Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study.

We found a significant reduction of hippocampal and amydgala volumes in borderline personality disorder.  There was a significant 24% reduction of the left orbitofrontal and a 26% reduction of the right anterior cingulate gyrus.

Biol Psychiatry 2003 Jul 15;54(2):163-71

A study of 21 women with BPD showed that those with BPD had a 16% reduction in size of a crucial limbic system component – the hippocampus.  This may partly explain the memory problems those with BPD usually experience since the hippocampus is a critical location for memory.  The reduction in hippocampus size was directly correlated with the severity of childhood trauma.

The amygdala may have a reduced size as well, but this has not been scientifically proven at this time.  The amygdala is another limbic system structure strongly correlated with an emotional response to the environment, particularly anger and rage.

Archives of General Psychiatry, December 2000.

 

2004

Int J Psychophysiol 2004 Jun;53(1):57-70
“Effects of BPD features and a family history of alcohol or drug dependence on P300 in adolescents.”
The “P300 amplitude” (a measurement found on a brain wave test – EEG) is associated with BPD symptoms during adolescence.

Psychiatry Res 2004 Jul 30;131(2):125-33
“Anatomical MRI study of BPD patients”
This study also found diminished hippocampal volumes.  Putamen enlargement seems to be due to substance use disorders.

Prog Neuropsychopharmacol Biol Psychiatry 2004 Mar;28(2):329-41
“Neurocognitive function in BPD.”
Neuropsychological testing implied a dysfunction in the right hemisphere frontotemporal region in BPD individuals.

Psychiatry Res 2004 Jan 1;121(3):239-52
“Neurobiological correlates of diagnosis and underlying traits in patients with BPD compared with normal controls.”
Psychological and neurotransmitter testing suggest that serotonin system abnormalities are associated with impulsive traits.

Biol Psychiatry 2004 Apr 1;55(7):759-65 (from Germany)
“A positron emission tomography study of memories of childhood abuse in BPD”
“Dysfunction of dorsolateral and medial prefrontal cortex, including anterior cingulate, seems to be correlated with the recall of traumatic memories in women with BPD.  These brain areas might mediate trauma-related symptoms, such as dissociation or affective instability, in patients with BPD.”

2005

Curr Psychiatry Rep. 2005; 7(1):65-72
“Neuroimaging and personality disorders”
“Functional and structural studies provide support for dysfunction in fronto-limbic circuits in BPD and APD, whereas temporal lobe and basal striatal-thalamic compromise is evident in schizotypal personality disorder.

Neuroreport 2005; 16(3):289-93
“Distinct pattern of P3a event-related potential in BPD”
“…distinctive disturbances in P3a in (unmedicated) BPD patients were found: abnormally enhanced amplitude, failure to habituate and a loss of temporal locking with P3b.”

Dev Psychopathol. 2005; 17(4):1197-206
“Defining the neurocircuitry of BPD: functional neuroimaging approaches”
“Functional neuroimaging…is beginning to identify abnormal frontolimbic circuitry…”

Clin Neurophysiol. 2005; 116(6):1424=32
“BPD features in adolescent girls: P300 evidence of altered brain maturation.”
“The present findings suggest abnormal brain maturation among adolescent girls exhibiting features of BPD.”

J Psychiatr Res. 2005; 39(5);489-98
“Increased delta power and discrepancies in objective and subjective sleep measurements in BPD”
“BPD patients showed a tendency for shortened REM latency and significantly decreased NonREM sleep (stage 2)…There was a marked discrepancy between objective and subjective sleep measurements, which indicates an altered perception of sleep in BPD.”

Am J Psychiatry 2005; 162(12):2360-73
“BPD, impulsivity, and the orbitofrontal cortex”
“The patients with orbitofrontal cortex lesions and the patients with BPD performed similarly on several measures.  Both groups were more impulsive and reported more inappropriate behaviors.”
(Note: the orbitofrontal cortex is considered part of the limbic system)

2007

J Neuropsychiatry Clin Neurosci 2007 Fall;19(4):383-90
“Frontal white matter integrity in BPD with self-injurious behavior”
“Women with BPD self-injurious behavior exhibit decreased white matter microstructural integrity in inferior frontal brain regions that may include components of orbito-frontal circuitry.”
(Another study showing BPD neurological abnormalities.  The orbito-frontal cortex is part of the limbic system.)

