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CRYSTAL CITY, VA. – Borderline personality disorder has a genetic and neurobiological component, but researchers remain unable to discern exactly why specific genetic markers are attributed to the disease, Emil F. Coccaro, MD, said at Focus on Neuropsychiatry presented by Current Psychiatry and the American Academy of Clinical Psychiatrists.
“The neurobiology at this point gives us clues that what’s going on with borderline personality disorder isn’t simply developmental or environmental. That’s all that it tells us,” said Dr. Coccaro, director of the Clinical Neuroscience & Psychopharmacology Research Unit at the University of Chicago.
Similarly, studies in twins that show heritability of borderline personal disorder at rates between 31% and 49% “only show there’s something in the DNA,” he added. Dr. Coccaro called the evidence for the neurobiology of borderline personality disorder “hazy.” said Dr. Coccaro, also chairman of the university’s department of psychiatry and behavioral neuroscience.
That is true of a lot of disorders, he said, so only the details explain why patients with borderline personality disorder look different from those who might have “similar types of circuitry abnormalities,” he said.
For example, genomewide association studies have found links between borderline personality disorder and the genes DPYD and PKP4, indicating problems with pyrimidine metabolism and myelin production. The study also found a strong association between borderline personality disorder, bipolar disorder, major depression, and schizophrenia (Transl Psychiatry. 2017 Jun. doi: 10.1038/tp.2017.115). DPYD has been associated with schizophrenia, but the relationship between DPYD and borderline personality disorder is unknown, Dr. Coccaro said.
“These [associations] are suggestive of what’s going on genetically, but it hardly makes a story that’s coherent enough to sink your teeth into,” he said.
The neuroscience behind borderline personality disorder, meanwhile, appears more promising, Dr. Coccaro noted. Studies of brain function have shown that negative emotions in patients with borderline personality disorder lead to increased amygdala reactivity. With regard to the neuroendocrinology of borderline personality disorder, trauma in those patients appears similar to what can be seen in patients with posttraumatic stress disorder (PTSD) with “increased central and decreased peripheral stress hormone response.” In fact, he said, 75% of people with borderline personality disorder experienced childhood physical, sexual, or emotional abuse (Curr Psychiatry Rep. 2005 Mar;7[1]:39).
Dr. Coccaro noted that, although the prevalence of borderline personality disorder is likely between 2% and 3%, the illness is encountered at a rate of 20% for patients in clinic and 40% for those in hospitals and emergency departments. Borderline personality disorder is more prevalent and more severe in women, but no gender differences are apparent in affective disturbance, impulsivity, or suicidality. Borderline personality disorder also is likely to be comorbid with at least two conditions: Men with borderline personality disorder tend to have narcissistic and antisocial personality disorders; women with borderline personality disorder have higher rates of major depression, anorexia and bulimia, and PTSD.
Borderline personality was traditionally associated with a “dismal prognosis,” but the lifetime course of the disorder appears to be more promising. In the Collaborative Longitudinal Personality Disorder Study (CLPS), 25% of 668 patients had achieved remission after 2 years, which was defined as having fewer than two symptoms for more than 2 months. After a decade, 85% of those patients had reached remission for at least 12 months (JAMA Psychiatry. 2011;68[8]:827-37). Another trial, the McLean Study of Adult Development, analyzed 290 patients who had a remission rate at 16 years of 78% that lasted for at least 8 years (J Pers Disord. 2005 Oct;19[5]:505-23).
However, Dr. Coccaro noted, patients with borderline personality disorder likely do not achieve true remission. Instead, he said, patients simply fail to meet all the criteria to be diagnosed with borderline personality disorder. “They still have some of the features, but they are less intense,” Dr. Coccaro said.
Dr. Coccaro reported serving as a consultant to Azevan, Avanir Pharma, and Brackett. He also reported receiving grants from the National Institute on Mental Illness and the National Institute on Alcoholic Abuse and Alcoholism, and receiving royalties from UpToDate.
The meeting was presented by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.
