The neurodevelopmental trajectory of Borderline Personality Disorder: a review

Borderline Personality Disorder (BPD) is a complex psychological condition characterised by affective instability, cognitive impairment, problematic behaviours and social dysfunction. Due to the variability in symptomatic profiles, efforts have recently been directed towards comprehending the disorder from a neurological standpoint within the aforementioned domains. Although adolescent-onset BPD is now reliably diagnosed as the adult-onset variant, a limited number of studies address the neural correlates of first presentation BPD. Moreover, research investigating the outcomes of therapeutic interventions on brain function and morphology is scarce. Preliminary findings consistently cite the involvement of grey matter deficiencies of the orbitofrontal cortex, hippocampus and amygdala in the neuropathology of BPD. Additionally, frontolimbic white matter deficits are thought to be implicated. Functionally, over-activity in limbic regions such as the cingulate cortices and amygdala are believed to partially account for emotion dysregulation, though the neural correlates of cognitive, social and behavioural impairments are relatively poorly understood. The present review will endeavour to evaluate the existing neurobiological evidence for BPD in adolescence as well as adulthood. Finally, a rudimentary neurodevelopmental model of BPD will be proposed.