Psychiatry Res 2007 Nov 15;156(2):139-49 (from Germany)
“Size abnormalities of the superior parietal cortices are related to dissociation in BPD”
“Recent evidence suggests that BPD is related to reduced size of the parietal lobe.  Dissociative symptoms occur in the majority of individuals with BPD. …Compared with control subjects, BPD subjects had significantly smaller right-sided precuneus (-9%) volumes.  The left postcentral gyrus of BPD subjects with the comorbid diagnosis of dissociative amnesia or dissociative identity disorder (DID) was significantly increased compared with controls (+13%) and compared with BPD subjects without these disorders (+11%).  In BPD subjects, stronger depersonalization was significantly related to larger right precuneus size.  Possibly, larger precuneus size in BPD is related to symptoms of depersonalization.  Increased postcentral gyrus size in BPD may be related to the development of dissociative amnesia or dissociative identity disorder (DID) in the presence of severe childhood abuse.”
(Note: most borderlines do not have dissociative symptoms or dissociative amnesia, and DID is extremely rare, although everyone I’ve treated for DID also had the BPD.  None-the-less this is an important study furthering the biological basis of the BPD.  The “precuneus” is a portion of the brain’s parietal lobe, believed by many to be part of the limbic system.)

J Psychiatr Res 2007 Sep 7 (e-published, published in July 2008)
“Frontolimbic structural changes in BPD”
“Frontolimbic dysfunction is observed in BPD, with responses to emotional stimuli that are exaggerated in the amygdala and impaired in the anterior cingulate cortex (ACC).” CONCLUSIONS: “This sample of BPD patients exhibits gross structural changes in gray matter in cortical and subcortical limbic regions that parallel the regional distribution of altered functional activation to emotional stimuli among these same subjects.”

Actas Esp Psiquiatr 2007 Aug 13 (from Spain)
“Association between the serotonin transporter gene and personality traits in BPD patients evaluated with Zuckerman-Kuhlman Personality Questionnaire (ZKPQ)”
“The results suggest a significant association between the 5-HTT (serotonin transporter) gene and some personality traits in BPD.”

J Psychiatry Neurosci 2007 Jul;32(4):234-40 (from Germany)
“[I-123] ADAM and SPECT in patients with BPD and healthy control subjects”
“The study provides evidence of a serotonergic dysfunction in patients with BPD and suggests a serotonergic component in the pathophysiology of the disorder SERT (serotonin transporter) binding reflected the level of impulsiveness as a common feature in BPD.”
(Note: low spinal fluid serotonin metabolite levels are strongly associated with suicidal and impulsive homicidal behavior with or without the BPD, and borderlines without strong suicidal ideation have normal levels)

Psychiatry Res 2007 Aug 15;155(3);231-43
“Fronto-limbic dysfunction in response to facial emotion in BPD: an event-related fMRI study”
“We conclude that adults with BPD exhibit changes in fronto-limbic activity in the processing of fear stimuli, with exaggerated amygdala response and impaired emotion-modulation of anterior cingulate cortex activity.

Actas Esp Psiquiatr 2007 Nov-Dec;35(6):387-92 (from Spain)
“Serotonin transporter polymorphism and fluoxetine effect on impulsiveness and aggression in BPD”
“L-allele carriers responded better to fluoxetine than S carriers, in a way as in depression.”
(Note: this study compared the “short allele {S}” to the {L} allele for the serotonin transporter gene.  In my experience Prozac (fluoxetine) is extraordinarily important for BPD treatment, although sometimes high doses are needed.  Some individuals with BPD need Tegretol (carbamazepine) in combination with Prozac (fluoxetine), and a genetic study of this combination with the S allele should be interesting.  A similar study with high doses of Effexor (venlafaxine) warrants investigation).

Biol Psychiatry 2007 Sep 15;62(6):580-7
“5HT2A receptor binding is increased in BPD”
“Postmortem studies in suicide victims demonstrate an increase in the number of post synaptic 5-HT(2A) receptor binding sites in ventral lateral and orbital frontal cortex.  Diminished metabolic responses to serotonergic activation are noted in these areas in impulsive subjects with BPD, a group at high risk for suicidal behavior.” Conclusions: “5HT(2A) receptor binding is increased in the hippocampus of BPD subjects independent of depressed mood, impulsivity, aggression, suicidality or childhood abuse.”

