Skip to main content

Advertisement

SpringerLink
Log in

The Brain in Overdrive: A New Look at Borderline and Related Disorders

  • Complex Medical-Psychiatric Issues (MB Riba, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Borderline personality disorder (BPD) has been recognized as heterogeneous, etiologically, stemming from many combinations of genetic and environmental factors BPD never occurs alone: it is always accompanied by traits of other personality disorders and by various symptom-conditions, especially mood disorders. The controversy about linkage between BPD and bipolar disorder could not be resolved when the debate relied only on clinical description. Some twin-studies suggested modest overlap between BPD and bipolar disorder. Current neuroimaging research points to similarities in brain changes among several conditions characterized by emotional over-reactivity to stress: bipolar disorder, certain cases of BPD and attention-deficit hyperactivity (ADHD). These include alterations in the limbic system (e.g., amygdala and hippocampus) and neocortex (especially the prefrontal cortex). An important subset of BPD exists in which brain changes are essentially identical with those of bipolar disorder. Relevant brain-change findings and treatment implications are summarized in this article.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. Diagnostic and Statistical Manual of Psychiatric Disorders, 3rd edition [DSM-III]. Washington, DC: American Psychiatric Press. 1980.

  2. Gunderson JG, Weinberg I, Daversa MT, Kueppenbender KD, Zanarini MC, et al. Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder. Amer J Psychiatry. 2006;163:1173–8.

    Article  Google Scholar 

  3. Kernberg OF. Borderline personality organization. J Amer Psychoanal Assoc. 1967;15:641–85.

    Article  CAS  Google Scholar 

  4. Stone MH. The borderline syndromes. New York: McGraw Hill; 1980.

    Google Scholar 

  5. Akiskal HS. Subaffective disorders: Dysthymic, cuclothymic, and bipolar II disorders in the “borderline” realm. Psychiatric Clin N Amer. 1981;4:25–46.

    CAS  Google Scholar 

  6. Stone MH. Borderline syndromes: A consideration of subtypes and an overview, directions for research. Psychiatric Clin N Amer. 1981;4:3–24.

    CAS  Google Scholar 

  7. Beck AT, Freeman A. Cognitive therapy of personality disorders. New York: Guilford Press; 1990.

    Google Scholar 

  8. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press; 1990.

    Google Scholar 

  9. Young JE, Klosko J, Weishaar ME. Schema therapy: a practitioner’s guide. New York: Guilford; 2003.

    Google Scholar 

  10. Bateman A, Fonagy P. Psychotherapy for borderline personality disorder: Mentalization-based treatment. New York: Oxford Univ Press; 2004.

    Google Scholar 

  11. Koenigsberg HW, Kernberg OF, Stone MH, Appelbaum AH, Yeomans FE, Diamond D. Borderline patients: extending the limits of treatability. New York: Basic Books; 2000.

    Google Scholar 

  12. Stone MH. Disorder in the domain of personality disorders. Psychodynamic Psychiatry. 2012;40:23–45.

    Article  PubMed  Google Scholar 

  13. •• Livesley WJ. Moving beyond specialized therapies for borderline personality disorder: The importance of integrated domain-focused treatment. Psychodynamic Psychotherapy. 2012;40: 47–74. This reference addresses more specific, narrower issues relative to borderline, bipolar and related disorders but is of especially good quality.

    Article  Google Scholar 

  14. Cravchik A, Goodman D. Neurochemical individuality: Genetic diversity among human dopamine and serotonin receptors and transporters. Arch Gen Psychiat. 2000;57:1103–14.

    Article  Google Scholar 

  15. Nahas Z, Molnar C, George MS. Brain imaging. In: Oldham JM, Skodol AE, Bender DS, editors. Textbook of personality disorders. Washington, DC: American Psychiatric Press; 2005. p. 623–39.

    Google Scholar 

  16. Driessen M, Hermann J, Stahl K, Zwaan M, Meier S, et al. Magnetic resonance imaging volumes of hippocampus and amygdala in women with BPD and early traumatization. Arch Gen Psychiat. 2000;57:1115–22.

