Current Psychiatry Reports

, Volume 12, Issue 1, pp 46–55 | Cite as

The Latest Neuroimaging Findings in Borderline Personality Disorder

Article

Abstract

This review provides an overview of the most recent neuroimaging findings in borderline personality disorder. The contributions of the structural and functional imaging studies of the past 3 years are presented to help us better understand this severe psychiatric disorder. There are three domains of functional imaging findings: 1) affective dysregulation; 2) the complex of dissociation, self-injurious behavior, and pain processing; and 3) social interaction. Knowledge of the neurobiological basis of borderline personality disorder has grown considerably. Therefore, these findings convey a good impression of the current findings from neuroimaging research in this disorder and also of the necessary next steps with regard to content and methodology.

Keywords

BPD Imaging studies Affective dysregulation Dissociation Social interaction 

Notes

Disclosure

Dr. Mauchnik has received a travel grant from GlaxoSmithKline.

Dr. Schmahl has received speakers’ honoraria from AstraZeneca and served on an advisory board for Lundbeck.

References

Papers of particular interest, published recently, have been highlighted as:• Of importance•• Of major importance

  1. 1.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  2. 2.
    American Psychiatric Association: Practice guideline for the treatment of patients with borderline personality disorder—introduction. Am J Psychiatry 2001, 158:2.Google Scholar
  3. 3.
    Grant BF, Chou SP, Goldstein RB, 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, 69:533–545.CrossRefPubMedGoogle Scholar
  4. 4.
    Bender DS, Dolan RT, Skodol AE, et al.: Treatment utilization by patients with personality disorders. Am J Psychiatry 2001, 158:295–302.CrossRefPubMedGoogle Scholar
  5. 5.
    Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J: Treatment histories of borderline inpatients. Compr Psychiatry 2001, 42:144–150.CrossRefPubMedGoogle Scholar
  6. 6.
    • Nunes PM, Wenzel A, Borges KT, et al.: Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis. J Pers Disord 2009, 23:333–345. This meta-analysis confirmed reduced hippocampal volumes in BPD patients.CrossRefPubMedGoogle Scholar
  7. 7.
    Bremner JD, Randall P, Scott TM, et al.: MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. Am J Psychiatry 1995, 152:973–981.PubMedGoogle Scholar
  8. 8.
    Bremner JD, Randall P, Vermetten E, et al.: Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse—a preliminary report. Biol Psychiatry 1997, 41:23–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Stein MB, Koverola C, Hanna C, et al.: Hippocampal volume in women victimized by childhood sexual abuse. Psychol Med 1997, 27:951–959.CrossRefPubMedGoogle Scholar
  10. 10.
    Driessen M, Herrmann J, Stahl K, 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, 57:1115–1122.CrossRefPubMedGoogle Scholar
  11. 11.
    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, 122:193–198.CrossRefPubMedGoogle Scholar
  12. 12.
    Tebartz van Elst L, Hesslinger B, Thiel T, et al.: Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry 2003, 54:163–171.Google Scholar
  13. 13.
    Brambilla P, Soloff PH, Sala M, et al.: Anatomical MRI study of borderline personality disorder patients. Psychiatry Res 2004, 131:125–133.CrossRefPubMedGoogle Scholar
  14. 14.
    Zetzsche T, Frodl T, Preuss UW, et al.: Amygdala volume and depressive symptoms in patients with borderline personality disorder. Biol Psychiatry 2006, 60:302–310.CrossRefPubMedGoogle Scholar
  15. 15.
    Schmahl C, Berne K, Krause A, et al.: Hippocampus and amygdala volumes in patients with borderline personality disorder with or without posttraumatic stress disorder. J Psychiatry Neurosci 2009, 34:289–295.PubMedGoogle Scholar
  16. 16.
    Weniger G, Lange C, Sachsse U, Irle E: Reduced amygdala and hippocampus size in trauma-exposed women with borderline personality disorder and without posttraumatic stress disorder. J Psychiatry Neurosci 2009, 34:383–388.PubMedGoogle Scholar
  17. 17.
    Zetzsche T, Preuss UW, Frodl T, et al.: Hippocampal volume reduction and history of aggressive behaviour in patients with borderline personality disorder. Psychiatry Res 2007, 154:157–170.CrossRefPubMedGoogle Scholar
  18. 18.
    Irle E, Lange C, Weniger G, Sachsse U: Size abnormalities of the superior parietal cortices are related to dissociation in borderline personality disorder. Psychiatry Res 2007, 156:139–149.CrossRefPubMedGoogle Scholar
  19. 19.
