Supplemental Materials
Aggression in Borderline Personality Disorder - a Multidimensional Model
by F. Mancke et al., 2014, Personality Disorders: Theory, Research, and Treatment
http://dx.doi.org/10.1037/per0000098
Table S1
Studies Empirically Investigating the Biobehavioral Dimensions Underlying Aggression in Borderline Personality Disorder (BPD)
First
Year
Sample
Methodology
Key Findings
2012
33 female BPD-patients, 26 female
BPD: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)
Female BPD showed greater skin conductance, compared with HC (p = .032).
healthy controls (HC)
Psychophysiology: electromyographic activity and skin conductance
40 female BPD-patients, 41 female HC
BPD: International Personality Disorders Examination (IPDE)
Behavioral tasks: BPD made faster (p < .01) and more (p < .10) reflexive fixation
Behavioral task: facial emotion recognition task while eye-movements were measured
changes to the eyes of angry faces compared with HC.
Neuroimaging: Functional magnetic resonance imaging (fMRI)
Functional Neuroimaging: Faster fixation changes to the eyes of angry faces were
Neurochemistry: double blind placebo controlled between subject design; intranasal oxytocin
related to increased right posterior amygdala responses in BPD (r = -.4, p < .05) but
(24 I.U.) administration.
not in HC.
Author
Barnow
Bertsch
2013
Neurochemistry: Oxytocin administration normalized abnormal behavioral and
neural patterns in BPD.
Bertsch
2013
13 male offenders with BPD and antisocial
BPD, ASPD: IPDE
BPD-ASPD displayed volume reduction in the ventromedial prefrontal cortex (puncorr
personality disorder (BPD-ASPD), 12
Psychopathy: Psychopathy Checklist Revised
.<
male offenders with ASPDand high
Neuroimaging: strucutural magnetic resonance imaging (stMRI), voxel based morphometry
compared with ASPD-PP
psychopathic traits (ASPD-PP), 14 male
(VBM)
ASPD-PP showed reduction in cortical midline structures such as dorsomedial
HC non-offenders
.003) and the orbitofrontal cortex (p < .10, Region of Interest (ROI) analysis),
prefrontal cortex (puncorr = .005), postcentral gyrus (puncorr = .001) and the precuneus
(puncorr = .01-.002) compared with BPD-ASPD.
Bertsch
2013
34 female BPD patients , 40 female HC
BPD: IPDE
Female BPD showed lower plasma oxytocin levels compared with HC (p < .001).
Aggression: Assessment of Factors of Aggression
Plasma oxytocin levels were negatively related with trait aggressiveness (r > -.39, p
Neurochemistry: analysis of plasma oxytocin levels
< .001).
Black
2007
220 offenders (198 men, 22 women)
BPD: Structured Interview for DSM-IV Personality
65 offenders (29.5%) met criteria for BPD.
Blackwood
1986
14 female BPD-patients, 25 clinical
BPD: DSM-III criteria, Diagnostic Interview for Borderlines, Borderline Ego Functions
BPD showed a smaller P300 amplitude compared with the clinical controls and HC
controls (various axis-I disoders, 14
Inventory
(p < .01).
women), 59 HC (32 women)
Psychophysiology: Auditory P300 event-related potential (ERP) in a two tone discrimination
task
Brunner
2010
20 female adolescent BPD-patients, 20
BPD: SCID-II
Female adolescent BPD showed volume decreases in the right (pfwe-corrected < .01)
clinical controls with mixed psychiatric
Neuroimgaing: stMRI, VBM
and left (pfwe-corr = .02) dorsolateral frontal gyrus and the left orbitofrontal gyrus (p =
diagnoses, 20 female HC
Chanen
Coccaro
Coccaro
2008
1997
1989
.02), compared with HC.
20 adolescent BPD-patients (15 women),
BPD: SCID-II
20 HC (15 women)
Neuroimaging: stMRI, functional automated segmentation tool and manual tracing
22 personality-disordered patients (8
BPD: Structured Interview for DSM-III-R Personality
Platelet serotonin-2a-receptor density (r = .39, p = .038) and dissociation constant (r
women, 3 BPD-patients), 12 HC (8
Aggression: Buss-Durkee Hostility Inventory, Life History of Aggression
= .55, p= .008) correlated positively with scores of the Buss-Durkee Hostility
women)
Neurochemistry: Analysis of platelet serotonin-2a-receptor density and dissociation constant
Inventory in the personality-disordered patients but not in the HC.
20 male personality-disordered patients (8
BPD: Structured Interview for DSM-III-R Personality
BPD showed reduced serotonergic functionality compared with other personality-
BPD-patients),
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
disordered patients (p < .012) or HC (p < .002). In male personality-disordered
Aggression: Buss-Durkee Hostility Inventory, Brown–Goodwin lifetime history of aggression,
patients, but not HC reduced serotonergic functionality was correlated with ratings
Psychopathic deviance scale of the Minnesota Multiphasic Personality Inventory
of aggression (Buss-Durkee Hostility Inventory, p < .002).
