Borderline Personality Disorder Research

Biological Markers

Biological markers in schizotypal and borderline personality disorders

Encephale 2000 Nov-Dec;26(6):42-54  (Article in French)
Ajamieh A, Ansseau M.
Service de Psychiatrie et de Psychologie Medicale, CHU du Sart Tilman, B-4000 Liege, Belgique.

"A preliminary but growing body of evidence supports the existence of biological substrates in personality disorders. Based on a review of the literature, the article deals with the major biological markers: genetic, cognitive, biochemical, electrophysiological and organic markers, of schizotypal and borderline personality disorders. In addition, the article compares these findings in these two types of pathological personality. In the field of genetics, we notice several indices in favour of a relationship between schizotypal personality disorder (SPD) and chronic schizophrenia. In contrast, in borderline personality disorder (BPD), indices were lacking for such a relationship between this disorder and one of the axis I diagnosis, or a clear genetic transmission. In the field of cognitive tests, we can note in both SPD and BPD, that the abnormalities which would be at the level of temporal and frontal lobes, may be implicated in the observable cognitive troubles in these two disorders. In the field of neurobiochemistry, the dopaminergic and serotonergic systems seem to be implicated in the etiology of SPD while several data point out the fact that several neurotransmitter systems (dopaminergic, serotonergic, noradrenergic and cholinergic) seem to be involved in the etiology of BPD. Finally, in the field of electrophysiology, we notice that some of these tests observed in SPD (smooth pursuit eye movements, evoked potentials, modification of the electrodermic response) seem reinforcing the relationship between SPD and schizophrenia while those observed in BPD seem reinforcing either a relationship between BPD and depression (sleep studies), or a relationship between BPD and schizophrenia (evoked potentials, smooth pursuit eye movements)."

Biologic markers in borderline personality disorder: a review.

J Clin Psychiatry 1989 Jun;50(6):217-25
Lahmeyer HW, Reynolds CF 3rd, Kupfer DJ, King R.
Department of Psychiatry, University of Illinois, Chicago 60680.

The use of biologic markers in the evaluation of borderline personality disorder (BPD) patients is reviewed. Many patients with Axis II BPD have coexisting Axis I diagnoses of which depression is the most commonly reported. Biologic markers have not aided in the diagnosis of BPD, but some markers, particularly EEG sleep, are not only abnormal in BPD, but also appear to discriminate Axis I depression from other Axis I codiagnoses. Monoamine oxidase, in vitro red blood cell lithium ratio, and P300 auditory evoked potential when used alone or in a combined diagnostic approach, show promise in identifying these codiagnoses as well. Dexamethasone suppression and thyrotropin-releasing hormone tests appear nonspecific in this population. Pharmacologic trials have demonstrated that some BPD patients have good therapeutic response to antipsychotics and tranylcypromine and poor response to alprazolam.

Etiology

Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma.
J Am Acad Child Adolesc Psychiatry 2001 Jan;40(1):100-5
Zelkowitz P, Paris J, Guzder J, Feldman R.
Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, 4333 Cote Ste. Catherine Road, Montreal, Quebec, Canada H3T 1E4.

Results:
"Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children."

A family study of outpatients with borderline personality disorder and no history of mood disorder

J Personal Disord 2000 Fall;14(3):208-17 Riso LP, Klein DN, Anderson RL, Ouimette PC.
Department of Psychology, Georgia State University, Atlanta 30303, USA

Relatives of borderline outpatients were studied for mood disorders and for personality disorders. There were increased rates of mood disorders and personality disorders in the relatives of borderlines compared with never psychiatrically ill patients. "Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders."

Pathways to the development of borderline personality disorder.

J Personal Disord 1997 Spring;11(1):93-104 
Zanarini MC, Frankenburg FR.
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts 02178, USA.

"The available empirical evidence concerning the etiology of borderline personality disorder is reviewed. A tripartite model of the development of BPD is then presented. This model has three elements: a traumatic childhood (broadly defined), a vulnerable (hyperbolic) temperament, and a triggering event or series of events. The authors conclude that each borderline patient has a unique pathway to the development of BPD that is a painful variation on an unfortunate but familiar theme."

Pharmacological Treatment

Depakote

J Clin Psychiatry 2001 Mar;62(3):199-203
Hollander E, Allen A, Lopez RP, Bienstock CA, Grossman R, Siever LJ, Merkatz L, Stein DJ.
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.

Depakote was compared to placebo in 16 borderline patients. 12 were given Depakote and 4 were given a placebo. "Treatment with divalproex sodium may be more effective than placebo for global symptomatology, level of functioning, aggression, and depression."

Eur Neuropsychopharmacol 1994 Dec;4(4):479-86
de la Fuente JM, Lotstra F.
Department of Psychiatry, Erasme Hospital, Free University of Brussels (ULB), Belgium.

