Acquired and developmental brain dysfunction in borderline personality disorder.

This paper examines the evidence that brain dysfunction causes borderline personality disorder (BPD). The rules of causation set forth by Sir Bradford Hill will be considered, which include the strength of association, consistency of findings, specificity, temporal relationship, biological gradient, biological plausibility, experimental verification and analogous evidence. Brain dysfunction, in this context, is considered to involve both acquired and developmental neurological (or "organic") brain injuries, as well as the evidence provided by neurological and neuropsychological testing, neurobehavioral models of brain functioning and response to treatment. Biochemical and genetic evidence will not be reviewed, but will be considered in proposing models of brain dysfunction in BPD. It is hoped that this review will provide both the stimulus and possible directions for future research and be of relevance to the clinician assessing and treating patients with BPD.