The Hypothalamic-Pituitary-Adrenal Axis in Borderline Personality Disorder

Zimmerman, Daniel J.; Choi-Kain, Lois W.

doi:10.1080/10673220902996734

Cited by 58 publications

(50 citation statements)

References 106 publications

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“…57 A specific vulnerability to stress (higher emotional intensity in response to stressors and a delayed return to baseline affect) has been proposed for individuals with BPD, 58 which might be associated with the hypothalamic-pituitary-adrenal axis (HPAA). 59 Adults with BPD show an attenuated cortisol response to acute stress, 60 and this has also been found in adolescents engaging in repetitive NSSI. 61 More numerous self-harm behaviors in adolescents with BPD were associated with increased pituitary volumes, 62 suggesting greater basal activation of the HPAA.…”

Section: Neurobiological Findingsmentioning

confidence: 99%

Borderline Personality Disorder in Adolescence

2014

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This is the 4th in our series on Adolescent Health. abstract Borderline personality disorder (BPD) is a common and severe mental disorder that is associated with severe functional impairment and a high suicide rate. BPD is usually associated with other psychiatric and personality disorders, high burden on families and carers, continuing resource utilization, and high treatment costs. BPD has been a controversial diagnosis in adolescents, but this is no longer justified. Recent evidence demonstrates that BPD is as reliable and valid among adolescents as it is in adults and that adolescents with BPD can benefit from early intervention. Consequently, adolescent BPD is now recognized in psychiatric classification systems and in national treatment guidelines. This review aims to inform practitioners in the field of adolescent health about the nature of BPD in adolescence and the benefits of early detection and intervention. BPD diagnosis and treatment should be considered part of routine practice in adolescent mental health to improve these individuals' well-being and long-term prognosis.

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Section: Neurobiological Findingsmentioning

confidence: 99%

Borderline Personality Disorder in Adolescence

2014

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“…studies of BPD are rather mixed (for example, see the review by Zimmerman and Choi-Kain 8 ). Comorbid disorders, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), which are frequent among patients with BPD and affect HPA axis functioning, as well as other confounding variables, such as sex, menstrual cycle and age, may at least partly explain these inconsistencies.…”

mentioning

confidence: 99%

“…Comorbid disorders, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), which are frequent among patients with BPD and affect HPA axis functioning, as well as other confounding variables, such as sex, menstrual cycle and age, may at least partly explain these inconsistencies. 8 The cause of HPA axis dysregulations is thought to result from adverse experiences in early life, with traumatic childhood experiences and sexual abuse in childhood impairing neurobiological systems involved in the stress response. 9,10 In addition to disturbances in HPA axis functioning, brain imaging studies have revealed volumetric alterations in structures crucially involved in the regulation of stress responses in patients with BPD.…”

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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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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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“…Rappelons que la réponse physiologique immédiate à un stress provoque une activation de l'axe hypothalamo-pituitairo-hypophysaire qui entraîne une cascade d'effets sur l'activité de la noradrénaline, du cortisol, de la glande thyroïde et du système des opioïdes (Simeon et al, 2007 ;Zimmerman et Choi-Kain, 2009 ;Wingenfeld et al, 2010).…”

Section: Constatations Neurophysiologiques Sur La Dissociationunclassified

“…Selon les analyses statistiques, la suppression du cortisol semble plus reliée au TSPT qu'au TP (Shea, 1999 ;Lewis et Grenyer, 2009). Les données sont de ce fait difficiles à interpréter lorsqu'il s'agit de faire la part des choses entre l'influence du traumatisme ou d'une personnalité limite sur la réponse physiologique au stress (Flory et al, 2009 ;Zimmerman et Choi-Kain, 2009 Toujours dans le champ de recherche en neuro-imagerie, les sujets avec TPL ou TPST ont aussi des volumes réduits des noyaux de l'hippocampe et de l'amygdale en comparaison à des sujets normaux (Lewis et Grenyer, 2009 ;Wingenfeld et al, 2010). Par contre, Donegan et al (2003) ont trouvé une amygdale gauche plus activée chez des sujets avec TPL en comparaison à des sujets normaux en imagerie fonctionnelle.…”

Section: Constatations Neurophysiologiques Sur La Dissociationunclassified

Comprendre la dissociation chez les patients avec un trouble de personnalité limite

Renaud

2011

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Cet article examine la dissociation, un concept psychiatrique controversé qui se rencontre dans le quotidien du clinicien. À partir d’une recherche sur Pubmed/Ovid avec les mots clés dissociation et trouble de personnalité limite et d’autres références, l’auteure décrit le phénomène dissociatif dans ses aspects cliniques chez les sujets atteints du trouble de personnalité limite (TPL). L’article discute des hypothèses psychodynamiques et des données neurophysiologiques pour expliquer la dissociation. Certains validateurs neurophysiologiques et neuro-anatomiques produits grâce à l’imagerie cérébrale, et des études du métabolisme de neurotransmetteurs sont étudiés pour étayer les énoncés hypothétiques. L’auteure conclut sur un modèle de mécanisme de défense dans un contexte de prédisposition biologique, de carence du développement psychologique ou d’une sensibilisation post-traumatique et suggère des pistes thérapeutiques.Dissociation is a disturbing psychiatric concept fraught with controversy. It is however encountered in clinical contexts and has to be understood by clinicians. This article based on a Pubmed/Ovid on line research with key words dissociation and borderline personality disorder and other references, describes the clinical aspects of the dissociative phenomena in patients with borderline personality disorder. Psychodynamic hypotheses and neurophysiological data are examined to explain dissociation. Neurophysiological and neuroanatomical variables provided by cerebral imagery controlled studies support hypotheses brought forward. The article concludes with a defence mechanism developed within a context of biological predisposition, deprived psychological development and in reaction to trauma. In conclusion, emerging psychotherapeutic solutions are summarized.Este artículo examina la disociación, concepto psiquiátrico controversial, con la que el clínico se encuentra cotidianamente. A partir de una búsqueda en Pubmed/Ovid con las palabras clave disociación y trastorno de la personalidad límite y otras referencias, la autora describe el fenómeno disociativo, en sus aspectos clínicos, en las personas que sufren de un trastorno de la personalidad límite (TPL). El artículo discute las hipótesis psicodinámicas y los datos neurofisiológicos para explicar la disociación. Se estudian ciertos validadores neurofisiológicos y neuroanatómicos producidos gracias a neuroimágenes, así como estudios del metabolismo de neurotransmisores, con el fin de apoyar los enunciados hipotéticos. La autora concluye con un modelo de mecanismo de defensa en un contexto de predisposición biológica, de carencia del desarrollo psicológico o de una sensibilización postraumática, y sugiere pistas terapéuticas.Este artigo examina a dissociação, um conceito psiquiátrico controverso que encontra-se no cotidiano do clínico. A partir de uma pesquisa sobre o Pubmed/Ovid com as palavras-chave dissociação e transtorno de personalidade limite e outras referências, a autora descreve o fenômeno dissociativo em seus aspectos clínicos nos paciente...

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The Hypothalamic-Pituitary-Adrenal Axis in Borderline Personality Disorder

Cited by 58 publications

References 106 publications

Borderline Personality Disorder in Adolescence

Borderline Personality Disorder in Adolescence

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

Comprendre la dissociation chez les patients avec un trouble de personnalité limite

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