26 personality-disordered subjects (8
BPD: According to DSM-IV criteria
In the personality-disordered patients, including BPD, vasopressin CSF
women, 7 BPD-patients)
Aggression: Life History of Aggression
concentration was positively correlated with aggression (r = .41, p = .04).
25
depressive
male
patients, 18 normal male control patients
Coccaro
1998
BPD showed reduced orbitofrontal gray matter (puncorr = .006) compared with HC.
Neurochemistry: cerebrospinal fluid (CSF) concentration of vasopressin
Coccaro
2007
31 male personality-disorders subjects (4
BPD: SCID-II
Testosterone CSF concentration of male personality disordered patients, including
BPD-patients)
Neurochemistry: CSF concentration of testosterone:
BPD is not correlated with aggression (Life history of aggression: p = .34)
Aggression: Life History of Aggression and research criteria for Intermittent Explosive
Disorder
Costa
2008
130 intimate aggressive men, 48 non
BPD: Millon Clinical Multiaxial Inventory-III
Jealousy correlated positively with BPD-traits (r = .13, p < .05).
aggressive men
Intimate partner aggression: Revised Conflict Tactics Scale, General Violence Questionnaire
Articulated thoughts: Articulated Thoughts in Simulated Situations Paradigm
Critchfield
2004
92 BPD-patients (85 women)
BPD: IPDE
No significant correlation between the aggression and impulsivity (r = –.18, ns).
Impulsivity: Barratt Impulsivity Scale, version 11
Aggression: Inventory of Personality Organization, Anger, Irritability, Assault Questionnaire,
Overt Aggression Scale—Modified
Critchfield
2008
92 BPD-patients (91 women)
BPD: IPDE
In BPD, the attachment patterns associated with interpersonal hypersensitivity, i.e.
Aggression: Multidimensional Personality Questionnaire, the Inventory of Personality
fearful attachment patterns (simultaneous presence of relationship anxiety and
Organization, the Anger, Irritability, Assault Questionnaire, the Overt Aggression Scale-
avoidance) are related to aggression.
Modified for Outpatient, the Suicide Attempt Self Injury Interview
Attachment style: Experiences in Close Relationships Scale
Domes
2009
174 BPD-patients (156 women)
Study: review of the literature
Results indicate an enhanced perception of social threat cues in BPD.
Domes
2008
25 female BPD-patients
BPD: IPDE
BPD perceived ambiguous blends of facial expressions as more angry, particularly
Behavioral task: facial emotion recognition task
for 50 % anger and 50% disgust (p = .020) and 40% anger: 60% happiness (p =
.016).
Dougherty
Dziobek
1999
2011
14 female BPD-patients , 17 female HC
BPD: SCID-II
BPD showed more aggression in the Point Subtraction Aggression Paradigm
Aggression: Point Subtraction Aggression Paradigm
compared with HC (p = .044).
Behavioral study: 21 female BPD-patients,
BPD: Mini-International Neuropsychiatric Interview, SCID-II
Behavioral study: BPD showed lower scores on the Interpersonal Reactivity Index
21 female HC
Empathy: Interpersonal Reactivity Index, The Multifaceted Empathy Test
(subscales: personal distress: p < .00 empathic concern: p < .06 and perspective
Neuroimaging: 30 female BPD-patients,
Neuroimaging: fMRI
taking: p < .07) and the Multifaceted Empathy Test [cognitive empathy: (p < .03)
20 female HC
and affective empathy: (p < .04)], compared with HC.
Neuroimaging: BPD showed hypoactivation in the superior temporal sulcus/gyrus
during cognitive empathy compared with HC (p < .001, ROI analysis). BPD showed
hypoactivation in the insula during affective empathy compared with HC (p < .005,
ROI analysis).
Ebner-
2007
Priemer
50 female BPD-patients (10 non-medicted
BPD: IPDE
Non-medicated BPD showed greater additional heart rate, i.e. that part of heart rate
and 40 medicated), 50 female HC
Psychophysiology: 24-hour ambulatory monitoring of physical activity and heart rate
increase that does not directly result from physical or metabolic activity, compared
with HC (p = .011).
Ebner-
2005
22 female BPD-patients, 21 female HC
BPD: SCID-II, Revised Diagnostic Interview for the Borderlines
BPD-patients showed an augmentated startle response compared with HC
Psychophysiology: startle-response as assessed by orbicularis oculi electromyogram
(p=.007).
30 BPD-patients (26 women) 29 HC (15
BPD: SCID-II
BPD-patients outperformed HC in a test involving cognitive and affective empathic
women)
Empathy: Reading the Mind in the Eyes task
strategies (p < .001).
