Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

World Psychiatry, Год журнала: 2024, Номер 23(1), С. 4 - 25

Опубликована: Янв. 12, 2024

Borderline personality disorder (BPD) was introduced in the DSM‐III 1980. From to DSM‐5, no major changes have occurred its defining criteria. The is characterized by instability of self‐image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings emptiness, strong abandonment fears, suicidal or self‐mutilation behavior, transient stress‐related paranoid ideation severe dissociative symptoms. There evidence that BPD can be reliably diagnosed differentiated from other mental disorders semi‐structured interviews. associated with considerable functional impairment, intensive treatment utilization, high societal costs. risk suicide high. In general adult population, lifetime prevalence has been reported 0.7 2.7%, while about 12% outpatient 22% inpatient psychiatric services. significantly disorders, including depressive substance use post‐traumatic stress disorder, attention‐deficit/hyperactivity bipolar bulimia nervosa, disorders. convincing suggest interaction between genetic factors adverse childhood experiences plays a central role etiology BPD. spite research, neurobiological underpinnings remain clarified. Psychotherapy choice for Various approaches empirically supported randomized controlled trials, dialectical behavior therapy, mentalization‐based transference‐focused schema therapy. No approach proved superior others. Compared as usual, psychotherapy more efficacious, effect sizes 0.50 0.65 regard core symptom severity. However, almost half patients do not respond sufficiently psychotherapy, further research this area warranted. It clear whether some may benefit one psychotherapeutic than available consistently showing any psychoactive medication efficacious features For discrete comorbid anxiety psychotic‐like features, pharmacotherapy useful. Early diagnosis reduce individual suffering high‐quality studies are required, both adolescents adults. This review provides comprehensive update clinical characterization, factors, neurobiology, cognition, management. also discusses current controversies concerning highlights areas which needed.

Язык: Английский

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The nature and neurobiology of fear and anxiety: State of the science and opportunities for accelerating discovery

Neuroscience & Biobehavioral Reviews, Год журнала: 2023, Номер 151, С. 105237 - 105237

Опубликована: Май 18, 2023

Язык: Английский

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Laboratory models of post-traumatic stress disorder: The elusive bridge to translation

Neuron, Год журнала: 2022, Номер 110(11), С. 1754 - 1776

Опубликована: Март 23, 2022

Язык: Английский

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Temporally and anatomically specific contributions of the human amygdala to threat and safety learning

Proceedings of the National Academy of Sciences, Год журнала: 2022, Номер 119(26)

Опубликована: Июнь 21, 2022

Neural plasticity in subareas of the rodent amygdala is widely known to be essential for Pavlovian threat conditioning and safety learning. However, less consistent results have been observed human neuroimaging studies. Here, we identify test three important factors that may contribute these discrepancies: temporal profile response conditioning, anatomical specificity responses during learning, insufficient power responses. We combined data across multiple studies using a well-validated paradigm examine involvement In 601 humans, show two subregions tracked conditioned stimulus with aversive shock early while only one demonstrated delayed responding not paired shock. Our findings cross-species similarities temporal- anatomical-specific contributions affirm associative learning highlight future research humans.

Язык: Английский

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Sensing fear: fast and precise threat evaluation in human sensory cortex

Trends in Cognitive Sciences, Год журнала: 2023, Номер 27(4), С. 341 - 352

Опубликована: Фев. 1, 2023

Язык: Английский

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Distributed neural representations of conditioned threat in the human brain

Nature Communications, Год журнала: 2024, Номер 15(1)

Опубликована: Март 12, 2024

Abstract Detecting and responding to threat engages several neural nodes including the amygdala, hippocampus, insular cortex, medial prefrontal cortices. Recent propositions call for integration of more distributed that process sensory cognitive facets related threat. Integrative, sensitive, reproducible decoders detection response safety have yet be established. We combine functional MRI data across varying conditioning negative affect paradigms from 1465 participants with multivariate pattern analysis investigate representations safety. The trained sensitively specifically distinguish between cues multiple datasets. further show many dynamically shift Our results establish integrate circuits, merging well-characterized ‘threat circuit’ nodes, discriminating regardless experimental designs or acquisition parameters.

