PDF
Abstract
Borderline personality disorder (BPD) is a dysfunctional, stable, and pervasive alteration in personality functioning with the inability to adapt to the environment, mental rigidity, and ego-syntonic. High suicidality in BPD patients underlines the significance of research into its pathology. While extensive research on the psychological and behavioral manifestations of BPD can be found in literature, the neuropsychological aspects of the disorder are still partially unknown, although the roles of certain brain structures in the manifestation of the pathology, such as the amygdala, hippocampus, insula, medial prefrontal and cingulate cortices, nucleus accumbens, and temporo-occipital areas, have already been clarified. This review aims to synthesize current knowledge of the neuroanatomical and functional correlates of BPD, providing insights that may inform future research and therapeutic strategies.
Keywords
amygdala
/
borderline
/
borderline personality disorder
/
limbic system
/
prefrontal
Cite this article
Download citation ▾
Giulio Perrotta.
Neuroanatomical and functional correlates in borderline personality disorder: A narrative review.
Ibrain, 2025, 11(1): 19-31 DOI:10.1002/ibra.12190
| [1] |
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V-TR). Raffaello Cortina Ed; 2022.
|
| [2] |
Colombo G. Psicopatologia Clinica. Cooperativa Libraria Ed; 2005.
|
| [3] |
Kring AM, Johnson SL, Davison GC, et al. Psicologia Clinica. Quinta edizione italiana condotta sulla tredicesima edizione americana. Zanichelli Ed; 2016.
|
| [4] |
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(4): 533-545.
|
| [5] |
Perrotta G. Perrotta Integrative Clinical Interviews 3 (PICI-3): development, regulation, updation, and validation of the psychometric instrument for the identification of functional and dysfunctional personality traits and diagnosis of psychopathological disorders, for children (8–10 years), preadolescents (11–13 years), adolescents (14–18 years), adults (19–69 years), and elders (70–90 years). Ibrain. 2024; 10: 146-163.
|
| [6] |
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.
|
| [7] |
Perrotta G. Borderline personality disorder: definition, differential diagnosis, clinical contexts and therapeutic approaches. Ann Psychiatry Treatm. 2020; 4(1): 043-056.
|
| [8] |
Perrotta G. Clinical evidence in troilism (Polygamy and Polyamory): definition, psychological profiles and clinical implications. Int J Sex Reprod Health Care. 2021; 4(1): 073-079.
|
| [9] |
Perrotta G. Massive use of tattoos and psychopathological clinical evidences. Arch Community Med Public Health. 2021; 7(2): 079-085.
|
| [10] |
Perrotta G. Clinical evidence in the phenomenon of Alien Abduction. Ann Psychiatry Treatment. 2021; 5(1): 107-115.
|
| [11] |
Giulio P. The psychopathological roots of affective dependence: the origin and clinical evolution of the toxic bond. Ann Psychiatry Treatment. 2022; 6(1): 017-022.
|
| [12] |
Giulio P. Psychopathological profiles and trends of Italian social network users (Facebook, Instagram, Twitter, and TikTok). Ann Psychiatry Treatment. 2022; 6(1): 053-061.
|
| [13] |
Giulio P. Psychopathologic evidence in the Italian “Trap Music” population. Ann Psychiatry Treatment. 2022; 6(1): 062-068.
|
| [14] |
Giulio P. Psychopathological investigation of the personality of “psychic mediums”: clinical evidence. Ann Psychiatry Treatment. 2023; 7(1): 001-009.
|
| [15] |
Poletti M. Deficit dei processi di cognizione sociale nella demenza frontotemporale: una base cognitiva per i disturbi del comportamento interpersonale e della condotta sociale. Giorn Ital Psicopat. 2008; 14: 197-210.
|
| [16] |
Sosic-Vasic Z, Eberhardt J, Bosch JE, et al. Mirror neuron activations in encoding of psychic pain in borderline personality disorder. Neuroimage: Clinical. 2019; 22:101737.
|
| [17] |
Bateman AW, Fonagy P. Mentalization-based treatment of BPD. J Pers Disord. 2004; 18(1): 36-51.
|
| [18] |
Carpenter RW, Trull TJ. Components of emotion dysregulation in borderline personality disorder: a review. Curr Psychiatry Rep. 2013; 15(1): 335.
|
| [19] |
Clarkin JF, Hull JW, Cantor J, Sanderson C. Borderline personality disorder and personality traits: a comparison of SCID-II BPD and NEO-PI. Psychol Assess. 1993; 5(4): 472-476.
