Current Psychiatry Reports

, Volume 2, Issue 1, pp 56–61 | Cite as

Impulsive aggression in borderline personality disorder

  • Marianne Goodman
  • Antonia New


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


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References and Recommended Reading

  1. 1.
    Virkkunen M: Reactive hypoglycemic tendency among habitually violent offenders. Nutr Rev 1976, 44(suppl):94–103.CrossRefGoogle Scholar
  2. 2.
    Pattison E, Kahan J: The deliberate self-harm syndrome. Am J Psychiatry 1983, 140:867–872.PubMedGoogle Scholar
  3. 3.
    Coid JW: Axis II disorders and motivation for serious criminal behavior. In Psychopathology and Violent Crime. Edited by Skodol AE. Washington, DC: American Psychiatric Press; 1998.Google Scholar
  4. 4.
    Brodsky B, Malone K, Ellis S, et al.: Characteristics of borderline personality disorder associated with suicidal behavior. Am J Psychiatry 1997, 154:1715–1719.PubMedGoogle Scholar
  5. 5.
    Stone MH: Long-term follow-up of narcissistic/borderline patients. Psychiatr Clin North Am 1989, 12:621–641.PubMedGoogle Scholar
  6. 6.
    Paris J, Brown R, Nowlis D: Long-term follow-up of borderline patients in a general hospital. Compr Psychiatry 1987, 28:530–535.PubMedCrossRefGoogle Scholar
  7. 7.
    Herpertz S, Gretzer A, Steinmeyer E, et al.: Affective instability and impulsivity in personality disorder results of an experimental study. J Affec Dis 1997, 50:31–37.CrossRefGoogle Scholar
  8. 8.
    Virkkunen M, Eggert M, Rawlings R, Linnoila M: A prospective follow-up study of alcoholic violent offenders and fire setters. Arch Gen Psychiatry 1996, 53:523–529.PubMedGoogle Scholar
  9. 9.
    Dutton DG, Starzomski A, Ryan L: Antecedents of abusive personality and abusive behavior in wife assaulters. J Family Violence 1996, 11:113–132.CrossRefGoogle Scholar
  10. 10.
    Eronen M, Hakola P, Tihonen J: Mental Disorders and homicidal behavior in Finland. Arch Gen Psychiatry 1996, 53:497–501.PubMedGoogle Scholar
  11. 11.
    Paris J: Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology? Compr Psychiatry 1997, 38:237–242.PubMedCrossRefGoogle Scholar
  12. 12.
    Breslow R, Klinger B, Erickson B: Crisis hospitalization on a psychiatric emergency service. Gen Hosp Psychiatry 1993, 15:307–315.PubMedCrossRefGoogle Scholar
  13. 13.
    Molinari V, Ames A, Essa M: Prevalence of personality disorders in two geropsychiatric inpatient units. J Geriatr Psychiatry Neurol 1994, 7:295–300.Google Scholar
  14. 14.
    Blais M, Hilsenroth M, Castlebury F: Content validity of the DSM-IV borderline and narcissistic personality disorder criteria sets. Comprehensive Psych 1997, 38:31–37.CrossRefGoogle Scholar
  15. 15.
    Trull T, Useda D, Doan B, et al.: Year stability of borderline personality measures. J Personality Disorders 1998, 12(3):187–197.Google Scholar
  16. 16.
    Watson D, Sinha B: Comorbidity of DSM-IV personality disorders in a nonclinical sample. J Clin Psychol 1998, 54:773–780.PubMedCrossRefGoogle Scholar
  17. 17.
    Pfohl B, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality, Washington DC: American Psychiatric Press; 1997.Google Scholar
  18. 18.
    Coccaro EF, Kavoussi RJ, Borman ME, Lish JD: Intermittent expolsive disorder-revised: development, reliability, and validity of research criteria. Compr Psychiatry 1998, 39:368–376.PubMedCrossRefGoogle Scholar
  19. 19.
