Neurotransmitter dysfunction in patients with borderline personality disorder

Inflammatory and oxidative endophenotypes in borderline personality disorder: A biomarker cluster analysis

OBJECTIVES

This study is designed to search for aggrupation of inflammatory/oxidative biomarker alterations in borderline personality disorder (BPD) and their association with phenotypic features.

METHODOLOGY

Inflammatory/nitrosative proteins were measures in plasma and peripheral blood mononuclear cells obtained from BPD patients. Patients were assessed on different clinical dimensions of BPD. Oxidative damage was tested by measuring TBARS, nitrites, catalase, GPx and SOD. Protein expression of IκBα, NFκB, iNOS, COX-2, PPARγ, Keap1, NQO1, Nrf2 and α7nAChR was also determined. Western blot and ELISA were used for measurements and a cluster analysis of inflammatory/oxidative biomarkers alterations was performed to investigate subgroups of patients with similar alterations and its relationship with clinical features of BPD.

RESULTS

69 patients were included in the study. Two inflammatory/nitrosative clusters of patients were found: Cluster 1 patients showed significantly higher levels of GPx, IκBα, keap1, NQO1, PPARγ, α7nAChR and Nrf2 than cluster 2 patients. These patients had significantly longer duration of illness, milder anxiety symptoms and lower prescription of antipsychotic drugs than cluster 2.

CONCLUSIONS

Two clusters of BPD patients according to the inflammatory/nitrosative profiles were identified. Cluster 1 had increased antioxidant and anti-inflammatory biomarkers and was characterised by greater chronicity of illness but less acute symptomatic severity.

Capturing Between- and Within-Person Variability of Borderline Traits in Youth from a Developmentally Sensitive Situational Judgment Perspective

The significance of early maladaptive traits for understanding the roots of borderline personality disorder (BPD) is increasingly endorsed. Given the interpersonal nature of BPD and fluctuations in phenotypic symptomatology, this study aims to test the assumption that a situation-contingent contextualized assessment of borderline traits is a viable avenue to more fully capture the way underlying traits are reflected in socioaffective behavior that occurs in age-relevant situations. We aimed to explore the extent to which the variability on these responses represents a meaningful construct for understanding the clinical richness of BPD. Toward this end, a contextualized measure of DSM-5 BPD traits was developed along a situational judgment test (SJT) format, allowing us to explore both between-person and within-person variability in a more economic format than repeated measurement does. Examination of the psychometric properties of the SJT revealed distinctive correlational patterns of the situation-based traits with symptom scales of a youth BPD measure, but also indicated that for certain traits consistency in trait level across different situations is more maladaptive, whereas for other traits a greater degree of variability in trait expression is more maladaptive. Overall, this work could set the stage for further research on the potential of SJTs for understanding personality vulnerabilities both at the dispositional and the dynamic level.

Effects of Maternal Separation and Subsequent Stress on Behaviors and Brain Monoamines in Rats

Childhood adversity can induce maladaptive behaviors and increase risk for affective disorders, post-traumatic stress disorder, personality disorders, and vulnerability to stress in adulthood. Deprivation of maternal care interrupts brain development through the disturbance of various neurotransmitters, however, the details remain unclear. The features of the symptoms of disorders are largely determined by early stress protocol, genetic characteristics (line), and the sex of the animals. The purpose of current study was (1) to assess behavioral changes in adult Wistar rats of both sexes after early life stress; (2) to determine the levels of monoamines in brain structures involved in the motor, emotional, and social reactions in rats aged 1 and 2 months; and (3) to determine the level of monoamines after physical or emotional stress in adult rats. The rat pups were separated from their dams and isolated from siblings in tight boxes at a temperature of 22-23 °C for 6 h during postnatal days 2-18. The data were processed predominantly using two-way analysis of variance and the Newman-Keys test as the post hoc analysis. The adult rats demonstrated an increase in motor activity and aggressiveness and a decrease in levels of anxiety and sociability. Behavioral disturbances were accompanied by region-, sex-, and age-dependent changes in the levels of monoamines and their metabolites. The dopaminergic and noradrenergic systems were found to be sensitive to psycho-emotional stress.

Neurotransmitters Regulation and Food Intake: The Role of Dietary Sources in Neurotransmission

Neurotransmitters (NTs) are biologically active chemicals, which mediate the electrochemical transmission between neurons. NTs control numerous organic functions particularly crucial for life, including movement, emotional responses, and the physical ability to feel pleasure and pain. These molecules are synthesized from simple, very common precursors. Many types of NTs have both excitatory and inhibitory effects. Neurotransmitters' imbalance can cause many diseases and disorders, such as Parkinson's disease, depression, insomnia, increased anxiety, memory loss, etc. Natural food sources containing NTs and/or their precursors would be a potential option to help maintain the balance of NTs to prevent brain and psychiatric disorders. The level of NTs could be influenced, therefore, by targeting dietary habits and nutritional regimens. The progressive implementation of nutritional approaches in clinical practice has made it necessary to infer more about some of the nutritional NTs in neuropsychiatry. However, the importance of the intake of nutritional NTs requires further understanding, since there are no prior significant studies about their bioavailability, clinical significance, and effects on nerve cells. Interventional strategies supported by evidence should be encouraged.

