Mount Sinai researchers have identified  that networks in the brain that help regulate emotion do not activate in patients with borderline personality disorder.

Mount Sinai researchers have found that real-time brain imaging suggests that people with Borderline Personality Disorder (BPD) are physically unable to activate neurological networks that can help regulate emotion.

Using functional magnetic resonance imaging (MRI), Harold W. Koenigsberg, MD,Professor of Psychiatry at Mount Sinai School of Medicine, observed how the brains of people with BPD reacted to social and emotional stimuli.

He found that when people with BPD attempted to control and reduce their reactions to disturbing emotional scenes, the areas of the brain that are active in healthy people under the same conditions remained inactive in the BPD patients.

This research shows that BPD patients are not able to use those parts of the brain that healthy people use to help regulate their emotions, said Dr. Koenigsberg. “This may explain why their emotional reactions are so extreme. The biological underpinnings of the disordered emotional control systems are central to borderline pathology.

Studying which areas of the brain function differently in patients with borderline personality disorder can lead to more targeted uses of psychotherapy and medications, and also provide a link to connect the genetic basis of the disorder.”

Borderline Personality Disorder is a common condition, affecting up to two percent of all adults in the United States, mostly women. Characteristics of BPD include being so emotionally over-reactive that they suffer alternating bouts of depression, anxiety and anger, are interpersonally hypersensitive, and are impelled to self-destructive and even suicidal behavior. Patients with BPD often exhibit other types of impulsive behaviors, including excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. The disorder is found in 10 to 20 percent of people in psychiatric care, and about 10 percent of people with this condition ultimately die of suicide. Only recently have researchers begun to identify underlying biological factors associated with the condition.

Gene function and serotonin levels may also be contributing factors in BPD, according to research findings from Larry Siever, MD, Professor of Psychiatry and Director of the Special Evaluation Program for Mood and Personality Disorders at Mount Sinai School of Medicine. Dr. Siever’s research demonstrates how genes related to serotonin and neuropeptides in the brain may be altered in serious personality disorders such as BPD.

Dr. Siever’s neuroimaging research suggests that a gene that controls production of a critical enzyme for the synthesis of serotonin, a brain chemical that modulates emotions and aggression, may be altered leading to reduced synthesis of serotonin in people with BPD and may be associated with increased aggression. This variant of gene may also be associated with reduced frontal lobe activation in the brain.

Mount Sinai Medical Center, Press Release, September 3, 2009

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