|
| [20] |
Fenske S, Lis S, Liebke L, et al. Emotion recognition in borderline personality disorder: effects of emotional information on negative bias. Borderline Personal Disord Emot Dysregul. 2015; 6(2): 10.
|
| [21] |
Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guilford Press; 1993.
|
| [22] |
Linehan MM. Understanding Borderline Personality Disorder. The Guilford Press; 1995.
|
| [23] |
Slotema CW, Blom JD, Niemantsverdriet MBA, Sommer IEC. Auditory verbal hallucinations in borderline personality disorder and the efficacy of antipsychotics: a systematic review. Front Psychiatry. 2018; 9(9):347.
|
| [24] |
Scalabrini A, Cavicchioli M, Fossati A, Maffei C. The extent of dissociation in borderline personality disorder: a meta-analytic review. J Trauma Dissociation. 2017; 18(4): 522-543.
|
| [25] |
Fertuck EA, Lenzenweger MF, Clarkin JF, Hoermann S, Stanley B. Executive neurocognition, memory systems, and borderline personality disorder. Clin Psychol Rev. 2006; 26(3): 346-375.
|
| [26] |
Sharp C, Pane H, Ha C, et al. Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolescent Psychiatry. 2011; 50(6): 563-573.e1.
|
| [27] |
Mucci C. Corpi Borderline. Raffaello Cortina Ed; 2020.
|
| [28] |
Soloff PH, Meltzer CC, Greer PJ, Constantine D, Kelly TM. A fenfluramine-activated FDG-PET study of borderline personality disorder. Biol Psychiatry. 2000; 47(6): 540-547.
|
| [29] |
Soloff PH, Meltzer CC, Becker C, Greer PJ, Kelly TM, Constantine D. Impulsivity and prefrontal hypometabolism in borderline personality disorder. Psychiatry Res: Neuroimaging. 2003; 123(3): 153-163.
|
| [30] |
Gabbard GO. Psichiatria Psicodinamica. V Edition. Raffaello Cortina Ed; 2015.
|
| [31] |
Shafie M, Shahmohamadi E, Cattarinussi G, et al. Resting-state functional magnetic resonance imaging alterations in borderline personality disorder: a systematic review. J Affect Disord. 2023; 341(341): 335-345.
|
| [32] |
Visintin E, De Panfilis C, Amore M, Balestrieri M, Wolf RC, Sambataro F. Mapping the brain correlates of borderline personality disorder: a functional neuroimaging meta-analysis of resting state studies. J Affect Disord. 2016; 204(204): 262-269.
|
| [33] |
Goleman D. Intelligenza emotive. CDE Ed; 2017.
|
| [34] |
Leukel F. Psicologia-Fisiologia. Zanichelli Ed; 2018.
|
| [35] |
Guyton AC. Neurofisiologia umana. Il Pensiero Scientifico Ed; 2019.
|
| [36] |
Schulze L, Schmahl C, Niedtfeld I. Neural correlates of disturbed emotion processing in borderline personality disorder: a multimodal meta-analysis. Biol Psychiatry. 2016; 79(7): 97-106.
|
| [37] |
Donegan NH, Sanislow CA, Blumberg HP, et al. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003; 54(11): 1284-1293.
|
| [38] |
Mitchell AE, Dickens GL, Picchioni MM. Facial emotion processing in borderline personality disorder: a systematic review and meta-analysis. Neuropsychol Rev. 2014; 24(2): 166-184.
|
| [39] |
Hazlett EA, Zhang J, New AS, et al. Potentiated amygdala response to repeated emotional pictures in borderline personality disorder. Biol Psychiatry. 2012; 72(6): 448-456.
|
| [40] |
Koenigsberg HW, Denny BT, Fan J, et al. The neural correlates of anomalous habituation to negative emotional pictures in borderline and avoidant personality disorder patients. Am J Psychiatry. 2014; 171(1): 82-90.
|
| [41] |
Bertsch K, Hillmann K, Herpertz SC. Behavioral and neurobiological correlates of disturbed emotion processing in borderline personality disorder. Psychopathology. 2018; 51(2): 76-82.
|
| [42] |
Niedtfeld I, Kirsch P, Schulze L, Herpertz SC, Bohus M, Schmahl C. Functional connectivity of pain-mediated affect regulation in borderline personality disorder. PLoS One. 2012; 7(3):e33293.
