Borderline personality disorder: The "perfect storm" of emotion dysregulation

A research team led by assistant professor Anthony Ruocco from the University of Toronto Scarborough led to new insights into the ‘borderline personality’ brain. Credit: University of Toronto Scarborough

Originally, the label "borderline personality disorder" was applied to patients who were thought to represent a middle ground between patients with neurotic and psychotic disorders. Increasingly, though, this area of research has focused on the heightened emotional reactivity observed in patients carrying this diagnosis, as well as the high rates with which they also meet diagnostic criteria for posttraumatic stress disorder and mood disorders.

New research now published in Biological Psychiatry from Dr. Anthony Ruocco at the University of Toronto and his colleagues paints perhaps the sharpest picture we have so far of the patterns of brain activity which may underlie the intense and unstable associated with this diagnosis.

In their report, the investigators describe two critical brain underpinnings of emotion dysregulation in borderline personality disorder: heightened activity in involved in the experience of and reduced activation of brain circuits that normally suppress negative emotion once it is generated.

To accomplish this, they undertook a meta-analysis of previously published neuroimaging studies to examine dysfunctions underlying negative emotion processing in borderline personality disorder. A thorough literature search identified 11 relevant studies from which they pooled the results to further analyze, providing data on 154 patients with borderline personality disorder and 150 healthy control subjects.

Ruocco commented, "We found compelling evidence pointing to two interconnected neural systems which may subserve symptoms of emotion dysregulation in this disorder: the first, centered on specific limbic structures, which may reflect a heightened subjective perception of the intensity of negative emotions, and the second, comprised primarily of frontal , which may be inadequately recruited to appropriately regulate emotions."

Importantly, reduced activity in a frontal area of the brain, called the subgenual anterior cingulate, may be unique to borderline personality disorder and could serve to differentiate it from other related conditions, such as recurrent major depression.

"This new report adds to the impression that people with borderline personality disorder are 'set-up' by their brains to have stormy emotional lives, although not necessarily unhappy or unproductive lives," commented Dr. John Krystal, Editor of .

"Given that many of the most effective psychotherapies for work to improve emotion regulation skills, these findings could suggest that dysfunctions in critical frontal 'control' centers might be normalized after successful treatment," concluded Ruocco.

More information: The article is "Neural Correlates of Negative Emotionality in Borderline Personality Disorder: An Activation-Likelihood-Estimation Meta-Analysis" by Anthony C. Ruocco, Sathya Amirthavasagam, Lois W. Choi-Kain, and Shelley F. McMain (doi: 10.1016/j.biopsych.2012.07.014). The article appears in Biological Psychiatry, Volume 73, Issue 2 (January 15, 2013)

add to favorites email to friend print save as pdf

Related Stories

Is it really bipolar disorder?

Mar 25, 2010

A study from Rhode Island Hospital has shown that a widely-used screening tool for bipolar disorder may incorrectly indicate borderline personality disorder rather than bipolar disorder. In the article that appears online ...

Recommended for you

Suicide risk falls substantially after talk therapy

6 hours ago

Repeat suicide attempts and deaths by suicide were roughly 25 percent lower among a group of Danish people who underwent voluntary short-term psychosocial counseling after a suicide attempt, new Johns Hopkins Bloomberg School ...

Brains transform remote threats into anxiety

Nov 21, 2014

Modern life can feel defined by low-level anxiety swirling through society. Continual reports about terrorism and war. A struggle to stay on top of family finances and hold onto jobs. An onslaught of news ...

Mental disorders due to permanent stress

Nov 21, 2014

Activated through permanent stress, immune cells will have a damaging effect on and cause changes to the brain. This may result in mental disorders. The effects of permanent stress on the immune system are studied by the ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.