PDF herunterladen
Nervenheilkunde 2013; 32(04): 216-224
DOI: 10.1055/s-0038-1628506
Übersichtsarbeit
Schattauer GmbH

Borderline personality disorder

update on recent scientific perspectives Artikel in mehreren Sprachen: deutsch | English
M. M. Schmid
1   Klinik für Psychiatrie and Psychotherapie III, Universitätsklinikum Ulm
,
M. Gahr
1   Klinik für Psychiatrie and Psychotherapie III, Universitätsklinikum Ulm
,
A.-K. Fladung
1   Klinik für Psychiatrie and Psychotherapie III, Universitätsklinikum Ulm
,
R. W. Freudenmann
1   Klinik für Psychiatrie and Psychotherapie III, Universitätsklinikum Ulm
,
R. C. Wolf
2   Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg
,
C. Schönfeldt-Lecuona
1   Klinik für Psychiatrie and Psychotherapie III, Universitätsklinikum Ulm
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received: eingegangen am: 10. April 2012

Accepted after resubmission 20. April 2012

Publikationsdatum:
24. Januar 2018 (online)

    Lizenzen und Reprints

Summary

Borderline personality disorder (BPD) has drawn more and more scientific interest in the last years. Results from genetic, imaging and neuro-endocrinologic studies had contributed to a more comprehensive understanding of this complex disorder. The aim of this article is to present a general view of the recent neurobiological findings concerning the etiology of the disorder and a possible integration between them. In particular, a link between psychodynamic theories like Object-Relation-Theory, and Attachment-Theory and neurobiological results are outlined in this essay.

Keywords

Borderline personality disorder - etiology - genetic - neurobiology - neurobehavioral theory - psychodynamic theory
 