CRYSTAL CITY, VA. – Borderline personality disorder has a genetic and neurobiological component, but researchers remain unable to discern exactly why specific genetic markers are attributed to the disease, Emil F. Coccaro, MD, said at Focus on Neuropsychiatry presented by Current Psychiatry and the American Academy of Clinical Psychiatrists.
“The neurobiology at this point gives us clues that what’s going on with borderline personality disorder isn’t simply developmental or environmental. That’s all that it tells us,” said Dr. Coccaro, director of the Clinical Neuroscience & Psychopharmacology Research Unit at the University of Chicago.
Similarly, studies in twins that show heritability of borderline personal disorder at rates between 31% and 49% “only show there’s something in the DNA,” he added. Dr. Coccaro called the evidence for the neurobiology of borderline personality disorder “hazy.” said Dr. Coccaro, also chairman of the university’s department of psychiatry and behavioral neuroscience.
That is true of a lot of disorders, he said, so only the details explain why patients with borderline personality disorder look different from those who might have “similar types of circuitry abnormalities,” he said.
For example, genomewide association studies have found links between borderline personality disorder and the genes DPYD and PKP4, indicating problems with pyrimidine metabolism and myelin production. The study also found a strong association between borderline personality disorder, bipolar disorder, major depression, and schizophrenia (Transl Psychiatry. 2017 Jun. doi: 10.1038/tp.2017.115). DPYD has been associated with schizophrenia, but the relationship between DPYD and borderline personality disorder is unknown, Dr. Coccaro said.
“These [associations] are suggestive of what’s going on genetically, but it hardly makes a story that’s coherent enough to sink your teeth into,” he said.
The neuroscience behind borderline personality disorder, meanwhile, appears more promising, Dr. Coccaro noted. Studies of brain function have shown that negative emotions in patients with borderline personality disorder lead to increased amygdala reactivity. With regard to the neuroendocrinology of borderline personality disorder, trauma in those patients appears similar to what can be seen in patients with posttraumatic stress disorder (PTSD) with “increased central and decreased peripheral stress hormone response.” In fact, he said, 75% of people with borderline personality disorder experienced childhood physical, sexual, or emotional abuse (Curr Psychiatry Rep. 2005 Mar;7[1]:39).
Dr. Coccaro noted that, although the prevalence of borderline personality disorder is likely between 2% and 3%, the illness is encountered at a rate of 20% for patients in clinic and 40% for those in hospitals and emergency departments. Borderline personality disorder is more prevalent and more severe in women, but no gender differences are apparent in affective disturbance, impulsivity, or suicidality. Borderline personality disorder also is likely to be comorbid with at least two conditions: Men with borderline personality disorder tend to have narcissistic and antisocial personality disorders; women with borderline personality disorder have higher rates of major depression, anorexia and bulimia, and PTSD.
Borderline personality was traditionally associated with a “dismal prognosis,” but the lifetime course of the disorder appears to be more promising. In the Collaborative Longitudinal Personality Disorder Study (CLPS), 25% of 668 patients had achieved remission after 2 years, which was defined as having fewer than two symptoms for more than 2 months. After a decade, 85% of those patients had reached remission for at least 12 months (JAMA Psychiatry. 2011;68[8]:827-37). Another trial, the McLean Study of Adult Development, analyzed 290 patients who had a remission rate at 16 years of 78% that lasted for at least 8 years (J Pers Disord. 2005 Oct;19[5]:505-23).
However, Dr. Coccaro noted, patients with borderline personality disorder likely do not achieve true remission. Instead, he said, patients simply fail to meet all the criteria to be diagnosed with borderline personality disorder. “They still have some of the features, but they are less intense,” Dr. Coccaro said.
Dr. Coccaro reported serving as a consultant to Azevan, Avanir Pharma, and Brackett. He also reported receiving grants from the National Institute on Mental Illness and the National Institute on Alcoholic Abuse and Alcoholism, and receiving royalties from UpToDate.
The meeting was presented by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.