Cannabis-Based Medicinal Products in the Management of Emotionally Unstable Personality Disorder (EUPD): A Narrative Review and Case Series

Emotionally unstable personality disorder (EUPD) is a common mental health disorder, manifesting with a range of chronic and debilitating symptoms, including impaired social functioning, unstable mood, and risky impulsive or self-injurious behaviour. Whilst the exact aetiology has not been fully elucidated, implicated factors seem to include genetic factors, environmental causes such as trauma, and neurotransmitter deficits. The literature suggests that impaired functioning of the endocannabinoid system in key brain regions responsible for emotional processing and stress response may underlie the manifestation of EUPD symptoms. The National Institute for Health and Care Excellence (NICE) 2009 guidelines state that “no drugs have established efficacy in treating or managing EUPD”, and yet, patients are commonly prescribed medication which includes antipsychotics, antidepressants, and mood stabilisers. Here we present a case series of seven participants diagnosed with EUPD and treated with cannabis-based medicinal products (CBMPs). Participants were given an initial assessment and followed up one month after CBMPs prescription. Improvement in symptoms was assessed by the completion of ratified rating scales by the participant and psychiatrist. Our results indicate that CBMPs were effective and well tolerated, as six participants reported a noticeable improvement in their symptoms and functioning. Although promising, further research is needed to ascertain the long-term tolerability, efficacy, and dosing strategy for CBMPs in EUPD.

Brief Admission for Patients with Self-Harm from the Perspective of Outpatient Healthcare Professionals

The aim of the study was to describe the role of brief-admission (BA) in treating high-risk patients with self-harm from the perspective of outpatient healthcare staff in Sweden. Ten outpatient healthcare professionals from three psychiatric clinics were interviewed. Data were analyzed using a conventional content analysis. The findings of this study help support the role of BA as an acute crisis management intervention, and describe how BA serves as a useful adjunct to outpatient treatment, especially for patients with complementarily psychotherapeutic interventions. The findings also suggest that implementing BA may increase treatment opportunities for outpatient staff and strengthen the concept of person-centered care.

Reduced glucocorticoid receptor expression in blood mononuclear cells of patients with borderline personality disorder

INTRODUCTION

Abnormal cortisol suppression in borderline personality disorder has been consistently reported in previous studies, suggesting that a hypersensitivity response of the hypothalamic-pituitary-adrenal (HPA) axis might occur in these patients. In this study, the abnormalities of the cortisol response in borderline personality disorder (BPD) are investigated through the cellular expression of the glucocorticoid receptors (GR) in BPD patients and its relationship with traumatic experiences.

METHODOLOGY

Sixty-nine male and female patients diagnosed with BPD and 62 healthy controls were studied. Peripheral blood mononuclear cells were obtained to investigate the expression of glucocorticoid receptors. Western blot was used to measure protein expression. Statistical correlations of GR expression with BPD clinical features and intensity of previous traumatic events were investigated.

RESULTS

A significant decrease in the nuclear expression of glucocorticoid receptors was found in BPD patients compared to healthy controls in a regression analysis controlling for the effect of medication. GR expression decrease correlated significantly with clinical levels of anxiety and depression, but not with previous traumatic experiences in patients.

CONCLUSIONS

BPD patients had a lower nuclear expression of glucocorticoid receptors than healthy controls, when it was controlled for the effect of medication. The reduced GR expression in BPD patients was not associated with previous traumatic events and might be associated with other aspects of BPD, such as emotional instability; more studies with larger samples of patients are still needed to understand the relevance and the implications of these findings.

Repetitive transcranial magnetic stimulation in patients with borderline personality disorder: A systematic review

The literature on the application of repetitive transcranial magnetic stimulation (rTMS) in Borderline Personality Disorder (BPD) is unclear, even though its neuromodulatory effects on underlying neural circuitry involved in BPD symptoms suggest that it could be a potential treatment option. We sought to review the evidence on rTMS as a treatment option in BPD. PubMed (for Medline database), Google Scholar, and Scopus were systematically searched following the PRISMA guidelines for studies of any design examining the application of the rTMS treatment in adult patients with precise and primary diagnosis of BPD written in the English language. The systematic review has been registered on PROSPERO (CRD42020215927). Forty one records were screened, and eight fulfilled inclusion criteria (total of 63 patients). The existing studies suggest that rTMS is a well-tolerated treatment in patients with BPD. Double-blind randomized controlled studies are necessary to help elucidate the effects of rTMS in the different symptoms in BPD and establish efficacy and the best cortical targets and stimulation protocols. Longitudinal studies that combine evidenced based psychotherapy with rTMS may be a future line of investigation that could potentially improve outcomes for this population.

Predicting the relationships between gut microbiota and mental disorders with knowledge graphs

Gut microbiota produce and modulate the production of neurotransmitters which have been implicated in mental disorders. Neurotransmitters may act as ‘matchmaker’ between gut microbiota imbalance and mental disorders. Most of the relevant research effort goes into the relationship between gut microbiota and neurotransmitters and the other between neurotransmitters and mental disorders, while few studies collect and analyze the dispersed research results in systematic ways. We therefore gather the dispersed results that in the existing studies into a structured knowledge base for identifying and predicting the potential relationships between gut microbiota and mental disorders. In this study, we propose to construct a gut microbiota knowledge graph for mental disorder, which named as MiKG4MD. It is extendable by linking to future ontologies by just adding new relationships between existing information and new entities. This extendibility is emphasized for the integration with existing popular ontologies/terminologies, e.g. UMLS, MeSH, and KEGG. We demonstrate the performance of MiKG4MD with three SPARQL query test cases. Results show that the MiKG4MD knowledge graph is an effective method to predict the relationships between gut microbiota and mental disorders.

Inflammatory and antioxidant pathway dysfunction in borderline personality disorder

INTRODUCTION

This study investigates the alteration of the inflammatory/oxidative pathway in patients with borderline personality disorder (BPD) and its relationship with clinical features of the disorder.