747 university students (482 women)
BPD: Personality Diagnostic Questionnaire-4
BPD-traits were predicted by the emotional subdimensions of aggression (p <
Aggression: Buss-Durkee Hostility Inventory
.0045).
10 Impulsive aggressive patients, (5
BPD: SCID-II f
Impulsive aggressive patients, including BPD, showed reduced serotonin
women, 7 with BPD), 10 HC (5 women)
Neurochemistry: density of serotonin transporter via radiotracer [11C]McN 5652
transporter density in the anterior cingulate cortex, as noted by differences in both
Neuroimaging: positron emission tomography (PET)
binding potential (p = .04, ROI analysis) and Specific-to-Nonspecific Partition
Priemer
Fertuck
Fossati
Frankle
2009
2004
2005
Coefficient (p < .02, ROI analysis), compared with HC.
Frick
Gardner
2012
2012
21 female BPD-patients, 20 female HC
BPD: SCID-II
BPD outperformed HC in a test involving cognitive and affective empathic strategies
Empathy: Reading Mind in the Eyes task
(p < .009). BPD showed hypoactivation in the right superior temporal gyrus during
Neuroimaging: fMRI
the Reading Mind in the Eyes Test, compared with HC (pfwe-corr < .05).
206 subjects from educational institutions
BPD: Personality Diagnostic Questionnaire-4
BPD-traits correlated positively with reactive aggression in adults (r = .24, p < .05)
(141 women) divided in adults (age: 19-
Aggression: Reactive–Proactive Aggression Questionnaire
and adolescents (r =.21, p < .05).
28) and adolescents: (age: 16-18)
Emotional coping mediated the relationship between BPD-traits and reactive
aggression in adults (CI 95%, .009-.124).
Gardner
Hallquist
1991
2012
46 BPD-patients (39 women), 27 HC (22
BPD: Structured Interview for DSM-III-R Personality, Diagnostic Interview for the Borderlines
BPD showed higher aggression scores compared with HC (p < .0001).
women)
Aggression: Buss-Durkee Hostility Inventory
362 clinical and nonclinical subjects (256
BPD: dimensional score based on DSM-IV-criteria
The best model revealed four BPD-subgroups, including one subgroup with co-
women, 94 BPD-patients)
Aggression: dimensional score based on DSM-IV-criteria for antisocial personality disorder, 9
occurring anger proneness and aggression (p < .001).
Items from the Inventory of Interpersonal Problems specifically measuring aggressiveness
Harari
Hazlett
Hazlett
2010
2005
2007
20 BPD-patients (18 women), 22 HC (19
BPD: Revised Diagnostic Interview for Borderlines
BPD were significantly impaired in cognitive (p = .038), but not affective empathy (p
women)
Empathy: Interpersonal Reactivity Index
= .205) compared with HC.
50 BPD patients (23 women), 50 HC (20
BPD: Structured Interview for DSM-III-R Personality
BPD showed reduced gray matter and more white matter volume in BA 24 and 31 of
women)
Neuroimaging: stMRI, manual tracing
the cingulate compared with HC (all p < .01,ROI analysis).
27 BPD-patients (9 women) , 21 HC (10
BPD: Structured Interview for DSM-IV Personality
BPD showed greater startle potentiation for unpleasant words but for the neutral
women)
Psychophysiology: startle-response as assessed by orbicularis oculi electromyogram during
words compared with HC (p = .01).
the presentation of unpleasant, borderline-salient (e.g., “hate”), and neutral (e.g., “view”)
words
Herpertz
2001
18
male
BPD-inmates,
25
male
psychopathic inmates, 24 male HC
BPD: IPDE
Psychopathic inmates showed more instrumental aggression than BPD-inmates (p
Psychopathy: screening version of the Psychopathy Checklist
< .05).
Subtype of aggression: procedure by the use of the formal records
Herr
2013
Community sample of 124 subjects (83
BPD: McLean Screening Instrument for Borderline Personality Disorder, The Personality
Negative interpersonal events in the week prior to aggressive actions partially
women, 35 BPD-patients)
Assessment Inventory Borderline Features subscale
mediated the relationship between baseline noninterpersonal BPD symptoms and
Aggression: The weekly diary included a six-item behavior checklist that measured whether or
aggressive behavior (p < .001).
not participants endorsed engaging in various aggressive behaviors over the previous 24 hr.