Язык: Английский

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Threat and Reward Imminence Processing in the Human Brain

Journal of Neuroscience, Год журнала: 2023, Номер 43(16), С. 2973 - 2987

Опубликована: Март 16, 2023

In the human brain, aversive and appetitive processing have been studied with controlled stimuli in rather static settings. addition, extent to which aversive-related appetitive-related engage distinct or overlapping circuits remains poorly understood. Here, we sought investigate dynamics of while male female participants engaged comparable trials involving threat avoidance reward seeking. A central goal was characterize temporal evolution responses during periods imminence. For example, domain, predicted that bed nucleus stria terminalis (BST), but not amygdala, would exhibit anticipatory given role former anxious apprehension. We also periaqueductal gray (PAG) threat-proximity based on its involvement proximal-threat processes, ventral striatum threat-imminence escape rodents. Overall, uncovered imminence-related temporally increasing ("ramping") multiple brain regions, including BST, PAG, striatum, subcortically, dorsal anterior insula midcingulate, cortically. Whereas generated proximity as expected, it exhibited threat-related imminence responses. fact, across observed a main effect arousal. other words, extensive evolving, both suggesting distributed are dynamically biologically relevant information regardless valence, findings further supported by network analysis.

Язык: Английский

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How reliable are amygdala findings in psychopathy? A systematic review of MRI studies

Neuroscience & Biobehavioral Reviews, Год журнала: 2022, Номер 142, С. 104875 - 104875

Опубликована: Сен. 15, 2022

Язык: Английский

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The cortical and subcortical correlates of face pareidolia in the macaque brain

Social Cognitive and Affective Neuroscience, Год журнала: 2022, Номер 17(11), С. 965 - 976

Опубликована: Апрель 20, 2022

Face detection is a foundational social skill for primates. This vital function thought to be supported by specialized neural mechanisms; however, although several face-selective regions have been identified in both humans and nonhuman primates, there no consensus about which region(s) are involved face detection. Here, we used naturally occurring errors of (i.e. objects with illusory facial features referred as examples 'face pareidolia') identify the macaque brain implicated Using whole-brain functional magnetic resonance imaging test awake rhesus macaques, discovered that subset patches inferior temporal cortex, on lower lateral edge superior sulcus, amygdala respond more than matched non-face objects. Multivariate analyses data revealed differences representation faces across functionally defined interest. These suggest cortical subcortical contribute uniquely features. We conclude multiplexed system primate brain.

Язык: Английский

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Dynamic threat–reward neural processing under semi‐naturalistic ecologically relevant scenarios

Human Brain Mapping, Год журнала: 2024, Номер 45(4)

Опубликована: Март 1, 2024

Abstract Studies of affective neuroscience have typically employed highly controlled, static experimental paradigms to investigate the neural underpinnings threat and reward processing in brain. Yet our knowledge more naturalistic settings remains limited. Specifically, studies generally examine features separately under brief time periods, despite fact that nature organisms are often exposed simultaneous presence for extended periods. To study mechanisms distinct temporal profiles, we created a modified version PACMAN game included these environmental features. We also conducted two automated meta‐analyses compare findings from semi‐naturalistic paradigm those constrained experiments. Overall, results revealed distributed system regions sensitive imminence less related imminence, both which exhibited overlap yet neither involved amygdala. Additionally, systems broadly overlapped with corresponding meta‐analyses, notable absence amygdala findings. Together, suggest shared salience reveals heightened sensitivity toward threats compared rewards when simultaneously present an environment. The broad correspondence consisting tightly controlled paradigms, illustrates how can corroborate previous literature while potentially uncovering novel resulting nuances contexts manifest such dynamic environments.

Язык: Английский

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