Zaburzenia osobowości – Patofizjologia i mechanizm

Zaburzenia osobowości
Patofizjologia i mechanizm

Zaburzenia osobowości, definiowane w DSM-5 jako trwałe, sztywne wzorce zachowań i doświadczeń, dotykają około 9-10% populacji i wiążą się z wysoką współchorobowością oraz zwiększonym ryzykiem śmiertelności. Patofizjologia tych zaburzeń jest złożona i obejmuje interakcję czynników genetycznych (dziedziczność około 50%), neurobiologicznych (m.in. nieprawidłowości w płatach czołowych, skroniowych i ciemieniowych, dysfunkcje neuroprzekaźników takich jak serotonina, dopamina, norepinefryna) oraz środowiskowych, zwłaszcza traum dziecięcych. Specyficzne zmiany mózgowe obserwuje się w różnych klastrach zaburzeń osobowości, np. zmniejszenie objętości płata czołowego w zaburzeniach schizotypowych, anomalie w korze przedczołowej i ciele migdałowatym w klastrze B, czy dysfunkcje osi HPA w zaburzeniu borderline. Model pięcioczynnikowy osobowości podkreśla rolę neurotyczności i ugodowości w rozwoju tych zaburzeń, a czynniki psychospołeczne, takie jak niepewne przywiązanie i wczesne traumy, mają kluczowe znaczenie w etiologii.

Patofizjologia zaburzeń osobowości

Model biopsychospołeczny zaburzeń osobowości
Czynniki genetyczne i biologiczne
Nieprawidłowości neuroanatomiczne
Nieprawidłowości neuroprzekaźnikowe
Model pięcio-czynnikowy osobowości

Czynniki środowiskowe w patogenezie zaburzeń osobowości

Trauma dziecięca i wczesne środowisko
Wzorce przywiązania i dynamika rodzinna
Czynniki społeczne i kulturowe

Mechanizmy neurobiologiczne specyficzne dla poszczególnych zaburzeń osobowości

Osobowość typu borderline
Antyspołeczne zaburzenie osobowości
Cechy psychopatyczne i narcystyczne

Modele agresji i reaktywności emocjonalnej
Implikacje dla leczenia
Wnioski i kierunki na przyszłość

Kolejne rozdziały

Patofizjologia zaburzeń osobowości

Zaburzenia osobowości, zgodnie z definicją Diagnostycznego i Statystycznego Podręcznika Zaburzeń Psychicznych Amerykańskiego Towarzystwa Psychiatrycznego (DSM-5), to trwały wzorzec wewnętrznych doświadczeń i zachowań, który znacząco odbiega od oczekiwań kultury danej osoby, jest wszechobecny i sztywny, ma początek w okresie dojrzewania lub wczesnej dorosłości, jest stabilny w czasie i prowadzi do cierpienia lub upośledzenia funkcjonowania¹. Zaburzenia osobowości dotykają około 9-10% populacji ogólnej i są związane z wysokimi wskaźnikami współchorobowości psychiatrycznej oraz zwiększonym ryzykiem zachorowalności i śmiertelności²³. Chociaż pierwotną metodą leczenia jest psychoterapia, patofizjologia zaburzeń osobowości pozostaje nadal w dużej mierze zagadką⁴.

Model biopsychospołeczny zaburzeń osobowości

Pochodzenie zaburzeń osobowości jest kwestią znacznych kontrowersji. Tradycyjne podejście zakłada, że te nieprzystosowawcze wzorce są wynikiem dysfunkcyjnych wczesnych środowisk, które uniemożliwiają rozwój adaptacyjnych wzorców percepcji, reakcji i obrony⁵. Jednak coraz więcej danych wskazuje na czynniki genetyczne i psychobiologiczne, które przyczyniają się do objawów tych zaburzeń⁶.

Dzisiejsze badania wskazują, że zaburzenia osobowości wynikają z kompleksowej interakcji między czynnikami biologicznymi, psychologicznymi i środowiskowymi⁷⁸. Model biopsychospołeczny sugeruje, że zaburzenia osobowości powstają w wyniku interakcji między predyspozycjami genetycznymi a doświadczeniami życiowymi⁹. Ta złożona interakcja obejmuje nieprawidłowości w strukturach mózgu, funkcjach neuroprzekaźników, czynnikach genetycznych i wczesnych traumatycznych doświadczeniach¹⁰.

Czynniki genetyczne i biologiczne

Badania wykazują, że dla większości zaburzeń osobowości poziomy dziedziczności wynoszą około 50%, co jest podobne lub wyższe niż w przypadku wielu innych poważnych zaburzeń psychiatrycznych¹¹. Stopień dziedziczności przeczy powszechnemu założeniu, że zaburzenia osobowości są głównie wadami charakteru kształtowanymi przez niekorzystne środowisko¹².

Warianty genetyczne, które pośredniczą w ryzyku wystąpienia zaburzeń osobowości, w dużej mierze pozostają nieznane. Kandydatami są geny regulujące neuroprzekaźniki takie jak serotonina, dopamina, norepinefryna i aminy, które odgrywają ważną rolę w regulacji nastroju, skłonnościach samobójczych, agresji, impulsywności i braku empatii¹³. Na przykład:

W przypadku paranoidalnego zaburzenia osobowości dziedziczność szacuje się na 21-50% w różnych badaniach bliźniąt¹⁴.
Badania wykazały związek między krótkimi (S) allelami i genotypami krótkimi/krótkimi (S/S) regionu polimorficznego związanego z genem transportera serotoniny (5-HTTLPR) a niższymi wynikami w Skali Paranoi Minnesocie wielowymiarowego inwentarza osobowości¹⁵.
Podjednostka alfa-1C kanału wapniowego typu L-bramkowanego napięciem (CACNA1C) jest pozytywnie związana z wynikami ideacji paranoidalnej¹⁶.
Warianty aktywności monoaminooksydazy A (MAOA) zostały powiązane z zaburzeniami osobowości z klastra B¹⁷.

Nieprawidłowości neuroanatomiczne

U pacjentów z zaburzeniami osobowości można zaobserwować nieprawidłowości w płatach czołowych, skroniowych i ciemieniowych. Nieprawidłowości te mogą być spowodowane urazami okołoporodowymi, zapaleniem mózgu, urazami lub czynnikami genetycznymi¹⁸. Badania neurobiologiczne różnych zaburzeń osobowości wykazały specyficzne zmiany w strukturach mózgu:

Zaburzenia z klastra A (dziwaczne, ekscentryczne): Badanie przeprowadzone na pacjentach z zaburzeniem schizotypowym osobowości wykazało zmniejszenie objętości płata czołowego mózgu¹⁹. Istnieją również dowody na powiązanie genetyczne między schizofrenią a zaburzeniami osobowości z klastra A²⁰.
Zaburzenia z klastra B (dramatyczne, emocjonalne lub kapryśne): Osobnicy z zaburzeniami osobowości z klastra B wykazują anomalie w górnej korze czołowej i ciele migdałowatym oraz powiększone objętości prążkowia²¹. Badania meta-analityczne wykazały, że zmniejszenie objętości i funkcji w korze przedczołowej to najbardziej powtarzalne odkrycia w badaniach neuroobrazowania u pacjentów z antyspołecznym zaburzeniem osobowości²².
Osobowość borderline: Nadreaktywny układ ciała migdałowatego może predysponować osoby z zaburzeniem osobowości typu borderline do nadmiernej czujności i nadmiernej reakcji na emocjonalne wyrażenia innych ludzi²³. Obserwuje się również zmiany w hipokampie (do 18% mniejszy), mniejsze ciało migdałowate, dysfunkcje w prążkowiu-jądrze półleżącym oraz w ścieżkach nerwowych zakrętu obręczy²⁴.
Zaburzenia z klastra C (lękowe lub bojaźliwe): Patofizjologia zaburzeń osobowości z klastra C jest słabo poznana. Istnieje hipoteza, że w zaburzeniu osobowości obsesyjno-kompulsywnej występuje zakłócenie w neurotransmisji serotoninergicznej podobne do tego obserwowanego w zaburzeniu obsesyjno-kompulsywnym²⁵.