METHODS

49 BPD patients and 33 healthy control subjects were studied. Plasma levels of TBARS, nitrites, and the antioxidant enzymes CAT, GPx and SOD were measured. In addition, peripheral blood mononuclear cells were obtained to investigate levels of intracellular components of the inflammatory/oxidative pathway including the IκBα, NFκB, iNOS, COX2, Keap1, NQO1, and HO1. Western Blot and ELISA were used to measure protein expression. Patients were assessed for different clinical dimensions of BPD with scales for depression, anxiety, impulsivity and functioning.

RESULTS

A significant decrease of IκBα levels and a significant increase of inflammatory factors, including NFκB, COX2 and iNOS levels were found in patients. On the other hand, a significant decrease was observed for all antioxidant enzymes in patients with BPD, except for HO1. The inflammatory factor NFκB showed a significant positive correlation with impulsivity scores.

CONCLUSIONS

Patients with BPD presented an increased activation of several components of the inflammatory pathways, as well as an inhibition of the antioxidant path. These alterations appear partially correlated with the impulsivity scores in these patients.

Identity: Recent Findings and Clinical Implications

After a review of foundational contributions to the concept of identity, including Erikson's, the author discusses the research methods and findings of the Personality Disorders Institute of the Joan and Sanford I. Weill Medical College of Cornell University regarding the concepts of normal identity and identity diffusion, toward an elucidation of the psychopathology of personality disorders--their etiology, diagnosis, and treatment. The application of an object relations theory model to analyze the development of identity clarifies the relationship of individual identity with the social and cultural frame that influences identity formation and may amplify the effects of pathological identity development. Detailed excerpts are presented from a diagnostic structural interview at the Personality Disorders Institute.

Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk

Biobehavioral dispositions can serve as valuable referents for biologically oriented research on core processes with relevance to many psychiatric conditions. The present study examined two such dispositional variables-weak response inhibition (or disinhibition; INH-) and threat sensitivity (or fearfulness; THT+)-as predictors of the serious transdiagnostic problem of suicide risk in two samples: male and female outpatients from a U.S. clinic (N=1078), and a population-based male military cohort from Finland (N=3855). INH- and THT+ were operationalized through scores on scale measures of disinhibition and fear/fearlessness, known to be related to DSM-defined clinical conditions and brain biomarkers. Suicide risk was assessed by clinician ratings (clinic sample) and questionnaires (both samples). Across samples and alternative suicide indices, INH- and THT+ each contributed uniquely to prediction of suicide risk-beyond internalizing and externalizing problems in the case of the clinic sample where diagnostic data were available. Further, in both samples, INH- and THT+ interactively predicted suicide risk, with individuals scoring concurrently high on both dispositions exhibiting markedly augmented risk. Findings demonstrate that dispositional constructs of INH- and THT+ are predictive of suicide risk, and hold potential as referents for biological research on suicidal behavior.

Pharmacotherapy for borderline personality disorder--current evidence and recent trends

Drug treatment of patients with borderline personality disorder (BPD) is common but mostly not supported by evidence from high-quality research. This review summarises the current evidence up to August 2014 and also aims to identify research trends in terms of ongoing randomised controlled trials (RCTs) as well as research gaps. There is some evidence for beneficial effects by second-generation antipsychotics, mood stabilisers and omega-3 fatty acids, while the overall evidence base is still unsatisfying. The dominating role SSRI antidepressants usually play within the medical treatment of BPD patients is neither reflected nor supported by corresponding evidence. Any drug treatment of BPD patients should be planned and regularly evaluated against this background of evidence. Research trends indicate increasing attention to alternative treatments such as dietary supplementation by omega-3 fatty acids or oxytocin.

Genetic modulation of borderline personality disorder: systematic review and meta-analysis

Borderline personality disorder (BPD) is a highly prevalent psychiatric disorder with high morbidity and mortality. Early theories ascribed an environmental etiology of BPD, but growing evidence supports a genetic vulnerability as well. The primary aim of this study was to systematically review genetic association studies focused on BPD. PubMed, ISI Web of Knowledge and PsycINFO databases were searched for studies published until December 2012. Meta-analyses were also performed when three or more studies reported genetic data on the same polymorphism. Data were analyzed with Cochrane Collaboration Review Manager Software (RevMan, version 5.0). Quality and publication bias were assessed. The systematic review of association studies examining genetic polymorphisms and BPD produced conflicting results. Meta-analyses were performed for three serotonergic polymorphisms: two common polymorphisms of the serotonin transporter gene (SLC6A4), the promoter insertion/deletion (5-HTTLPR) and the intron 2 VNTR (STin2 VNTR), and the rs1800532 (A218C) polymorphism of the tryptophan hydroxylase 1 gene (TPH1), all showing no association. No direct role of genetic polymorphisms was found in BPD. However, a few studies only are present in literature to draw definite conclusions. Further studies focusing on gene × gene and gene × environment interactions are needed to more deeply dissect the genetic role in the modulation of BPD.

Activation of the cholinergic anti-inflammatory system in peripheral blood mononuclear cells from patients with borderline personality disorder

A case-control study including patients (n = 20) with Borderline Personality Disorder (BPD) and healthy controls (n = 33) was carried out. To avoid interferences of other clinical conditions on biological findings, patients were free of current major depressive episodes or substance dependence disorders, and had no life history of schizophrenia, bipolar or neuropsychiatric disorders. Patients were free of medication for at least two weeks at the time of the study. Studies carried out in peripheral mononuclear blood cells and plasma evidence a systemic inflammatory condition in unstable-impulsive BPD patients. Specifically, a significant increase in some intracellular components of two main pro-inflammatory pathways such as iNOS and COX-2, as well as an increase in the plasma levels of the inflammatory cytokine IL1β. Interestingly, patients have an increase in the protein expression of the anti-inflammatory subtype of nicotinic receptor α7nAChR. This finding may reflect a possible mechanism trying to maintain intracellular inflammation pathways under control. All together, these results describe an imbalanced, pro-inflammatory and oxidant phenotype in BPD patients independent of plasma cotinine levels. Although more scientific evidence is needed, the determination of multiple components of pro- and anti-inflammatory cellular pathways have interesting potential as biological markers for BPD and other generalized impulsive syndromes, specially data obtained with α7nAChR and its lack of correlation with plasma levels of nicotine metabolites. Their pharmacological modulation with receptor modulators can be a promising therapeutic target to take into account in mental health conditions associated with inflammatory or oxido/nitrosative consequences. Also, identifying at-risk individuals would be of importance for early detection and intervention in adolescent subjects before they present severe behavioural problems.