Negative interpersonal events: The Inventory of Small Life Events
Study design: longitudinal design, participants completed an online diary measure, at baseline
and once per week for 4 weeks
Hines
2008
14154 university-students (10100 women)
BPD: Personal and Relationships Profile
BPD traits predicted physical, psychological and sexual intimate aggression (all p <
Aggression: physical aggression, psychological aggression, and sexual aggression scales of
.001).
the revised Conflict Tactics Scales
Holtzworth
2000
102 intimate aggressive men, 62 non
BPD: Millon Clinical Multiaxial Inventory-III
Four clusters of violent men, including a “borderline-dysphoric” group characterized
aggressive men
Intimate partner aggression: Revised Conflict Tactics Scale, Generality of Violence
by high measures on dependency, jealousy, impulsivity and hostility towards women
Questionnaire
Izurieta
Koch
2014
2007
36 female BPD-patients, 29 female HC
8 female patients with BPD, 9 female HC
BPD: IPDE
BPD showed an increased occipital P100 amplitude (p = .098) and reduced parietal
Psychophysiology: visual event-related potentials in a facial recognition task with blends of
P300 amplitudes (p < .01), with strongest difference for predominantly happy faces
happy versus angry faces
compared with HC.
BPD: the Diagnostic Interview for Borderlines
BPD showed higher serotonin transporter availability in the hypothamalus compared
Neurochemistry:
availability
of
serotonin
transporter
via
ADAM
(2-([2-
with HC (p = .049, ROI-analysis).
([dimethylamino]methyl)phenyl]thio)).
Neuroimaging: single photon emission computed tomography
Koenigsberg
2001
152 personality-disordered patients (85
BPD: Structured Interview for the Diagnosis of Personality Disorders
women, 41 BPD-patients)
Impulsivity: Barratt Impulsivity Scale, version 7B
Impulsivity and aggression in BPD loaded on the same factor (p < .00625).
Aggression: Buss-Durkee Hostility Inventor
Kuhlmann
2013
30 female BPD-patients and 33 female
BPD: IPDE
Female BPD had larger gray matter volume in the left hypothalamus (p = .023, ROI
HC
Traumatization: Childhood Trauma Questionnaire
analysis) and the cerebellar vermis (puncorr = .002) compared to HC. Childhood
Neuroimaging: stMRI, VBM
Trauma Questionnaire scores were positively correlated with hypothalamic gray
matter volume (r = .58, p = .001).
Leyton
Linnoila
2001
1983
13 BPD-patients (8 women), 11 HC (5
BPD: Diagnostic Interview for Borderline Patients—Revised
Male BPD- showed lesser serotonin syntheses capacity in the bilateral medial
women)
Neuroimaging: PET
frontal cortex (peak difference in Brodmann’s area 10) extending into the
Neurochemistry: serotonin synthesis capacity via the serotonin precursor analog α-
orbitofrontal cortex and bilateral anterior cingulate (Brodmann’s areas 24, 32),
[11C]methyl-L- tryptophan
compared with HC (z-scores = 3.48-3.52).
7 male BPD-patients with comorbid
BPD: n/a
BPD-patients showed lower CSF concentration of the serotonin metabolite 5-
Antisocial personality disorder and/or IED,
Neurochemistry: CSF concentration of the serotonin metabolite 5-hydroxyindoleacetic acid
hydroxyindoleacetic acid compared with clinical controls (p < .05).
BPD: IPDE
BPD patients showed enhanced responses of the corrugator supercilii muscle in
Behavioral task: facial emotion recognition task while facial muscle activity was recorded
response to angry (p =.011), disgusted (p =.013) and sad (p =.041) facial
9 male clinical controls with paranoid or
passive-aggressive personality disorder
Matzke
2014
28 female BPD-patients , 28 HC
expressions compared with HC.
McCloskey
2009
127 BPD-patients (69 women), clinical
BPD: Structured Interview for DSM-IV Personality
control group consisting of 122 patients
Aggression: Life History of Aggression, Aggression Questionnaire,
with a non cluster-B-personality disorder
Aggression Paradigm
(57 women) and 112 HC (55 women)
Mier
2013
BPD showed higher scores in the Point Subtraction Aggression Paradigm (p < .001)
Point Subtraction
compared with HC and clinical controls; BPD showed higher scores in the Life
History of Aggression and the Aggression Questionnaire compared with HC (both p
< .001).
13 BPD-patients (9 women) , 13 HC (8
BPD: DSM-IV diagnosis by experienced psychiatrist
BPD showed hypoactivation in the left superior temporal gyrus during cognitive
women)
Empathy: Social cognition task
empathy (p < .027, ROI analysis), hyperactivation in the amygdala during affective
Neuroimaging: fMRI
and cognitive empathy (puncorr < .001), hypoactivation of the left Inferior prefrontal
gyrus and hyperactivation in the somatosensory cortex in all conditions (both puncorr <
.001) compared with HC.
Minzenberg
Morandotti
2008
2013
BPD-patients (5 women), 12 HC (6
BPD: Structured Interview for DSM-IV Personality
BPD had reduced gray matter volume in the anterior cingulate (BA 24/32) compared
women)
Neuroimaging: stMRI, VBM
to HC (p < .003-007, ROI analysis).
