Initially, the diagnosis borderline personality disorder was used to denote patients in the borderline between neurotic and psychotic disorders. In recent times, research has placed much greater emphasis on the extreme sensitivity of people with this diagnosis. A person with borderline personality disorder can be experienced as a "hurricane of emotional dysregulation. 

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Researchers have also tried to find out why people with this disorder have such tremendous problems regulating their own emotions. 


What is borderline personality disorder?

Borderline or emotionally unstable personality disorder is characterized by being impulsive, having fluctuating and strong affects, having poor self-esteem, being self-destructive and entering into unstable relationships. They exhibit constant mood swings and often have outbursts of anger. 

The person may have periods of dissociation. The symptoms occur especially in close personal relationships, so-called attachment relationships. In impersonal contexts, the function may be inconspicuous.

The difficulties therefore mainly lead to difficult relationships with family, friends and colleagues. Self-harm is not uncommon. Symptoms of post-traumatic stress disorder are common in these patients.

Much research has been done on borderline personality disorder, and over time various forms of treatment have been tried, where some can show good results. Without treatment, the symptoms can worsen and in extreme cases lead to suicide attempts. 

Brain research on borderline personality disorder

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

The researchers conducted a meta-analysis of previously published imaging studies to examine dysfunctions of underlying negative emotions in borderline personality disorder. A thorough literature search identified 11 relevant studies as the overall results for analysis, yielding data on 154 patients with borderline personality disorder and 150 healthy controls. 

Two areas of the brain are misregulated in borderline personality disorder

In their report, the researchers conclude that there is a dysregulation in two important areas of the brain, both of which may help explain the emotional dysregulation we see in borderline personality disorder. More specifically, the researchers found an increased brain activity in areas that have to do with the experience of negative emotions, and a decreased brain activity in areas that normally inhibit negative emotions when they first occur.

Ruocco commented:

- We found convincing evidence for two interconnected brain systems that may explain symptoms of emotional dysregulation in this disorder: the first, centered on specific limbic structures, may reflect an increased subjective perception of the intensity of negative emotions, and the second, which consists mainly of frontal regions, can be neglected and thus hinder the proper regulation of emotions. 

This difference in brain functioning is not to say the borderline personality disorder is inherited. Other research has shown how childhood trauma shapes the brain, and how a damaged brain might be re-shaped.


Recurrent depression due to borderline personality disorder

Another important finding is that there appears to be a reduced brain activity in a frontal area of ​​the brain, called the subgenual anterior cingulate, which may be unique to borderline personality disorder. This finding may explain some of the reasons why people with this disorder get recurrent depression 

Brain changes with successful therapy 

- This new report gives us the impression that people with borderline personality disorder have a "setup" in the brain that provides the basis for having stormy emotional lives, but not necessarily having to have unhappy or unproductive lives, says Dr. John Krystal, editor in Biological Psychiatry.

"Given that many of the most effective psychotherapies for borderline personality disorder work specifically to improve patients' emotional skills, these findings may indicate that dysfunctions in critical frontal control centers in the brain are normalized after successful treatment," Ruocco concluded.