Psychiatr Genet 2007 Jun 17(3):153-7 (from Canada)
“Monoamine oxidase a gene is associated with BPD”
“We found that the BPD patients had a high frequency of the high activity VNTR alleles and a low frequency of the low activity haplotype.”

Br J Psychiatry 2007 Apr; 190:357-8 (from Spain)
“Hypothalamic-pituitary-adrenal axis response in BPD without post-traumatic features.”
“Baseline cortisol levels in the patients were … lower than in the controls.  The 0.25mg dexamethasone suppression test reveals increased feedback inhibition of the HPA in BPD.”

Neurosci Lett 2007 Apr 24;417(1):36-41 (from Germany)
“Evidence of disturbed amygdalar energy metabolism in patients with BPD”
“Confirming earlier reports we found a significant 11-17% reduction of amygdalar volumes in patients with BPD.  In addition there was a significant 17% increase in left amygdalar creatine concentrations in BPD patients.”

Psychiatry Res 2007 Feb 28;154(157-70) (from Germany)
“Hippocampal volume reduction and history of aggressive behavior in patients with BPD”
“Hippocampal grey matter volume was significantly decreased in BPD patient: the reduction was more pronounced in patients with multiple hospitalizations.”

Neuroimage 2007 Apr 1;35(2):738-47 (from Germany)
“Inferior frontal white matter microstructure and patterns of psychopathology in women with BPD and comorbid ADHD”
“Inferior frontal white matter microstructural abnormalities may be linked to key aspects of psychopathology in women with BPD and comorbid ADHD and add to alternations in orbitofrontal and limbic areas.  The relationship between neuropsychological functioning and white matter structure remains unclear. ”

Biol Psychiatry 2007 Aug 1:62(3):250-5
“Exaggerated affect-modulated startle during unpleasant stimuli in BPD”
“The BPD patients exhibited larger startle eyeblink during unpleasant but not neutral words, indicating exaggerated physiological affect.  This finding remained significant when we controlled for comorbid diagnoses, including generalized anxiety disorder and PTSD (post traumatic stress disorder).  Greater symptom severity was associated with greater affective-startle difference scores.  CONCLUSIONS: Consistent with the symptom of affective dysregulation, these results suggest an abnormality in the processing of unpleasant emotional stimuli by BPD patients.”

Psychol Med 2007 Jul;37:971-81 (from Germany)
“Enhanced emotion-induced amnesia in BPD”
“BPD patients displayed enhanced retrograde and anterograde amnesia in response to presentation of negative stimuli, while positive stimuli elicited no episodic memory-modulating effects.

Neuropsychopharmacology 2007 Jul, 32 (7):1629-40
“Amygdala-prefrontal disconnection in BPD”
“We demonstrated a tight coupling of metabolic activity between right orbitofrontal cortex and ventral amygdala in healthy subjects with dorsoventral differences in amygdala circuitry, not present in impulsive aggressive BPD.  We demonstrated no significant differences in amygdala volumes or metabolism between BPD patients and controls.”

Psychiatry Res 2007 Jan 15;149(1-3):139-45
“Early visual information processing deficit in depression with and without BPD”
“Poor early information processing appears to be a feature of BPD, and may play a role in the impulsive behavior that is characteristic of the disorder”

2009

J Pers Disord 2009 Dec;23(6):555-62 (from Hungary)
“The neuropsychology of BPD (borderline personality disorder): relationship with clinical dimensions and comparison with other personality disorders.”
“Borderline patients showed deficient attention, immediate and delayed memory, and relatively spared visuospatial and language functions compared with controls. … The neuropsychological deficit significantly correlated with the impulsivity sector score of the Zanarini Rating Scale for Borderline Personality Disorder. … These results suggest the borderline patients are impaired in neuropsychological domains sensitive for frontal and temporal lobe functioning, and this deficit is related to impulsivity.”

J Neural Transm 2009 Sep;1185-8 (from Germany)
“Association analysis of serotonin receptor 1B (HTR1B) and brain-derived neurotrophic factor gene polymorphisms in borderline personality disorder.”
“Logistical regression analyses revealed an over-representation of the BDNF 196A allele in HTR1B A-161 allele carrying BPD patients.”

J Psychiatry Neurosci 2009 Jul;34(4):289-95 (from Germany)
“Hippocampus and amygdala volumes in patients with borderline personality disorder with or without posttraumatic stress disorder.”
“Comorbid PTSD may be related to volumetric alterations in brain regions that are of central importance to our understanding of borderline psychopathology.”