    Article  PubMed  CAS  Google Scholar 

  17. Dell’Osso B, Berlin HA, Serato M, Altamura AC. Neuropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology. 2010;61:169–79.

    Article  PubMed  Google Scholar 

  18. •• Ruocco AC, Amirthavasagam S & Zakzanis KK. Amygdala and hippocampal volume reductions as candidate endophenotypes for borderline personality disorder: A meta-analysis of magnetic resonance imaging studies. Psychiatry Res. 2012;201: 245–252. This reference addresses fundamental issues in neuroscience as they pertain to borderline personality disorder.

  19. Weninger 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;34:383–8.

    Google Scholar 

  20. • De-Almeida CP, Wenzel A, de-Carvalho CS, Powell VB, Araújo-Neto C, Quarantini LC & de-Oliveira IR. Amygdalar volume in borderline personality disorder with and without comorbid post-traumatic stress disorder. CNS Spectr. 2012;17: 70–75. This reference addresses more specific, narrower issues relative to borderline, bipolar and related disorders but is of especially good quality.

  21. Zetzsche T, Preuss UW, Bondy B, Frodl T, Zill P, et al. 5-HT 1A receptor gene c-1019G polymorphism and amygdala volume in borderline personality disorder. Gene Brain Behav. 2008;7:306–13.

    Article  CAS  Google Scholar 

  22. Lemonde S, Turecki G, Bakish D, Du L, Hrdina PD. Impaired repression at a 5-hydroxytryptamine 1A receptor gene polymorphism associated with major depression and suicide. J Neurosci. 2003;23:8788–99.

    PubMed  CAS  Google Scholar 

  23. Dunsmoor JE, Labar KS. Neural basis of human fear learning. In: Armony J, Vuilleumier P, editors. The Cambridge handbook of human affective neuroscience. New York: Cambridge Univ Press; 2013. p. 419–43.

    Chapter  Google Scholar 

  24. • O’Neill A & Frodl T. Brain structure and function in borderline personality disorder. Brain Struct Funct. 2012;217: 767–78. This reference addresses more specific, narrower issues relative to borderline, bipolar and related disorders but is of especially good quality.

    Article  PubMed  Google Scholar 

  25. New AS, Goodman M, Triebwasser J, Siever LJ. Recent advances in the biological study of personality disorders. Psychiat Clin N Amer. 2008;31:441–61.

    Article  Google Scholar 

  26. Bouchard S, Lemelin S, Dubé C, Giguère JE. Dysregulation of the executive system and theory of mind: clinical interest of a neuroscientific conception of BPD. Santé Ment Québec. 2010;35:227–51.

    Article  Google Scholar 

  27. Riggs AD, Russo VEA, Martienssen RA. Epigenetic mechanisms of gene regulation. Plainview NY: Cold Springs Harbor Lab Press; 1996.

    Google Scholar 

  28. Brendel GR, Stern E, Silbersweig DA. Defining the neurocircuitry of borderline personality disorder: functional neuroimaging approaches. Dev Psychopathol. 2005;17:1197–206.

    Article  PubMed  Google Scholar 

  29. • Rodrigues E, Wenzel A, Ribeiro MP, Quarantini LC, Miranda-Scippa A, de Sena EP & de Oliveira IR. Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis. Eur Psychiatry. 2011;26: 452–456. This reference addresses more specific, narrower issues relative to borderline, bipolar and related disorders but is of especially good quality.

  30. •• Hughes AE, Crowell SE, Uyeji L & Coan JA. A developmental neuroscience of borderline pathology: emotional dysregulation and social baseline theory. J Abnorm Child Psychol. 2012;40: 21–33. This reference addresses fundamental issues in neuroscience as they pertain to borderline personality disorder.

    Article  PubMed  Google Scholar 

  31. Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, et al. Neural correlates of emotion processing in borderline personality disorder. Psychiatry Res. 2009;172:192–9.