18 BPD-patients (13 women) and 19 HC
BPD: SCID-II
In BPD-patients with a history of traumatization the gray matter volume in the right
(13 women)
Aggression: Buss– Durkee Hostility Inventory
ventrolateral prefrontal cortex (BA47) correlated negatively with aggression (r = -.87,
Traumatization: The Child Abuse Scale
p = .002).
Neuroimaging: stMRI, VBM
New
New
New
2012
2007
2004
79 BPD-patients (53 women), 76 HC (48
BPD: Structured Interview for DSM-IV Personality
BPD were impaired in aspects of cognitive (p < .0002, subscale perspective taking)
women)
Empathy: Interpersonal Reactivity Index
but not affective empathy compared with HC.
BPD: Structured Interview for DSM-IV Personality
BPD-IED-patients differed significantly in the correlations between prefrontal and
Intermittent Explosive disorder (9 women,
Intermittent Explosive disorder: Module for Intermittent Explosive disorder
amygdalar areas at rest and after m-CPP stimulation compared to HC (all p <
24 HC (9 women)
Neuroimaging: PET at rest and after stimulation with m-CPP (meta-chloropiperazine)
.001,ROI analysis ).
146 patients (56 women, 37 BPD-
BPD: Structured Interview for DSM-III-R Personality, Structured Interview for DSM-IV
Male personality-disordered patients tended to have lower baseline serotonergic
patients), 23 HC (8 women)
Personality
functionality compared to HC (p = .098).
26
BPD-patients
with
comorbid
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
New/Perez-
2009/20
38
Rodriguez
12
BPD-patients
with
comorbid
BPD: SCID-II
After provocation, BPD-IED showed greater glucose uptake in orbitofrontal (BA 11,
intermittent-explosive-disorder (IED) (16
Intermittent Explosive disorder: Module for Intermittent Explosive disorder
12, and 47, p < .02, ROI analysis) and amygdalar brain regions (p < .05, ROI
women), 36 HC (18 women)
Aggression: modified Overt Aggression Scale, Buss-Durkee Hostility Inventory, Aggression
analysis) but failed to mobilize anterior, medial and dorsolateral prefrontal regions (p
Questionnaire, Point Subtraction Aggression Paradigm
= n/a). Male BPD-IED displayed reduced glucose metabolism rate in the striatum
Neuroimaging: PET when performing the Point Subtraction Aggression Paradigm
when performing the Point Subtraction Aggression Paradigm, compared with male
HC (p < .006, ROI analysis).
Newhill
2012
220 BPD-patients (gender: n/a)
BPD: Structured Interview for DSM-III-R Personality
Affective dysregulation fully mediated the relationship between aggression and
Aggression: Three sources of data: arrest records, collateral informants, and patient self-
BPD-diagnosis.
report.
Affective dysregulation: items from the Novaco Anger Scale
Newhill
2009
220 BPD-patients (116 women)
BPD-diagnosis: Structured Interview for DSM-III-R Personality
160 individuals (73%) with BPD engaged in aggressive acts over the 1 year follow-
Aggression: threefold by arrest records, collateral reports, patients report using behaviors
up. The majority of these acts consisted of interpersonal altercations and were
adapted from the Conflict Tactics Scale
targeted against acquaintances (33%) or spouses/cohabitants/significant others
(29%). After controlling for antisocial personality disorder and Psychopathy, BPD
was no longer a significant predictor of aggression, which was due to the shared
variance among the constructs, and not the lack of predictive power of BPD.
Nunes
2009
104 BPD patients (100 women) and 122
BPD: SCID-II, Revised Diagnostic Interview for the Borderlines
BPD showed smaller hippocampal [mean effect size: -1.27 (95% CI =-1.82 to -0.72)]
HC (108 women)
Study: systematic review
and amygdalar volume [mean effect size: -0.96 (95% CI =-1.76 to -0.15)] compared
with HC.
O’Neil
2012
38 studies comparing BPD-patients to HC
BPD: categorical diagnosis according to DSM III/IV
BPD showed lesser volume oft the hippocampi and amygdalae as well as lesser
Study: Qualitative review of the literature
activity in prefrontal brain regions and greater amygdalar activity when confronted
with emotion-related stimulus compared with HC.
Ostrov
2009
679 university students (341 women)
BPD: Personality Diagnostic Questionnaire-4, Cluster B
BPD-traits were associated with reactive and instrumental forms of relational
Aggression: Self-report of Aggression and Social Behavior Measure, Impulsive-premeditated
aggression (p < .001).
Aggression Scales
Perez-
2010
Rodriguez
251 personality-disordered patients (109
BPD: Structured Interview for DSM-IV Personality
The “risk” haplotype was higher in BPD-patients than in HC (p < .05).