Loudness dependence of auditory evoked potentials in patients with borderline personality disorder--impact of psychopathology

Alterations of the central serotonergic system are considered to be involved in the pathophysiology of borderline personality disorder (BPD). The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been shown to indirectly reflect central serotonergic activity. The aim of this study was to investigate LD in patients with BPD compared to healthy controls, and to evaluate the association between LD and psychopathology such as anxiety, anger or impulsiveness. Female patients with BPD were included and compared to age- and sex-matched healthy subjects. Self-rating instruments, such as the State-Trait Anxiety Inventory (STAI), State-Trait Anger Expression Inventory (STAXI), and the Barratt Impulsiveness Scale (BIS) were used to assess clinical scores of anxiety, anger, and impulsiveness. Evoked potentials were recorded following the application of acoustic stimuli with increasing intensities; the LD was analysed using dipole source analysis. The mean LD was significantly higher in patients with BPD compared to controls. In the entire sample there were significant positive correlations of LD with state anxiety scores and STAXI subscores. The data contribute to the knowledge of neurophysiological alterations in patients with BPD, supporting the hypothesis of serotonergic dysregulation in the pathophysiology of the disorder. The significant clinical correlations suggest monoaminergic modulations of psychopathology on the symptom level.

Affective intensity and lability: heritability in adult male twins

BACKGROUND

Inability to monitor and self-regulate heightened levels of affect lability and affect intensity is associated with a range of mood, anxiety, and personality disorders, psychosomatic symptoms and socially maladaptive behaviors. Despite the importance of these aspects of affective regulation, there are no twin study data to shed light on the genetic and environmental components of these constructs.

METHODS

Affective Lability Scale (ALS) and Affect Intensity Measure (AIM) questionnaires were administered to 796 male twins in the Vietnam Era Twin Registry and subjected to twin and model-fitting analyses. Complete data were available from 182 monozygotic and 119 dizygotic twin pairs.

RESULTS

Biometrical genetic model-fitting estimates indicated that additive genetic influence accounted for 40% of the variance in affect intensity and 25% of the variance in the ALS subscale assessing anxiety-depression mood shifts. Nonadditive genetic influence was indicated for ALS subscales measuring shifts between normal mood and depression (29%) and anger (27%), respectively. There was negligible evidence of shared environmental influence on affect measures. In contrast, estimates of nonshared environmental influences ranged from 52% to 74%.

LIMITATIONS

Female were not included in this study due to the nature of the twin cohort. Data from subjects in a population cohort may not generalize to clinical populations. Measures of environment were not included.

CONCLUSIONS

These results provide evidence for moderate heritability of affect intensity and specific measures of affect lability. Individual differences in mood regulation may represent phenotypic variation in a core psychobiologic vulnerability (e.g., neurotransmitter systems).

Attachment and its vicissitudes in borderline personality disorder

This article reviews the recent literature on attachment and attachment-related constructs in borderline personality disorder, with attention given to how recent findings in this area may inform understanding of the mechanisms underlying the etiology, maintenance, and treatment of the disorder. Most findings on this topic have stemmed from three major areas of research, each of which is reviewed in this article: 1) developmental psychopathology studies; 2) experimental psychopathology studies, particularly those using a neuroscience approach; and 3) treatment studies that have examined variables relevant to attachment. Overall, these findings suggest that attachment and related constructs may factor greatly into the underlying psychopathology of borderline personality disorder and may significantly impact the process and outcome of psychotherapy for the disorder. These findings are discussed as they relate to existing theories and ongoing debates in the field, and the implications for future research and clinical practice are highlighted.

Increased psychological and attenuated cortisol and alpha-amylase responses to acute psychosocial stress in female patients with borderline personality disorder

OBJECTIVE

Borderline personality disorder (BPD) is characterized by increased self-reported stress and emotional responding. Knowledge about the psychological and physiological mechanisms that underlie these experiences in BPD patients is scarce. The objective was to assess both psychological and endocrinological responses to a standardized psychosocial stressor in female BPD patients and healthy controls.

METHODS

A total of 15 female BPD patients and 17 healthy control subjects were included in a case-control study. All subjects were free of any medication, had a regular menstrual cycle, and were investigated during the luteal phase of their menstrual cycle. Co-occurring current major depression, current substance abuse/dependence, and lifetime schizophrenia or bipolar I disorder were excluded. Psychological measures of stress, salivary cortisol, salivary alpha-amylase, plasma ACTH, plasma norepinephrine and epinephrine concentrations were measured before, during, and after exposure to a standardized psychosocial stress protocol.

RESULTS

BPD patients displayed maladaptive cognitive appraisal processes regarding the upcoming stressor as well as significantly higher subjective stress, coupled with a substantial cortisol and alpha-amylase hyporeactivity to the stressor in comparison to the controls. No significant differences for ACTH and catecholaminergic responses were observed, while the ACTH:cortisol ratio was higher in BPD patients than in controls.

CONCLUSIONS

Attenuated cortisol responsiveness in BPD patients might in part be explained by decreased adrenal responsiveness to endogenous ACTH and altered central noradrenergic activation as reflected by alpha-amylase.

Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls

BACKGROUND

There is a decreased serotonergic function in impulsive aggression and borderline personality disorder (BPD), and genetic association studies suggest a role of serotonergic genes in impulsive aggression and BPD. Only one study has analyzed the association between the tryptophan-hydroxylase 2 (TPH2) gene and BPD. A TPH2 "risk" haplotype has been described that is associated with anxiety, depression and suicidal behavior.

METHODS

We assessed the relationship between the previously identified "risk" haplotype at the TPH2 locus and BPD diagnosis, impulsive aggression, affective lability, and suicidal/parasuicidal behaviors, in a well-characterized clinical sample of 103 healthy controls (HCs) and 251 patients with personality disorders (109 with BPD). A logistic regression including measures of depression, affective lability and aggression scores in predicting "risk" haplotype was conducted.

RESULTS

The prevalence of the "risk" haplotype was significantly higher in patients with BPD compared to HCs. Those with the "risk" haplotype have higher aggression and affect lability scores and more suicidal/parasuicidal behaviors than those without it. In the logistic regression model, affect lability was the only significant predictor and it correctly classified 83.1% of the subjects as "risk" or "non-risk" haplotype carriers.

CONCLUSIONS

We found an association between the previously described TPH2 "risk" haplotype and BPD diagnosis, affective lability, suicidal/parasuicidal behavior, and aggression scores.

Association analysis between gene variants of the tyrosine hydroxylase and the serotonin transporter in borderline personality disorder

OBJECTIVES

For patients with borderline personality disorder (BPD), we previously reported an independent effect of the catechol-o-methyl-transferase (COMT) low-activity (Met(158)) allele and an interaction with the low-expression allele of the deletion/insertion (short/long or S/L, resp.) polymorphism in the serotonin transporter-linked promoter region (5-HTTLPR). The purpose of the present study was to extend these findings to the tyrosine hydroxylase (TH) Val(81)Met single nucleotide polymorphism (SNP), the 5-HTTLPR S/L polymorphism incorporating the recently described functional A/G SNP within the long allele of the 5-HTTLPR (rs25531) as well as the variable number of tandem repeat (VNTR) polymorphism within intron 2 of the serotonin transporter gene (STin2).

METHODS

In 156 Caucasian BPD patients and 152 healthy controls, we tested for association between BPD and the TH Val(81)Met SNP, the 5-HTTLPR/rs25531 polymorphism, the STin2, the interaction of the TH Val(81)Met SNP with the tri-allelic 5-HTTLPR/rs25531, the interaction of the TH Val(81)Met SNP with STin2.

RESULTS

Between BPD patients and controls, we observed a slight over-representation of the TH Met(81)Met genotype in BPD patients compared to controls, but no statistically significant differences in genotype distribution of the individual markers after adjusting for multiple testing. Logistic regression analysis showed a lack of interaction between the TH Val(81)Met and the 5-HTTLPR/rs25531 as well as between the TH Val(81)Met and the STin2 polymorphism.

CONCLUSIONS

These data do not suggest independent or interactive effects of the TH Val(81)Met, the 5-HTTLPR/rs25531, or the STin2 polymorphisms in BPD.

The interpersonal dimension of borderline personality disorder: toward a neuropeptide model

Borderline personality disorder is characterized by affective instability, impulsivity, identity diffusion, and interpersonal dysfunction. Perceived rejection and loss often serve as triggers to impulsive, suicidal, and self-injurious behavior, affective reactivity, and angry outbursts, suggesting that the attachment and affiliative system may be implicated in the disorder. Neuropeptides, including the opioids, oxytocin, and vasopressin, serve a crucial role in the regulation of affiliative behaviors and thus may be altered in borderline personality disorder. While clinical data are limited, the authors propose alternative neuropeptide models of borderline personality disorder and review relevant preclinical research supporting the role of altered neuropeptide function in this disorder in the hope of stimulating more basic research and the development of new treatment approaches.

Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli

This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups.

Interaction between gene variants of the serotonin transporter promoter region (5-HTTLPR) and catechol O-methyltransferase (COMT) in borderline personality disorder

Borderline personality disorder (BPD) is characterized by a heterogeneous symptomatology with instability in impulse control, interpersonal relationships and self-image. BPD patients display repeated self-injury, chronic suicidal tendencies and emotional dysregulation, mainly dysregulation of negative affect. In its etiology, genetic and environmental factors have been suggested. Recently, an investigation in male healthy volunteers found gene-gene effects of the catechol-O-methyl-transferase (COMT) low-activity (Met(158)) and the low-expression allele of the deletion/insertion (short/long or S/L, respectively) polymorphism in the serotonin transporter-linked promoter region (5-HTTLPR) on the central processing of aversive stimuli. The purpose of the present study was to test for association between BPD and the COMT Val(158)Met single nucleotide polymorphism (SNP), the 5-HTTLPR S/L variant and the interaction of these two gene variants. One hundred sixty one well-defined Caucasian BPD patients and 156 healthy controls were recruited from central Germany. In BPD patients, the genotype COMT Met(158)Met was over-represented compared to healthy controls (P = 0.0085; adjusted P = 0.034). We observed no differences in 5-HTTLPR genotypes between BPD and controls (P = 0.286). Additionally, the COMT Met(158)Met genotype was significantly over-represented in BPD patients carrying at least one 5-HTTLPR S allele (P = 0.0007; adjusted P = 0.028). Logistic regression analysis confirmed an interaction of the COMT Met(158) and the 5-HTTLPR S allele (P = 0.001). These data suggest an involvement of altered dopaminergic and/or noradrenergic neurotransmission as well as an interactive effect of COMT and 5-HTTLPR gene variants in the etiology of BPD, and underline the usefulness of analyses of gene-gene effects in diseases of complex inheritance with multiple genes involved.