Nieprawidłowości neuroprzekaźnikowe

Zaburzenia osobowości są również związane ze zmniejszoną aktywnością monoaminooksydazy (MAO) i obniżonym poziomem serotoniny²⁶. Jednakże związki anatomii, receptorów i neuroprzekaźników z zaburzeniami osobowości są na tym etapie czysto spekulatywne²⁷. Różne badania sugerują:

Niski próg impulsywnej agresji może być związany ze zmniejszonym hamowaniem przedczołowym i zmniejszoną aktywnością serotoninergiczną mózgu²⁸.
Dysregulacja szlaków dopaminergicznych u pacjentów z zaburzeniami typu schizoidalnego²⁹.
Niskie poziomy hamowania behawioralnego mogą być pośredniczone przez dysregulację serotoninergiczną w układzie przegrodowo-hipokampowym u osób z antyspołecznym zaburzeniem osobowości³⁰.
W zaburzeniu osobowości typu borderline istnieją dowody na zakłócenia w osi podwzgórzowo-przysadkowo-nadnerczowej zgodne ze zmianami związanymi ze stresem i przewlekłym podwyższeniem kortyzolu, wpływającym na regulację emocjonalną i kontrolę impulsów³¹.
Nieprawidłowości w układach neuropeptydowych i funkcji układu endogennych opioidów mogą również przyczyniać się do niektórych objawów zaburzeń osobowości³².

Wszystkie te odkrycia sugerują związek między zaburzoną funkcjonalnością osi HPA a traumą dziecięcą i podkreślają zaangażowanie tego biologicznego systemu w rozwój zaburzeń osobowości³³.

Model pięcio-czynnikowy osobowości

Model pięcioczynnikowy osobowości, rozwinięty w latach 80. i 90. XX wieku, wykazał, że osobowość składa się z pięciu odrębnych cech³⁴. Zaburzenia osobowości są przede wszystkim wynikiem pozytywnej korelacji z Neurotycznością i negatywnego związku z Ugodowością. Ekstrawersja jest związana na oba sposoby³⁵. Ten model pozostaje najbardziej powszechnie akceptowanym wyjaśnieniem rozwoju zaburzeń osobowości³⁶.

Czynniki środowiskowe w patogenezie zaburzeń osobowości

Chociaż badania wykazują istotny komponent genetyczny w rozwoju zaburzeń osobowości, równie ważne są czynniki środowiskowe, szczególnie wczesne doświadczenia życiowe³⁷.

Trauma dziecięca i wczesne środowisko

Teoria psychodynamiczna kładzie duży nacisk na negatywne doświadczenia z wczesnego dzieciństwa i to, jak te doświadczenia wpływają na niezdolność jednostki do nawiązywania zdrowych relacji w dorosłości³⁸. Osoby z zaburzeniami osobowości zgłaszają wyższe poziomy stresu dziecięcego, takie jak życie w ubóstwie, narażenie na przemoc domową i doświadczanie powtarzającego się złego traktowania³⁹.

Badania wykazały, że trauma dziecięca jest silnie związana z rozwojem zaburzeń osobowości:

Do 70% osób z zaburzeniem osobowości typu borderline doświadczyło wykorzystywania seksualnego, emocjonalnego lub fizycznego jako dziecko⁴⁰.
Separacja od matki, słabe przywiązanie matczyne, nieodpowiednie granice rodzinne i zaburzenia używania substancji przez rodziców są również związane z rozwojem osobowości borderline⁴¹.
Jedno badanie ujawniło związek między traumami z dzieciństwa a rozwojem zaburzeń osobowości. Osoby, które doświadczyły znęcania słownego jako dzieci, były trzy razy bardziej narażone na borderline, narcystyczne, obsesyjno-kompulsywne lub paranoidalne zaburzenia osobowości w dorosłości⁴².
U pacjentów z zaburzeniem osobowości borderline często występuje historia przemocy fizycznej i seksualnej, zaniedbania, separacji od opiekunów i/lub utraty rodzica⁴³.

Wzorce przywiązania i dynamika rodzinna

Innym sposobem, w jaki złe traktowanie w dzieciństwie przyczynia się do zaburzeń osobowości, są więzi emocjonalne lub przywiązania rozwijane z podstawowymi opiekunami⁴⁴. Zaburzenia osobowości są często formułowane jako rezultat niepewnego przywiązania, które rozwija się w okresie niemowlęcym i wczesnym dzieciństwie⁴⁵.

Podczas gdy bezpiecznie przywiązane dzieci na ogół nie rozwijają zaburzeń osobowości, osoby z lękowym, ambiwalentnym i zdezorganizowanym przywiązaniem są bardziej narażone na rozwój różnych zaburzeń⁴⁶:

Osoby z lękowym przywiązaniem są narażone na rozwój zaburzeń internalizacyjnych.
Osoby z ambiwalentnym przywiązaniem są narażone na rozwój zaburzeń eksternalizacyjnych.
Osoby ze zdezorganizowanym przywiązaniem są narażone na objawy dysocjacyjne i zaburzenia związane z osobowością⁴⁷.

Czynniki społeczne i kulturowe

Wysoki poziom dysfunkcji psychologicznej i społecznej w rodzinach został również zidentyfikowany jako czynnik przyczyniający się do rozwoju zaburzeń osobowości⁴⁸. U osób z diagnozą zaburzeń osobowości regularnie obserwuje się wysoki poziom ubóstwa, bezrobocia, separacji rodzinnej i bycia świadkiem przemocy domowej⁴⁹.

Czynniki kulturowe mogą również odgrywać rolę w rozwoju zaburzeń osobowości, o czym świadczą różne wskaźniki zaburzeń osobowości w różnych krajach. Na przykład istnieje wyjątkowo niska liczba przypadków antyspołecznych zaburzeń osobowości na Tajwanie, w Chinach i Japonii, wraz ze znacznie wyższymi wskaźnikami zaburzeń osobowości klastra C⁵⁰.

Mechanizmy neurobiologiczne specyficzne dla poszczególnych zaburzeń osobowości

Osobowość typu borderline

Zaburzenie osobowości typu borderline (BPD) charakteryzuje się niestabilnością w relacjach interpersonalnych, zniekształconym poczuciem siebie i intensywnymi reakcjami emocjonalnymi⁵¹. Patofizjologia BPD obejmuje szereg mechanizmów neurobiologicznych:

Badania wykazały zmiany w dwóch obwodach mózgowych związanych z dysregulacją emocjonalną charakterystyczną dla BPD: po pierwsze, eskalacja aktywności w obwodach mózgowych związanych z doświadczaniem silnego bólu emocjonalnego, a po drugie, zmniejszona aktywacja w obwodach odpowiedzialnych za regulację lub tłumienie tych intensywnych emocji⁵².
Neurobiologiczne modele zaburzenia osobowości typu borderline łączą odkrycia w zakresie neuroendokrynologii, strukturalnego neuroobrazowania i funkcjonalnego neuroobrazowania⁵³.
Badania neuroobrazowe wykazały zmniejszenie objętości ciała migdałowatego u osób z zaburzeniem osobowości typu borderline⁵⁴.
Sugeruje się, że ciało migdałowate jest również bardziej wrażliwe u osób z zaburzeniem osobowości typu borderline; gdy osobom z zaburzeniem osobowości typu borderline pokazywane są obrazy mające wywoływać nieprzyjemne emocje, aktywacja ciała migdałowatego jest wyższa w porównaniu z osobami bez tego zaburzenia⁵⁵.
Badania neuroobrazowania osób z objawami zaburzenia osobowości typu borderline ujawniają nieprawidłowości w obwodach czołowo-limbicznych, w tym w brzusznym prążkowiu, ciele migdałowatym, hipokampie, wyspie oraz w korze oczodołowo-czołowej, przedczołowej lub obręczy⁵⁶.

Badania sugerują, że nieprawidłowości w osi podwzgórzowo-przysadkowo-nadnerczowej, mechanizmach neurotransmisji, układzie endogennych opioidów i neuroplastyczności odgrywają rolę w patofizjologii BPD związanej z traumą z dzieciństwa⁵⁷.

