Introduction

Neuroimaging in borderline personality disorder

Christian Schmahl^a,* and J. Douglas Bremner^b

^aDepartment of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J5, D-68159 Mannheim, Germany

^bDepartments of Psychiatry and Behavioral Sciences and Radiology, and Center for Positron Emission Tomography, Emory University School of Medicine, Atlanta, GA, and Atlanta VAMC, Decatur, GA, USA

^* Corresponding author. Tel.: +49 621 1703 4401; fax: +0049 621 1703 4405., Email: schmahl@zi-mannheim.de (C. Schmahl)

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Abstract

Neuroimaging has become one of the most important methods in the investigation of the neurobiological underpinnings of borderline personality disorder. Structural and functional imaging studies have revealed dysfunction in different brain regions which seem to contribute to borderline symptomatology. This review presents relevant studies using different methodologies: volumetry of limbic and prefrontal regions, investigations of brain metabolism under resting conditions, studies of serotonergic neurotransmission, and challenge studies using emotional, stressful, and sensory stimuli. Dysfunction in a frontolimbic network is suggested to mediate much, if not all of the borderline symptomatology.

Keywords: Neuroimaging, Borderline personality disorder, Prefrontal cortex, Amygdala

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Introduction

The past few years have seen a rapidly growing body of research in the field of neurobiological correlates of borderline personality disorder (BPD) (Lieb et al., 2004; Schmahl et al., 2002; Skodol et al., 2002). In addition to research on the genetic basis of the disorder (Jang et al., 1996; Torgersen et al., 2000), psychopharmacological treatment (Soloff, 2000), and neuroendocrinology (Rinne et al., 2002), progress in neuroimaging has been fruitful in the elucidation of the underlying neurobiology of this severe and chronic disorder.

Affective dysregulation has been suggested to represent the core of borderline symptomatology and to underlie most if not all of the characteristic features of the disorder, such as instable self image, disturbed interpersonal relationships, and self-injurious behavior. Animal studies as well as investigations in healthy human subjects suggest that limbic as well as prefrontal regions play a decisive role in emotion regulation (Davidson and Irwin, 1999). Thus, it can be hypothesized that frontolimbic dysfunction underlies affective dysregulation as well as other closely connected symptoms of BPD. Consequently, structural as well as functional neuroimaging investigations have focussed on alterations in these brain regions.

This review on neuroimaging in BPD is arranged according to the different imaging methods used. It will start with studies using volumetrics and spectroscopy of different brain regions, such as hippocampus, amygdala, and prefrontal regions. An overview of functional neuroimaging will begin with studies of brain metabolism under resting conditions using FDG-PET. Imaging of the serotonergic neurotransmission system using serotonergic agents will then be reviewed, followed by challenge studies that investigate reactivity of brain areas to stimuli such as emotional pictures, stressful memories, or sensory challenges with the aid of PET or functional MRI. Finally, conclusions from the literature reviewed will be drawn and an outlook on future studies will be given.

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