Table 1

Summary of papers relating to anatomic brain changes

Brambilla et al4MRI: hippocampus, amygdala, dorsolateral prefrontal cortex, temporal lobes, basal ganglia10 participants (6 F) with various comorbidities, drug-free 2 moExamine hippocampal and amygdala volume reduction in BPD associated with childhood abuse; investigate areas important in the regulation of emotion and impulsivityDecreased hippocampus volumes in BPD patients, especially those with childhood abuse; enlarged putamen volumes in BPD especially with comorbid substance use disordersSmall sample size
Driessen et al5MRI: hippocampus, amygdala, temporal lobes, prosencephalon21 F with BPD, 21–40 yr, previously without comorbid psychiatric disordersVolumes of studied brain structures will be smaller than in control subjectsSignificantly 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 historyDid not assess for past depression; did not control for history of psychotropic drug use
Hazlett et al6MRI: measure grey and white matter in BAs within the cingulate50 patients (18–52 yr, mean 33) with various comorbidities, assessed with DSM-III criteria; 13 had SPD, 37 did notExamine 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 withoutReduced 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 subjectsDSM-III diagnoses
Irle et al7MRI: parietal cortex, hippocampus30 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 disorderExamine anatomical changes in BPD via MRIReduced 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 symptomsHigh 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 al8MRI: frontal lobes, temporal lobes, lateral ventricles, cerebral hemispheres25 subjects from inpatient and outpatient wards, with no other current axis 1 or 2 illnessesVolumes of the frontal and temporal lobes of the brain may change in BPD subjectsReduced frontal lobe volume (6.2%); no other significant differencesParticipants 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 al9Voxel-based morphometric study20 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 schoolingVolume reduction and possibly loss of cortical grey matter density in hippocampus, amygdala, left orbitofrontal and right anterior cingulate cortexVolume reduction in basolateral amygdale; no differences in regional cortical grey or white matter density or volumeExcluded 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 al10MRI: amygdala and hippocampus10 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 disorderSmaller hippocampal and amygdala volumes in BPD patientsSupported hypothesisSmall sample, history of psychotropic medication and/or drug use in most patients
Tebartz van Elst et al11MRI: hippocampus, amygdala, and orbitofrontal, dorsolateral prefrontal, and anterior cingulate cortexEight 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 depressionSmaller amygdala and hippocampus in BPD patients, differences in prefrontal lobeNo 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 volumeDid 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.