|
| [43] |
Rüsch N, Elst LT, Ludaescher P, et al. A voxel-based morphometric MRI study in female patients with borderline personality disorder. Neuroimage. 2003; 20: 385-392.
|
| [44] |
Stevenson J, Meares R, Comerford A. Diminished impulsivity in older patients with borderline personality disorder. Am J Psychiatry. 2003; 160(1): 165-166.
|
| [45] |
Pessoa L. Emotion and cognition and the amygdala: from “what is it?” to “what's to be done?”. Neuropsychologia. 2010; 48(12): 3416-3429.
|
| [46] |
Martin J. Neuroanatomy: Text and Atlas. McGraw Hill Pub; 2016.
|
| [47] |
Andersen P, Morris R, Amaral D. The Hippocampus Book. Oxford University Press; 2017.
|
| [48] |
Pearce JMS. Ammon's horn and the hippocampus. J Neurol Neurosurg Psychiatry. 2001; 71(3):351.
|
| [49] |
Squire LR, Schacter DL. The Neuropsychology of Memory. Guilford Press; 2002.
|
| [50] |
Squire LR. Memory and the hippocampus: a synthesis from findings with rats, monkeys, and humans. Psychol Rev. 1992; 99(2): 195-231.
|
| [51] |
Ding JB, Hu K. Structural MRI brain alterations in borderline personality disorder and bipolar disorder. Cureus. 2021; 13(7):e16425.
|
| [52] |
Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR. Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis. J Pers Disord. 2009; 23(4): 333-345.
|
| [53] |
Nenadic I, Voss A, Besteher B, et al. Brain structure and symptom dimensions in borderline personality disorder. Eur Psychiatry. 2020; 63(1):e9.
|
| [54] |
Sala M, Caverzasi E, Lazzaretti M, et al. Dorsolateral prefrontal cortex and hippocampus sustain impulsivity and aggressiveness in borderline personality disorder. J Affect Disord. 2011; 131(1-3): 417-421.
|
| [55] |
Soloff PH, Abraham K, Burgess A, Ramaseshan K, Chowdury A, Diwadkar VA. Impulsivity and aggression mediate regional brain responses in borderline personality disorder: an fMRI study. Psychiatry Res: Neuroimaging. 2017; 260(260): 76-85.
|
| [56] |
Latalova A, Radimecka M, Lamos M, et al. Neural correlates of social exclusion and overinclusion in patients with borderline personality disorder: an fMRI study. Borderline Personal Disord Emot Dysregul. 2023; 10(1): 35.
|
| [57] |
Metz S, Fleischer J, Gärnter M, et al. Effects of hydrocortisone on autobiographical memory retrieval in patients with posttraumatic stress disorder and borderline personality disorder: the role of childhood trauma. Neuropsychopharmacology. 2019; 44(12): 2038-2044.
|
| [58] |
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(12): 1115-1122.
|
| [59] |
Critchley HD. Neural mechanisms of autonomic, affective, and cognitive integration. J Comp Neurol. 2005; 493(1): 154-166.
|
| [60] |
Karnath HO, Baier B, Nägele T. Awareness of the functioning of one's own limbs mediated by the insular cortex? J Neurosci. 2005; 25: 7134-7138.
|
| [61] |
(Bud) Craig AD. How do you feel—now? The anterior insula and human awarenesshow do you feel-now? The anterior insula and human awareness. Nat Rev Neurosci. 2009; 10: 59-70.
|
| [62] |
Wicker B, Keysers C, Plailly J, Royet JP, Gallese V, Rizzolatti G. Both of us disgusted in my insula. Neuron. 2003; 40(3): 655-664.
|
| [63] |
Nestor PJ. Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula. Brain. 2003; 126(11): 2406-2418.
|
| [64] |
Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol. 2004; 55(3): 335-346.
|
| [65] |
Naqvi NH, Rudrauf D, Damasio H, Bechara A. Damage to the insula disrupts addiction to cigarette smoking. Science. 2007; 315(5811): 531-534.
|
| [66] |
Hyman SE. Addiction: a disease of learning and memory. Am J Psychiatry. 2005; 162(8): 1414-1422.
|
| [67] |
Paulus MP, Stein MB. An insular view of anxiety. Biol Psychiatry. 2006; 60(4): 383-387.
|
| [68] |
Lis E, Greenfield B, Henry M, Guilé JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci: JPN. 2007; 32(3): 162-173.