Antyspołeczne zaburzenie osobowości

Antyspołeczne zaburzenie osobowości (ASPD) charakteryzuje się brakiem empatii, poczuciem braku winy i wstydu oraz impulsywnością⁵⁸. Mechanizmy patofizjologiczne w ASPD obejmują:

Badania bliźniąt i rodzin wykazały predyspozycję genetyczną w ASPD. Niektóre geny kandydujące związane z ASPD obejmują SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 i kilka genów serotoninergicznych⁵⁹.
Nieprawidłowości strukturalne obejmujące ciało modzelowate, ciało migdałowate, skorupę, przednią część kory obręczy, a także korę oczodołowo-czołową i korę grzbietowo-boczną zostały zidentyfikowane w ASPD⁶⁰.
Inne obserwowane zmiany strukturalne obejmują zmniejszenie objętości istoty szarej, objętości całego mózgu oraz objętości i grubości istoty białej⁶¹.
Funkcjonalne anomalie związane z aktywnością autonomiczną, funkcjami przedczołowymi, a także mózgowymi sieciami funkcjonalnymi, takimi jak sieci sensomotoryczne, sieci poznawcze i połączenia korowo-prążkowiowe⁶².
Czynniki biochemiczne związane z ASPD obejmują redukcję hydrolazy amidów kwasów tłuszczowych (FAAH) w ciele migdałowatym, a także zmiany w poziomach osoczowych biomarkerów zapalnych i czynników neurotropowych, a mianowicie czynnika martwicy nowotworów (TNF)-, interleukiny 10 (IL-10), transformującego czynnika wzrostu (TGF) -1 i neurotroficznego czynnika pochodzenia mózgowego (BNDF)⁶³.

Cechy psychopatyczne i narcystyczne

Cechy psychopatyczne są związane z nieprawidłowościami w ciele migdałowatym, korze oczodołowo-czołowej, przedniej części kory obręczy, tylnej części kory obręczy, hipokampie i górnym zakręcie skroniowym⁶⁴. Narcystyczne zaburzenie osobowości charakteryzuje się wszechobecnym wzorcem wielkości, potrzebą podziwu i brakiem empatii⁶⁵.

Model Lilienfelda podkreśla nieustraszoną dominację, impulsywne antyspołeczne zachowania i zimne serce, podczas gdy model Patricka podkreśla śmiałość, brak zahamowań i złośliwość⁶⁶.

Modele agresji i reaktywności emocjonalnej

Agresja w zaburzeniach osobowości, zwłaszcza w osobowości typu borderline, jest zazwyczaj wywoływana przez rzeczywiste lub postrzegane zagrożenie społeczne, frustrację lub prowokację społeczną⁶⁷. Na podstawie danych behawioralnych i neurobiologicznych zaproponowano model, według którego reaktywna agresja w BPD wynika z kilku mechanizmów:

Nadwrażliwość na zagrożenie społeczne, czyli nadczujność na sygnały zagrożenia społecznego, stronnicze negatywne postrzeganie innych i niemożność rozpoznania sygnałów bezpieczeństwa społecznego.
Podejście, a nie unikanie sygnałów zagrożenia społecznego.
Nieprzystosowawcza regulacja gniewu, gdzie dysregulacja emocjonalna i gniew sekwencyjnie pośredniczą w relacji między BPD a agresją.
Niska zdolność do adekwatnej mentalizacji intencji, poznania i emocji innych.
Nadmierna imitacja emocjonalna i zarażenie emocjami⁶⁸.

Wychodząc z teorii, że rozwój terapii powinien być dostosowany do mechanizmów patogenetycznych leżących u podstaw określonej psychopatologii, opracowano program interwencji psychoterapeutycznej specyficznej dla agresji, zwany terapią psychologiczną opartą na mechanizmach anty-agresji (MAAP), który specjalnie ukierunkowany jest na te mechanizmy⁶⁹.

Implikacje dla leczenia

Lepsze zrozumienie patofizjologii zaburzeń osobowości ma istotne implikacje dla leczenia. Chociaż pierwszą linią leczenia tych zaburzeń jest psychoterapia, pacjenci z zaburzeniami osobowości mogą być wysoce objawowi i często przepisuje się im wiele leków w sposób niepoparty dowodami⁷⁰.

Dowody wstępne z metaanaliz badań klinicznych stanowią wczesną podstawę do kierowania leczeniem i ograniczenia praktyki polyfarmakoterapii. Jednakże dowody pozostają ograniczone ze względu na brak opublikowanych badań oraz ograniczenia w projektowaniu badań i wielkości próby⁷¹.

Ostatnie badania wskazują, że:

Niskie dawki leków przeciwpsychotycznych i stabilizatory nastroju mogą być skuteczne w leczeniu określonych domen objawowych zaburzeń osobowości⁷².
Pacjenci z zaburzeniem osobowości typu borderline mogą odnieść korzyść z suplementacji kwasami tłuszczowymi omega-3, leków przeciwpsychotycznych drugiej generacji i stabilizatorów nastroju⁷³.
Pacjenci z antyspołecznym zaburzeniem osobowości mogą odnieść korzyść ze stosowania stabilizatorów nastroju, leków przeciwpsychotycznych i przeciwdepresyjnych⁷⁴.
Niskie poziomy leków przeciwpsychotycznych są skuteczne w łagodzeniu niektórych objawów zaburzenia osobowości typu schizotypowego⁷⁵.

Pomimo tych obiecujących wyników, praktyka kliniczna jest w dużej mierze kierowana opinią ekspercką i doświadczeniem, które wspierają ocenę względnych zagrożeń i korzyści dla poszczególnych pacjentów z niskimi dawkami leków przeciwpsychotycznych i stabilizatorów nastroju, gdy są stosowane w określonych domenach objawowych⁷⁶.

Wnioski i kierunki na przyszłość

Patogeneza zaburzeń osobowości, podobnie jak większości zaburzeń psychiatrycznych, prawdopodobnie obejmuje predyspozycję organiczną, a także czynniki psychospołeczne i środowiskowe⁷⁷. Niektórzy badacze postulują obecność podstawowej niestabilności afektywnej, na którą jednostka reaguje nieprzystosowawczymi zachowaniami⁷⁸.

Pomimo znacznych postępów w zrozumieniu mechanizmów biologicznych leżących u podstaw zaburzeń osobowości, nadal istnieje wiele pytań bez odpowiedzi. Lepsze zrozumienie biologicznych i epigenetycznych mechanizmów, na które wpływa trauma dziecięca i które są zmienione u pacjentów z zaburzeniami osobowości, mogłoby pozwolić na identyfikację osób wysokiego ryzyka i zapobieganie lub minimalizowanie rozwoju choroby w późniejszym życiu⁷⁹.

Przyszłe badania powinny skupić się na:

Identyfikacji konkretnych genów związanych z zaburzeniami osobowości.
Wyjaśnieniu interakcji między czynnikami genetycznymi a środowiskowymi.
Opracowaniu biomarkerów, które mogą pomóc w diagnozie i leczeniu zaburzeń osobowości.
Opracowaniu ukierunkowanych interwencji farmakologicznych i psychoterapeutycznych opartych na mechanizmach patofizjologicznych.
Badaniu wpływu wczesnych interwencji na zapobieganie rozwojowi zaburzeń osobowości u osób z grupy wysokiego ryzyka.

