Summary of papers relating to anatomic brain changes
| Study | Design | Subjects | Objective/hypothesis | Results | Limitations |
|---|---|---|---|---|---|
| Brambilla et al4 | MRI: hippocampus, amygdala, dorsolateral prefrontal cortex, temporal lobes, basal ganglia | 10 participants (6 F) with various comorbidities, drug-free 2 mo | Examine hippocampal and amygdala volume reduction in BPD associated with childhood abuse; investigate areas important in the regulation of emotion and impulsivity | Decreased hippocampus volumes in BPD patients, especially those with childhood abuse; enlarged putamen volumes in BPD especially with comorbid substance use disorders | Small sample size |
| Driessen et al5 | MRI: hippocampus, amygdala, temporal lobes, prosencephalon | 21 F with BPD, 21–40 yr, previously without comorbid psychiatric disorders | Volumes of studied brain structures will be smaller than in control subjects | Significantly reduced volumes of both brain structures (left hemisphere hippocampus reduced 15.7%, right hemisphere hippocampus reduced 15.8%, left hemisphere amygdala reduced 7.9%, right hemisphere amygdala reduced 7.5%); mean hippocampal volume negatively correlated with duration of abuse in history | Did not assess for past depression; did not control for history of psychotropic drug use |
| Hazlett et al6 | MRI: measure grey and white matter in BAs within the cingulate | 50 patients (18–52 yr, mean 33) with various comorbidities, assessed with DSM-III criteria; 13 had SPD, 37 did not | Examine grey and white matter volume within BAs of the cingulate gyrus and frontal lobe, examine comorbidity by subgrouping into BPD patients with SPD and those without | Reduced cingulate grey and increased white matter volume in BA 24 and 31; BPD without SPD group showed this abnormality in BA 24 but 31 was spared; BPD with SPD group had reduced grey matter volume in both; grey matter loss in BA 31 was greater in the BPD with SPD subjects than BPD only subjects | DSM-III diagnoses |
| Irle et al7 | MRI: parietal cortex, hippocampus | 30 F inpatients; excluded for history of neurological disease, electroencephalograph abnormalities indicative of temporal lobe epilepsy, hyperintense MRI signals, psychotic disorders; patients tested were also diagnosed with PTSD, panic disorder, generalized anxiety disorder, OCD, major depression, somatization disorder, anorexia, depersonalization disorder, dissociative amnesia, dissociative identity disorder | Examine anatomical changes in BPD via MRI | Reduced size of the right parietal cortex, stronger parietal leftward asymmetry; reduced leftward asymmetry associated with stronger psychotic symptoms and more schizoid personality traits; smaller hippocampal volumes associated with stronger clinical symptoms | High prevalence of axis 1 disorders in the participants might have added confounds but made the sample more representative of BPD; only F tested |
| Lyoo et al8 | MRI: frontal lobes, temporal lobes, lateral ventricles, cerebral hemispheres | 25 subjects from inpatient and outpatient wards, with no other current axis 1 or 2 illnesses | Volumes of the frontal and temporal lobes of the brain may change in BPD subjects | Reduced frontal lobe volume (6.2%); no other significant differences | Participants were excluded if they demonstrated a history of axis I or axis II mental disorders other than BPD; head tilt during scanning not corrected for; differences in grey and white matter not analyzed |
| Rusch et al9 | Voxel-based morphometric study | 20 BPD patients (F, mean age 29.3 yr) with various comorbidities; excluded for history of loss of consciousness and coma, schizophrenia, bipolar disorder, alcohol/drug abuse, current major depression, current anorexia; participants psychotropic-free for 2 wk and had completed schooling | Volume reduction and possibly loss of cortical grey matter density in hippocampus, amygdala, left orbitofrontal and right anterior cingulate cortex | Volume reduction in basolateral amygdale; no differences in regional cortical grey or white matter density or volume | Excluded current depression and anorexia; VBM limits: eliminates rater bias and error but its ability to detect subtle differences not yet been proven sufficiently |
| Schmahl et al10 | MRI: amygdala and hippocampus | 10 F with BPD and history of sexual or childhood abuse; exclusion for organic mental disorder, history of head trauma, current alcohol abuse, history of psychotic disorder | Smaller hippocampal and amygdala volumes in BPD patients | Supported hypothesis | Small sample, history of psychotropic medication and/or drug use in most patients |
| Tebartz van Elst et al11 | MRI: hippocampus, amygdala, and orbitofrontal, dorsolateral prefrontal, and anterior cingulate cortex | Eight F patients with BPD, aged 20–40 yr, finished regular schooling, no psychotropic drugs for 2 wk; exclusion criteria: lifetime diagnosis of schizophrenia, bipolar I disorder, alcohol/drug abuse in past 6 mo, current anorexia, major depression | Smaller amygdala and hippocampus in BPD patients, differences in prefrontal lobe | No significant difference in total brain volume; 20%–21% reduction of hippocampal and 23%–25% reduction amygdala volumes; 24% reduction of the left OFC, 26% reduction of the right ACC; amygdala volumes of both sides correlated with left orbitofrontal volume; positive correlation between no. of self-injurious incidents and bilateral anterior cingulated volume | Did not separate grey from white matter. Cannot specify which of the different gyri contributed most to the reported volume loss; exclusion reduced generalizability |
F = female; BPD = borderline personality disorder; BA = Brodmanní s area; DSM-III = Diagnostic and Statistical Manual of Mental Disorders, third edition; SPD = schitzotypal personality disorder; PTSD = posttraumatic stress disorder; OCD = obsessive–compulsive disorder; VBM = voxel-based morphometry; OFC = orbitofrontal cortex; ACC = anterior cingulate cortex.