J Psychiatry Neurosci 2009 May;34(3):214-22 (from Germany)
“Emotional learning during dissociative states in borderline personality disorder”
“Emotional, amygdala-based learning processes seem to be inhibited during state dissociative experience.”

Psychiatry Res 2009 Feb 28;171(2):94-105 (from Germany)
“Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: an fMRI study.”
“Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.”

Psychoneuroendocrinology 2009 Apr;34(3):353-7
“Angiogenic factors in patients with current major depressive disorder comorbid with borderline personality disorder”
“Depressive episodes in the context of borderline personality disorder may be accompanied by increased serum concentrations of VEGF (vascular endothelial growth factor) and FGF-2 (fibroblast growth factor-2). Similar findings have been observed in patients with major depression without a borderline personality disorder. A dysregulation of angiogenic factors may be another facet of the endocrine and immunologic disturbances frequently seen in patients with depressive episodes.”

Biol Psychiatry 2009 May 1;65(9):819-22 (from Germany)
“Amygdala deactivation as a neural correlate of pain processing in patients with borderline personality disorder and co-occurrent post traumatic stress disorder”
“Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD.”

Psychoneuroendocrinology 2009 May;34(4):571-86 (from Germany)
“Neural correlates of the individual emotional Stroop in borderline personality disorder”
“These results provide further evidence for a dysfunctional network of brain areas in BPD, including the anterior cingulate cortex and frontal brain regions.”

Am J Med Genet B Neuropsychiatr Genet 2009 Jun 5;150B(4):487-95 (from Germany)
“Interaction between gene variants of the serotonin transporter promoter region (5-HTTLPR) and catechol O-methyltransferase (COMT) in borderline personality disorder.”

“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 disease of complex inheritance with multiple genes involved.”

Psychol Med 2009 May;39(5):855-64 (from Germany)
“Negative bias in fast emotion discrimination in borderline personality disorder”
“Our data suggest a selective deficit in BPD patients in rapid and direct discrimination of negative and neutral emotional expressions that may underlie difficulties in social interactions.”

2010

Pain Res Manag 2010 Nov-Dec;15(6):369-70
“Disability and borderline personality disorder in chronic pain patients”
“Findings suggest that among chronic pain patients, there may be no meaningful relationship between having every been on medical disability and borderline personality symptomatology”

J Nerv Ment Dis.  2010 Dec;198(12):914-5
“Self-harm behaviors in borderline personality: an analysis by gender”
Head banging and losing a job on purpose were more common in men, otherwise there were no gender differences.

Am J Psychiatry 2010 Oct;167(10:1210-7
“Impact of co-occurring posttraumatic stress disorder on suicidal women with borderline personality disorder”
The results indicate greater impairment among individuals with both disorders.

J Pers Disord 2010 Dec:24 (6):812-22
“Co-morbid ADHD in borderline patients defines an impulsive subtype of borderline personality disorder”
In this study from Spain they found ADHD was comorbid with BPD 38% of the time (I suspect that number is higher).  The combination had a 55% higher risk of substance abuse. Interestingly they found that those with the combination didn’t have the avoidant personality disorder.

Biol Psychiatry 2010 Dec 20 (From Germany)
“Neuronal correlates of cognitive reappraisal in borderline patients with affective instability.
“Patients demonstrated enhanced activation of left amygdala and right insula during the initial viewing of aversive stimuli.”
While attempting to diminish the excessive reaction, the left orbitofrontal cortex didn’t respond as well as normal and there was increased activation of the insula on both sides.

J Clin Psychiatry (Primary Care Companion) 2010; 12(5)
“Sleep quality in borderline personality disorder: a cross sectional study”
“Individuals with borderline personality symptomatology demonstrate a poorer overall quality of sleep…”

Am J Psychiatry 2010 Aug;167(8): 925-33
“Dysregulation of regional endogenous opioid function in borderline personality disorder”
“Differences exist between patients with borderline personality disorder and comparison subjects in baseline in vivo mu-opioid receptor concentrations and in the endogenous opioid system response to a negative emotional challenge…”

J Psychiatr Res 2010 Nov;44 (15): 1075-81
“Tryptophan-hyroxylase 2 haplotype (TPH2) association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls.”
This gene is associated with increased risk of borderline personality disorder, impulsive aggression, mood swings, suicidal behavior, and self-mutilation.