BPD-patients), 103 HC
Aggression: composite score of the Buss-Durkee Hostility Inventory and the Aggression
In the combined patient/control sample those with the “risk” haplotype have higher
Questionnaire
aggression than those without the “risk” haplotype (p = .05)
Genotyping: haplotype analysis of the tryptophan-hydroxylase 2 (TPH2) gene
Peters
2014
823 undergraduates (579 women)
BPD: Personality Assessment Inventory
Anger mediates the relationship between shame and BPD-traits (p < .005).
Anger: Anger Rumination Scale, Aggression Questionnaire, subscale oft the Positive and
Negative Affect Scale – Expanded Form
Shame proneness: Subscale of the Positive and Negative Affect Scale – Expanded Form,
The Test of Self--ious Affect
Preissler
2010
42 female BPD-patients, 38 female HC
BPD: SCID-II
No difference between BPD and HC in the Reading the Mind in the Eyes task
Empathy: The revised version of the Reading the Mind in the Eyes task, The Movie for the
BPD showed impaired scores in the Movie for the Assessment of Social Cognition
Assessment of Social Cognition
compared to HC (p = .001).
Raine
1993
37 male long-term prisoners
BPD: dimensional assessment of BPD-traits according to DSM-III
BPD-traits were positively related to aggression (p < .04).
Rinne
2000
12 female BPD-patients, 9 female HC
BPD: Structured Interview for DSM-III-R Personality
Female BPD showed reduced serotonergic functionality compared with HC (p <
Neurochemistry: serotonergic functionality via stimulation with meta-chlorophenylpiperazine
.05).
27 BPD-patients (25 women), 53 HC (29
BPD: SCID-II
BPD showed reduced scores in the Movie for the Assessment of Social Cognition (p
women)
Empathy: Interpersonal Reactivity Index, Multifaceted Empathy Test and Movie for the
< .011), Multifaceted Empathy Test (cognitive empathy: p < .005, emotional
Assessment of Social Cognition
empathy: p < .001) and Interpersonal Reactivity Index (cognitive empathy: p < .017,
Ritter
2010
emotional empathy: p < .046) compared with HC.
Ross
2009
124 intimate aggressive men (7 BPD-
BPD: SCID-II
Male BPD with comorbid ASPD were more likely than ASPD and subjects without a
patients, 16 BPD-patients with comorbid
Intimate partner aggression: Revised Conflict Tactics Scale
personality disorder to react aggressively upon women’s displays of stress (both: p
ASPD, 18 ASPD-patients and 83 subjects
< .01).
without a personality disorder)
Rüsch
Sala
2007
2011
60 female BPD-patients, 30 women with
BPD: SCID-II
Female BPD reported higher levels of shame in comparison to HC and women with
social phobia and 60 healthy women
Shame: Test of Self-Conscious Affect–3, Experiential Shame Scale, Implicit Association Test
social phobia (p < .001-.02, depending on the instrument to measure shame).
15 BPD patients (11 women) 15 HC (11
BPD: SCID-II, Diagnostic interview for Borderlines
Right hippocampal volumes inversely correlated with Buss-Durkee Hostility
women)
Aggression: Buss–Durkee Hostility Inventory
Inventory score in BPD (r = -.6, p = .02, ROI analysis), but not in HC.
Neuroimaging: stMRI , manual tracing
Scott
2014
75
psychiatric
outpatients
and
75
community residents (98 women)
BPD: dimensional score using a Diagnostic and Statistical Manual of Mental Disorders
Affective dysregulation fully mediated the relationship between BPD-traits and
checklist and the Structured Interview for DSM-IV Personality
subsequent aggressive behavior (p < .05). Impulsivity did not significantly mediate
Affective dysregulation: Difficulties in Emotion Regulation Scale
the relationship between BPD-traits and aggression.
Impulsivity: Composite score of the Impulsiveness, Self- Discipline (reversed), and
Deliberation (reversed) facet scales oft he NEO Personality Inventory
Aggression: Revised Conflict Tactics Scale
Sharp
Siever
2011
1999
111 adolescents inpatients (62 girls, 24
BPD: Borderline Personality Features Scale for Children, Childhood Interview for DSM-IV
BPD showed hypermentalizing compared with clinical controls (p < .03). BPD-traits
BPD-patients)
Borderline Personality Disorder
correlated with hypermentalizing (r = .41; p < .001).
Affective dysregulation: Difficulties in Emotion Regulation Scale
Affective dysregulation mediated the association between hypermentalizing and
Empathy: Movie for the Assessment of Social Cognition
BPD-traits (p < .01).
BPD: The Revised Schedule for Interviewing DSM-IV Personality Disorders
The patient sample, including BPD, showed significantly blunted metabolic
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
responses after d-fenfluramine stimulation in medial, orbital and dorsolateral frontal
Neuroimaging: PET
cortex (all p < .05, ROI analysis) compared with HC.