CRYSTAL CITY, VA. – Borderline personality disorder has a genetic and neurobiological component, but researchers remain unable to discern exactly why specific genetic markers are attributed to the disease, Emil F. Coccaro, MD, said at Focus on Neuropsychiatry presented by Current Psychiatry and the American Academy of Clinical Psychiatrists.
“The neurobiology at this point gives us clues that what’s going on with borderline personality disorder isn’t simply developmental or environmental. That’s all that it tells us,” said Dr. Coccaro, director of the Clinical Neuroscience & Psychopharmacology Research Unit at the University of Chicago.
Similarly, studies in twins that show heritability of borderline personal disorder at rates between 31% and 49% “only show there’s something in the DNA,” he added. Dr. Coccaro called the evidence for the neurobiology of borderline personality disorder “hazy.” said Dr. Coccaro, also chairman of the university’s department of psychiatry and behavioral neuroscience.
That is true of a lot of disorders, he said, so only the details explain why patients with borderline personality disorder look different from those who might have “similar types of circuitry abnormalities,” he said.
For example, genomewide association studies have found links between borderline personality disorder and the genes DPYD and PKP4, indicating problems with pyrimidine metabolism and myelin production. The study also found a strong association between borderline personality disorder, bipolar disorder, major depression, and schizophrenia (Transl Psychiatry. 2017 Jun. doi: 10.1038/tp.2017.115). DPYD has been associated with schizophrenia, but the relationship between DPYD and borderline personality disorder is unknown, Dr. Coccaro said.
“These [associations] are suggestive of what’s going on genetically, but it hardly makes a story that’s coherent enough to sink your teeth into,” he said.
The neuroscience behind borderline personality disorder, meanwhile, appears more promising, Dr. Coccaro noted. Studies of brain function have shown that negative emotions in patients with borderline personality disorder lead to increased amygdala reactivity. With regard to the neuroendocrinology of borderline personality disorder, trauma in those patients appears similar to what can be seen in patients with posttraumatic stress disorder (PTSD) with “increased central and decreased peripheral stress hormone response.” In fact, he said, 75% of people with borderline personality disorder experienced childhood physical, sexual, or emotional abuse (Curr Psychiatry Rep. 2005 Mar;7[1]:39).
Dr. Coccaro noted that, although the prevalence of borderline personality disorder is likely between 2% and 3%, the illness is encountered at a rate of 20% for patients in clinic and 40% for those in hospitals and emergency departments. Borderline personality disorder is more prevalent and more severe in women, but no gender differences are apparent in affective disturbance, impulsivity, or suicidality. Borderline personality disorder also is likely to be comorbid with at least two conditions: Men with borderline personality disorder tend to have narcissistic and antisocial personality disorders; women with borderline personality disorder have higher rates of major depression, anorexia and bulimia, and PTSD.
Borderline personality was traditionally associated with a “dismal prognosis,” but the lifetime course of the disorder appears to be more promising. In the Collaborative Longitudinal Personality Disorder Study (CLPS), 25% of 668 patients had achieved remission after 2 years, which was defined as having fewer than two symptoms for more than 2 months. After a decade, 85% of those patients had reached remission for at least 12 months (JAMA Psychiatry. 2011;68[8]:827-37). Another trial, the McLean Study of Adult Development, analyzed 290 patients who had a remission rate at 16 years of 78% that lasted for at least 8 years (J Pers Disord. 2005 Oct;19[5]:505-23).
However, Dr. Coccaro noted, patients with borderline personality disorder likely do not achieve true remission. Instead, he said, patients simply fail to meet all the criteria to be diagnosed with borderline personality disorder. “They still have some of the features, but they are less intense,” Dr. Coccaro said.
Dr. Coccaro reported serving as a consultant to Azevan, Avanir Pharma, and Brackett. He also reported receiving grants from the National Institute on Mental Illness and the National Institute on Alcoholic Abuse and Alcoholism, and receiving royalties from UpToDate.
The meeting was presented by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.
REPORTING FROM FOCUS ON NEUROPSYCHIATRY 2019