The Spectrum of Borderline Personality Disorder: A Neurophysiological View

Abstract

Borderline Personality Disorder (BPD) has been defined as a personality disorder in all editions of DSM since 1980; namely, DSM III through V. The criteria are a mixture of symptoms and traits; the etiology, a heterogeneous array of genetic, constitutional, and environmental factors. Until recently the diagnosis relied on clinical descriptions. In the last two decades, neurophysiological data, including MRI and fMRI, have established correlates in various brain regions, particularly those involving the frontal lobes and various limbic structures, that show promise of providing a more substantial basis for diagnosis-relying primarily on (internal) brain changes, rather than on (external) clinical observation. Some of the changes in BPD consist of decreased volume in the orbitofrontal and dorsolateral prefrontal cortices and smaller volume in both the amygdala and hippocampus, though with heightened reactivity in the amygdala. Similar abnormalities have been noted in bipolar disorders (BDs) and in ADHD, both of which often accompany BPD and share certain clinical features. Persons with strong genetic predisposition to BDs can develop BPD even in the absence of adverse environmental factors; those with extreme adverse environmental factors (chiefly, early sexual molestation) can develop BPD in the absence of bipolar vulnerability. In some BPD patients, both sets of factors are present. As ideal treatment depends on careful analysis of these factors, neurophysiological testing may permit both more rational, brain-based diagnostic decisions and more appropriate therapeutic strategies.

Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder

“…Several replicated findings are now available that are pertinent to the hypothesis that BPD could in some cases have a cyclothymic background (Akiskal et al, 1985a;Levitt et al, 1990;Perugi et al, 2003Perugi et al, , 2011Perugi et al, , 2013bStone, 2014): cyclothymia occurred more frequently in BPD than in other personality disorders, regardless of which diagnostic system was used (Levitt et al, 1990). From a neurobiological point of view too, bipolar spectrum disorder and borderline personality share some similarities: a number of studies have reported structural as well as functional abnormalities in the amygdala of borderline subjects, as also in regulatory areas such as vPFC, OFC, ACC (Domes et al, 2009).…”

Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode

“…Family and twin studies support the idea that some forms of BPD have a genetic and hence biological basis in common with BD, and in a relevant proportion of patients, both conditions coexist (8,9). Zimmerman et al (10) reviewed the frequency of BPD in 24 studies of patients with BD.…”

“…Recently, Michael Stone, a forerunner of the modern concept of borderline personality, proposed that BPD should not be seen as a unitary and homogeneous diagnostic category, but rather as a heterogeneous syndrome due to complex interactions among genetic, biological and environmental factors (8). Family and twin studies support the idea that some forms of BPD have a genetic and hence biological basis in common with BD, and in a relevant proportion of patients, both conditions coexist (8,9).…”

Clinical, neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review

“…Moreover functional and volumetric abnormalities of the anterior cingulated cortex (ACC) have been found in both ADHD and BPD, which may reflect deficits in executive control, particularly conflict monitoring and attention, but also play an important role in emotional processing (Carlotta et al, 2013). Overall the brain changes in BPD are characterized by decreased volume in the orbitofrontal and dorsolateral prefrontal cortices and smaller volume in both the hippocampus and amygdala (though in the latter with heightened reactivity); similar abnormalities have been noted in ADHD (Stone, 2014). However when considering the cognitive function of impulse control Sebastian et al (2014) suggested that individuals with BPD exhibited frontal dysfunctions mainly in orbitofrontal, dorsomedial (dorsal ACC), and dorsolateral prefrontal regions, whereas individuals with ADHD displayed dysfunctional activation rather in ventrolateral prefrontal regions including inferior frontal gyrus (IFG) and insula, as well as in more dorsal medial frontal regions, particularly in ACC; in addition there are further variations in prefrontal dysfunctions between ADHD and BPD, when considering different impulse control components (Sebastian et al, 2014).…”