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    Path o Physiology

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    Patricia Vasquez
    The pathophysiology of borderline personality disorder is thought to involve a genetic predisposition interacting with childhood environmental factors and neurobiological abnormalities. There is over 50% heritability seen in twin studies, and environmental stressors like childhood maltreatment are present in many cases. Neuroimaging studies have found differences in the amygdala, hippocampus and other brain regions involved in processing emotions. Serotonin and other neurotransmitter systems may also play a role in the impaired regulation of affect seen in BPD.

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    Path o Physiology

    Uploaded by

    Patricia Vasquez
    90 views3 pages
    The pathophysiology of borderline personality disorder is thought to involve a genetic predisposition interacting with childhood environmental factors and neurobiological abnormalities. There is over 50% heritability seen in twin studies, and environmental stressors like childhood maltreatment are present in many cases. Neuroimaging studies have found differences in the amygdala, hippocampus and other brain regions involved in processing emotions. Serotonin and other neurotransmitter systems may also play a role in the impaired regulation of affect seen in BPD.

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    Pathophysiology of Borderline Personality Disorder

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    The pathophysiology of borderline personality disorder is thought to involve a genetic predisposition interacting with childhood environmental factors and neurobiological abnormalities. There is over 50% heritability seen in twin studies, and environmental stressors like childhood maltreatment are present in many cases. Neuroimaging studies have found differences in the amygdala, hippocampus and other brain regions involved in processing emotions. Serotonin and other neurotransmitter systems may also play a role in the impaired regulation of affect seen in BPD.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    90 views3 pages

    Path o Physiology

    Uploaded by

    Patricia Vasquez
    The pathophysiology of borderline personality disorder is thought to involve a genetic predisposition interacting with childhood environmental factors and neurobiological abnormalities. There is over 50% heritability seen in twin studies, and environmental stressors like childhood maltreatment are present in many cases. Neuroimaging studies have found differences in the amygdala, hippocampus and other brain regions involved in processing emotions. Serotonin and other neurotransmitter systems may also play a role in the impaired regulation of affect seen in BPD.

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    © All Rights Reserved
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    Pathophysiology

    The pathophysiology of borderline personality disorder is likely a combination of genetic predisposition combined with early childhood environmental factors and
    neurobiological dysfunction.

    1. There is a genetic predisposition. Twin studies show over 50% heritability (greater than that for major depression). Twin studies performed in 2000 and 2008
    both demonstrated higher concordance of the rate of borderline personality disorder for monozygotic versus dizygotic twins. First-degree relatives of patients
    with borderline personality disorder are 5 times more likely to have the disorder than the general population.
    2. Environmental factors that have been identified as contributing to the development of borderline personality disorder include primarily childhood maltreatment
    (physical, sexual, or neglect), found in up to 70% of people with BPD, as well as maternal separation, poor maternal attachment, inappropriate family
    boundaries, parental substance abuse, and serious parental psychopathology.
    3. Neuroimaging studies have identified differences in the amygdala, hippocampus, and medial temporal lobes in patients with borderline personality disorder.
    Such studies also suggest that patients with borderline personality disorder misattribute negative emotions (fear, anger, disgust) to neutral faces more so than
    controls or other patients, despite having the perception of happy and upset faces equivalent to those groups. These abnormalities may be caused by perinatal
    injury, encephalitis, trauma or genetics.

    Research revealed heightened activation during processing of negative emotional stimuli in the left amygdala, left hippocampus, and posterior
    cingulate cortex as well as diminished activation in prefrontal regions (including the dorsal lateral prefrontal cortex). Other imaging studies noted left
    amygdala and right hippocampus gray volume decreases in persons with BPD. Conflicting amygdala results are believed to result from the medication status
    of research participants because psychoactive drugs attenuate limbic activity.

    Connectivity studies developed over the past 2 years and can be described in terms of anatomical and functional connectivity. Functional connectivity
    analyses provide information about which brain regions are co-activated. The 3 networks most salient in BPD are:

    • The default mode: a network activated when the brain is at rest in the absence of goal-directed activity; it is influenced by the medial prefrontal
    cortex and posterior cingulate cortex and is responsible for self-referential thinking

    • The salience network, including the orbital frontal insula and the dorsal anterior cingulate cortex

    • The medial temporal lobe network, which is responsible for processing negative emotions

    In BPD, there are alterations in the connections between these 3 networks with particularly problematic connectivity between salience detection and
    self-referential encoding. This results in misidentification with neutral stimuli as well as a failure to integrate salience information with internal
    representations.

    4. Neurobiological studies have suggested that impaired neuropeptide function, specifically serotonin, may be present in patients with borderline personality
    disorder. Dysfunctional signalling of serotonin (May play a role in impulsive aggression) and acethylcholine (may play a role in affective instability).
    Other theories for the Causes of Borderline Personality Disorder

     In the mentalizing model of Peter Fonagy and Anthony Bateman, borderline personality disorder is the result of a lack of resilience against psychological
    stressors. In this framework, Fonagy and Bateman define resilience as the ability to generate adaptive re-appraisal of negative events or stressors; patients
    with impaired re-appraisal accumulate negative experiences and fail to learn from good experiences
     In the biosocial model popularized by Dr. Marsha Linehan, genetic vulnerability interacts with a "chronically invalidating environment" to produce the
    constellation of borderline personality disorder symptoms.
     In another theory, borderline personality disorder arises from the inability to regulate affect and the lack of formation of appropriate coping mechanisms in
    response to stress
     Persons with BPD are at higher risk for depression, panic disorder, and agoraphobia. Studies commonly reveal that patients with BPD are anxious,
    dependent, and acutely sensitive to rejection and loss; these observations suggest that the condition might be specifically related to attachment bond
    regulation.
     Otto Kernberg theorized that lack of integration in the early material relationship led to borderline personality disorder. Kernberg hypothesized that the
    infant experiences the maternal figure in a dichotomous framework, the loving and nurturing mother who provides for the child and the punishing, hateful
    mother who deprives the child. This contradiction causes intense anxiety and, if not integrated into a more moderate unitary concept, ultimately leads to
    the development of splitting. The term "splitting" refers to the defense mechanism in which the patient cannot form a realistic view of another person. At
    any given time, the other person is viewed as entirely good or entirely bad. This inability to view others as having both positive and negative attributes
    impairs personal relationships.

    References:

     Borderline Personality Disorder (BPD) - Psychiatric Disorders. (n.d.). MSD Manual Professional Edition.
    https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/borderline-personality-disorder-bpd
     Borderline Personality Disorder: Pathogenesis and Clinical ... (2020, May 23). GrepMed.
    https://www.grepmed.com/images/8216/personalitydisorder-criteria-signs-mnemonic-amsuicide
     Borderline Personality Disorder: Practice Essentials, Background, Pathophysiology. (2021). EMedicine.
    https://emedicine.medscape.com/article/913575-overview#a4
     Chapman, J., Jamil, R. T., & Fleisher, C. (2021). Borderline Personality Disorder. PubMed; StatPearls Publishing.
    https://www.ncbi.nlm.nih.gov/books/NBK430883/#:~:text=The%20pathophysiology%20of%20borderline%20personality
     Ma, G., Fan, H., Shen, C., & Wang, W. (2016). Genetic and Neuroimaging Features of Personality Disorders: State of the Art. Neuroscience
    Bulletin, 32(3), 286–306. https://doi.org/10.1007/s12264-016-0027-8
     The Neurobiology of Borderline Personality Disorder. (n.d.). Psychiatric Times. https://www.psychiatrictimes.com/view/neurobiology-
    borderline-personality-disorder

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