Psychiatr Genet 2010 Feb;20(1):25-30
“Fluoxetine response in impulsive-aggressive behavior and serotonin transporter polymorphism in personality disorder”
Some types of serotonin genes are more responsible for impulsive and aggressive behavior than others, particularly the response to Prozac (fluoxetine).

Biol Psychiatry 2010 Mar 1;67(5):399-405
“Metabolic alterations in the amygdala in borderline personality disorder: a proton magnetic resonance spectroscopy study”
“Decreased tNAA (N-acetylaspartate) and tCr (total creatine) might indicate disturbed affect regulation and emotional information processing in the amygdala of BPD patients.”

Eur Psychiatry 2010 Oct 6
“Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis”
“…hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.”

Int J Psychophysiol 2010 Dec;78:257-64
“Processing of visual stimuli in borderline personality disorder: a combined hehavioral and magnetoencephalographic (MEG) study.
“This MEG study provides evidence for disturbances in cortical visual perception in BPD patients regardless of emotional salience of the stimulus.  In line with previous studies, subtle deficits in visual perception might be related to impairment in interpersonal communication in BPD.”

Psychiatry Res 2010 Apr 30;182(1):73-6
“Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder”
Individual with violent episodes had smaller left STG (superior temporal gyrus) volumes compared to those without violent episodes.

World J Biol Psychiatry 2010 Mar;11:372-81
“Neurochemical alterations in women with borderline personality disorder and comorbid attention deficit hyperactive disorder”
“Glutamatergic changes in the anterior cingulate may be associated with BPD and comorbid ADHD. Increased anterior cingulate tNAA (total N-acetylaspartate) may indicate disturbed energy metabolism or impaired frontal maturation.”

World J Biol Psychiatry 2010 Mar;11(:364-71
“Pain sensitivity is reduced in borderline personality disorder, but not in PTSD (post traumatic stress disorder) and bulimia nervosa.”
These findings “may differentiate the BPD from other stress-related psychiatric conditions.”

Psychiatry Res 2010 Feb 28;181(2):151-4
“Reduced interhemispheric structural connectivity between anterior cingulate cortices in borderline personality disorder”
Decreased communication between both sides of the brain was discovered in those with BPD.

J Clin Psychiatry 2010 Jan;71 (1): 26-31
“Psychiatric diagnoses in patients previously overdiagnosed with bipolar disorder”
“Psychiatric outpatients overdiagnosed with bipolar disorder were characterized by more Axis I and Axis II diagnostic comorbidity in general, and borderline personality disorder in particular.”

J Psychopharmacol 2010 Mar;24 (3): 333-9
“Efficacy and tolerability of duloxetine (Cymbalta) in the treatment of patients with borderline personality disorder: a pilot study”
There was improvement in impulsivity, anger outbursts, mood instability and physical symptoms. (This is an expensive medication, very similar to Effexor (venlafaxine).  I’ve switched many patients from Cymbalta (duloxetine) to Prozac (fluoxetine) and seen significant improvement by this change.)

J Pers Disord 2010 Dec;24(6): 785-99
“Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress”
“…the BPD is characterized by a preference for immediate gratification and tendency to discount longer-term rewards.”

J Pers Disord 2010 Dec;24(6): 763-72
“A comparison of depressed patients with and without borderline personality disorder: implications for interpreting studies of the validity of the bipolar spectrum”
“Our results do NOT support inclusion of borderline personality disorder as part of the bipolar spectrum.”

J Psychiatr Res 2010 Dec 1 (Mary Zanarini from Harvard)
“Predictors of self-mutilation in patients with borderline personality disorder: a 10 year follow up study.”
Female gender, severity of dysphoric ideas, severity of dissociation (deja vu, unreality), major depression, history of childhood sexual abuse and sexual assaults as an adult were significant risk factors.

Personal Disord 2010 Oct 1;1 (4): 239-249
“Does comorbid substance use disorder exacerbate borderline personality features?: a comparison of borderline personality disorder individuals with versus without current substance dependence.”
“Our results do not support the notion that BPD individuals with substance use disorder display more severe BPD features than individuals with BPD alone.”

Compr Psychiatry 2010 Sep-Oct; 51(5):458-61
“Being bullied in childhood: correlations with borderline personality in adulthood.”
“A history of being bullied in childhood demonstrates a positive correlation with BPD in adulthood…”

Int J Psychiatry Med 2010;40(1):21-9
“Road rage: relationships with borderline personality and driving citations”
Individuals with BPD have a 250% higher risk of road rage and a significantly higher risk of driving citations.