W miarę jak nasze zrozumienie patofizjologii zaburzeń osobowości staje się bardziej wyrafinowane, interwencje terapeutyczne mogą być coraz bardziej ukierunkowane i skuteczne, prowadząc do lepszych wyników dla osób dotkniętych tymi złożonymi zaburzeniami⁸⁰.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
A personality disorder, as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association, Fifth Edition (DSM-5) is an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. […] Although the most common etiologies for personality disorders are multifactorial, these conditions may also be secondary to biologic, developmental, or genetic abnormalities. Stressful situations may often result in decompensation, revealing a previously unrecognized personality disorder. Indeed, personality disorders are aggravated by stressors, external or self-induced. Individuals may have more than 1 personality disorder.
#2 Personality disorders: Overview of pharmacotherapy – UpToDate
https://www.uptodate.com/contents/personality-disorders-overview-of-pharmacotherapy
Personality disorders cause significant distress and impairment of social, occupational, and role functioning. They are associated with high rates of psychiatric comorbidity and high risks of morbidity and mortality. […] First-line treatment of these disorders is psychotherapy; however, patients with personality disorders may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. In the absence of comprehensive trials assessing efficacy and/or comparing medications, there is limited information to guide adjunctive pharmacotherapy. Preliminary evidence from meta-analyses of clinical trials provides an early basis to guide treatment and limit the practice of polypharmacy. However, the evidence remains limited by lack of published studies and limitations in study design and sample size. Therefore, clinical practice is largely guided by expert opinion and experience, which support the assessing the relative risks and benefits for individual patients of low-dose antipsychotics and mood stabilizers when applied to specified symptom domains. […] On overview of pharmacotherapy for personality disorders are reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis and treatment of individual personality disorders are reviewed separately.
#3 Personality disorders | EBSCO Research Starters
https://www.ebsco.com/research-starters/psychology/personality-disorders
Personality disorders are a group of psychological conditions characterized by enduring, inflexible patterns of thinking, behavior, and emotional response that significantly impair an individual’s ability to function in daily life. […] The personality disorders are a cluster of psychological disorders characterized by inflexible and long-standing patterns of relating to others and the environment that create significant impairment in functioning. […] According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) of the American Psychiatric Association (APA), the personality disorders are defined by an enduring pattern of inner experience and behavior that is consistently dysfunctional and creates impairment in functioning. […] Because the symptoms of cluster-A personality disorders resemble symptoms of schizophrenia, researchers believe these disorders may be genetically related to schizophrenia.
#4 Personality disorder pathophysiology – wikidoc
https://www.wikidoc.org/index.php/Personality_disorder_pathophysiology
The exact pathogenesis of personality disorder is not fully understood. Personality disorders are related to multifactorial causes. […] However still, the pathophysiology of PDs remains enigmatic. The five-factor model of personality was developed in the 1980s and 1990s, which demonstrated that it comprises five distinct traits. […] PDs are primarily the result of positive correlation with Neuroticism and negative association with Agreeableness. Extraversion is associated in both ways. […] This remains the most widely accepted explanation for development of personality disorder.
#5 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
In patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels. However, the relationships of anatomy, receptors, and neurotransmitters to personality disorders are purely speculative at this point. […] The origin of personality disorders is a matter of considerable controversy. Traditional thinking holds that these maladaptive patterns are the result of dysfunctional early environments that prevent the evolution of adaptive patterns of perception, response, and defense. A body of data points toward genetic and psychobiologic contributions to the symptomology of these disorders; however, the inconsistency of the data prevents authorities from drawing definite conclusions.
#6 Personality Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK556058/
Personality disorders reflect an enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the surrounding culture. Individuals with personality disorders may experience distorted perceptions of reality and abnormal affective responses. […] The DSM-5-TR defines a personality disorder as an enduring pattern of inner experience and behavior that deviates significantly from the norms and expectations of the surrounding culture. The behavioral pattern is pervasive, inflexible, and generally starts in adolescence and persists through adulthood, causing distress or impairments. […] There are limited high-quality, evidence-based studies focused directly on the etiology of personality disorders, which are complex and multifactorial. Biological factors contribute to the development of personality in multiple ways. Temperament is a heritable and innate psychobiological characteristic that significantly contributes to personality development.
#7 Borderline personality disorder: diagnosis, clinical features and pathophysiology – The Pharmaceutical Journal
https://pharmaceutical-journal.com/article/ld/borderline-personality-disorder-diagnosis-clinical-features-and-pathophysiology
People with borderline personality disorder often have difficulties in maintaining social relationships and they have a high risk of suicide. […] The exact underlying cause of borderline personality disorder is unclear. This can make it particularly challenging to understand how and why certain medicines or psychological therapies work. […] A biopsychosocial model, where genetic factors and life experiences interplay, can be used to understand how borderline personality disorder develops. […] Genetic and environmental factors are both believed to have a role in the development of borderline personality disorder. Although personality traits are known to be influenced by genetics, no specific genes associated with borderline personality disorder have been identified. […] The brain areas of particular interest in borderline personality disorder are the limbic system and the frontal areas.
#8 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Research regarding the development of personality disorders is limited compared to that of other mental health disorders. The following is a general overview of contributing factors to personality disorders. While there is some research lending itself to specific causes of specific personality disorders, the overall contribution of biological, psychological, and social factors will be reviewed. […] Research across the personality disorders suggests some underlying biological or genetic component; however, identification of specific mechanisms have not been identified in most disorders, except for those below. Because of this lack of concrete evidence, researchers argue that it is difficult to determine what role genetics plays into the development of these disorders compared to that of environmental influences. Therefore, while there is likely a biological predisposition to personality disorders, exact causes cannot be determined at this time.
#9 Personality disorders – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
People with personality disorders often have a hard time understanding emotions and tolerating distress. […] It’s believed that personality disorders are caused by a blend of how genetics and your environment affect you. Your genes may make it more likely that you develop a personality disorder, and what happens to you in life may set a personality disorder into motion. […] Although the specific causes of personality disorders are not known, some factors seem to increase the risk of having one: Specific personality traits. This includes always trying to stay away from harm, or the opposite a strong need to seek out new activities that get the adrenaline pumping. It also includes poor impulse control. […] Personality disorders can seriously disrupt your life and the lives of those who care about you. They may cause issues in relationships, work or school. And they can lead to social isolation, other mental health issues with addictions, as well as occupational and legal issues.
#10 The Neurobiology of Borderline Personality Disorder
https://www.psychiatrictimes.com/view/neurobiology-borderline-personality-disorder
There is more to BPD than meets the eye. A complex interaction exists between environmental, anatomical, functional, genetic, and epigenetic factors. […] Clarification of the molecular and biological underpinnings of borderline personality disorder (BPD) is imperative for a more thorough understanding of the disorder, one that anchors our quest for effective treatment. […] Research clearly demonstrates that BPD evolves from a complex interaction between environmental, anatomical, functional, genetic, and epigenetic factors. There are many risk factors, and each one serves to strengthen the others. […] While functional imaging and genetic studies are beginning to gain momentum, these preliminary findings await replication with larger sample sizes, longitudinal capacities, and more refined methodologies.
#11 Overview of Personality Disorders – Psychiatric Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders
Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. […] For most personality disorders, levels of heritability are about 50%, which is similar to or higher than that of many other major psychiatric disorders. This degree of heritability argues against the common assumption that personality disorders are character flaws primarily shaped by an adverse environment. […] Diagnosis of a personality disorder requires a persistent, inflexible, pervasive pattern of maladaptive traits involving 2 of the following: Cognition (ie, ways of perceiving and interpreting self, others, and events), Affectivity (ie, range, intensity, lability, and appropriateness of emotional response), Interpersonal functioning, Impulse control.
#12 Overview of Personality Disorders – Psychiatric Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders
Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. […] For most personality disorders, levels of heritability are about 50%, which is similar to or higher than that of many other major psychiatric disorders. This degree of heritability argues against the common assumption that personality disorders are character flaws primarily shaped by an adverse environment. […] Diagnosis of a personality disorder requires a persistent, inflexible, pervasive pattern of maladaptive traits involving 2 of the following: Cognition (ie, ways of perceiving and interpreting self, others, and events), Affectivity (ie, range, intensity, lability, and appropriateness of emotional response), Interpersonal functioning, Impulse control.