|
| [69] |
Ducasse D, Courtet P, Olié E. Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review. Curr Psychiatry Rep. 2014; 16(5): 443.
|
| [70] |
Sampedro F, Farrés CC, Soler J, et al. Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response. Brain Imaging Behav. 2021; 15(5): 2502-2512.
|
| [71] |
Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2014; 16(3): 438.
|
| [72] |
Schmahl C, Niedtfeld I, Herpertz SC. Borderline-Persönlichkeitsstörung: veränderung der hirnstruktur und -funktion durch psychotherapie. Nervenarzt. 2018; 89(11): 1232-1236.
|
| [73] |
Yang Y, Raine A. Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis. Psychiatry Res: Neuroimaging. 2009; 174: 81-88.
|
| [74] |
Miller EK, Freedman DJ, Wallis JD. The prefrontal cortex: categories, concepts and cognition. Biol. Sci. 2002; 354: 1123-1136.
|
| [75] |
DeYoung CG, Hirsh JB, Shane MS, Papademetris X, Rajeevan N, Gray JR. Testing predictions from personality neuroscience. Psychol Sci. 2010; 21: 820-828.
|
| [76] |
Kohn N, Eickhoff SB, Scheller M, Laird AR, Fox PT, Habel U. Neural network of cognitive emotion regulation-an ALE meta-analysis and MACM analysis. Neuroimage. 2014; 87(87): 345-355.
|
| [77] |
Marceau EM, Meuldijk D, Townsend ML, Solowij N, Grenyer BFS. Biomarker correlates of psychotherapy outcomes in borderline personality disorder: a systematic review. Neurosci Biobehav Rev. 2018; 94: 166-178.
|
| [78] |
Fertuck EA, Stanley B, Kleshchova O, et al. Rejection distress suppresses medial prefrontal cortex in borderline personality disorder. Biol Psychiatry. Cogn Neurosci Neuroimaging. 2023; 8(6): 651-659.
|
| [79] |
Fertuck EA, Grinband J, Mann JJ, et al. Trustworthiness appraisal deficits in borderline personality disorder are associated with prefrontal cortex, not amygdala, impairment. NeuroImage: Clinical. 2019; 21:101616.
|
| [80] |
Wolf RC, Thomann PA, Sambataro F, Vasic N, Schmid M, Wolf ND. Orbitofrontal cortex and impulsivity in borderline personality disorder: an MRI study of baseline brain perfusion. Eur Arch Psychiatry Clin Neurosci. 2012; 262(8): 677-685.
|
| [81] |
Rossi R, Lanfredi M, Pievani M, et al. Abnormalities in cortical gray matter density in borderline personality disorder. Eur Psychiatry. 2015; 30(2): 221-227.
|
| [82] |
Winter D, Elzinga B, Schmahl C. Emotions and memory in borderline personality disorder. Psychopathology. 2014; 47(2): 71-85.
|
| [83] |
New AS, Buchsbaum MS, Hazlett EA, et al. Fluoxetine increases relative metabolic rate in prefrontal cortex in impulsive aggression. Psychopharmacology. 2004; 176: 451-458.
|
| [84] |
Haas BW, Miller JD. Borderline personality traits and brain activity during emotional perspective taking. Pers Disord: Theory, Res, Treat. 2015; 6(4): 315-320.
|
| [85] |
Goethals I, Audenaert K, Jacobs F, et al. Brain perfusion SPECT in impulsivity-related personality disorders. Behav Brain Res. 2005; 157: 187-192.
|
| [86] |
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(9): 854-863.
|
| [87] |
Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013; 73(2): 153-160.
|
| [88] |
Olié E, Doell KC, Corradi-Dell'Acqua C, Courtet P, Perroud N, Schwartz S. Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder. Soc Cogn Affect Neurosci. 2018; 13(10): 1071-1080.
|
| [89] |
Dusi N, Bracco L, Bressi C, Delvecchio G, Brambilla P. Imaging associations of self-injurious behaviours amongst patients with borderline personality disorder: a mini-review. J Affect Disord. 2021; 295: 781-787.
|
| [90] |
Quattrini G, Marizzoni M, Magni LR, et al. Whole-brain microstructural white matter alterations in borderline personality disorder patients. Personality Mental Health. 2019; 13(5): 96-106.
|
RIGHTS & PERMISSIONS
2024 The Author(s). Ibrain published by Affiliated Hospital of Zunyi Medical University and Wiley-VCH GmbH.