antipsychotic agents in border line personality disorder and from provocative challenges with amphetamine and methylphenidate of subjects with the disorder [15]. DA and noradrenaline dysfunction could be a compensatory response to alterations in the primary neural control systems, mediated by glutamate and g-aminobutyric acid (GABA).…”

Personality assessment inventory profiles of university students with eating disorders

“…This suggests that future studies may want to consider the presence of other forms of psychopathology in addition to the diagnosis of an eating disorder when studying this population. For example, comparing those with an eating disorder and borderline personality disorder (BPD) separately from those without BPD, and those with obsessive compulsive disorder separately from those without the comorbid diagnosis [30,[71][72][73][74]. It may be that eating disorder symptoms present differently when there are comorbid diagnoses and this is why there have been inconsistent results relating psychopathology to eating disorders.…”