#13 Genetic and Neuroimaging Features of Personality Disorders: State of the Art
https://pmc.ncbi.nlm.nih.gov/articles/PMC5563771/
The genetic variants that mediate the risk for personality disorders remain largely unknown. Candidate genes include those that regulate neurotransmitters such as serotonin, dopamine, norepinephrine, and amines, which play important roles in mood regulation, suicidality, aggression, impulsivity, lack of empathy, and other important sub-domains of the symptomatology of personality disorders. […] The heritability of paranoid personality disorder has been estimated at 50% in a study of 122 twins aged 415 years, and at 21% and 28% in others, although these studies suffered equally from imperfect test-retest reliability of the measurement for personality disorder. […] In a study that used both self-report questionnaires and interviews as measures of personality disorder, the heritability estimate reached 66%.
#14 Genetic and Neuroimaging Features of Personality Disorders: State of the Art
https://pmc.ncbi.nlm.nih.gov/articles/PMC5563771/
The genetic variants that mediate the risk for personality disorders remain largely unknown. Candidate genes include those that regulate neurotransmitters such as serotonin, dopamine, norepinephrine, and amines, which play important roles in mood regulation, suicidality, aggression, impulsivity, lack of empathy, and other important sub-domains of the symptomatology of personality disorders. […] The heritability of paranoid personality disorder has been estimated at 50% in a study of 122 twins aged 415 years, and at 21% and 28% in others, although these studies suffered equally from imperfect test-retest reliability of the measurement for personality disorder. […] In a study that used both self-report questionnaires and interviews as measures of personality disorder, the heritability estimate reached 66%.
#15 Genetic and Neuroimaging Features of Personality Disorders: State of the Art
https://pmc.ncbi.nlm.nih.gov/articles/PMC5563771/
A study of patients with affective disorder and schizophrenia spectrum disorders and healthy controls has identified an association between the short (S) allele and short/short (S/S) allele genotypes of the serotonin-transporter gene-linked polymorphic region (5-HTTLPR) with lower scores on the Paranoia Scale of the Minnesota Multiphasic Personality Inventory, suggesting that the S/S allele genotype might minimize the expression of the paranoid trait. […] The alpha-1C subunit of the L-type voltage-gated Ca2+ channel (CACNA1C) couples transient activation of the inward Ca2+ current to transcriptional regulation and plays important roles in dendritic development, neuronal survival, synaptic plasticity, memory formation, learning, and behavior. […] A gene study has demonstrated that CACNA1C (rs1006737) is positively associated with paranoid ideation scores as assessed by the Schizotypal Traits Questionnaire.
#16 Genetic and Neuroimaging Features of Personality Disorders: State of the Art
https://pmc.ncbi.nlm.nih.gov/articles/PMC5563771/
A study of patients with affective disorder and schizophrenia spectrum disorders and healthy controls has identified an association between the short (S) allele and short/short (S/S) allele genotypes of the serotonin-transporter gene-linked polymorphic region (5-HTTLPR) with lower scores on the Paranoia Scale of the Minnesota Multiphasic Personality Inventory, suggesting that the S/S allele genotype might minimize the expression of the paranoid trait. […] The alpha-1C subunit of the L-type voltage-gated Ca2+ channel (CACNA1C) couples transient activation of the inward Ca2+ current to transcriptional regulation and plays important roles in dendritic development, neuronal survival, synaptic plasticity, memory formation, learning, and behavior. […] A gene study has demonstrated that CACNA1C (rs1006737) is positively associated with paranoid ideation scores as assessed by the Schizotypal Traits Questionnaire.
#17 Cluster B Personality Disorders are Associated with Allelic Variation of Monoamine Oxidase A Activity | Neuropsychopharmacology
https://www.nature.com/articles/1300737
Genetic variants of the monoamine oxidase A (MAOA) have been associated with aggression-, anxiety-, and addiction-related behavior in several nonclinical and clinical populations. Here, we investigated the influence of allelic variation of MAOA activity on aggression-related personality traits and disease risk in patients with personality disorders. […] MAOA genotype was significantly associated with cluster B personality disorders (Ï2=7.77, p=0.005, df=1) but not with cluster C personality disorders. […] Our findings further support the notion that allelic variation of MAOA activity contributes modestly to the balance of hyper- (impulsive-aggressive) and hyporeactive (anxious-depressive) traits. […] The MAOA-LPR has been linked to antisocial behavior in alcohol-dependent males, and with impulsivity, hostility, and a lifetime history of aggression in a community sample of men.
#18 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
In patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels. However, the relationships of anatomy, receptors, and neurotransmitters to personality disorders are purely speculative at this point. […] The origin of personality disorders is a matter of considerable controversy. Traditional thinking holds that these maladaptive patterns are the result of dysfunctional early environments that prevent the evolution of adaptive patterns of perception, response, and defense. A body of data points toward genetic and psychobiologic contributions to the symptomology of these disorders; however, the inconsistency of the data prevents authorities from drawing definite conclusions.
#19 Personality Disorders: Types, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview
Personality disorders are among the least understood mental health conditions. Scientists are still trying to figure out the cause of them. […] So far, they believe the following factors may contribute to the development of personality disorders: […] Scientists have identified a malfunctioning gene that may be a factor in obsessive-compulsive personality disorder. Researchers are also exploring genetic links to aggression, anxiety and fear, which are traits that can play a role in personality disorders. […] Researchers have identified subtle brain differences in people with certain personality disorders. For example, findings in studies on paranoid personality disorder point to altered amygdala functioning. The amygdala is the part of your brain that’s involved with processing fearful and threatening stimuli. In a study on schizotypal personality disorder, researchers found a volumetric decrease in the frontal lobe of their brain.
#20 Personality Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK556058/
Genetic factors have been attributed as significant contributors to the development of a personality disorder; this was supported by multiple studies that investigated twin, linkage, candidate gene association studies, genome-wide association studies, and polygenic analyses. […] Limited high-quality, evidence-based investigations of neuroimaging and histopathological findings among personality disorders exist. Some studies propose that there is a genetic link between schizophrenia and cluster A personality disorder, forming a spectrum of schizophrenia-like illnesses; however, the current clinical understanding of the relationship between cluster A personality disorders and schizophrenia is limited. […] Current neurobiological models of borderline personality disorder link findings across neuroendocrinology, structural neuroimaging, and functional neuroimaging. Specific genes may be involved with disruptions in the hypothalamic-pituitary-adrenal axis consistent with stress-related changes and chronic elevation of cortisol, affecting emotional regulation and impulse control.
#21 The Biological Basis to Personality Disorders
https://www.psychiatrist.com/pcc/biological-basis-to-personality-disorders/
Objective: To provide understanding into the biological basis of thinking and behavior in people with personality disorders, explain anatomic findings, and appraise therapeutic options. […] There are anatomic features typical to the brains of individuals with cluster B personality disorders, for example, abnormalities in the superior frontal cortex and amygdala and enlarged striatal volumes. Emotional dysregulation and impulsiveness are 2 prominent symptoms. Hereditary factors may contribute to the development of such conditions. […] Understanding the neurobiology of cluster B personality disorders expands knowledge that hopefully results in better clinical management and development of improved treatments. […] The psychobiology of personality disorders is best understood in the cluster B group. Expressions of borderline personality disorder include emotional dysregulation, poor response inhibition, impulsive or externalizing behaviors, and strong substance use associations.
#22 Genetic and Neuroimaging Features of Personality Disorders: State of the Art
https://pmc.ncbi.nlm.nih.gov/articles/PMC5563771/
A meta-analytical study has shown that reduced volume and function in the prefrontal cortex are the most replicated neuroimaging findings in patients with antisocial personality disorder. […] Some findings have also suggested that male preponderance in antisocial personality disorder might be partly explained by the smaller orbitofrontal and middle frontal volumes in males than in females. […] Neuroimaging techniques have greatly enriched the field of brain research, and have also added extensive new knowledge regarding personality disorders.
#23 The Biological Basis to Personality Disorders
https://www.psychiatrist.com/pcc/biological-basis-to-personality-disorders/
A hyperreactive amygdala could predispose individuals with borderline personality disorder to be hypervigilant and overreactive to other peoples emotional expressions; these individuals might also exhibit ambiguity about the attitudes of others. […] In addition to excessive amygdala reactivity, a low threshold for impulsive aggression may also be related to reduced prefrontal inhibition and reduced serotonergic brain activity. […] Neuroimaging studies of subjects with symptoms of borderline personality disorder or a diagnosis of a cluster B personality disorder reveal abnormalities in frontolimbic circuitry, including at the ventral striatum, amygdala, hippocampus, insula, and orbitofrontal, prefrontal, or cingulate cortexes. […] There may be a genetic component for the development of borderline personality disorder in that there are genetic influences on traits such as neuroticism, impulsivity, anxiousness, lability, and insecurity.
#24 Personality disorder – Wikipedia
https://en.wikipedia.org/wiki/Personality_disorder
