Structural Brain Alterations in Borderline Personality Disorder
Keywords:
Borderline personality disorder, MRI in BPD, BPD patients, personality disorders, structural imaging BPD, neurobiology BPDAbstract
Borderline personality disorder (BPD) is one of three clusters of personality disorders characterized by a pattern of difficulty regulating emotion, impulse control, interpersonal relationships, and self-image. Emotional dysregulation, impulsive aggression, repetitive self-injury, and chronic suicidal tendencies make these individuals frequent users of mental health services. BPD has a variety of causes and involves several factors which interact in various ways with each other. Emotional dysregulation and impulsivity can be caused by genetic factors and traumatic childhood experiences and lead to dysfunctional behaviors, psychosocial conflicts, and deficits that may exacerbate emotional dysregulation and impulsivity. BPD has been linked to anatomical alterations in brain areas in the prefrontal cortex, cingulate cortex, hippocampus, amygdala, hypothalamus, corpus callosum, and frontolimbic network. These brain changes can lead to the manifestation of the inability to control behavior, feelings, and interpersonal relationships, which often leads to violence. These symptoms may begin at a young age or in early adulthood and tend to continue as the individual ages. The goal of this article is to review how structural changes in the brain can cause BPD.
References
Personality Disorders. In: Diagnostic and statistical manual of mental disorders [Internet]. Ameri-can Psychiatric Association; 2013 [cited 2021 Nov 12]. (DSM Library). Available from: https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm18
Cluster B personality disorders: Types and symptoms [Internet]. 2020 [cited 2021 Nov 12]. Available from: https://www.medicalnewstoday.com/articles/320508
Ninomiya T, Oshita H, Kawano Y, Goto C, Matsuhashi M, Masuda K, et al. Reduced white matter integrity in borderline personality disorder: A diffusion tensor imaging study. J Affect Disord. 2018; 225:723-32.
Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2014; 16:438.
ICD-10 Version: 2019 [Internet]. [cited 2022 Mar 8]. Available from: https://icd.who.int/browse10/2019/en#/
Lis E, Greenfield B, Henry M, Guilé JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci JPN. 2007; 32:162-73.
Samuel DB, Widiger TA, Pilkonis PA, Miller JD, Lynam DR, Ball SA. Conceptual changes to the definition of borderline personality disorder proposed for DSM-5. J Abnorm Psychol. 2012; 121:467-76.
McGowan A, King H, Frankenburg FF, Fitzmaurice G, Zanarini MC. The course of adult experiences of abuse in patients with borderline personality disorder and axis II comparison subjects: A 10-year follow-up study. J Personal Disord. 2012;26:192-202.
Chapman AL, Specht MW, Cellucci T. Borderline personality disorder and deliberate self-harm: Does experiential avoidance play a role? Suicide Life Threat Behav. 2005;35:388-99.
Vandekerckhove M, Berens A, Wang YL, Quirin M, De Mey J. Alterations in the fronto-limbic network and corpus callosum in borderline-personality disorder. Brain Cogn. 2020;138:103596.
Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the national comorbidity survey replication. Biol Psychiatry. 2007;62:553-64.
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69:533-45.
Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry. 2005; 162: 1911-8.
American Psychiatric Association, American Psychiatric Association, editors. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; 2013. p. 947.
Perrotta G. Borderline personality disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches. Ann Psychiatry Treat. 2020;4:043-56.
Johnson DM, Shea MT, Yen S, Battle CL, Zlotnick C, Sanislow CA, et al. Gender differences in borderline personality disorder: findings from the collaborative longitudinal personality disorders study. Compr Psychiatry. 2003;44:284-92.
Borderline personality disorder | NAMI: National Alliance on Mental Illness [Internet]. [cited 2022 Mar 8]. Available from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder
Amad A, Ramoz N, Thomas P, Jardri R, Gorwood P. Genetics of borderline personality disorder: systematic review and proposal of an integrative model. Neurosci Biobehav Rev. 2014;40:6-19.
Kendler KS, Aggen SH, Czajkowski N, Røysamb E, Tambs K, Torgersen S, et al. The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. Arch Gen Psychiatry. 2008;65:1438-46.
Skoglund C, Tiger A, Rück C, Petrovic P, Asherson P, Hellner C, et al. Familial risk and heritability of diagnosed borderline personality disorder: a register study of the Swedish population. Mol Psychiatry. 2021;26:999-1008.