    Berlin HA, Rolls ET, Iversen SD: Borderline personality disorder, impulsivity, and the orbitofrontal cortex. Am J Psychiatry 2005, 162:2360–2373.CrossRefPubMedGoogle Scholar
  20. 20.
    • New AS, Hazlett EA, Buchsbaum MS, et al.: Amygdala-prefrontal disconnection in borderline personality disorder. Neuropsychopharmacology 2007, 32:1629–1640. This functional connectivity study showed a disturbed connection between the amygdala and prefrontal brain regions.CrossRefPubMedGoogle Scholar
  21. 21.
    Williams LM, Sidis A, Gordon E, Meares RA: “Missing links” in borderline personality disorder: loss of neural synchrony relates to lack of emotion regulation and impulse control. J Psychiatry Neurosci 2006, 31:181–188.PubMedGoogle Scholar
  22. 22.
    Ruesch N, Luders E, Lieb K, et al.: Corpus callosum abnormalities in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. J Psychiatry Neurosci 2007, 32:417–422.Google Scholar
  23. 23.
    Teicher MH, Dumont NL, Ito Y, et al.: Childhood neglect is associated with reduced corpus callosum area. Biol Psychiatry 2004, 56:80–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Minzenberg MJ, Fan J, New AS, et al.: Frontolimbic structural changes in borderline personality disorder. J Psychiatry Res 2008, 42:727–733.CrossRefGoogle Scholar
  25. 25.
    Hazlett EA, New AS, Newmark R, et al.: Reduced anterior and posterior cingulate gray matter in borderline personality disorder. Biol Psychiatry 2005, 58:614–623.CrossRefPubMedGoogle Scholar
  26. 26.
    Soloff P, Nutche J, Goradia D, Diwadkar V: Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res 2008, 164:223–236.CrossRefPubMedGoogle Scholar
  27. 27.
    Brunner R, Henze R, Parzer P, et al.: Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: is it disorder specific? Neuroimage 2010, 49:114–120.CrossRefPubMedGoogle Scholar
  28. 28.
    Chanen AM, Velakoulis D, Carison K, et al.: Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder. Psychiatry Res 2008, 163:116–125.CrossRefPubMedGoogle Scholar
  29. 29.
    Whittle S, Chanen AM, Fornito A, et al.: Anterior cingulated volume in adolescents with first-presentation borderline personality disorder. Psychiatry Res 2009, 172:155–160.CrossRefPubMedGoogle Scholar
  30. 30.
    Takahashi T, Chanen AM, Wood SJ, et al.: Midline brain structures in teenagers with first-presentation borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009, 33:842–846.CrossRefPubMedGoogle Scholar
  31. 31.
    Takahashi T, Chanen AM, Wood SJ, et al.: Insular cortex volume and impulsivity in teenagers with first-presentation borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009, 33:1395–1400.CrossRefPubMedGoogle Scholar
  32. 32.
    Skodol AE, Gunderson JG, Pfohl B, et al.: The borderline diagnosis I: psychopathology comorbidity, and personality structure. Biol Psychiatry 2002, 51:936–950.CrossRefPubMedGoogle Scholar
  33. 33.
    Skodol AE, Siever LJ, Livesley WJ, et al.: The borderline diagnosis II: biology, genetics, and clinical course. Biol Psychiatry 2002, 51:951–963.CrossRefPubMedGoogle Scholar
  34. 34.
    Linehan MM, Kehrer CA: Borderline personality disorder. In Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, edn 2. Edited by Barlow DH. New York: Guilford Press; 1993:396–441.Google Scholar
  35. 35.
    Koenigsberg HW, Siever LJ, Lee H, et al.: Neural correlates of emotion processing in borderline personality disorder. Psychiatry Res 2009, 172:192–199.CrossRefPubMedGoogle Scholar
  36. 36.
    Lynch TR, Rosenthal MZ, Kosson, DS, et al.: Heightened sensitivity to facial expressions of emotion in borderline personality disorder. Emotion 2006, 6:647–655.Google Scholar
  37. 37.
    Minzenberg MJ, Fan J, New AS, et al.: Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res 2007, 155:231–243.CrossRefPubMedGoogle Scholar
  38. 38.
    Guitart-Masip M, Pascual JC, Carmona S, et al.: Neural correlates of impaired emotional discrimination in borderline personality disorder: an fMRI study. Prog Neuropsychopharmacol Biol Psychiatry 2009, 33:1537–1545.CrossRefPubMedGoogle Scholar
  39. 39.
    Levine D, Marziali E, Hood J: Emotion processing in borderline personality disorders. J Nerv Ment Dis 1997, 185:240–246.CrossRefPubMedGoogle Scholar
  40. 40.
    Fertuck EA, Jekal A, Song I, et al.: Enhanced ‘reading the mind in the eyes’ in borderline personality disorder compared to healthy controls. Psychol Med 2009, 39:1979–1988.CrossRefPubMedGoogle Scholar
  41. 41.
    Wagner AW, Linehan MM: Facial expression recognition ability among women with borderline personality disorder: implications for emotion regulation? J Pers Disord 1999, 13:329–344.PubMedGoogle Scholar