Research shows that several brain regions are altered in personality disorders, particularly: hippocampus up to 18% smaller, a smaller amygdala, malfunctions in the striatum-nucleus accumbens and the cingulum neural pathways connecting them and taking care of the feedback loops on what to do with all the incoming information from the multiple senses; so what comes out is anti-social not according to what is the social norm, socially acceptable and appropriate.
#25 Personality Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK556058/
The pathophysiology of cluster C personality disorders is poorly understood. Although obsessive-compulsive disorder and obsessive-compulsive personality disorder are separate conditions, they have intersecting traits. There is a hypothesis stating that in obsessive-compulsive personality disorder, there is a disruption in serotonergic neurotransmission similar to that seen in obsessive-compulsive disorder.
#26 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
In patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels. However, the relationships of anatomy, receptors, and neurotransmitters to personality disorders are purely speculative at this point. […] The origin of personality disorders is a matter of considerable controversy. Traditional thinking holds that these maladaptive patterns are the result of dysfunctional early environments that prevent the evolution of adaptive patterns of perception, response, and defense. A body of data points toward genetic and psychobiologic contributions to the symptomology of these disorders; however, the inconsistency of the data prevents authorities from drawing definite conclusions.
#27 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
In patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels. However, the relationships of anatomy, receptors, and neurotransmitters to personality disorders are purely speculative at this point. […] The origin of personality disorders is a matter of considerable controversy. Traditional thinking holds that these maladaptive patterns are the result of dysfunctional early environments that prevent the evolution of adaptive patterns of perception, response, and defense. A body of data points toward genetic and psychobiologic contributions to the symptomology of these disorders; however, the inconsistency of the data prevents authorities from drawing definite conclusions.
#28 The Biological Basis to Personality Disorders
https://www.psychiatrist.com/pcc/biological-basis-to-personality-disorders/
A hyperreactive amygdala could predispose individuals with borderline personality disorder to be hypervigilant and overreactive to other peoples emotional expressions; these individuals might also exhibit ambiguity about the attitudes of others. […] In addition to excessive amygdala reactivity, a low threshold for impulsive aggression may also be related to reduced prefrontal inhibition and reduced serotonergic brain activity. […] Neuroimaging studies of subjects with symptoms of borderline personality disorder or a diagnosis of a cluster B personality disorder reveal abnormalities in frontolimbic circuitry, including at the ventral striatum, amygdala, hippocampus, insula, and orbitofrontal, prefrontal, or cingulate cortexes. […] There may be a genetic component for the development of borderline personality disorder in that there are genetic influences on traits such as neuroticism, impulsivity, anxiousness, lability, and insecurity.
#29 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling. […] Support for the heritability of this disorder exists. […] This disorder is genetically linked with schizophrenia. Evidence for dysregulation of dopaminergic pathways in these patients exists. […] A genetic contribution to antisocial behaviors is strongly supported. Low levels of behavioral inhibition may be mediated by serotonergic dysregulation in the septohippocampal system. There may also be developmental or acquired abnormalities in the prefrontal brain systems and reduced autonomic activity in antisocial personality disorder. This may underlie the low arousal, poor fear conditioning, and decision-making deficits described in antisocial personality disorder.
#30 Personality Disorders: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/294307-overview
A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling. […] Support for the heritability of this disorder exists. […] This disorder is genetically linked with schizophrenia. Evidence for dysregulation of dopaminergic pathways in these patients exists. […] A genetic contribution to antisocial behaviors is strongly supported. Low levels of behavioral inhibition may be mediated by serotonergic dysregulation in the septohippocampal system. There may also be developmental or acquired abnormalities in the prefrontal brain systems and reduced autonomic activity in antisocial personality disorder. This may underlie the low arousal, poor fear conditioning, and decision-making deficits described in antisocial personality disorder.
#31 Personality Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK556058/
Genetic factors have been attributed as significant contributors to the development of a personality disorder; this was supported by multiple studies that investigated twin, linkage, candidate gene association studies, genome-wide association studies, and polygenic analyses. […] Limited high-quality, evidence-based investigations of neuroimaging and histopathological findings among personality disorders exist. Some studies propose that there is a genetic link between schizophrenia and cluster A personality disorder, forming a spectrum of schizophrenia-like illnesses; however, the current clinical understanding of the relationship between cluster A personality disorders and schizophrenia is limited. […] Current neurobiological models of borderline personality disorder link findings across neuroendocrinology, structural neuroimaging, and functional neuroimaging. Specific genes may be involved with disruptions in the hypothalamic-pituitary-adrenal axis consistent with stress-related changes and chronic elevation of cortisol, affecting emotional regulation and impulse control.
#32 Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1383-2
All these findings suggest an association between a deregulated functionality of the HPA axis and childhood trauma and highlight the involvement of this biological system in the development of BPD. […] In addition to the presence of HPA axis dysfunction, several studies have also proposed that childhood trauma can affect glutamatergic, serotonergic, dopaminergic and noradrenergic transmission, suggesting that BPD is the result of alterations in several interacting neurotransmitter systems. […] According to Bandelow and Schmahls theory, a reduction in the sensitivity of the opioid receptors or in the availability of endogenous opioids might constitute part of the underlying pathophysiology of BPD. […] Among the biological systems found involved in BPD pathogenesis and particularly affected by childhood trauma events, there are: the HPA axis, the neurotransmission mechanisms, the endogenous opioid system and the neuroplasticity.
#33 Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1383-2
All these findings suggest an association between a deregulated functionality of the HPA axis and childhood trauma and highlight the involvement of this biological system in the development of BPD. […] In addition to the presence of HPA axis dysfunction, several studies have also proposed that childhood trauma can affect glutamatergic, serotonergic, dopaminergic and noradrenergic transmission, suggesting that BPD is the result of alterations in several interacting neurotransmitter systems. […] According to Bandelow and Schmahls theory, a reduction in the sensitivity of the opioid receptors or in the availability of endogenous opioids might constitute part of the underlying pathophysiology of BPD. […] Among the biological systems found involved in BPD pathogenesis and particularly affected by childhood trauma events, there are: the HPA axis, the neurotransmission mechanisms, the endogenous opioid system and the neuroplasticity.
#34 Personality disorder pathophysiology – wikidoc
https://www.wikidoc.org/index.php/Personality_disorder_pathophysiology
The exact pathogenesis of personality disorder is not fully understood. Personality disorders are related to multifactorial causes. […] However still, the pathophysiology of PDs remains enigmatic. The five-factor model of personality was developed in the 1980s and 1990s, which demonstrated that it comprises five distinct traits. […] PDs are primarily the result of positive correlation with Neuroticism and negative association with Agreeableness. Extraversion is associated in both ways. […] This remains the most widely accepted explanation for development of personality disorder.
#35 Personality disorder pathophysiology – wikidoc
https://www.wikidoc.org/index.php/Personality_disorder_pathophysiology
The exact pathogenesis of personality disorder is not fully understood. Personality disorders are related to multifactorial causes. […] However still, the pathophysiology of PDs remains enigmatic. The five-factor model of personality was developed in the 1980s and 1990s, which demonstrated that it comprises five distinct traits. […] PDs are primarily the result of positive correlation with Neuroticism and negative association with Agreeableness. Extraversion is associated in both ways. […] This remains the most widely accepted explanation for development of personality disorder.
#36 Personality disorder pathophysiology – wikidoc
https://www.wikidoc.org/index.php/Personality_disorder_pathophysiology
The exact pathogenesis of personality disorder is not fully understood. Personality disorders are related to multifactorial causes. […] However still, the pathophysiology of PDs remains enigmatic. The five-factor model of personality was developed in the 1980s and 1990s, which demonstrated that it comprises five distinct traits. […] PDs are primarily the result of positive correlation with Neuroticism and negative association with Agreeableness. Extraversion is associated in both ways. […] This remains the most widely accepted explanation for development of personality disorder.
#37 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Psychodynamic, cognitive, and behavioral theories are among the most common psychological models used to explain the development of personality disorders. Although much is still speculation, the following are general etiological views with regards to each specific theory. […] The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individuals inability to establish healthy relationships in adulthood. More specifically, individuals with personality disorders report higher levels of childhood stress, such as living in impoverished environments, exposure to domestic violence, and experiencing repeated maltreatment. Additionally, high levels of childhood neglect and parental rejection are also observed in personality disorder patients, with early parental loss and rejection leading to fears of abandonment throughout an individuals life.
