Impulsive aggression in borderline personality disorder

Abstract

Impulsive aggressive behaviors that include physical aggression directed towards others, self-mutilation, suicide attempts, domestic violence, substance abuse, and property destruction account for a substantial portion of the morbidity and mortality associated with personality disorders, in particular borderline personality disorder (BPD). Recent genetic, neurobiologic, and diagnostic studies suggest a dimensional approach to BPD symptomatology with impulsive aggression as one of the core dimensions for the disorder. The underlying biologic basis for impulsive aggression is centered on the serotonin hypothesis; that central 5-HT function is inversely related to aggression and suicidality. More recent research refines the theory to include associated brain regions, receptor types and neuromodulators potentially involved in the etiology of aggressivity. Treatment utilizes this information with substantial progress in well-designed placebo-controlled studies of selective serotonin reuptake inhibitors such as fluoxetine, and open-label series of atypical neuroleptics, mood stabilizers, and opioid antagonists

Psychopathy and Axis I psychiatric disorders among criminal offenders: relationships to impulsive and proactive aggression

“…Numerous factors that have a role in the development of Axis I disorders may also lead to IA. Examples of such factors include socioeconomic status [Hudson, 2005;, childhood abuse [Malinosky-Rummell and Hansen, 1993], and psychopathological conditions such as borderline personality disorder [Comtois et al, 1999;Goodman and New, 2000] that were not measured in this study. In addition, given the crosssectional nature of our study we are not able to rule a different etiological pattern in which IA or its sequellae (e.g., disintegration of relationships, legal difficulties) increase risk for depression, anxiety, and reliance on alcohol.…”

Aggression in Borderline Personality Disorder: Evidence for Increased Risk and Clinical Predictors

“…The assumption of aggression in BPD being mostly mediated by poor impulse control [8] could be challenged; other factors, such as interpersonal context and the possibility that violence in BPD may be more instrumental than initially thought, must be considered.…”

“…Clinical lore holds that patients with BPD are at risk of committing violence, especially in the context of perceived or feared loss or abandonment in interpersonal relationships [7], and cogent theories have been developed over the past two decades that explain the risk of aggression in terms of an impulsive-aggression trait at the core of BPD pathology [8,9]. This would imply that there may be factors specific to BPD that could predict an increased risk of aggression in certain patients.…”

Aggression in Borderline Personality Disorder

“…Impulsiveness is a clinical hallmark (as well as a DSM-IV-TR diagnostic criterion) of BPD, and aggressive acts by BPD patients are largely of the impulsive type [16]. Crimes committed by BPD patients are impulsive and likely to consist in ''explosive episodes of physical violence'', whereas those committed by patients diagnosed with antisocial personality disorder are more goal-oriented (instrumental) [17].…”