Adult attachment, personality traits, and borderline personality disorder features in young adults

Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits. The current cross-sectional study used structural equation modeling to compare two competing models of the relationship between adult attachment patterns, trait negative affect and impulsivity, and BPD features in a large nonclinical sample of young adults: (M1) attachment anxiety and avoidance are positively related to trait negative affect and impulsivity, which in turn, are directly associated with BPD features; and (M2) trait negative affect and impulsivity are positively related to attachment anxiety and avoidance, which in turn, are directly associated with BPD features. Consistent with attachment theory, M1 provided a better fit to the data than M2. However, only attachment anxiety, and not attachment avoidance, was significantly associated with negative affect and impulsivity. The results favored a model in which the relationship between adult attachment anxiety and BPD features is fully mediated by trait negative affect and impulsivity.

A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory

Over the past several decades, research has focused increasingly on developmental precursors to psychological disorders that were previously assumed to emerge only in adulthood. This change in focus follows from the recognition that complex transactions between biological vulnerabilities and psychosocial risk factors shape emotional and behavioral development beginning at conception. To date, however, empirical research on the development of borderline personality is extremely limited. Indeed, in the decade since M. M. Linehan initially proposed a biosocial model of the development of borderline personality disorder, there have been few attempts to test the model among at-risk youth. In this review, diverse literatures are reviewed that can inform understanding of the ontogenesis of borderline pathology, and testable hypotheses are proposed to guide future research with at-risk children and adolescents. One probable pathway is identified that leads to borderline personality disorder; it begins with early vulnerability, expressed initially as impulsivity and followed by heightened emotional sensitivity. These vulnerabilities are potentiated across development by environmental risk factors that give rise to more extreme emotional, behavioral, and cognitive dysregulation. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Clonidine improves hyperarousal in borderline personality disorder with or without comorbid posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition borderline personality disorder (BPD) seems to constitute a very heterogeneous category. Therefore, pharmacological therapy is symptom-oriented or targets comorbid conditions. A high comorbidity exists between BPD and posttraumatic stress disorder (PTSD). In a double-blind, randomized, placebo-controlled crossover study, we sought to determine whether the antinoradrenergic agent clonidine was effective in reducing hyperarousal and measures of BPD-specific and general psychopathology in a sample of 18 patients with BPD, with or without comorbid PTSD, and with a prominent hyperarousal syndrome. Hyperarousal as measured by the Clinician Administered PTSD scale improved significantly compared with placebo (P = 0.003) irrespective of PTSD comorbidity. Improvements in general and BPD-typical psychopathology were mainly seen in the PTSD-positive subgroup, whereas the subjective sleep latency (P = 0.005) and the restorative qualities of the sleep (P = 0.014) improved in the whole sample. Improvements, despite the small sample size of this pilot study, lead us to conclude that clonidine might be a useful adjunct to pharmacotherapy in patients with BPD who have marked hyperarousal and/or sleep problems and, in particular, in patients with BPD who have a PTSD comorbidity.

Neurophysiological correlates of borderline personality disorder: a transcranial magnetic stimulation study

BACKGROUND

Cortical inhibition deficits have been demonstrated in several disorders with deficits in impulsive control (e.g., attention-deficit/hyperactivity disorder [ADHD], tic disorder, Tourette syndrome) by using transcranial magnetic stimulation (TMS). With borderline personality disorder (BPD), we investigated another disorder associated with high impulsivity by TMS. We hypothesized that BPD patients display decreased cortical inhibition and/or increased cortical excitation as assessed with TMS.

METHODS

Different inhibitory and excitatory TMS parameters were investigated in 19 unmedicated female BPD patients and 19 healthy control subjects matched for sex, age, handedness, and body height. Additionally, the results were controlled for ADHD symptomatology.

RESULTS

A reduced cortical silent period (CSP) duration was found in BPD patients compared with healthy control subjects in the right cortex. Even after controlling for ADHD symptoms, this result remained significant.

CONCLUSIONS

These findings support an association between BPD and cortical inhibition deficits as indexed through TMS. The results are discussed considering basic neurobiological mechanisms that may explain our findings of decreased intracortical inhibition in BPD patients.

Emotion-based dispositions to rash action: positive and negative urgency

Under heightened emotional states, individuals are more inclined to engage in ill-considered or rash actions than at other times. The authors present evidence for the existence of 2 related traits called positive and negative urgency. The traits refer to individual differences in the disposition to engage in rash action when experiencing extreme positive and negative affect, respectively. The authors provide evidence that these traits are distinct from other dispositions toward rash action and that they play distinct roles in predicting problem levels of involvement in behaviors such as alcohol consumption, binge eating, drug use, and risky sexual behavior. The authors identify facilitative conditions for the emergence of the urgency traits from neuroscience. Certain gene polymorphisms are associated with low levels of serotonin and high levels of dopamine; that pattern of neurotransmitter activity in a brain system linking the orbitofrontal cortex and the amygdala appears to facilitate the development of positive and negative urgency. The authors discuss the implications of this theory.

The case for shifting borderline personality disorder to Axis I

Through reviewing what is known about the nature, course, and heritability of borderline personality disorder (BPD), we argue for a reconceptualization of this disorder that would lead to its placement on Axis I. Borderline personality disorder is a prevalent and disabling condition, and yet the empirical research into its nature and treatment has not been commensurate with the seriousness of the illness. We not only review empirical evidence about the etiology, phenomenology, and course of the disorder in BPD but we also address fundamental misconceptions about BPD that we believe have contributed to misunderstanding and stigmatization of the disease. Finally, we suggest future directions for research that might permit the identification of core features of this disorder, with a focus on the importance of naturalistic assessments and of assessments through the course of development.

