Neuropsychobiological Aspects, Comorbidity Patterns and Dimensional Models in Borderline Personality Disorder

Dell’Osso, Bernardo; Berlin, Heather A.; Serati, Marta; Altamura, Alfredo Carlo

doi:10.1159/000297734

Cited by 54 publications

(38 citation statements)

References 209 publications

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“…The putamen and the basal ganglia are involved not only in planning and execution of movement, but also in higher cognitive functions, such as attention and decision-making, 61 which at least in some studies have been reported to be impaired in patients with BPD. 62 We also found reduced grey matter in the cerebellar vermis. Recent findings suggest a major involvement of cerebellar structures in emotional behaviour, 63 which is mediated by reciprocal connections to structures of the limbic system.…”

Section: Discussionsupporting

confidence: 54%

“…Changes in grey matter volume in the parietal lobe could explain attentional capacity deficits described in patients with BPD. 62 The Heschl gyrus is located in the primary auditory cortex and is involved in the processing of auditory information. 71 Studies addressing the involvement of the auditory system in patients with BPD have been scarce.…”

Section: Discussionmentioning

confidence: 99%

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Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder

Kuhlmann

Bertsch

Schmidinger

et al. 2013

J Psychiatry Neurosci

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IntroductionPsychosocial stress plays an important role in the development and manifestation of borderline personality disorder (BPD). Early life stress and traumatization are risk factors for BPD, and reports of traumatic childhood abuse are frequent in patients with BPD.1 Furthermore, patients with BPD ex peri ence psychosocial daily hassles more intensely than healthy individuals, indicating a reactivity and vulnerability to stress.2 Kuo and Linehan 3 measured higher skin conductance response in patients with BPD, which is positively correlated with stress. Moreover, the acute symptoms of patients with BPD are precipitated by acute stress. They show higher dissoci ative symptom scores than subjective stress ratings in comparison to healthy individuals and patients with major depressive and panic disorders. 4 Furthermore, high dissociation scores in patients with BPD correlate with greater childhood trauma and greater hypothalamus-pituitary-adrenal (HPA) axis reactivity to stress, 5 indicating a link between traumatic childhood experiences, endocrine stress response and acute symptoms. Under subjective stress, patients with BPD display a higher pain threshold, 6 and self-injurious behaviour is used as a means of stress reduction.7 It seems plausible that these stress-related symptoms may be linked to dysregulations in the functioning of the HPA axis, which is crucially involved in the body's response to stress. Correspondingly, patients with BPD show signs of abnormal cortisol reactivity and feedback regulation, indicating disturbed HPA axis functioning, although findings on baseline cortisol, HPA feedback sensitivity and cortisol responses to psychosocial stress in Background: Experiences of early life stress, increased psychological arousal and the body's physiologic stress response seem to play an important role in the pathogenesis and maintenance of borderline personality disorder (BPD). In the present study, we investigated alterations in grey matter of central stress-regulating structures in female patients with BPD. Methods: We examined T 1 -weighted structural magnetic resonance imaging scans of unmedicated, right-handed female patients with BPD (according to DSM-IV criteria) and healthy controls matched for age, intelligence and education using fully automated DARTEL voxel-based morphometry. Our regions of interest analyses included the hippocampus, amygdala, anterior cingulate cortex (ACC) and hypothalamus. Results: We enrolled 30 patients and 33 controls in our study. The grey matter of patients with BPD was reduced in the hippocampus, but increased in the hypothalamus compared with healthy participants. Hypothalamic volume correlated positively with the history of traumatization in patients with BPD. No significant alterations were found in the amygdala and ACC. Limitations: This study is limited by the lack of measures of corticotropin-releasing hormone, adrenocorticotropic hormone and cortisol levels. Furthermore, moderate sample size and comorbid disorders need to be considered. Conclusion: Our ...

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder

Kuhlmann

Bertsch

Schmidinger

et al. 2013

J Psychiatry Neurosci

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“…Much research has focused on structural and functional abnormalities in brain areas related to emotion and impulsivity, and these areas may also serve as endophenotypes for BPD, although they are not always presented as such. Lis et al [47], Goodman et al [48•], and Dell'Osso et al [49] reviewed neuroimaging and neurobiological studies of BPD and found evidence for both structural and functional abnormalities in the brain areas of individuals with BPD, including the hippocampus, amygdala, anterior cingulate cortex, prefrontal cortex, and orbitofrontal cortex. These endophenotypes may influence the traits that underlie BPD symptoms (eg, emotion dysregulation, poor cognitive control), and for this reason, insight into these factors promises to add to the development of a more comprehensive (dimensional) classification of BPD.…”

Section: Endophenotypesmentioning

confidence: 99%

DSM-5 Borderline Personality Disorder: At the Border Between a Dimensional and a Categorical View

Trull

Distel²,

Carpenter

2010

Curr Psychiatry Rep

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Recently, the DSM-5 Personality Disorders Workgroup offered its proposed revision for borderline personality disorder (BPD) and other personality disorder types ( http://www.dsm5.org ). According to the workgroup, this revision reflects an attempt to address excessive comorbidity among personality disorders, place personality pathology on continua, and replace individual behavioral criteria with personality traits. Essentially, the committee proposes a hybrid model of BPD (ie, categorical and dimensional)-one that combines the notion of a borderline "type" with supplemental dimensional ratings of relevant personality traits. In this article, we review recent findings on the dimensionality of BPD from phenotypic, genetic, and endophenotypic perspectives. Finally, we evaluate the current DSM-5 proposal for diagnosing BPD-one that ostensibly combines a categorical and dimensional perspective-in light of these findings.

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“…While emotional dysregulation is a core feature of BPD itself, it may also be an important candidate to explain high rates of comorbidity between BPD and other mental disorders (e.g. substance use disorders and affective disorders) (Dell'Osso et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Resting state vagal tone in borderline personality disorder: A meta-analysis

Koenig

Kemp

Feeling

et al. 2016

Progress in Neuro-Psychopharmacology and Biological Psychiatry

115

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Borderline personality disorder (BPD) is the most common personality disorder in clinical settings. It is characterized by negative affectivity, emotional liability, anxiety, depression, as well as disinhibition (i.e., impulsivity and risk taking), all of which have been linked to lower resting state vagal tone, which may be indexed by vagally-mediated heart rate variability (vmHRV). Here, we aimed to quantify the current evidence on alterations in resting state vmHRV in individuals with BPD, relative to healthy controls. A rigorous search of the literature, according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses", revealed 5 studies suitable for meta-analysis, reporting vmHRV in individuals with BPD (n=95), relative to healthy controls (n=105). Short-term measures of resting state vmHRV were extracted and subjected to meta-analysis using both random- and fixed effect models in RevMan. BPD displayed lower resting state vmHRV relative to healthy controls in random- (Hedges' g=-0.59, 95% CI [-1.11; -0.06], k=5) and fixed-effect meta-analysis (Hedges' g=-0.56, 95% CI [-0.86; -0.27], k=5). Control for potential publication bias did not change observed findings. Lowered resting state vagal tone may be an important trait characteristic underlying BPD. As prior studies have observed lowered vmHRV in a variety of psychiatric disorders, we propose that lowered vmHRV may reflect a common psychophysiological mechanism underlying difficulties in emotion regulation and impulsivity, in particular.

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Neuropsychobiological Aspects, Comorbidity Patterns and Dimensional Models in Borderline Personality Disorder

Cited by 54 publications

References 209 publications

Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder

Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder

DSM-5 Borderline Personality Disorder: At the Border Between a Dimensional and a Categorical View

Resting state vagal tone in borderline personality disorder: A meta-analysis

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