Pardossi Simone, Cuomo Alessandro, Koukouna Despoina, Pinzi Mario, Firenzuoli Bernardo, Fagiolini Andrea
Department of Molecular Medicine, School of Medicine, University of Siena, 53100 Siena, Italy.
Life (Basel). 2025 Feb 27;15(3):380. doi: 10.3390/life15030380.
Impulsivity is increasingly recognized as a transdiagnostic feature that spans multiple psychiatric disorders, including borderline personality disorder (BPD), bipolar disorder, and substance use disorders. In BPD, impulsive behaviors manifest as substance misuse, risky sexual activity, self-injury, and other maladaptive patterns. This review article updates the clinical and preclinical literature to explore the biological and psychological bases of impulsivity in BPD and considers whether methylphenidate (MPH) can be used as a treatment in this context. Although no medication is specifically approved for BPD, limited evidence from patients with comorbid BPD and attention-deficit/hyperactivity disorder (ADHD) indicates that MPH may reduce impulsivity and improve key symptoms. In addition, real-world data indicate that MPH may be associated with better outcomes and a lower risk of suicidal behaviors in patients with BPD. Nevertheless, such evidence remains scant, particularly among those with a primary diagnosis of BPD without a diagnosis of ADHD. Larger, methodologically rigorous studies are needed to clarify the efficacy and safety of MPH in targeting impulsivity within this population. An improved understanding of dopaminergic mechanisms may eventually shed light on MPH's therapeutic role in BPD, although current data remain preliminary. Overall, recognizing impulsivity as a core symptom rather than focusing exclusively on diagnostic boundaries may facilitate more tailored and effective interventions for BPD.
冲动性日益被视为一种跨诊断特征，它跨越多种精神疾病，包括边缘型人格障碍（BPD）、双相情感障碍和物质使用障碍。在边缘型人格障碍中，冲动行为表现为物质滥用、危险性性行为、自我伤害及其他适应不良模式。这篇综述文章更新了临床和临床前文献，以探讨边缘型人格障碍中冲动性的生物学和心理学基础，并考虑在这种情况下哌醋甲酯（MPH）是否可用作一种治疗方法。尽管尚无药物被专门批准用于治疗边缘型人格障碍，但来自边缘型人格障碍合并注意力缺陷多动障碍（ADHD）患者的有限证据表明，哌醋甲酯可能会降低冲动性并改善关键症状。此外，现实世界的数据表明，哌醋甲酯可能与边缘型人格障碍患者更好的治疗结果及更低的自杀行为风险相关。然而，此类证据仍然很少，尤其是在那些主要诊断为边缘型人格障碍而无注意力缺陷多动障碍诊断的患者中。需要开展更大规模、方法严谨的研究，以阐明哌醋甲酯针对该人群冲动性的疗效和安全性。尽管目前的数据仍然是初步的，但对多巴胺能机制的深入理解最终可能会揭示哌醋甲酯在边缘型人格障碍中的治疗作用。总体而言，将冲动性视为核心症状而非仅仅关注诊断界限，可能有助于为边缘型人格障碍制定更具针对性和有效的干预措施。