The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including "reactive" counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed.

Borderline personality disorder: A comparison between children and adults

Recently, more empirical studies have been devoted to the investigation of borderline personality disorder (BPD) in children and adolescents. Against this background, the purpose of the current review is to compare research findings on diagnostic-related phenomena in child and adolescent samples with those in adult samples to establish the utility of the BPD construct in childhood and adolescence. A search of relevant publications reported in Pubmed and PsycInfo from 1940 (the first clinical descriptions of BPD in childhood) to 2006 was carried out. A total of 58 studies were included. The review of the adult literature was not exhaustive but relied on excellent existing and comprehensive reviews of the adult literature carried out in the past 5 years. Although significant differences seem to exist between juveniles and adults in diagnostic-related phenomena associated with BPD, these can be explained by the principle of heterotypic continuity in development. Moreover, enough overlap between juvenile and adult BPD has been observed to warrant further empirical investigation into the construct of juvenile BPD. Specific areas for future research in juvenile BPD suggested by this review include studies of comorbidity, measure development, and the use of neurobiological measures such as functional neuroimaging.

The interface between borderline personality disorder and bipolar spectrum disorders

OBJECTIVE

This review examines whether borderline personality disorder (BPD) should be considered part of the bipolar spectrum.

METHODS

A literature review examined studies of co-occurrence, phenomenology, family prevalence, medication response, longitudinal course, and etiology.

RESULTS

Borderline personality disorder and bipolar disorder co-occur, but their relationship is not consistent or specific. There are overlaps but important differences in phenomenology and in medication response. Family studies suggest clear distinctions, and it is unusual for BPD to evolve into bipolar disorder. Research is insufficient to establish whether these disorders have a common etiology.

CONCLUSIONS

Existing data fail to support the conclusion that BPD and bipolar disorders exist on a spectrum but allows for the possibility of partially overlapping etiologies.

Social-emotion recognition in borderline personality disorder

Borderline personality disorder (BPD) is characterized by interpersonal disturbances, but the neurocognitive aspects of these symptoms are poorly understood. We hypothesized that patients with BPD have impaired perception of emotional expressions, which are related to symptoms of interpersonal dysfunction. To control potential confounding factors, this study excluded subjects with comorbid diagnoses known to be associated with impaired affect perception. We tested 43 outpatients with BPD and 26 healthy controls on emotion recognition tasks (facial, prosodic, and integrated facial/prosodic), nonemotional facial feature recognition, and interpersonal antagonism (Buss-Durkee Hostility Index). Patients with BPD showed normal ability to recognize isolated facial or prosodic emotions but had impaired recognition of emotions in integrated facial/prosodic stimuli, as well as impaired discrimination of nonemotional facial features. In patients with BPD, impaired recognition of integrated emotional stimuli was associated with interpersonal antagonism, particularly suspiciousness and assaultiveness. These results suggest that patients with BPD have deficits in higher order integration of social information, which may be related to some of the more serious symptoms of the disorder.

Psychotherapy for patients with borderline personality disorder: focusing on the mechanisms of change

A major development in the field of psychotherapy research is the growing recognition of the need for evidence on the mechanisms of change in psychotherapy. The empirical evidence that psychotherapy has a positive and significant effect must be amplified with data on the mechanisms of action in the various psychotherapies. This special issue is devoted to the articulation of putative mechanisms of change in the psychotherapy of patients with borderline personality disorder by leading researchers in this field.

Executive neurocognition, memory systems, and borderline personality disorder

Borderline Personality Disorder (BPD) is a common, disabling, and burdensome psychiatric condition. It is characterized by turbulent fluctuations of negative emotions and moods, unstable and conflictual interpersonal relationships, an incoherent and often contradictory sense of self, and impulsive, potentially lethal self-injurious behaviors. The neurobehavioral facets of BPD have not been extensively studied. However, clinical theoreticians and researchers have proposed that the symptoms and behaviors of BPD are, in part, associated with disruptions in basic neurocognitive processes. This review summarizes and evaluates research that has investigated the relationship between executive neurocognition, memory systems, and BPD. Three historical phases of research are delineated and reviewed, and the methodological and conceptual challenges this body of investigation highlights are discussed. Laboratory-based assessment of executive neurocognition and memory systems is integral to an interdisciplinary approach to research in BPD. Such an approach holds promise in elucidating the neurobehavioral facets, development, diagnostic boundaries, prevention, and optimal interventions for this debilitating and enigmatic disorder.

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.

The implications of attachment theory and research for understanding borderline personality disorder

Borderline personality disorder (BPD) is a highly prevalent, chronic, and debilitating psychiatric problem characterized by a pattern of chaotic and self-defeating interpersonal relationships, emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation. Recently, psychopathology researchers and theorists have begun to understand fundamental aspects of BPD such as unstable, intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment and intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. These investigators have noted that the impulsivity, affective lability, and self-damaging actions that are the hallmark of borderline personality occur in an interpersonal context and are often precipitated by real or imagined events in relationships. This article reviews attachment theory and research as a means of providing a developmental psychopathology perspective on BPD. Following a brief review of Bowlby's theory of attachment, and an overview of the evidence with respect to the major claims of attachment theory, I discuss individual differences, the evidence that these differences are rooted in patterns of interaction with caregivers, and how these patterns have important implications for evolving adaptations and development. Following this discussion, I present recent work linking attachment theory and BPD, focusing on the implications for understanding the etiology and treatment of BPD. In conclusion, I address some of the salient issues that point to the direction for future research efforts.