    Google Scholar 

  32. •• Panksepp J & Biven L. Archaeology of mind: Neuroevolutionary origins of human emotions. 2012. New York: W W Norton. This reference addresses fundamental issues in neuroscience as they pertain to borderline personality disorder. It also contains a wealth of information about brain changes pertaining to the emotions, including to those most severely affected in borderline and bipolar patients.

    Google Scholar 

  33. Siegel A. The neurobiology of aggression and rage. Boca Raton, Florida: CRC Press; 2005. p. 55–8.

    Google Scholar 

  34. Herpertz SC, Dietrich TM, Wenning B, Krings T, Erberich SG, Willmes K, et al. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study. Biol Psychiatry. 2001;50:292–8.

    Google Scholar 

  35. Prossin AR, Love TM, Koeppe RA, Zubieta JK, Silk KR. Dysregulation of regional opioid dysfunction in borderline personality disorder. Amer J Psychiatry. 2010;167:925–33.

    Article  Google Scholar 

  36. Jackowski AP, Araújo Filho GM, Almeida AG, Araújo CM, Reis M, Nery F, et al. The involvement of the orbitofrontal cortex in psychiatric disorders: an Update of neuroimaging findings. Rev Bras Psiquiatr. 2012;34:207–12.

  37. Garrett AS, Reiss AL, Howe ME, Kelley RG, Singh MK, Adleman NE, et al. Abnormal amygdala and prefrontal cortex activation to facial expressions in pediatric bipolar disorder. J Amer Acad Child Adolesc Psychiatry. 2012;51:821–31.

    Google Scholar 

  38. Vizueta N, Rudie JD, Townsend JD, Torrisi S, Moody TD, Bookheimer SY, et al. Regional fMRI hypoactivation and altered functional connectivity during emotion processing in nonmedicated depressed patients with bipolar-II disorder. Ame J Psychiatry. 2012;169:831–40.

    Google Scholar 

  39. Altshuler L, Bookheimer S, Proenza MA, Townsend J, Sabb F, Firestine A, et al. Increased amygdala activity during mania: a functional magnetic resonance imaging study. Amer J Psychiatry. 2005;162:1211–3.

    Google Scholar 

  40. Benazzi F. Borderline personality-bipolar spectrum relationship. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:68–74.

    Article  PubMed  Google Scholar 

  41. Altshuler L, Bookheimer S, Townsend J, Proenza MA, Sabb F. Regional brain changes in bipolar I depression: a functional magnetic resonance imaging study. Bipolar Disord. 2008;10:708–17.

    Article  PubMed  Google Scholar 

  42. Anticevic A, Brumbaugh MS, Winkler AM, Lombardo LE, Barrett J, et al. Global prefrontal and fronto-amygdalar dysconnectivity in Bipolar I disorder with psychosis history. Biol Psychiatry. 2013;73(6):565–73. doi:10.1016/j.biopsych.2012.07.031.

    Article  PubMed  Google Scholar 

  43. Selvaraj S, Arnone D, Job D, Stanfield A, Farrow TF, et al. Grey matter differences in bipolar disorder: a meta-analysis of voxel-based morphometry studies. Bipolar Disord. 2012;14:135–45.

    Article  PubMed  Google Scholar 

  44. Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, et al. The functional neuroanatomy of bipolar disorder: A consensus model. Bipolar Disord. 2010;14:313–25.

    Google Scholar 

  45. Mackinnon DF, Pies R. Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders. Bipolar Disord. 2006;8:1–14.

    Article  PubMed  CAS  Google Scholar 

  46. Minzenberg MJ, Poole JH, Vinogradov S. A neurocognitive model of borderline personality disorder: effects of childhood sexual abuse and relationship to adult social attachment disturbance. Dev Psychopathol. 2008;20:341–68.

