What impact can brain stimulation interventions have on borderline personality disorder?

ABSTRACT

Introduction

Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors.

Areas covered

In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation.

Expert opinion

According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.

KEYWORDS:

• Borderline personality disorder
• depressive symptoms
• emotion regulation
• impulsivity
• NIBS
• rTMS
• suicidality
• tDCS

Article highlights

• BPD is a difficult-to-treat mental disorder.

• NIBS interventions improve emotional and behavioral dysregulation in BPD individuals.

• Mixed results are available on neuropsychological impairments improvement by NIBS.

• NIBS interventions improve depressive symptoms in BPD individuals, but sparse results are available on suicidality.

• Heterogeneity of stimulation protocols and of assessment tools are important limitations of the available evidence regarding NIBS application in BPD individuals.

• Further studies have to consider the role of BPD comorbidities and the need to combine NIBS with specialized psychotherapies.

Declaration of interest

In the past three years, S Barlati has received advisory board/consultancy fees and support from clinical studies or trials, conferences, and congress presentations from Angelini, Lundbeck, and Otsuka. Meanwhile, in the past three years, A Vita has received advisory board/consultancy fees and support for clinical studies or trials, conferences, and congress presentations from Alkermes, Angelini, Boehringer Ingelheim, Janssen-Cilag, Lundbeck, Otsuka, Roche, and Rovi Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.