"Borderline personality disorder does not have a first choice pharmacological treatment. We studied 20 borderline inpatients in a double-blind parallel placebo-controlled trial with carbamazepine for a mean of 30.9 days. No significant positive effects of the drug were found."

Treatment with Psychotropic Medication

Tidsskr Nor Laegeforen 2000 Aug 10;120(18):2135-41
Nissen T. Psykiatrisk senter for Tromso og Karlsoy Regionsykehuset i Tromso.  (Article in Norwegian)

"Neuroleptics have a modest, but broad therapeutic effect on symptoms in all domains. Doses are lower than those used for treating schizophrenia. Antidepressants have a more inconsistent effect. Tricyclics have been the least successful, whereas irreversible MAO inhibitors and selective serotonin reuptake inhibitors (SSRIs) have been effective in treating mood symptoms and impulsivity. Lithium has a possible effect in diminishing anger and suicidal symptoms.

As there is no "drug of choice" for the treatment of borderline personality disorder, a more rational clinical approach might be to treat different symptom clusters (cognitive/schizotypal, affective, impulsive) rather than the disorder itself."

Zyprexa

Biol Psychiatry 1999 Nov 15;46(10):1429-35
Schulz SC, Camlin KL, Berry SA, Jesberger JA.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA.

Open-label pilot study where borderlines treated with Zyprexa "showed statistically significant reduction in self-rated and clinician-rated scales. Symptoms associated with BPD and dysthymia were among those to be substantially reduced. Further studies to explore olanzapine's efficacy versus placebo, as well as comparison to other potential treatments for BPD, are important next steps."

Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial.

J Clin Psychiatry 1999 Sep;60(9):598-603
Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Bohme R, Schmahl CG.
Department of Psychiatry, University of Freiburg, Freiburg im Breisgau, Germany.

BPD and PTSD consumers many times experience dissociative symptoms, including flashbacks. Female BPD patients were treated with naltrexone, an opiate antagonist; 25 to 100 mg three times a day., for at least 2 weeks. The "scores reflected a highly significant reduction of the duration and the intensity of dissociative phenomena and tonic immobility as well as a marked reduction in analgesia during treatment with naltrexone. Six of 9 patients reported a decrease in the mean number of flashbacks per day.

CONCLUSION: These observations support the hypothesis that an increased activity of the opioid system contributes to dissociative symptoms, including flashbacks, in borderline personality disorder and suggest that these symptoms may respond to treatment with opiate antagonists."

Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.

Am J Psychiatry 1999 Oct;156(10):1563-9
Bateman A, Fonagy P.
Halliwick Day Unit, St. Ann's Hospital.

"Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment."

Psychiatry Res 1998 Feb 9;77(2):131-8
De la Fuente JM, Tugendhaft P, Mavroudakis N.
Psychiatry Department, Erasme Hospital, Free University of Brussels, Belgium.

"Epilepsy and non-localized brain dysfunction have been invoked, among others, as underlying factors in borderline personality disorder. We have recorded 58 electroencephalograms in 20 borderline patients, first after complete drug washout and then under carbamazepine or placebo double-blind treatment. Taking into account only definite abnormal tracings, we found a 40% incidence of abnormal diffuse slow activity. No patient disclosed focal or epileptiform EEG features. Carbamazepine did not appear to modify the electroencephalogram."

Genetics

Genetics of patients with borderline personality disorder.

Psychiatr Clin North Am 2000 Mar;23(1):1-9
Torgersen S.
Center for Research in Clinical Psychology, University of Oslo, Norway.

"An overview of the existing literature suggests that traits similar to BPD are influenced by genes. It is too early to say to what extent BPD is also influenced by genes, but because personality traits generally show a strong genetic influence, this should also be true for BPD. Nonetheless, if the equal-environment assumption were to be violated for MZ and DZ pairs, twin studies may be overestimating genetic effects and hiding the effect of common family environment. The less than-ideal reliability of measurements used in this research may also reduce the effects of genes and common environment while increasing the effects of unique or nonshared environment. The effect of genes on the development of BPD is likely substantial. The effect of common family environment may be close to zero. More studies, large and small, are needed to reach firmer conclusions about the influence of genetics on BPD."

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study.

Can J Psychiatry 1996 Jun;41(5):285-90
Weiss M, Zelkowitz P, Feldman RB, Vogel J, Heyman M, Paris J.
Division of Child Psychiatry, University of British Columbia, Vancouver.

Are children of mothers with the BPD at higher risk for psychopathology? 21 children of BPDs were studied with 23 children of non borderline mothers. Diagnoses were obtained and global assessments were taken using tests. "Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed.

RESULTS: The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma. CONCLUSION: The offspring of borderline mothers are at high risk for psychopathology."

Stay tuned....More will be coming.

Last Updated:  12/13/02