#38 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Psychodynamic, cognitive, and behavioral theories are among the most common psychological models used to explain the development of personality disorders. Although much is still speculation, the following are general etiological views with regards to each specific theory. […] The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individuals inability to establish healthy relationships in adulthood. More specifically, individuals with personality disorders report higher levels of childhood stress, such as living in impoverished environments, exposure to domestic violence, and experiencing repeated maltreatment. Additionally, high levels of childhood neglect and parental rejection are also observed in personality disorder patients, with early parental loss and rejection leading to fears of abandonment throughout an individuals life.
#39 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Psychodynamic, cognitive, and behavioral theories are among the most common psychological models used to explain the development of personality disorders. Although much is still speculation, the following are general etiological views with regards to each specific theory. […] The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individuals inability to establish healthy relationships in adulthood. More specifically, individuals with personality disorders report higher levels of childhood stress, such as living in impoverished environments, exposure to domestic violence, and experiencing repeated maltreatment. Additionally, high levels of childhood neglect and parental rejection are also observed in personality disorder patients, with early parental loss and rejection leading to fears of abandonment throughout an individuals life.
#40 Borderline Personality Disorder: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9762-borderline-personality-disorder-bpd
Borderline personality disorder is one of a group of conditions called Cluster B personality disorders, which involve dramatic and erratic behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress. […] Healthcare providers believe BPD results from a combination of factors, including: […] Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries and parental substance use disorder are also associated with BPD. […] Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely but not guaranteed to develop the condition. […] Brain changes: In people with BPD, the parts of their brain that control emotion and behavior don’t communicate properly. These problems affect the way their brain works.
#41 Borderline Personality Disorder: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9762-borderline-personality-disorder-bpd
Borderline personality disorder is one of a group of conditions called Cluster B personality disorders, which involve dramatic and erratic behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress. […] Healthcare providers believe BPD results from a combination of factors, including: […] Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries and parental substance use disorder are also associated with BPD. […] Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely but not guaranteed to develop the condition. […] Brain changes: In people with BPD, the parts of their brain that control emotion and behavior don’t communicate properly. These problems affect the way their brain works.
#42 Personality Disorders: Types, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview
One study revealed a link between childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma. People with borderline and antisocial personality disorders have issues with intimacy and trust, both of which may be related to childhood abuse and trauma. […] In one study, people who experienced verbal abuse as children were three times as likely to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood. […] Cultural factors may also play a role in the development of personality disorders, as demonstrated by the varying rates of personality disorders between different countries. For example, there are remarkably low cases of antisocial personality disorders in Taiwan, China and Japan, along with significantly higher rates of cluster C personality disorders.
#43 Borderline Personality Disorder (BPD) – Psychiatric Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/borderline-personality-disorder-bpd
Stresses during early childhood may contribute to the development of borderline personality disorder. A childhood history of physical and sexual abuse, neglect, separation from caregivers, and/or loss of a parent is common among patients with borderline personality disorder. […] Certain people may have a genetic tendency to have pathologic responses to environmental life stresses, and borderline personality disorder clearly appears to have a heritable component. First-degree relatives of patients with borderline personality disorder are 5 times more likely to have the disorder than the general population. […] Disturbances in regulatory functions of the brain and neuropeptide systems may also contribute but are not present in all patients with borderline personality disorder.
#44 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers. […] While securely attached children generally do not develop personality disorders, those with anxious, ambivalent, and disorganized attachment are at an increased risk of developing various disorders. More specifically, those with an anxious attachment are at-risk for developing internalizing disorders, ambivalent are at-risk for developing externalizing disorders, and disorganized are at-risk for dissociative symptoms and personality-related disorders. […] Biological causes of personality disorders have not been identified in most disorders, the exception being schizotypal which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes.
#45 Borderline Personality Disorder: BPD Symptoms, Signs, Help
https://www.helpguide.org/mental-health/personality-disorders/borderline-personality-disorder
Most mental health professionals believe that borderline personality disorder is caused by a combination of inherited or internal biological factors and external environmental factors. Symptoms usually first appear in the teen years and tend to be more severe in young adulthood. […] While the exact causes of BPD aren’t fully known, genetic factors may play a role. Studies have indicated that you have an elevated risk of developing borderline personality disorder if you have a family history of BPD, especially in close family, such as your parents or siblings. […] In addition to genetics, environmental factors may also increase your risk of developing borderline personality disorder. These factors could include childhood trauma, abuse, or neglect. Abandonment by a parent or an otherwise disrupted home life. Interrupted bonding as an infant, resulting in insecure attachment.
#46 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers. […] While securely attached children generally do not develop personality disorders, those with anxious, ambivalent, and disorganized attachment are at an increased risk of developing various disorders. More specifically, those with an anxious attachment are at-risk for developing internalizing disorders, ambivalent are at-risk for developing externalizing disorders, and disorganized are at-risk for dissociative symptoms and personality-related disorders. […] Biological causes of personality disorders have not been identified in most disorders, the exception being schizotypal which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes.
#47 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers. […] While securely attached children generally do not develop personality disorders, those with anxious, ambivalent, and disorganized attachment are at an increased risk of developing various disorders. More specifically, those with an anxious attachment are at-risk for developing internalizing disorders, ambivalent are at-risk for developing externalizing disorders, and disorganized are at-risk for dissociative symptoms and personality-related disorders. […] Biological causes of personality disorders have not been identified in most disorders, the exception being schizotypal which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes.
#48 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Behavioral theorists apply three major theories to explain the development of personality disorders: modeling, reinforcement, and lack of social skills. […] High levels of psychological and social dysfunction within families have also been identified as contributing factors to the development of personality disorders. High levels of poverty, unemployment, family separation, and witnessing domestic violence are routinely observed in individuals diagnosed with personality disorders. […] Childhood maltreatment is among the most influential argument for the development of personality disorders in adulthood. Individuals with personality disorders often struggle with a sense of self and the ability to relate to otherssomething that is generally developed during the first four to six years of a childs life, and it is affected by the emotional environment in which that child was raised.
#49 13.4: Personality Disorders – Etiology – Social Sci LibreTexts
https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology
Behavioral theorists apply three major theories to explain the development of personality disorders: modeling, reinforcement, and lack of social skills. […] High levels of psychological and social dysfunction within families have also been identified as contributing factors to the development of personality disorders. High levels of poverty, unemployment, family separation, and witnessing domestic violence are routinely observed in individuals diagnosed with personality disorders. […] Childhood maltreatment is among the most influential argument for the development of personality disorders in adulthood. Individuals with personality disorders often struggle with a sense of self and the ability to relate to otherssomething that is generally developed during the first four to six years of a childs life, and it is affected by the emotional environment in which that child was raised.
#50 Personality Disorders: Types, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview
One study revealed a link between childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma. People with borderline and antisocial personality disorders have issues with intimacy and trust, both of which may be related to childhood abuse and trauma. […] In one study, people who experienced verbal abuse as children were three times as likely to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood. […] Cultural factors may also play a role in the development of personality disorders, as demonstrated by the varying rates of personality disorders between different countries. For example, there are remarkably low cases of antisocial personality disorders in Taiwan, China and Japan, along with significantly higher rates of cluster C personality disorders.
#51 Borderline personality disorder – Wikipedia
https://en.wikipedia.org/wiki/Borderline_personality_disorder
Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. […] The causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development. […] A genetic predisposition is evident, with the disorder significantly more common in people with a family history of BPD, particularly immediate relatives. […] Psychosocial factors, particularly adverse childhood experiences, have been proposed. […] Research employing structural neuroimaging techniques, such as voxel-based morphometry, has reported variations in individuals diagnosed with BPD in specific brain regions that have been associated with the psychopathology of BPD.