  • Literatur

  • 1 Choi-Kain LW, Gunderson JG. Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. Am J Psychiatry 2008; 165 (09) 1127-35.
    CrossrefPubMedGoogle Scholar
  • 2 Gunderson JG. Borderline personality disorder: ontogeny of a diagnosis. Am J Psychiatry 2009; 166 (05) 530-9.
    CrossrefPubMedGoogle Scholar
  • 3 WHO. Internationale Klassifikation psychischer Störungen: ICD-10. 2000
    PubMedGoogle Scholar
  • 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – DSM-IVTR (4th edition, Text Revision). American Psychiatric Association, Washington, DC. 2000
    PubMedGoogle Scholar
  • 5 Semiz UB, Basoglu C, Ebrinc S, Cetin M. Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry Clin Neurosci 2008; 62 (01) 48-55.
    CrossrefPubMedGoogle Scholar
  • 6 Gunderson JG. The borderline patient’s intolerance of aloneness: insecure attachments and therapist availability. Am J Psychiatry 1996; 153 (06) 752-8.
    CrossrefPubMedGoogle Scholar
  • 7 Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 2001; 58 (06) 590-6.
    CrossrefPubMedGoogle Scholar
  • 8 Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD. 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 (04) 533-45.
    CrossrefPubMedGoogle Scholar
  • 9 Höschel K, Bohus M. An der Grenze zur Verzweiflung – Borderline Persönlichkeitsstörungen in der Praxis. Der Neurologe und Psychiater 2005; 03: 20-6.
    Google Scholar
  • 10 Bohus M, Schmahl C. Psychopathology and treatment of borderline personality disorder. Nervenarzt 2007; 78 (09) 1069-80.
    CrossrefPubMedGoogle Scholar
  • 11 Gunderson JG, Kolb JE, Austin V. The diagnostic interview for borderline patients. Am J Psychiatry 1981; 138 (07) 896-903.
    CrossrefPubMedGoogle Scholar
  • 12 Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet 2004; 364 (9432): 453-61.
    CrossrefPubMedGoogle Scholar
  • 13 Grilo CM, Sanislow CA, McGlashan TH. Co-occurrence of DSM-IV personality disorders with borderline personality disorder. J Nerv Ment Dis 2002; 190 (08) 552-4.
    CrossrefPubMedGoogle Scholar
  • 14 Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A. et al. Axis II comorbidity of borderline personality disorder. Compr Psychiatry 1998; 39 (05) 296-302.
    CrossrefPubMedGoogle Scholar
  • 15 Philipsen A, Limberger MF, Lieb K, Feige B, Kleindienst N, Ebner-Priemer U. et al. Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. Br J Psychiatry 2008; 192 (02) 118-23.
    CrossrefPubMedGoogle Scholar
  • 16 Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry 2004; 161 (11) 2108-14.
    CrossrefPubMedGoogle Scholar
  • 17 Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Lewis RE, Williams AA. et al. Biparental failure in the childhood experiences of borderline patients. J Pers Disord 2000; 14 (03) 264-73.
    CrossrefPubMedGoogle Scholar
  • 18 Zanarini MC, Yong L, Frankenburg FR, Hennen J, Reich DB, Marino MF. et al. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis 2002; 190 (06) 381-7.
    CrossrefPubMedGoogle Scholar
  • 19 Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychol Bull 2009; 135 (03) 495-510.
    CrossrefPubMedGoogle Scholar
  • 20 Zanarini MC, Williams AA, Lewis RE, Reich RB, Vera SC, Marino MF. et al. Reported pathological childhood experiences associated with the development of borderline personality disorder. Am J Psychiatry 1997; 154 (08) 1101-6.
    CrossrefPubMedGoogle Scholar
  • 21 Skodol AE, Siever LJ, Livesley WJ, Gunderson JG, Pfohl B, Widiger TA. The borderline diagnosis II: biology, genetics, and clinical course. Biol Psychiatry 2002; 51 (12) 951-63.
    CrossrefPubMedGoogle Scholar
  • 22 Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J. et al. A twin study of personality disorders. Compr Psychiatry 2000; 41 (06) 416-25.
    CrossrefPubMedGoogle Scholar
  • 23 Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry 1993; 50 (12) 971-4.
    CrossrefPubMedGoogle Scholar
  • 24 Silk KR. Borderline personality disorder. Overview of biologic factors. Psychiatr Clin North Am 2000; 23 (01) 61-75.
    CrossrefPubMedGoogle Scholar
  • 25 Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M. Aversive tension in patients with borderline personality disorder: a computer-based controlled field study. Acta Psychiatr Scand 2005; 111 (05) 372-9.
    CrossrefPubMedGoogle Scholar
  • 26 Wolff S, Stiglmayr C, Bretz HJ, Lammers CH, Auckenthaler A. Emotion identification and tension in female patients with borderline personality disorder. Br J Clin Psychol 2007; 46 (Pt 3): 347-60.
    CrossrefPubMedGoogle Scholar
  • 27 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 (04) 292-8.
    CrossrefPubMedGoogle Scholar