BPD: IPDE
BPD with the LL genotype of the serotonin transporter gene promoter region show
Aggression: Overt Aggression Scale Modified
gene a greater reduction of aggressiveness than the LS and SS carriers when they
Genotyping: analysis of the short variation (S) and long variation (L) of the polymorphisms of
were treated with fluoxetine (p-value: n/a)
6
impulsive-aggressive
patients
(2
women, 4 BPD-patients), 5 male HC
Silva
2007
49 BPD-patients (36 women)
the serotonin transporter gene promoter region
Snyder
1984
37 male BPD-patients, 31 male patients
BPD: six criteria of DSM-III
BPD showed more electroencephalographic slow wave activity, compared with the
with a dysthymia
Psychophysiology: Analysis of resting electroencephalographic activity, including one period
clinical controls (p < .05)
of hyperventilation
Soloff
2000
5 female BPD-patients, 8 HC (3 women)
BPD: IPDE, Diagnostic Interview for Borderline Patients
Female BPD-patients showed lesser activation in an area of the right prefrontal
Neuroimaging: PET
cortex, BA 10 compared to HC (z = 3.34).
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
Soloff
2003a
13 female BPD-patients, 9 female HC
BPD: IPDE, Revised Diagnostic Interview for the Borderlines
Female BPD showed reduced bilateral glucose metabolization in the orbital frontal
Aggression: Buss-Durkee Hostility Inventory
cortices, compared with HC (puncorr < .001).A longitudinal study of the group, referred
Neuroimaging: PET
to in the article, revealed that 58 % of BPD had been “occasionally or often”
involved in physical fights and 25 % have used a weapon against other.
Soloff
Soloff
2003b
2005
64 BPD-patients (44 women), 57 HC (21
BPD: IPDE
BPD scored score higher in the aggression instruments (p < .001), compared to HC.
women)
Aggression: Buss-Durkee Hostility Inventory, Brown–Goodwin lifetime history of aggression
BPD showed diminished serotonergic functionality compared with HC (p = .02).
Neuroimaging: PET
Separated by gender, only male, but not female BPD-patients, showed a diminished
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
serotonergic functionality (p = .02).
22 BPD-patients (15 women), 24 HC (14
BPD: IPDE, Revised Diagnostic Interview for the Borderlines
Upon serotonergic stimulation, male BPD showed decreased glucose
women)
Aggression: Brown-Goodwin Assessment of Lifetime History of Aggression
metabolization in the lt. temporal and posterior cingulate cortex lobe compared to
Neurochemistry: : Serotonergic functionality via stimulation with d-fenfluramine
HC (p corr < .05).
Neuroimaging: PET
Soloff
2007
14 female BPD-patients, 11 female HC.
BPD: IPDE, Revised Diagnostic Interview for the Borderlines
BPD showed increased hippocampal serotonin receptor binding compared to HC (p
Neurochemistry: Serotonin receptor binding via Altanserin
= .004).
Neuroimaging: PET
Stepp
2012
138 psychiatric outpatients (104 women,
BPD: dimensional score based on DSM-IV-criteria.
Interpersonal problems mediated the relationship between BPD-traits and
54 BPD-patients, 55 patients with other
Interpersonal problems: Interpersonal Relations Assessment Inventory of Interpersonal
subsequent aggressive behaviors. Expression of anger correlated with perpetrating
personality disorder, and 29 patients with
Problems
aggressive behavior (r = .41, p < .001) and showed a marginal significant prediction
no personality dysfunction)
Aggression: Revised Conflict Tactics Scale
for subsequent aggressive behavior (p < .10).
Tebartz van
2003
8 female BPD-patients, 8 female HC
BPD: Structured Clinical Interview for DSM-IV Personality Disorders, Revised Diagnostic
BPD showed reduced volumes in the left orbital frontal cortex (p = .001, Bonferroni
Interview for the Borderlines
p = .0083, ROI analysis) and the right anterior cingulate cortex (p = .008.,
Neuroimaging: stMRI, manual tracing
Bonferroni p = .0083, ROI analysis) compared with HC.
60 outpatients (34 with BPD; 26 with
BPD: Structured Interview for DSM-IV Personality
BPD experienced more frequently extreme spikes of hostility compared with
current depressive disorder but not with
Ecological momentary assessment: record of affects, experiences, and behaviors six times a
depressive patients (p = .016).
BPD, 53 women)
day over a 28-day period
Elst
Trull
2008
Affective instability: mood descriptor items from the Positive and Negative Affect Schedule
Vogel
2012
161 BPD-patients (112 women), 157 HC
BPD: SCID-II
Aggression was higher in carriers of the short than the long alleles (p = .016).
