Understanding borderline personality disorder: Clinical features, neurobiological insights, and therapeutic strategies

Abstract

Borderline personality disorder (BPD) is a complex personality disorder characterised by immense emotional dysregulation, impulsivity, aggression and substantial interpersonal difficulties. This review begins with examining DSM-5-TR diagnostic clusters for BPD, highlighting the importance of accurate classification. It provides an in-depth analysis of BPD, starting with its epidemiology, diagnostic subtypes, core symptoms, and the challenges these symptoms pose for patients and their support networks. The review explores common co-occurring conditions, such as mood disorders, anxiety disorders, and other personality disorders, which frequently compound the effects of BPD and complicate its management. A detailed examination of BPD's neurobiological underpinnings is presented, focusing on structural and functional alterations in brain, aberrant connectivity, and neurotransmitter dysregulation, particularly within serotonin, dopamine, and glutamate pathways, being vital to understanding the effects of this disorder on impulsivity and emotional instability. Therapeutic strategies for BPD are also reviewed, encompassing psychotherapeutic methods like Dialectical Behavior Therapy (DBT) and other validated therapies, alongside pharmacological treatments that target mood stabilisation, impulsivity, and affective control through antidepressants, antipsychotics, and mood stabilisers. Neuromodulation techniques, such as neurofeedback and transcranial magnetic stimulation (TMS), are discussed for their potential to enhance cognitive and emotional control in BPD. The review closes with future directions, emphasizing the value of integrated, personalised treatment approaches to optimise outcomes for individuals with BPD and reduce the broader social and emotional impact of the disorder.

Neurotransmitters

• Serotonin (5-HT)

Stimuli

• Borderline Personality Disorder

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