Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a severely impairing mental disorder, characterized by affective instability, stormy interpersonal relationships, and behavioral impulsivity. Accumulating research in the past two decades has provided evidence for a neurobiological basis of mental disorders, including BPD. It has long been argued, though, that the level of clinical heterogeneity within the BPD diagnosis may be suggestive of multiple underlying neural processes and circuits. As such, the relative involvement of different sets of neural abnormalities across individuals could be informative about the possible pathophysiological mechanisms underlying different dimensions of the disorder. Task-based neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), are potentially capable of teasing apart neurobiological domains of BPD by identifying the differential neural involvement of key circuits during psychological processes in relation to specific aspects of BPD symptomatology. In this paper, we review the literature on task-based fMRI in BPD with a focus on how neuroimaging studies, have revealed different neural correlates for the prominent symptom clusters (unstable interpersonal relationships, behavioral impulsivity, and emotion dysregulation) within BPD. Evidence suggests the prominence of altered neural activity in key brain networks and regions including the salience network, the default mode/theory of mind network, the central executive network, and the orbitofrontal cortex. We suggest future directions for neuroimaging and BPD research to further shed light on the pathophysiology of the disorder and the nature of the BPD diagnosis.