    Article  PubMed  Google Scholar 

  47. • Faraone SV, Biederman J, and Wozniak J. Examining the comorbidity between attention deficit hyperactivity disorder and bipolar I disorder: A meta-analysis of family genetic studies. Amer J Psychiat. 2012;169: 1256–1266. This reference addresses more specific, narrower issues relative to borderline, bipolar and related disorders but is of especially good quality.

  48. Passarotti AM, Sweeney JA, Pavuluri MN. Neural correlates of response inhibition in pediatric bipolar and attention deficit hyperactivity disorder. Psychiat Res. 2010;181:36–43.

    Article  Google Scholar 

  49. Brotman MA, Rich BA, Guyer AE, Lunsford JR, Horsey SE, et al. Amygdala activation during emotional processing of neutral faces in children with severe mood dysregualtion versus ADHD or bipolar disorder. Amer J Psychiatry. 2010;167:61–9.

    Article  Google Scholar 

  50. Makris N, Seidman LJ, Brown A, Valera EM, Kaiser RJ, et al. Further understanding of the comorbidity between Attention-Deficit Hyperactivity Disorder and bipolar disorder in adults: an MRI study of cortical thickness. Psychiat Res. 2012;202:1–11.

    Article  Google Scholar 

  51. Olza-Fernández I, Palanca-Maresca I, Jiménez-Fernández S, Cazorla-Calleja MR. Trichotillomania, bipolar disorder and white matter hyperintensities in a six-year old girl. J Can Acad Adolesc Psychiatry. 2012;21:213–5.

    Google Scholar 

  52. Nagy, N El-S. Attention-deficit hyperactivity disorder and bipolar disorder continuum of pathology. Presented at the World Congress of Psychiatry, Prague, Czech Rep. Friday, 20 October 2012.

  53. Posner J, Nagel BJ, Maia TV, Mechling A, Oh M, et al. Abnormal amygdalar activation and connectivity in adolescents with attention-deficit /hyperactivity disorder. J Amer Acad Child Adolesc Psychiatry. 2011;50:828–37.

    Article  Google Scholar 

  54. • Cocchi L, Bramati IE, Zalesky A, Furukawa E, Fontenelle LF, MollJ, TrippG & Mattos P. Altered functional brain connectivity in a non-clinical sample of young adults with attention-deficit/hyperactivity disorder. J Neurosci. 2012;32: 17753-17761. This reference addresses the importance of the connections between the amygdala and the neocortex relating to emotional regulation.

  55. Coccaro EF, McCloskey MS, Fitzgerald DA, Khan KL. Amygdala and orbitofrontal reactivity to social threat in individuals with impulsive aggression. Biol Psychiat. 2007;62:168–78.

    Article  PubMed  Google Scholar 

  56. Coccaro EF, Sripada CS, Yanowitch RN, Phan KL. Corticolimbic function in impulsive aggressive behavior. Biol Psychiatry. 2011;69:1153–9.

    Article  PubMed  Google Scholar 

  57. Vacheron-Tristram MN, Braitman A, Cheref S, Auffray L. Antipsychotics in bipolar disorder. Encephale. 2004;30:417–24.

    Article  Google Scholar 

Download references

Compliance with ethics Guidelines

ᅟ

Conflict of Interest

Michael H. Stone has been a consultant to the Personality Disorders Institute (New York City, Otto Kernberg MD, director). He has provided expert testimony in numerous forensic cases in various courts within the U.S. He has received payment for lectures including service on speakers bureaus from lectures and workshops in the U.S. and 17 other countries. He has received royalties from WW Norton, McGraw Hill, American Psychiatric Publishing, New York University Press, Guilford Press, and other publishing companies.He has not received stock/stock options from any company.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Columbia College of Physicians & Surgeons, 225 Central Park West, New York, NY, 10024, USA

    Michael H. Stone

Authors
  1. Michael H. Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael H. Stone.

Additional information

This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stone, M.H. The Brain in Overdrive: A New Look at Borderline and Related Disorders. Curr Psychiatry Rep 15, 399 (2013). https://doi.org/10.1007/s11920-013-0399-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-013-0399-7

Keywords

Search

Navigation