J Pers Disord 2010 Jun;24(3): 365-76 (Mary Zanarini)
“A Longitudinal study of the 10 year course of interpersonal features in borderline personality disorder”
“The interpersonal features slowest to remit were affective responses to being alone, active caretaking, discomfort with care and dependency.”

Psychiatr Serv 2010 Jun;61(6): 612-6 (Mary Zanarini)
“Ten-year use of mental health services by patients with borderline personality disorder and other axis II disorders.”
“…patients with borderline personality disorder tend to use outpatients treatments without interruption over prolonged periods. They also suggest that inpatient treatment is used far more intermittently by patients with borderline personality disorder.”

Ann Clin Psychiatry 2010 May;22(2): 121-8
“Impact on suicidality of borderline personality traits impulsivity and affective instability.”
Impulsivity rather than mood instability is more strongly associated with suicidality.

Am J Psychiatry 2010 Jun;167(6):618-9 (Mary Zanarini)
“Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study.”
“…the results of this study suggest that recovery from borderline personality disorder, with both symptomatic remission and good psychosocial functioning, seems difficult for many patients to attain.  The results also suggest that once attained, such a recovery is relatively stable over time.”

Clin J Pain 2010 May;26(4):348-53
“Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample.”
“…individuals with higher levels of BPD features reported greater severity of pain and somatic complaints…this association was no longer significant after controlling for affect scales.  In particularly, depression was strongest in accounting for this association.”

J Clin Psychiatry 2010 Sep;71(9):1212-7
“Screening for bipolar disorder and finding borderline personality disorder”
“Positive results on the MDQ (mood disorder questionnaire) were as likely to indicate that a patient has borderline personality disorder as bipolar disorder.”

Clin Psychol Psychother 2010 Feb 25
“Dialectic behavioural therapy has an impact on self-concept clarity and facets of self-esteem in women with borderline personality disorder”
“…in BPD patients, self-esteem and the diagnostic criteria identity disturbance…can be influenced with short-term psychotherapy.”

Psychiatry Res 2010 Mar 30;181(3):233-6
“Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder”
“BPD subjects showed left medial prefrontal cortex hyperactivation during social exclusion suggesting potential dysfunction of frontolimbic circuitry.”

J Psychiatry Res 2010 Oct;44(13):847-52
“Incidence of polycystic ovaries and androgen serum levels in women with BPD.”
“Polycystic ovaries and excessive testosterone have been found in a number of women with BPD compared to depressed patients.”

J Clin Psychopharmacol 2010 Feb;30(1):44-7
“olanzapine (Zyprexa) versus haloperidol (Haldol) in the management of borderline personality disorder: a randomized double-blind trial.”
Chronic use of both medications showed no difference in effectiveness regarding anxiety, tension, depressive mood, and hostility.  (Note: there are pluses and minuses for chronic use of both medications.  In my experience, Haldol (haloperidol) works much more quickly, Zyprexa is better for severe acute stresses)

Br J Psychiatry 2010 Jan;196(1):4-12
“Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomized trials.”
There is limited scientific data for medical treatment of BPD.  (Even more limited are medication combination studies such as Prozac with Tegretol, Prozac with as needed Haldol, etc.  This report confirms the lack of good medication trials, which makes current treatment of the BPD more art than science.  There are some studies confirming medication effectiveness, therefore backing up most treatment approaches to some degree.  Lack of scientific studies does not prove lack of effectiveness.)

J Psychiatr Res. 2010 Apr;44(6):405-8
“Borderline personality disorder and misdiagnosis of bipolar disorder”
“Patients with borderline personality disorder, regardless of how they meet criteria, may be at increased risk of being misdiagnosed with bipolar disorder.”

 

One Response to Structural Brain Abnormalities In Those With BPD

  1. Robbie says:

    What would you suggest for a BiPolar I patient who has a history of adverse reactions which have not been acknowledged by past doctors? Current doctor is willing to refer to the pattern as a “sensitivity” and has lowered medications somewhat in hospital. We believe they are still too high , as has been the case in the past. Hospital is pushing for ECT. We want further testing with MRI’s , neuro-psych assessment, a full Thyroid screen. Patient recently had neuroleptic malignancy. We think ECT is unnecessary and too risky, especially given history of “sensitivity” and NM.

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