Borderline personality disorder

Borderline personality disorder is a chronic psychiatric disorder characterized by marked impulsivity, instability of mood and interpersonal relationships, and suicidal behaviour that can complicate medical care. Identifying this diagnosis is important for treatment planning. Although the cause of borderline personality disorder is uncertain, most patients improve with time. There is an evidence base for treatment using both psychotherapy and psychopharmacology. The clinical challenge centres on managing chronic suicidality.

Inhibition of perforant path input to the CA1 region by serotonin and noradrenaline

Bath-applied monoamines-dopamine (DA), serotonin (5-HT), and noradrenaline (NE)-strongly suppress the perforant path (PP) input to CA1 hippocampal region with very little effect on the Schaffer collaterals (SC) input. The effect of DA action on PP field excitatory postsynaptic potential (fEPSP) has been characterized in detail, but relatively little is known about the NE and 5-HT effects. Here we show that the maximal inhibition of the PP fEPSP by NE is approximately 55%, whereas 5-HT inhibition is weaker ( approximately 35%). The half-maximal inhibitory concentration of both 5-HT and NE is approximately 1 muM. Neither NE nor 5-HT affected paired-pulse facilitation, suggesting that the effect is not presynaptic. This is in contrast to DA, which does have a presynaptic effect. The NE effect was blocked by alpha2 antagonists, whereas the alpha1 antagonist corynanthine and beta-antagonist propranolol were ineffective. The effect of 5-HT was mimicked by the agonist, 5-carboxamidotryptamine maleate (5-CT), and not affected by adrenergic and dopaminergic antagonists. To determine the 5-HT receptors involved, we tested a number of 5-HT antagonists, but none produced a complete suppression of the 5-HT effect. Of these, only the 5-HT7 and 5-HT2 antagonists produced weak but significant inhibition of 5-HT effect. We conclude that NE inhibits the PP fEPSP through postsynaptic action on alpha2-adrenoceptors and that 5-HT7, 5-HT2, and some other receptor may be involved in 5-HT action in PP.

Attachment and borderline personality disorder: implications for psychotherapy

BACKGROUND

Psychopathology researchers and theorists have begun to understand fundamental aspects of borderline personality disorder (BPD) such as unstable and intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment, intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. In the present study, we will examine self-reported attachment in a study group of well-characterized patients reliably diagnosed with BPD.

SAMPLING AND METHODS

Ninety-nine outpatients reliably diagnosed with BPD using the International Personality Disorders Examination, completed a number of attachment measures including the Relationship Questionnaire, Relationship Style Questionnaire, and Experiences in Close Relationships inventory.

RESULTS

Factor analysis revealed six factors that clustered into three groups corresponding to an avoidant attachment pattern, a preoccupied attachment pattern, and a fearfully preoccupied pattern. The preoccupied pattern showed more concern and behavioral reaction to real or imagined abandonments, whereas the avoidant group had higher ratings of inappropriate anger. The fearfully preoccupied group had higher ratings on identity disturbance, although only at the trend level.

CONCLUSIONS

The psychometric properties and response characteristics of the ECR items suggest that the scales, keying, and domains are appropriate for assessment of attachment in BPD samples. The scales generally retain their factor structure and show a similar pattern of correlations and inter-relationships. Nevertheless, consistent with a developmental psychopathology model, there are some important differences in factor structure, indicating the need to look at both typical and atypical samples when constructing models of attachment. Further research is needed to delineate the prognostic and prescriptive significance of attachment patterns for treating patients with BPD.

Defining the mechanisms of borderline personality disorder

Understanding the biological connections to mental processes was one of the original goals of psychoanalysis, and the development of cognitive and affective neuroscience and its methods might contribute to actualizing this goal. Personality disorders provide an opportunity to examine the complex mental structures of individuals experiencing extreme difficulties in interacting with their social environment. We provide initial information on a collaboration exploring an approach to one of the most serious personality disorders, borderline personality disorder, based upon the study of normal attention, individual differences in temperament, self definition and attachment organization, with the potential to illuminate the psychology and psychobiology of the disorder and to contribute to psychotherapeutic intervention. This developing model of borderline personality disorder can relate the symptoms to more enduring temperamental aspects of the patients. The goal is to understand the development of neural networks that underlie the abnormalities of adults, and eventually work out the interaction between temperament, genes, and experience that produce the disorder, and potentially inform intervention.

Dopamine dysfunction in borderline personality disorder: a hypothesis

Research on the biological basis of borderline personality disorder (BPD) has focused primarily on the serotonin model of impulsive aggression. However, there is evidence that dopamine (DA) dysfunction may also be associated with BPD. Pertinent research and review articles, identified by Medline searches of relevant topics, books, references from bibliographies, and conference proceedings from 1975 to 2003, were reviewed. Evidence of DA dysfunction in BPD derives from the efficacy of traditional and atypical antipsychotic agents in BPD, and from provocative challenges with amphetamine and methylphenidate of subjects with the disorder. In addition, human and animal studies indicate that DA activity plays an important role in emotion information processing, impulse control, and cognition. The results of this review suggest that DA dysfunction is associated with three dimensions of BPD, that is, emotional dysregulation, impulsivity, and cognitive-perceptual impairment. The main limitation of this hypothesis is that the evidence reviewed is circumstantial. There is no study that directly demonstrates DA dysfunction in BPD. In addition, the therapeutic effects of antipsychotic agents observed in BPD may be mediated by non-DA mechanisms of action. If the stated hypothesis is correct, DA dysfunction in BPD may result from genetic, developmental, or environmental factors directly affecting specific DA pathways. Alternatively, DA dysfunction in BPD may be a compensatory response to alterations in the primary neural systems that control emotion, impulse control, and cognition, and that are mediated by the brain's main neurotransmitters, glutamate, and GABA, or in one or more other neuromodulatory pathways such as serotonin, acetylcholine, and norepinephrine.