  42. 42.
    Domes G, Schulze L, Herpertz SC: Emotion recognition in borderline personality disorder—a review of the literature. J Pers Disord 2009, 23:6–19.CrossRefPubMedGoogle Scholar
  43. 43.
    Silbersweig D, Clarkin JF, Goldstein M, et al.: Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry 2007, 164:1832–1841.CrossRefPubMedGoogle Scholar
  44. 44.
    Wingenfeld K, Rullkoetter N, Mensebach C, et al.: Neural correlates of the individual emotional Stroop in borderline personality disorder. Psychoneuroendocrinology 2009, 34:571–586.CrossRefPubMedGoogle Scholar
  45. 45.
    •• Koenigsberg HW, Fan J, Ochsner KN, 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, 66:854–863. This was the first study to directly investigate emotion regulation mechanisms that can be assumed to be key to the understanding of BPD.CrossRefPubMedGoogle Scholar
  46. 46.
    Driessen M, Wingenfeld K, Rullkoetter N, Mensebach C, Woermann FG, Mertens M, Beblo T: One-year functional magnetic resonance imaging follow-up study of neural activation during the recall of unresolved negative life events in borderline personality disorder. Psychol Med 2008, 39:507–516.CrossRefPubMedGoogle Scholar
  47. 47.
    • Schnell K, Herpertz S: Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. J Psychiatr Res 2007, 41:837–847. This was the first pilot study to look at the influence of DBT on neural correlates of affective arousal.CrossRefPubMedGoogle Scholar
  48. 48.
    Stiglmayr CE, Shapiro DA, Stieglitz RD, et al.: Experience of aversive tension and dissociation in female patients with borderline personality disorder–a controlled study. J Psychiatr Res 2001, 35:111–118.CrossRefPubMedGoogle Scholar
  49. 49.
    Roeder CH, Michal M, Overbeck G, et al.: Pain response in depersonalization: a functional imaging study using hypnosis in healthy subjects. Psychother Psychosom 2007, 76:115–121.CrossRefGoogle Scholar
  50. 50.
    Schmahl C, Bohus M: Translational research issues in dissociation. In Traumatic Dissociation. Edited by Vermetten E, Dorahy M, Spiegel D. Washington, DC: American Psychiatric Publishing; 2007:121–138.Google Scholar
  51. 51.
    Kleindienst N, Bohus M, Ludaescher P, et al.: Motives for non-suicidal self-injury among women with borderline personality disorder. J Nerv Ment Dis 2008, 196:230–236.CrossRefPubMedGoogle Scholar
  52. 52.
    Ludaescher P, Valerius G, Stiglmayr C, et al.: Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid PTSD—a pilot study. J Psychiatry Neurosci 2010 (in press).Google Scholar
  53. 53.
    Ludascher P, Bohus M, Lieb K, et al.: Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res 2007, 149:291–296.CrossRefPubMedGoogle Scholar
  54. 54.
    Lanius RA, Williamson PC, Boksman K, et al.: Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation. Biol Psychiatry 2002, 52:305–311.CrossRefPubMedGoogle Scholar
  55. 55.
    Schmahl C, Bohus M, Esposito F, et al.: Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry 2006, 63:659–667.CrossRefPubMedGoogle Scholar
  56. 56.
    Geuze E, Westenberg HG, Jochims A, et al.: Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry 2007, 64:76–85.CrossRefPubMedGoogle Scholar
  57. 57.
    Kraus A, Esposito F, Seifritz E, et al.: Amygdala deactivation as a neural correlate of pain processing in patients with borderline personality disorder and co-occurrent posttraumatic stress disorder. Biol Psychiatry 2009, 65:819–822.CrossRefPubMedGoogle Scholar
  58. 58.
    Kraus A, Valerius G, Seifritz E, et al.: Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study. Acta Psychiatr Scand 2009, 119:1–11.CrossRefGoogle Scholar
  59. 59.
    Buchheim A, Erk S, George C, et al.: Neural correlates of attachment trauma in borderline personality disorder: a functional magnetic resonance imaging study. Psychiatry Res 2008, 163:223–235.CrossRefPubMedGoogle Scholar
  60. 60.
    •• King-Casas B, Sharp C, Lomax-Bream L, et al.: The rupture and repair of cooperation in borderline personality disorder. Science 2008, 321:806–810. This study used an innovative design to examine trust as one of the central problems in BPD.CrossRefPubMedGoogle Scholar
  61. 61.
    Spitzer M, Fischbacher U, Herrnberger B, et al.: The neural signature of social norm compliance. Neuron 2007, 56:185–196.CrossRefPubMedGoogle Scholar
  62. 62.
    Paulus MP: Decision-making dysfunctions in psychiatry—altered homeostatic processing? Science 2007, 318:602–606.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Psychosomatic Medicine and PsychotherapyCentral Institute of Mental HealthMannheimGermany

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