Neural Possibilities: Study Expands Potential of Borderline Personality Disorder Treatment

Now, a meta-analysis by a group of German researchers sheds new light on the characteristics of brain function in people with Borderline Personality Disorder, giving experts a clearer understanding of how BPD acts on the brain, or, perhaps more specifically, how a brain with BPD acts. The study sought to investigate the neural foundations of BPD by examining “functional neuroimaging findings of emotion processing tasks, as well as structural neuroimaging findings, and investigat[ing] multimodally affected brain region.” The researchers focused on the analysis of neurostimuli in 281 patients with BPD and 293 control subjects, as well as grey matter analysis on 263 patients with BPD and 278 control subjects. As Amanda Oldt of Helio Psychiatric Annals writes:

Individuals with BPD exhibited increased activation of the left amygdala and posterior cingulate cortex and decreased responses in the bilateral dorsolateral prefrontal cortex during negative emotional stimuli processing, compared with healthy controls. Multimodal analysis indicated a combination of functional hyperactivity and lower gray matter volume in the left amygdala among individuals with BPD.

In other words, the major memory, decision-making, and emotional centers of the brain are not behaving the way they do in healthy brains. As a result of these structural and functional abnormalities, people with BPD are less able to effectively integrate emotional knowledge and react in a rational way, which may explain the emotional instability, self-injury, unpredictable aggression, and dissociation that characterize many people’s BPD and significantly undermine psychosocial wellness. This window into how BPD looks neurally supports a more cohesive understanding of what causes BPD symptoms to emerge and how the illness may be more accurately classified. As researchers note, “[These] results strengthen the assumption that dysfunctional dorsolateral prefrontal and limbic brain regions are a hallmark feature of BPD and therefore are consistent with the conceptualization of BPD as an emotion dysregulation disorder.”

The study also offers some clarity regarding the origins of certain neural changes; hippocampal volume reduction, for example, has been observed in adults with Post-Traumatic Stress Disorder, as well as in “healthy adults with a history of childhood maltreatment, and would therefore be best interpreted as the result of traumatic stress” rather than a congenital condition, which is consistent with what we know about the experiential causes of BPD. Although the researchers point out that more detailed research must take place to more accurately identify the specific regions of limbic abnormality and to determine whether the atypical amygdala and prefrontal cortex functions are related, the preliminary findings are an ideal jumping-off point for future investigations.

The meta-analysis not only provides important clues about how BPD functions, it also opens up a number of possibilities for enhanced diagnosis, treatment, and a more accurate understanding of this much-maligned illness:

• Recognizing BPD as a brain-based emotional dysregulation disorder directly challenges assumptions that people with BPD are simply being difficult, manipulative, or malicious, increasing understanding of the disorder both within the medical community and in society as a whole.

• If certain neural structures are indeed hallmarks of BPD, incorporating neural imaging in diagnostic testing in cases where BPD is suspected may reduce instances of misdiagnosis, leading to an earlier identification of the illness while also giving those who don’t have BPD the chance to more rapidly move toward an accurate diagnosis.

• A more accurate understanding how the brains of people with BPD behave may lead to the development of more effective pharmacological, psychotherapeutic, and behavioral interventions that specifically seek to target the effected areas of function.

Indeed, pharmacological interventions already in use by some people with BPD appear to normalize certain aspects of neural function. As the researchers note:

Our results suggest that psychotropic medication has a substantial impact on neural activations in a cluster comprising the left amygdala and hippocampus. Medication-free samples showed hyperreactivity in response to negative stimuli, whereas no such effect was found in BPD samples currently taking psychotropic medication.

This pronounced moderating effect of psychotropic medications supports a growing body of evidence that, despite the popular belief that BPD does not respond to drug treatment, people with the illness can indeed experience meaningful benefits from pharmacological interventions. As such, both people suffering from BPD and clinicians may become more willing to integrate psychotropics in Borderline Personality Disorder treatment while pharmaceutical researchers may be encouraged to investigate more effective medications.

But medications aren’t the only possibility for promoting healthy brain function in people with BPD; psychotherapeutic and behavioral interventions have been proven to normalize neural activity and rebuild grey matter in people with a variety of mental health conditions, traumatic brain injuries, and even healthy individuals who experience natural neural changes in response to everyday stressors. By thoughtfully harnessing the plastic nature of our highly adaptable brains through a variety of therapeutic modalities, you can rejuvenate not only your mind, but your spirit.