Brendel Gary R, Stern Emily, Silbersweig David A
Weill Medical College of Cornell University, USA.
Dev Psychopathol. 2005 Fall;17(4):1197-206. doi: 10.1017/s095457940505056x.
Functional neuroimaging recently has been used to localize brain dysfunction in borderline personality disorder (BPD). Initial studies have examined baseline activity or emotional reactivity, and our group has investigated what we consider to be a crucial interaction between negative emotion and behavioral (dys)control. This research is beginning to identify abnormal frontolimbic circuitry likely underlying core clinical features of this condition. We review the evidence for dysfunction in specific frontolimbic regions, leading to a mechanistic model of symptom formation in BPD. In addition, we offer an integration of these neuroimaging findings with developmental perspectives on the emergence of borderline psychopathology, focusing on the ways in which early psychosocial experience may interact with developing brain systems. We also consider possible mechanisms of psychotherapeutic change at the neural systems level in BPD. Finally, we propose that future neuroimaging studies of BPD should integrate multiple levels of observation (structural, functional, neurochemical, genetic, and clinical) in a model-driven fashion to further understand the dynamic relationship between biological and psychological factors in the development and treatment of this difficult condition.
功能性神经成像技术近来已被用于确定边缘型人格障碍（BPD）患者的脑功能障碍部位。最初的研究检测了基线活动或情绪反应，而我们的团队则研究了我们认为负面情绪与行为（失调）控制之间的关键相互作用。这项研究开始识别出可能是该疾病核心临床特征基础的异常额边缘回路。我们回顾了特定额边缘区域功能障碍的证据，从而得出了BPD症状形成的机制模型。此外，我们将这些神经成像研究结果与边缘型精神病理学出现的发展观点相结合，重点关注早期心理社会经历与发育中的脑系统相互作用的方式。我们还考虑了BPD在神经系统层面心理治疗改变的可能机制。最后，我们提出，未来对BPD的神经成像研究应以模型驱动的方式整合多个观察层面（结构、功能、神经化学、基因和临床），以进一步理解在这种复杂疾病的发展和治疗中生物因素与心理因素之间的动态关系。
