Disturbed fronto-limbic brain circuits in borderline personality disorder

Borderline Personality Disorder is characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Clinical hallmarks of the disorder are emotional dysregulation, impulsive aggression, repeated self-injurious behavior and chronic suicidality. Recent evidence indicates that a dual brain pathology affecting prefrontal areas and the limbic system may cause impulsivity and affective dysregulation. Brain imaging data have shown amygdalar hyperreactivity to emotional stimuli and dysfunctions in prefrontal areas including lower metabolism and smaller volumes which may cause insufficient inhibition of limbic responses. However, other brain areas are also affected which may modulate limbic responses: Examples are the anterior cingulate cortex for pain processing and the hippocampus for memory of e.g. traumatic experiences. Interactions in this complex network may explain the broad spectrum of symptoms and may be a starting point for the development of specific therapeutic approaches for this severly ill patient group.