Ellappan Surendar, Subba Rhea, Mondal Amal Chandra
Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, 110067 New Delhi, India.
Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, 110067 New Delhi, India.
Prog Neuropsychopharmacol Biol Psychiatry. 2025 May 20;139:111403. doi: 10.1016/j.pnpbp.2025.111403.
Borderline personality disorder (BPD) is a complex personality disorder characterised by immense emotional dysregulation, impulsivity, aggression and substantial interpersonal difficulties. This review begins with examining DSM-5-TR diagnostic clusters for BPD, highlighting the importance of accurate classification. It provides an in-depth analysis of BPD, starting with its epidemiology, diagnostic subtypes, core symptoms, and the challenges these symptoms pose for patients and their support networks. The review explores common co-occurring conditions, such as mood disorders, anxiety disorders, and other personality disorders, which frequently compound the effects of BPD and complicate its management. A detailed examination of BPD's neurobiological underpinnings is presented, focusing on structural and functional alterations in brain, aberrant connectivity, and neurotransmitter dysregulation, particularly within serotonin, dopamine, and glutamate pathways, being vital to understanding the effects of this disorder on impulsivity and emotional instability. Therapeutic strategies for BPD are also reviewed, encompassing psychotherapeutic methods like Dialectical Behavior Therapy (DBT) and other validated therapies, alongside pharmacological treatments that target mood stabilisation, impulsivity, and affective control through antidepressants, antipsychotics, and mood stabilisers. Neuromodulation techniques, such as neurofeedback and transcranial magnetic stimulation (TMS), are discussed for their potential to enhance cognitive and emotional control in BPD. The review closes with future directions, emphasizing the value of integrated, personalised treatment approaches to optimise outcomes for individuals with BPD and reduce the broader social and emotional impact of the disorder.
边缘型人格障碍（BPD）是一种复杂的人格障碍，其特征为严重的情绪失调、冲动、攻击性以及显著的人际关系困难。本综述首先考察了BPD的《精神疾病诊断与统计手册》第五版修订版（DSM-5-TR）诊断类别，强调了准确分类的重要性。它对BPD进行了深入分析，从其流行病学、诊断亚型、核心症状，以及这些症状给患者及其支持网络带来的挑战入手。该综述探讨了常见的共病情况，如情绪障碍、焦虑障碍和其他人格障碍，这些情况常常使BPD的影响更为复杂，并使其管理变得困难。文中详细介绍了BPD的神经生物学基础，重点关注大脑的结构和功能改变、异常连接以及神经递质失调，特别是血清素、多巴胺和谷氨酸途径中的失调，这对于理解该障碍对冲动和情绪不稳定的影响至关重要。还综述了BPD的治疗策略，包括辩证行为疗法（DBT）等心理治疗方法和其他经过验证的疗法，以及通过抗抑郁药、抗精神病药和心境稳定剂来针对情绪稳定、冲动控制和情感调节的药物治疗。文中讨论了神经调节技术，如神经反馈和经颅磁刺激（TMS），因其在增强BPD患者认知和情绪控制方面的潜力。综述最后展望了未来方向，强调了综合、个性化治疗方法对于优化BPD患者治疗效果以及减少该障碍更广泛的社会和情感影响的价值。
