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Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response

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Abstract

Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.

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Acknowledgments

This study was supported by Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and by a grant from Instituto de Salud Carlos III (PI13/00134) and co-financed by the European Regional Development Fund (ERDF). ME has a Juan de la Cierva research contract awarded by the ISCIII (FJCI-2017-31738). ME wants to thank unrestricted research funding from “Secretaria d′Universitats i Recerca del Departament d′Economia i Coneixement (2017 SGR 134 to “Mental Health Research Group”), Generalitat de Catalunya (Government of Catalonia). The contribution of CS is also supported by CONICYT PFCHA/BCH 72190624 scholarship. We thank Bradley Londres for professional English language editing.

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  1. Frederic Sampedro and Cristina Carmona i Farrés contributed equally to this work.

Authors and Affiliations

  1. Movement Disorders Unit Neurology Department Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain

    Frederic Sampedro

  2. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain

    Frederic Sampedro

  3. Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain

    Cristina Carmona i Farrés, Joaquim Soler, Matilde Elices, Carlos Schmidt, Iluminada Corripio, Elisabet Domínguez-Clavé & Juan C. Pascual

  4. Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain

    Cristina Carmona i Farrés, Joaquim Soler, Matilde Elices, Iluminada Corripio, Edith Pomarol-Clotet, Raymond Salvador & Juan C. Pascual

  5. Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, UAB, Barcelona, Spain

    Joaquim Soler, Iluminada Corripio & Juan C. Pascual

  6. FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain

    Edith Pomarol-Clotet & Raymond Salvador

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  1. Frederic Sampedro
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Contributions

JS, JCP, IC and EPC conceived the study. FS and RS performed the neuroimaging procedures and statistical analyses. CCF and CS drafted the first version of the manuscript. JS and ME performed the psychotherapeutic intervention. All authors contributed to the writing and reviewing of the manuscript.

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Correspondence to Joaquim Soler.

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Sampedro, F., Farrés, C.C.i., Soler, J. et al. Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response. Brain Imaging and Behavior 15, 2502–2512 (2021). https://doi.org/10.1007/s11682-021-00451-6

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