Borderline Personality Disorder: Not for Life

The focus was on the so-called neural coupling: When two people interact with each other, certain brain regions show a similar activation pattern in both. This applies, for example, to the temporo-parietal transition between the temporal and parietal lobes, which is important for processing social information and for mentalizing. If one of the two participants suffered from an acute borderline personality disorder, the neural coupling was lower; so the brains worked less synchronously. This neural abnormality fits in with the considerable social problems that those affected and their relatives report. Interestingly, there was no coupling deficit in former borderline patients; they did not differ from healthy test subjects.

A team led by biometrician Nikolaus Kleindienst observed another interesting change in remitted patients in 2020. The researchers presented participants with drawings of the female body and asked them to use color to mark which regions of their own bodies they like and which they don’t. While acutely ill people showed a negative body image, those in whom the symptoms had regressed perceived their own body more positively overall.

Improved interoception

The findings of Laura Müller and her colleagues at Heidelberg University Hospital also fit in with this. Previous research had found a link between the ability to sense body signals such as the heartbeat and the ability to sense emotions. The Heidelberg psychologists recorded voltage fluctuations in the brain using electroencephalography. In the process, electrodes on the scalp measure the electrical brain activity, which can be graphically displayed as a regular curve pattern. It provides information about nerve cell activities in the brain. The researchers were looking for a very specific wave: It is an indicator of how well someone can perceive their own heartbeat. In fact, the rash was greater in those participants who were more able to regulate their emotions. There was a clear difference between borderline patients and healthy people. In patients whose symptoms had receded, the wave was stronger than in acutely ill persons, but less strong than in healthy participants. This supports the assumption that the body perception of remitted patients improves and is more and more similar to that of healthy people.

In such studies, which record the current situation at a certain point in time, the differences between remitted and acute patients could have existed before. So it would be conceivable that people whose symptoms have receded exhibited neuronal peculiarities from the start. In order to rule out such effects, longitudinal studies over several months and years will be required in the future.

The history of borderline personality disorder is shaped by a lot of suffering that those affected have experienced from the disease with its diverse symptoms, but also from lack of understanding, incorrect treatment and exclusion. In addition, she talks about how research can shed more light on the understanding of mental illnesses and how new therapeutic options can be established.

Numerous findings from the neurosciences have contributed to the fact that personality disorder is now understood as a complex interplay of biological and environmental factors. They have revealed that the disease does not necessarily have to be associated with severe lifelong impairments; rather, the symptoms can be treated successfully with psychotherapy and regress in the majority of patients after a few years. In the future, neuroscientists will possibly dispel further reservations about patients – and provide information on how those affected can manage to lead a full life despite some difficulties.

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