Chapman J, Jamil RT, Fleisher C. Borderline personality disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2021 [cited 2021 Nov 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430883/
Dittrich K, Boedeker K, Kluczniok D, Jaite C, Attar CH, Fuehrer D, et al. Child abuse potential in mothers with early life maltreatment, borderline personality disorder and depression. Br J Psychiatry. 2018;213:412-8.
Schulze L, Schmahl C, Niedtfeld I. Neural correlates of disturbed emotion processing in borderline personality disorder: A multimodal meta- analysis. Biol Psychiatry. 2016;79:97-106.
Krause-Utz A, Elzinga BM, Oei NYL, Paret C, Niedtfeld I, Spinhoven P, et al. Amygdala and dorsal anterior cingulate connectivity during an emotional working memory task in borderline personality disorder patients with interpersonal trauma history. Front Hum Neurosci. 2014;8:848.
Lischke A, Domin M, Freyberger HJ, Grabe HJ, Mentel R, Bernheim D, et al. Structural alterations in the corpus callosum are associated with suicidal behavior in women with borderline personality disorder. Front Hum Neurosci. 2017;11:196.
New AS, Carpenter DM, Perez-Rodriguez MM, Ripoll LH, Avedon J, Patil U, et al. Developmental differences in diffusion tensor imaging parameters in borderline personality disorder. J Psychiatr Res. 2013;47:1101-9.
Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73:153-60.
Brunner R, Henze R, Parzer P, Kramer J, Feigl N, Lutz K, et al. Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: is it disorder specific? NeuroImage. 2010;49:114-20.
Sampedro F, Farrés CC i., Soler J, Elices M, Schmidt C, Corripio I, et al. Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response. Brain Imaging Behav. 2021;15:2502-12.
Lou J, Sun Y, Cui Z, Gong L. Common and distinct patterns of gray matter alterations in borderline personality disorder and posttraumatic stress disorder: A dual meta-analysis. Neurosci Lett. 2021;741:135376.
Driessen M, Herrmann J, Stahl K, Zwaan M, Meier S, Hill A, et al. Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Arch Gen Psychiatry. 2000;57:1115-22.
Caetano SC, Hatch JP, Brambilla P, Sassi RB, Nicoletti M, Mallinger AG, et al. Anatomical MRI study of hippocampus and amygdala in patients with current and remitted major depression. Psychiatry Res. 2004;132:141-7.
Schmahl CG, Vermetten E, Elzinga BM, Douglas Bremner J. Magnetic resonance imaging of hippocampal and amygdala volume in women with childhood abuse and borderline personality disorder. Psychiatry Res. 2003;122:193-8.
Tebartz van Elst L, Ludaescher P, Thiel T, Büchert M, Hesslinger B, Bohus M, et al. Evidence of disturbed amygdalar energy metabolism in patients with borderline personality disorder. Neurosci Lett. 2007;417:36-41.
Tebartz van Elst L, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux L, et al. Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry. 2003;54:163-71.
Zetzsche T, Frodl T, Preuss UW, Schmitt G, Seifert D, Leinsinger G, et al. Amygdala volume and depressive symptoms in patients with borderline personality disorder. Biol Psychiatry. 2006;60: 302-10.
Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res. 2008;164:223-36.
Kreisel SH, Labudda K, Kurlandchikov O, Beblo T, Mertens M, Thomas C, et al. Volume of hippocampal substructures in borderline personality disorder. Psychiatry Res. 2015;231:218-26.
Dyck M, Kellermann T, Boers F, Gur R, Mathiak K. Dyck M, Loughead J, Kellermann T, Boers F, Gur RC, Mathiak K. Cognitive versus automatic mechanisms of mood induction differentially activate left and right amygdala. NeuroImage. 2010; 54:2503-13.
Koenigsberg HW, Denny BT, Fan J, Liu X, Guerreri S, Mayson SJ, et al. The neural correlates of anomalous habituation to negative emotional pictures in borderline and avoidant personality disorder patients. Am J Psychiatry. 2014;171:82-90.
Herpertz SC, Bertsch K. A new perspective on the pathophysiology of borderline personality disorder: A model of the role of oxytocin. Am J Psychiatry. 2015;172:840-51.
New AS, Hazlett EA, Buchsbaum MS, Goodman M, Mitelman SA, Newmark R, et al. Amygdala-prefrontal disconnection in borderline personality disorder. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2007;32:1629-40.
Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR. Volumes of the hippocampus and amygdala in patients with borderline personality disorder: A meta-analysis. J Personal Disord. 2009;23:333-45.