  • 28 Lis E, Greenfield B, Henry M, Guile JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci 2007; 32 (03) 162-73.
    PubMedGoogle Scholar
  • 29 Brendel GR, Stern E, Silbersweig DA. Defining the neurocircuitry of borderline personality disorder: functional neuroimaging approaches. Dev Psychopathol 2005; 17 (04) 1197-206.
    PubMedGoogle Scholar
  • 30 Schmahl C, Bohus M, Esposito F, Treede RD, Di Salle F, Greffrath W. et al. Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry 2006; 63 (06) 659-67.
    CrossrefPubMedGoogle Scholar
  • 31 Cardenas-Morales L, Fladung AK, Kammer T, Schmahl C, Plener PL, Connemann BJ. et al. Exploring the affective component of pain perception during aversive stimulation in borderline personality disorder. Psychiatry Res. 2010 9 Sept E-pub.
    PubMedGoogle Scholar
  • 32 Ferguson JN, Young LJ, Insel TR. The neuroendocrine basis of social recognition. Front Neuroendocrinol 2002; 23 (02) 200-24.
    CrossrefPubMedGoogle Scholar
  • 33 Carter CS. Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology 1998; 23 (08) 779-818.
    CrossrefPubMedGoogle Scholar
  • 34 Panksepp J. Oxytocin effects on emotional processes: separation distress, social bonding, and relationships to psychiatric disorders. Ann N Y Acad Sci 1992; 652: 243-52.
    CrossrefPubMedGoogle Scholar
  • 35 Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. Oxytocin increases trust in humans. Nature 2005; 435 (7042): 673-6.
    CrossrefPubMedGoogle Scholar
  • 36 Baumgartner T, Heinrichs M, Vonlanthen A, Fischbacher U, Fehr E. Oxytocin shapes the neural circuitry of trust and trust adaptation in humans. Neuron 2008; 58 (04) 639-50.
    CrossrefPubMedGoogle Scholar
  • 37 Buchheim A, Heinrichs M, George C, Pokorny D, Koops E, Henningsen P. et al. Oxytocin enhances the experience of attachment security. Psychoneuroendocrinology 2009; 34 (09) 1417-22.
    CrossrefPubMedGoogle Scholar
  • 38 Costa B, Pini S, Gabelloni P, Abelli M, Lari L, Cardini A. et al. Oxytocin receptor polymorphisms and adult attachment style in patients with depression. Psychoneuroendocrinology 2009; 34 (10) 1506-14.
    CrossrefPubMedGoogle Scholar
  • 39 King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science 2008; 321 (5890): 806-10.
    CrossrefPubMedGoogle Scholar
  • 40 Domes G, Heinrichs M, Michel A, Berger C, Herpertz SC. Oxytocin improves “mind-reading” in humans. Biol Psychiatry 2007; 61 (06) 731-3.
    CrossrefPubMedGoogle Scholar
  • 41 Rejon CAltable, Vidal CCastro, Lopez JMSantin. Concept of representation and mental symptoms. The case of theory of mind. Psychopathology 2009; 42 (04) 219-28.
    CrossrefPubMedGoogle Scholar
  • 42 Sharp C, Mosko O, Chang B, Ha C. The cross-informant concordance and concurrent validity of the Borderline Personality Features Scale for Children in a community sample of boys. Clin Child Psychol Psychiatry 2011; 16 (03) 335-49.
    CrossrefPubMedGoogle Scholar
  • 43 Sharp C, Pane H, Ha C, Venta A, Patel AB, Sturek J. et al. Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry 2011; 50 (06) 563-73.
    CrossrefPubMedGoogle Scholar
  • 44 Heim C, Young LJ, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. Lower CSF oxytocin concentrations in women with a history of childhood abuse. Mol Psychiatry 2009; 14 (10) 954-8.
    CrossrefPubMedGoogle Scholar
  • 45 Lee R, Ferris C, Van de Kar LD, Coccaro EF. Cerebrospinal fluid oxytocin, life history of aggression, and personality disorder. Psychoneuroendocrinology 2009; 34 (10) 1567-73.
    CrossrefPubMedGoogle Scholar
  • 46 Panksepp J. Neuroscience. Feeling the pain of social loss. Science 2003; 302 (5643): 237-9.
    CrossrefPubMedGoogle Scholar
  • 47 Eisenberger NI, Lieberman MD. Why rejection hurts: a common neural alarm system for physical and social pain. Trends Cogn Sci 2004; 08 (07) 294-300.
    CrossrefPubMedGoogle Scholar
  • 48 Nelson EE, Panksepp J. Brain substrates of infantmother attachment: contributions of opioids, oxytocin, and norepinephrine. Neurosci Biobehav Rev 1998; 22 (03) 437-52.
    CrossrefPubMedGoogle Scholar
  • 49 Herman BH, Panksepp J. Effects of morphine and naloxone on separation distress and approach attachment: evidence for opiate mediation of social affect. Pharmacol Biochem Behav 1978; 09 (02) 213-20.
    CrossrefPubMedGoogle Scholar
  • 50 Knowles PA, Conner RL, Panksepp J. Opiate effects on social behavior of juvenile dogs as a function of social deprivation. Pharmacol Biochem Behav 1989; 33 (03) 533-7.
    CrossrefPubMedGoogle Scholar
  • 51 Keverne EB, Martensz ND, Tuite B. Beta-endorphin concentrations in cerebrospinal fluid of monkeys are influenced by grooming relationships. Psychoneuroendocrinology 1989; 14 (1–2): 155-61.
