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Emotion dysregulation in borderline personality disorder: A problem of too much drive and too little control?

Answers from a new study in Biological Psychiatry


Philadelphia, PA, January 13, 2016 - Borderline personality disorder (BPD) is a diagnostic label applied to people who have problems regulating emotional mood swings. This emotional instability leaves such individuals vulnerable to emotional upheaval that puts them at risk for problem behaviors, including self-destructive acts and impulsive aggression.

A new study in Biological Psychiatry provides a quantitative summary of the brain abnormalities that may be underlying the emotional upheaval patients with BPD experience daily.

Dr. Lars Schulze at Freie Universität Berlin and his colleagues at Heidelberg University focused on emotional processing in this meta-analysis to investigate the related functional and structural abnormalities in patients with borderline personality disorder.

They pooled functional data from 19 published studies, providing a total of 281 patients with BPD and 293 healthy control subjects. Structural data was available for 10 studies, with a total of 263 patients with BPD and 278 healthy subjects.

Their analyses revealed that during the processing of negative emotions, BPD patients show enhanced activations of the left amygdala along with blunted responses of the dorsolateral prefrontal cortex compared to healthy controls. These brain regions were also found to overlap with abnormalities in gray matter volume.

"Our results highlight brain abnormalities in the amygdala and the dorsolateral prefrontal cortex," said Schulze. "The amygdala is known to process emotional arousal and is hyperactive in BPD. The dorsolateral prefrontal cortex, which has a key role in the regulation of emotions, is less active during the processing of negative emotional stimuli in BPD."

"In order to understand these findings, it might be useful to imagine that the brain was a like a car," explains Dr. John Krystal, Editor of Biological Psychiatry. "The gas pedal for emotion might be the amygdala and the emotional brake might be the dorsolateral prefrontal cortex. The current findings seem to suggest that, in borderline personality disorder, the brain steps on the gas yet does not as effectively brake emotion."

Together, these findings support the concept of borderline personality disorder as a disorder of emotion dysregulation. Treatment options that can help fine-tune the brain's 'motor' may help alleviate some of the distressing clinical symptoms that individuals with BPD experience and grapple with on a daily basis.

Schulze added, "It is my hope that these findings will give an impetus to future neuroimaging studies evaluating different treatment options in BPD, such as psycho- or pharmacotherapy."


The article is "Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis" by Lars Schulze, Christian Schmahl, and Inga Niedtfeld (doi: Lars Schulze, Christian Schmahl, Inga Niedtfeld). The article appears in Biological Psychiatry, Volume 79, Issue 2 (January 15, 2016), published by Elsevier.

Notes for editors

Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at +1 214 648 0880 or Journalists wishing to interview the authors may contact Dr. Lars Schulze at +49 30 838 56446 or

The authors' affiliations, and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry

Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 6th out of 140 Psychiatry titles and 10th out of 252 Neurosciences titles in the Journal Citations Reports® published by Thomson Reuters. The 2014 Impact Factor score for Biological Psychiatry is 10.255.

About Elsevier

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