Nenadić I, Voss A, Besteher B, Langbein K, Gaser C. Brain structure and symptom dimensions in borderline personality disorder. Eur Psychiatry J Assoc Eur Psychiatr. 2020;63: e9.
Kimmel CL, Alhassoon OM, Wollman SC, Stern MJ, Perez-Figueroa A, Hall MG, et al. Age-related parieto-occipital and other gray matter changes in borderline personality disorder: A meta-analysis of cortical and subcortical structures. Psychiatry Res Neuroimaging. 2016;251:15-25.
Gosnell SN, Meyer MJ, Jennings C, Ramirez D, Schmidt J, Oldham J, et al. Hippocampal volume in psychiatric diagnoses: Should psychiatry biomarker research account for comorbidities? Chronic stress. 2020;4:2470547020906799.
Ferber SG, Hazani R, Shoval G, Weller A. Targeting the endocannabinoid system in borderline personality disorder: Corticolimbic and hypothalamic perspectives. Curr Neuropharmacol. 2021;19:360-71.
Tae W-S, Ham B-J, Pyun S-B, Kang S-H, Kim B-J. Current clinical applications of diffusion-tensor imaging in neurological disorders. J Clin Neurol. 2018;14:129-40.
Grant JE, Correia S, Brennan-Krohn T, Malloy PF, Laidlaw DH, Schulz SC. Frontal white matter integrity in borderline personality disorder with self-injurious behavior. J Neuropsychiatry Clin Neurosci. 2007;19:383-90.
Lischke A, Domin M, Freyberger HJ, Grabe HJ, Mentel R, Bernheim D, et al. Structural alterations in white-matter tracts connecting (para-)limbic and prefrontal brain regions in borderline personality disorder. Psychol Med. 2015;45:3171-80.
Whalley HC, Nickson T, Pope M, Nicol K, Romaniuk L, Bastin ME, et al. White matter integrity and its association with affective and interpersonal symptoms in borderline personality disorder. NeuroImage Clin. 2015;7:476-81.
Kelleher-Unger I, Tajchman Z, Chittano G, Vilares I. Meta-analysis of white matter diffusion tensor imaging alterations in borderline personality disorder. Psychiatry Res Neuroimaging. 2021;307: 111205.
Niedtfeld I I, Schulze L, Krause-Utz A, Demirakca T, Bohus M, Schmahl C. Voxel-based morphometry in women with borderline personality disorder with and without comorbid posttraumatic stress disorder. PLoS ONE. 2013;8: e65824.
Kuhlmann A, Bertsch K, Schmidinger I, Thomann PA, Herpertz SC. Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder. J Psychiatry Neurosci JPN. 2013;38:129-37.
Hall J, Olabi B, Lawrie SM, McIntosh AM. Hippocampal and amygdala volumes in borderline personality disorder: A meta-analysis of magnetic resonance imaging studies: Brain volumes in borderline personality. Personal Ment Health. 2010;4:172-9.
Koenigsberg HW, Fan J, Ochsner KN, Liu X, Guise KG, Pizzarello S, et al. Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biol Psychiatry. 2009;66:854-63.
Rüsch N, Luders E, Lieb K, Zahn R, Ebert D, Thompson PM, et al. Corpus callosum abnormalities in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. J Psychiatry Neurosci JPN. 2007;32:417-22.
Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res. 2007; 155:231-43.
Zetzsche T, Preuss UW, Frodl T, Schmitt G, Seifert D, Münchhausen E, et al. Hippocampal volume reduction and history of aggressive behaviour in patients with borderline personality disorder. Psychiatry Res. 2007;154:157-70.
Rausch J, Flach E, Panizza A, Brunner R, Herpertz SC, Kaess M, et al. Associations between age and cortisol awakening response in patients with borderline personality disorder. J Neural Transm Vienna Austria. 2021;128:1425-32.
Rausch J, Gäbel A, Nagy K, Kleindienst N, Herpertz SC, Bertsch K. Increased testosterone levels and cortisol awakening responses in patients with borderline personality disorder: gender and trait aggressiveness matter. Psychoneuroendocrinology. 2015;55:116-27.
Thomas N, Gurvich C, Kulkarni J. Borderline personality disorder, trauma, and the hypothalamus-pituitary-adrenal axis. Neuropsychiatr Dis Treat. 2019;15:2601-12.
Drews E, Fertuck EA, Koenig J, Kaess M, Arntz A. Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis. Neurosci Biobehav Rev. 2019;96:316-34.