(111 women)
Aggression: Buss-Durkee Hostility Inventory
Genotyping: analysis of three polymorphisms of the arginine vasopressin receptor 1A
von
2010a,
30 female adolescents BPD-patients, 29
BPD: SCID-II
BPD focused more initial attention toward negative facial expressions than HC (p =
Ceurmen-
b
female adolescents with mixed psychiatric
Behavioral task: visual dot probe task to test for attentional biases
.03). BPD exhibited a significantly greater focus on negative emotional stimuli when
Lindenstjern
diagnoses, and 30 healthy controls (HC)
in a neutral mood compared to HC (p < .003) and clinical controls (p < .05).
a
Wagner
1999
21 female BPD-patients, 21 women with a
BPD: SCID-II
BPD over-reported fear when presented with neutral faces compared with women
history of childhood sexual abuse, 20
Behavioral task: Facial emotion recognition task
with a history of childhood sexual abuse (p < .01) and women w/o a BPD-diagnosis
women w/o a BPD-diagnosis and w/o a
and w/o a history of childhood sexual abuse (p = .05).
history of childhood sexual abuse
Wagner
2010
159 BPD-patients (110 women, 49 men)
BPD: SCID-II
In BPD with the BDNF Val66Val, but not the Val66Met or Met66Met polymorphism,
Aggression: Buss-Durkee Hostility Inventory
the occurrence of childhood sexual abuse led to lower aggression scores than in
Genotyping:
those BPD without childhood sexual abuse (p = .005).
polymorphism
analysis of the
brain-derived neurotrophic factor (BDNF) Val66Met
Serious life events: PTSD-section of the Munich-Composite International Diagnostic Interview
Wagner
2010b
112 female BPD-patients
BPD: SCID-II
In BPD with the COMT Val158Val carriers, but not the Val158Met and Met158Met
Aggression: Buss-Durkee Hostility Inventory
polymorphism, the occurrence of childhood sexual abuse led to lower aggression
Genotyping: analysis of the catechol o-methyltransferase (COMT) val158met polymorphism
scores than in those without childhood sexual abuse (p = .001).
Serious life events: PTSD-section of the Munich- Composite International Diagnostic
Interview
Weinstein
2012
847 late middle-age (55-64) adults (347
BPD: Structured Interview for DSM-IV Personality, Multi-Source Assessment of Personality
BPD-traits predicted intimate partner aggression (p < .005)
women) from a community sample
Pathology fulfilled by the participant and an informant
.
Aggression: Revised Conflict Tactics Scale
Whisman
Wolf
2009
2012
1,147 individuals (635 women) from the
BPD: International Personality Disorder Examination Screening Questionnaire
BPD-traits were positively associated with perpetration of minor (p < .001) and
National Comorbidity Survey Replication
Aggression: Conflict Tactics Scales
severe aggression (p < .05).
16 female BPD-patients, 16 female HC
BPD: SCID-II
BPD exhibited decreased CBF in the medial orbitofrontal cortex (Brodmann area
Impulsivity: Barratt Impulsiveness Scale
[BA] 10, Cohen’s d = 1.14) and increased CBF in the lateral orbitofrontal cortex (left
Neuroimaging: resting state cerebral blood flow (CBF) via continuous arterial spin labeling
BA 11, Cohen’s d = 1.67; right BA 11, Cohen’s d = 1.44) compared to HC.
Impulsivity correlated positively with the CBF in the medial (p = .024), left lateral (p =
.009) and right lateral orbitofrontal cortex (p = .004).
Zetzsche
2007
25 female BPD-patients, 25 female HC
BPD: SCID-II, Diagnostic interview for Borderlines
In BPD hippocampal gray matter volume loss correlated with measures of
Aggression: Brown-Goodwin Assessment of Lifetime History of Aggression, the Buss- Durkee
aggression (r > -.43-48, p < .01-.03, depending on the instrument to measure
Hostility Inventory
aggression).
Neuroimaging: stMRI, manual tracing
Zetzsche
2006
25 female BPD-patients, 25 female HC
BPD: SCID-II, Diagnostic interview for Borderlines
There were no significant correlations between amygdala volumes and ratings for
Aggression: Brown-Goodwin Assessment of Lifetime History of Aggression, the Buss- Durkee
aggression.
Hostility Inventory
Depression: The Hamilton Depression Scale (21-items version)
Neuroimaging: stMRI, manual tracing
Note. The studies are listed in alphabetical order based on the author’s first name.
Abbreviations: CSF: cerebrospinal fluid, ERP: event-related potential, IPDE: International Personality Disorders Examination, fMRI: functional magnetic resonance imaging, SCID-II: Structured Clinical Interview for DSM-IV Axis II Personality
Disorders, stMRI: structural magnetic resonance imaging, PET: positron emission tomography, ROI: region of interest, VBM: voxel based morphometry