    CrossrefPubMedGoogle Scholar
  • 52 Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI study of social exclusion. Science 2003; 302 (5643): 290-2.
    CrossrefPubMedGoogle Scholar
  • 53 Kross E, Berman MG, Mischel W, Smith EE, Wager TD. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci USA 2011; 108 (15) 6270-5.
    CrossrefPubMedGoogle Scholar
  • 54 Eisenberger NI, Jarcho JM, Lieberman MD, Naliboff BD. An experimental study of shared sensitivity to physical pain and social rejection. Pain. 2006 126. (1–3): 132-8.
    PubMedGoogle Scholar
  • 55 Stanley B, Siever LJ. The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry 2010; 167 (01) 24-39.
    CrossrefPubMedGoogle Scholar
  • 56 Barr CS, Schwandt ML, Lindell SG, Higley JD, Maestripieri D, Goldman D. et al. Variation at the mu-opioid receptor gene (OPRM1) influences attachment behavior in infant primates. Proc Natl Acad Sci USA 2008; 105 (13) 5277-81.
    CrossrefPubMedGoogle Scholar
  • 57 Way BM, Taylor SE, Eisenberger NI. Variation in the mu-opioid receptor gene (OPRM1) is associated with dispositional and neural sensitivity to social rejection. Proc Natl Acad Sci USA 2009; 106 (35) 15079-84.
    CrossrefPubMedGoogle Scholar
  • 58 Prossin AR, Love TM, Koeppe RA, Zubieta JK, Silk KR. Dysregulation of regional endogenous opioid function in borderline personality disorder. Am J Psychiatry 2010; 167 (08) 925-33.
    CrossrefPubMedGoogle Scholar
  • 59 Stanley B, Sher L, Wilson S, Ekman R, Huang YY, Mann JJ. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord 2010; 124 (1–2): 134-40.
    CrossrefPubMedGoogle Scholar
  • 60 Gu XL, Yu LC. Involvement of opioid receptors in oxytocin-induced antinociception in the nucleus accumbens of rats. J Pain 2007; 08 (01) 85-90.
    CrossrefPubMedGoogle Scholar
  • 61 Damasio AR. How the brain creates the mind. Sci Am 1999; 281 (06) 112-7.
    CrossrefPubMedGoogle Scholar
  • 62 Panksepp J, Northoff G. The trans-species core SELF: the emergence of active cultural and neuroecological agents through self-related processing within subcortical-cortical midline networks. Conscious Cogn 2009; 18 (01) 193-215.
    CrossrefPubMedGoogle Scholar
  • 63 Rusch N, Bracht T, Kreher BW, Schnell S, Glauche V, Il’yasov KA. et al. Reduced interhemispheric structural connectivity between anterior cingulate cortices in borderline personality disorder. Psychiatry Res 2010; 181 (02) 151-4.
    CrossrefPubMedGoogle Scholar
  • 64 Wolf RC, Sambataro F, Vasic N, Schmid M, Thomann PA, Bienentreu SD. et al. Aberrant connectivity of resting-state networks in borderline personality disorder. J Psychiatry Neurosci 2011; 36 (02) 100150.
    Google Scholar
  • 65 Spreng RN, Mar RA, Kim AS. The common neural basis of autobiographical memory, prospection, navigation, theory of mind, and the default mode: a quantitative meta-analysis. J Cogn Neurosci 2009; 21 (03) 489-510.
    CrossrefPubMedGoogle Scholar
  • 66 Buckner RL, Carroll DC. Self-projection and the brain. Trends Cogn Sci 2007; 11 (02) 49-57.
    CrossrefPubMedGoogle Scholar
  • 67 Jorgensen CR. Disturbed sense of identity in borderline personality disorder. J Pers Disord 2006; 20 (06) 618-44.
    CrossrefPubMedGoogle Scholar
  • 68 Wilkinson-Ryan T, Westen D. Identity disturbance in borderline personality disorder: an empirical investigation. Am J Psychiatry 2000; 157 (04) 528-41.
    CrossrefPubMedGoogle Scholar
  • 69 Lanius RA, Williamson PC, Bluhm RL, Densmore M, Boksman K, Neufeld RW. et al. Functional connectivity of dissociative responses in posttraumatic stress disorder: a functional magnetic resonance imaging investigation. Biol Psychiatry 2005; 57 (08) 873-84.
    CrossrefPubMedGoogle Scholar
  • 70 Kernberg O. Objektbeziehungen und Praxis der Psychoanalyse. 7. Auflage. Stuttgart: Klett-Cotta; 2007
    Google Scholar
  • 71 Cardasis W, Hochman JA, Silk KR. Transitional objects and borderline personality disorder. Am J Psychiatry 1997; 154 (02) 250-5.
    CrossrefPubMedGoogle Scholar
  • 72 Hardy LT. Attachment theory and reactive attachment disorder: theoretical perspectives and treatment implications. J Child Adolesc Psychiatr Nurs 2007; 20 (01) 27-39.
    CrossrefPubMedGoogle Scholar
  • 73 Lyons-Ruth K. Attachment relationships among children with aggressive behavior problems: the role of disorganized early attachment patterns. J Consult Clin Psychol 1996; 64 (01) 64-73.
    CrossrefPubMedGoogle Scholar
  • 74 Agrawal HR, Gunderson J, Holmes BM, Lyons-Ruth K. Attachment studies with borderline patients: a review. Harv Rev Psychiatry 2004; 12 (02) 94-104
    Google Scholar