    Buss AH, Durkee A: An inventory for assessing different kinds of hostility. J Consult Psychol 1957, 21:343–348.PubMedCrossRefGoogle Scholar
  20. 20.
    Dougherty D, Bjork J, Huckabee H, et al.: Laboratory measure of aggression and impulsivity in worm with borderline personality disorder. Psychiatry Res 1999, 85:315–326.PubMedCrossRefGoogle Scholar
  21. 21.
    Alnaes R, Torgersen S: Clinical differentiation between major depression only, major depression with panic disorder and panic disorder only: childhood, personality and personality disorder. Acta Psychiatr Scand 1989, 79:370–377.PubMedGoogle Scholar
  22. 22.
    Torgersen S: Genetics in borderline conditions. Acta Psychiatr Scand 1992, 379(suppl):19–25.Google Scholar
  23. 23.
    Coccaro E, Bergman CS, McLean GE: Heritability of irritable impulsiveness: a study of twins reared together and apart. Psychiatry Res 1993, 48:229–242.PubMedCrossRefGoogle Scholar
  24. 24.
    Cadoret RJ, O’Gorman TW, Troughton E, Heywood E: Alcoholism and antisocial personality: interrelationships, genetic and environmental factors. Arch Gen Psych 1985, 42:161–167.Google Scholar
  25. 25.
    Crowe RR: An adoption study of antisocial personality. Arch Gen Psychiatry 1974, 31:785–791.PubMedGoogle Scholar
  26. 26.
    Cadoret RJ, Yates WR, Troughton E, et al.: Genetic-environmental interaction in the genesis of aggressivity and conduct disorders. Arch Gen Psychiatry 1995, 52:916–924.PubMedGoogle Scholar
  27. 27.
    New A, Gelernter J, Yovell Y, et al.: Increases in irritable aggression associated with “LL” genotype at the tryptophan hydroxylase locus. Am J Med Genet 1998, 81:13–17. The “LL” genotype of candidate gene tryptophan hydroxylase is associated with irritable aggression demonstrating preliminary genetic evidence of aggressive impulsivity.PubMedCrossRefGoogle Scholar
  28. 28.
    Coccaro EF, Siever LJ, Klar HM, et al.: Serotonergic studies in patients with affective and personality disorders. Arch Gen Psychiatry 1989, 46:587–599.PubMedGoogle Scholar
  29. 29.
    Coccaro E, Gabriel S, Siever L: Buspirone challenge: preliminary evidence for a role of 5HT1A receptor function in impulsive aggressive behavior in humans. Psychopharmacol Bull 1990, 26:393–405.PubMedGoogle Scholar
  30. 30.
    New AS, Trestman RL, Mitropoulou V, et al.: Serotonergic function and self-injurious behavior in personality disorder patients. Psychiatry Res 1997, 69:17–26.PubMedCrossRefGoogle Scholar
  31. 31.
    De La Fuente J, Goldman S, Stanus E, et al.: Brain glucose metabolism. J Psychiatr Res 1997, 31:531–41.CrossRefGoogle Scholar
  32. 32.
    Siever L, Buchsbaum M, New A, et al.: D,l-fenfluramine response in impulsive personality disorder assessed with [18 F]flurodeoxyglucose positron emission tomography. Neuropsychopharmacology 1999, 20:413–423. This paper details a study examining 5-HT activity as assessed by comparing changes in regional glucose metabolism after D,L-fenfluramine challenge in placebo versus personality disordered patients with impulsive aggression. Blunted responses in the orbital frontal, adjacent ventral medial and cingulate cortex were found in aggressive patients suggesting putative brain regions involved in serotonergic dysfunction.PubMedCrossRefGoogle Scholar
  33. 33.
    Coccaro R, Kavoussi R, Hauger R: Serotonin function and antiaggressive response to fluoxetine: a pilot study. Biol Psychiatry 1997, 42:546–552.PubMedCrossRefGoogle Scholar
  34. 34.
