Are we able to see physical signs of borderline personality disorder when we look at the brain?
In this excerpt from the second edition of his book, “Borderline Personality Disorders in Adolescents,” Dr. Blaise Aguirre discusses some of the structural and functional differences that researchers have identified in persons with borderline personality disorder (BPD).
What the Brain Reveals About Borderline Personality Disorder
In 2006, researchers from the University of Freiburg, in Germany looked at all the published studies on neuroimaging and BPD.
They noted that neuroimaging had become one of the most important tools for investigating the biological causes of BDP. All the studies regarding imaging and BPD found abnormalities in the limbic system and the frontal lobes, which the researchers considered to be consistent with the idea that problems in these areas of the brain led to BPD symptoms.
People often ask whether any such brain scans or blood tests will “prove” that a person has PBD or at least show that the person has “something wrong with her brain,” as one parent put it.
The short answer is that researchers are looking at information from various types of scans to see whether they can detect differences between the brains of people with BPD and those without BPD.
So far, these scans have shown what researchers hypothesize—that the frontal lobes and limbic system play an important role in BPD.
How BPD Brains are Different
Charles, a sixteen-year-old junior in high school, came in for treatment because he had a hard time controlling his rage. He did well in the classroom; but with close friends and when out on dates, he would explode when he felt things weren’t going his way or that people weren’t being fair.
He admitted that on a few occasions, he had yelled at friends, and, in desperate moments, physically attacked his girlfriend. He is not unlike many adolescents who come to see us because of the impulsivity or aggression that’s directed toward others or themselves.
In research, behaviors such as self-mutilation, physical violence, assault, destruction of property, and drug use fall under the category of impulse aggression, which is the one area in BPD that is well-researched.
In a 1996 study of violent offenders and impulsive fire setters, 47 percent were found to have a personality disorder diagnosis—in particular, borderline and antisocial personality disorders. In another study, male perpetrators of domestic violence were more likely to have a diagnosis of BPD than men who did not engage in domestic violence.
Brain scans show that people with impulsive aggression have lower levels of activity in the prefrontal cortex (PFC). What this means is that the PFC is not as active in people who display impulsive aggression.
Most brain-scanning studies demonstrate that people with BPD show disordered functioning in the PFC, compared to people without BPD, and this is particularly true if the person with BPD also suffers from post-traumatic stress disorder (PTSD).
As I noted earlier, having a less-active PFC means having a more difficult time with regulating emotions (such as anger) that arise in the amygdala.
Essentially, all neuroimaging points to abnormalities in the amygdala and the prefrontal cortex in people with BPD. Whether these abnormalities cause BPD, or if having BPD leads to these abnormalities, remains to be seen.
This second edition of Borderline Personality Disorder in Adolescents offers parents, caregivers, and adolescents themselves a complete understanding of this complex and tough-to-treat disorder. It is a comprehensive guide which thoroughly explains what BPD is and what a patient’s treatment options are, including an overview of the revolutionary new treatment called dialectic behavior therapy. Author Blaise A. Aguirre, M.D., one of the foremost experts in the field, describes recent advances in treatments and brings into focus what we know, and don’t know, about this condition. Revised and updated from the previous edition, readers will learn all about the scientific development of BPD; treatment options (e.g., medication and therapy); myths and misunderstandings; tips and strategies for parents; the prognosis for BPD; and practical techniques for effective communication with those who have BPD. They will also hear from BPD adolescents and parents who have learned how to make the best of the cards they have been dealt.