Individuals with BPD have an underlying vulnerability to emotional hyperarousal states due to abnormalities in neurobiological systems subserving emotion regulation and stress responsivity. They also have an underlying vulnerability to social/interpersonal stressors due to abnormalities in the neurobiological systems mediating social cognition, attachment, and social reward. When individuals with BPD encounter social/interpersonal stressors, they are unable to regulate their emotions and quickly return to their baseline emotional state.
(Source: Journal of Personality Disorders, February 22, 2018. Adapted from M. Goodman, personal communication.)

A workgroup of experts in borderline personality disorder in the Department of Psychiatry at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center has published a literature review and a direction for future research in BPD in the February 2018 issue of Journal of Personality Disorders. The Tusiani Family, which founded the Borderline Personality Disorder Resource Center at NewYork-Presbyterian in memory of their daughter and sibling, Pamela Ann Tusiani, supported the joint Columbia University-Cornell University Think Tank of experts whose insights led to this white paper on BPD.

“Our report suggests how to advance research in BPD by exploring the dimensions that underlie the disorder, in addition to studying the disorder as a unitary diagnostic entity,” says co-lead author Barbara H. Stanley, PhD, Professor of Medical Psychology in the Department of Psychiatry at Columbia University Irving Medical Center, and Research Scientist in Molecular Imaging and Neuropathology at the New York State Psychiatric Institute. “We propose that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.”

A biobehavioral researcher in BPD and suicidal behavior, Dr. Stanley notes that in the past research in BPD has been relatively underfunded within the mental health field as compared to depression or bipolar disorder, but it is critically needed. “Those of us who work with patients who have this disorder are well aware that the mortality and morbidity are very high,” she says. “This is a group of individuals who can go on to live good lives, but while the disorder is fulminating, it’s incredibly painful and debilitating.”

“Our workgroup sought to reframe how we view borderline personality disorder,” continues Dr. Stanley. “Traditionally the study of personality disorders had been based on psychoanalytic or behavior models of the diagnostic group, a very heterogeneous group of people. We proposed to break it down into crucial elements of the disorder, and then study the underlying neurobiology of these elements. We suggested looking at emotion dysregulation, interpersonal deficits, and impulsive aggression — three characteristics of BPD. Instead of studying how people with BPD differ from other people or other diagnoses, we suggest examining these characteristics alone or in combination across diagnoses. For example, what typifies emotion dysregulation across the diagnostic spectrum in the context of somebody who also has interpersonal dysregulation? Our work is designed to move forward research on BPD as a brain disease and to identify underlying treatment targets. The point of our paper was to suggest direction of future research.”