    Coccaro E, Kavoussi R, Hauger R, et al.: Cerebrospinal fluid vasopressin levels, correlates with aggression and serotonin function in personality-disordered subjects. Arch Gen Psychiatry 1998, 55:798–714.CrossRefGoogle Scholar
  35. 35.
    Hommer D, Andreasen P, Rio D, et al.: Effects of m-chlorophenylpiperazine on regional brain glucose utilization: a positron emission tomographic comparison of alcohol and control subjects. J Neurosci 1997, 17:2796–2806.PubMedGoogle Scholar
  36. 36.
    Ferris C, Delville Y: Vasopressin and serotonin interactions in the control of agonistic behavior. Psychneuroendocrinology 1994, 19:593–601.CrossRefGoogle Scholar
  37. 37.
    Markowitz P: Pharmacotherapy of impulsivity, aggression and related disorders. In Impulsive Aggression and Disorders of Impulse Control. Edited by Stein D, Hollander E. Sussex: J Wiley; 1995:263–287.Google Scholar
  38. 38.
    Salzman C, Wolfson A, Schatzberg A, et al.: Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 1995, 15:23–29.PubMedCrossRefGoogle Scholar
  39. 39.
    Coccaro E, Kavoussi R: Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 1997, 54:1081–1088.PubMedGoogle Scholar
  40. 40.
    Kallioniemi H, Syvalahti E: Citalopram, a specific inhibitor of serotonin reuptake in treatment of psychotic and borderline patients. Nordic J Psychiatry 1993, 47(suppl 28):79–84.Google Scholar
  41. 41.
    Kavoussi R, Liu J, Coccaro E: An open trial of sertraline in borderline personality disordered patients with impulsive aggression. J Clin Psychiatry 1994, 55:137–141.PubMedGoogle Scholar
  42. 42.
    Hollander E: Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder. J Clin Psychiatry 1999, 60(suppl 15):38–44.PubMedGoogle Scholar
  43. 43.
    Pinto O, Akiskal H: Lamotrigine as a promising approach to borderline personality: an open case series without concurrent DSM-IV major mood disorder. J Affec Dis 1998, 51:333–343.CrossRefGoogle Scholar
  44. 44.
    Pollack M, Scott E: Gabapentin and lamotrigine: novel treatments for mood and anxiety disorders. CNS Spectrums 1997, 2:56–61.Google Scholar
  45. 45.
    Frankenburg F, Zanarini M: Clozapine treatment of borderline patients: a preliminary study. Comp Psychiatry 1993, 34:402–405.CrossRefGoogle Scholar
  46. 46.
    Benedetti F, Sforzini L, Colombo C, et al.: Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. J Clin Psychiatry 1998, 59:103–107.PubMedGoogle Scholar
  47. 47.
    Chengappa KN, Ebeling T, Kang JS, et al.: Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. J Clin Psychiatry 1999, 60:477–484.PubMedCrossRefGoogle Scholar
  48. 48.
    Khouzam H, Donnelly N: Remission of self-mutilation in a patient with borderline personality disorder during risperidone therapy. J Nerv Mental Dis 1997, 185:348–349.CrossRefGoogle Scholar
  49. 49.
    Roth A, Ostroff R, Hoffman R: Naltrexone as a treatment for repetitive self-injurious behavior: an open-label trial. J Clin Psychiatry 1996, 57:233–237.PubMedGoogle Scholar
  50. 50.
    Kim S: Opiod antagonists in the treatment of impulse-control disorders. J Clin Psychiatry 1998, 59:159–164.PubMedGoogle Scholar
  51. 51.
    Bohus M, Landwehrmeyer GB, Stiglmayr C, et al.: Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry 1999, 60:598–603.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Marianne Goodman
    • 1
  • Antonia New
    • 1
  1. 1.Psychiatry Service 116-ABronx Veterans Affairs Medical CenterBronxUSA

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