#52 Borderline personality disorder – Wikipedia
https://en.wikipedia.org/wiki/Borderline_personality_disorder
Research has shown changes in two brain circuits implicated in the emotional dysregulation characteristic of BPD: firstly, an escalation in activity within brain circuits associated with experiencing severe emotional pain, and secondly, a decreased activation within circuits tasked with the regulation or suppression of these intense emotions. […] The etiology, or causes, of BPD is multifaceted, with no consensus on a singular cause. […] BPD may share a connection with post-traumatic stress disorder (PTSD), having both a traumatic substrate. […] While childhood trauma is a recognized contributing factor, the roles of congenital brain abnormalities, genetics, neurobiology, and non-traumatic environmental factors remain subjects of ongoing investigation.
#53 Personality Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK556058/
Genetic factors have been attributed as significant contributors to the development of a personality disorder; this was supported by multiple studies that investigated twin, linkage, candidate gene association studies, genome-wide association studies, and polygenic analyses. […] Limited high-quality, evidence-based investigations of neuroimaging and histopathological findings among personality disorders exist. Some studies propose that there is a genetic link between schizophrenia and cluster A personality disorder, forming a spectrum of schizophrenia-like illnesses; however, the current clinical understanding of the relationship between cluster A personality disorders and schizophrenia is limited. […] Current neurobiological models of borderline personality disorder link findings across neuroendocrinology, structural neuroimaging, and functional neuroimaging. Specific genes may be involved with disruptions in the hypothalamic-pituitary-adrenal axis consistent with stress-related changes and chronic elevation of cortisol, affecting emotional regulation and impulse control.
#54 Borderline personality disorder: diagnosis, clinical features and pathophysiology – The Pharmaceutical Journal
https://pharmaceutical-journal.com/article/ld/borderline-personality-disorder-diagnosis-clinical-features-and-pathophysiology
Neuroimaging studies have found there is a reduction in volume of the amygdala in people with borderline personality disorder. […] It has been suggested that the amygdala is also more sensitive in people with borderline personality disorder; when people with borderline personality disorder are shown images designed to elicit unpleasant emotions, activation of the amygdala has been found to be higher compared with those without the disorder.
#55 Borderline personality disorder: diagnosis, clinical features and pathophysiology – The Pharmaceutical Journal
https://pharmaceutical-journal.com/article/ld/borderline-personality-disorder-diagnosis-clinical-features-and-pathophysiology
Neuroimaging studies have found there is a reduction in volume of the amygdala in people with borderline personality disorder. […] It has been suggested that the amygdala is also more sensitive in people with borderline personality disorder; when people with borderline personality disorder are shown images designed to elicit unpleasant emotions, activation of the amygdala has been found to be higher compared with those without the disorder.
#56 The Biological Basis to Personality Disorders
https://www.psychiatrist.com/pcc/biological-basis-to-personality-disorders/
A hyperreactive amygdala could predispose individuals with borderline personality disorder to be hypervigilant and overreactive to other peoples emotional expressions; these individuals might also exhibit ambiguity about the attitudes of others. […] In addition to excessive amygdala reactivity, a low threshold for impulsive aggression may also be related to reduced prefrontal inhibition and reduced serotonergic brain activity. […] Neuroimaging studies of subjects with symptoms of borderline personality disorder or a diagnosis of a cluster B personality disorder reveal abnormalities in frontolimbic circuitry, including at the ventral striatum, amygdala, hippocampus, insula, and orbitofrontal, prefrontal, or cingulate cortexes. […] There may be a genetic component for the development of borderline personality disorder in that there are genetic influences on traits such as neuroticism, impulsivity, anxiousness, lability, and insecurity.
#57 Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1383-2
All these findings suggest an association between a deregulated functionality of the HPA axis and childhood trauma and highlight the involvement of this biological system in the development of BPD. […] In addition to the presence of HPA axis dysfunction, several studies have also proposed that childhood trauma can affect glutamatergic, serotonergic, dopaminergic and noradrenergic transmission, suggesting that BPD is the result of alterations in several interacting neurotransmitter systems. […] According to Bandelow and Schmahls theory, a reduction in the sensitivity of the opioid receptors or in the availability of endogenous opioids might constitute part of the underlying pathophysiology of BPD. […] Among the biological systems found involved in BPD pathogenesis and particularly affected by childhood trauma events, there are: the HPA axis, the neurotransmission mechanisms, the endogenous opioid system and the neuroplasticity.
#58 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
Antisocial personality disorder (ASPD) is characterized by a lack of empathy, a sense of guiltlessness and shamelessness, as well as impulsiveness. […] This review gives an overview of the etiological and clinical aspects of ASPD and critically examines ASPD from the structural, functional and biochemical perspectives. […] Twin and family studies showed genetic predisposition in ASPD. Some candidate genes associated with ASPD include SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 and several serotonergic genes. […] Structural abnormalities involving the corpus callosum, amygdala, putamen, anterior cingulate cortex, as well as orbitofrontal- and dorsolateral frontal cortices have been identified in ASPD. […] Other observed structural changes include a decrease in grey matter volume, whole-brain volume, and white matter volume and thickness.
#59 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
Antisocial personality disorder (ASPD) is characterized by a lack of empathy, a sense of guiltlessness and shamelessness, as well as impulsiveness. […] This review gives an overview of the etiological and clinical aspects of ASPD and critically examines ASPD from the structural, functional and biochemical perspectives. […] Twin and family studies showed genetic predisposition in ASPD. Some candidate genes associated with ASPD include SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 and several serotonergic genes. […] Structural abnormalities involving the corpus callosum, amygdala, putamen, anterior cingulate cortex, as well as orbitofrontal- and dorsolateral frontal cortices have been identified in ASPD. […] Other observed structural changes include a decrease in grey matter volume, whole-brain volume, and white matter volume and thickness.
#60 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
Antisocial personality disorder (ASPD) is characterized by a lack of empathy, a sense of guiltlessness and shamelessness, as well as impulsiveness. […] This review gives an overview of the etiological and clinical aspects of ASPD and critically examines ASPD from the structural, functional and biochemical perspectives. […] Twin and family studies showed genetic predisposition in ASPD. Some candidate genes associated with ASPD include SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 and several serotonergic genes. […] Structural abnormalities involving the corpus callosum, amygdala, putamen, anterior cingulate cortex, as well as orbitofrontal- and dorsolateral frontal cortices have been identified in ASPD. […] Other observed structural changes include a decrease in grey matter volume, whole-brain volume, and white matter volume and thickness.
#61 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
Antisocial personality disorder (ASPD) is characterized by a lack of empathy, a sense of guiltlessness and shamelessness, as well as impulsiveness. […] This review gives an overview of the etiological and clinical aspects of ASPD and critically examines ASPD from the structural, functional and biochemical perspectives. […] Twin and family studies showed genetic predisposition in ASPD. Some candidate genes associated with ASPD include SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 and several serotonergic genes. […] Structural abnormalities involving the corpus callosum, amygdala, putamen, anterior cingulate cortex, as well as orbitofrontal- and dorsolateral frontal cortices have been identified in ASPD. […] Other observed structural changes include a decrease in grey matter volume, whole-brain volume, and white matter volume and thickness.
#62 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
In addition, functional abnormalities involving autonomic activity, prefrontal functions, as well as brain functional networks like sensorimotor networks, cognitive networks and cortico-striatal connectivity have been reported. […] Biochemical factors associated with ASPD include fatty acid amide hydrolase (FAAH) reduction in the amygdala, as well as changes in plasma levels of inflammatory biomarkers and neurotropic factors namely, tumor necrosis factor (TNF)-, interleukin 10 (IL-10), transforming growth factor (TGF)-1 and brain-derived neurotrophic factor (BNDF). […] Understanding the disease from different perspectives is important, as this provides insights into the underlying mechanisms of ASPD, whereas the associated biochemical markers can be used as potential diagnostic and treatment targets for ASPD.
#63 Psychopathology of antisocial personality disorder: from the structural, functional and biochemical perspectives | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00717-4
In addition, functional abnormalities involving autonomic activity, prefrontal functions, as well as brain functional networks like sensorimotor networks, cognitive networks and cortico-striatal connectivity have been reported. […] Biochemical factors associated with ASPD include fatty acid amide hydrolase (FAAH) reduction in the amygdala, as well as changes in plasma levels of inflammatory biomarkers and neurotropic factors namely, tumor necrosis factor (TNF)-, interleukin 10 (IL-10), transforming growth factor (TGF)-1 and brain-derived neurotrophic factor (BNDF). […] Understanding the disease from different perspectives is important, as this provides insights into the underlying mechanisms of ASPD, whereas the associated biochemical markers can be used as potential diagnostic and treatment targets for ASPD.
#64 The Biological Basis to Personality Disorders
https://www.psychiatrist.com/pcc/biological-basis-to-personality-disorders/
Psychopathic traits are associated with abnormalities in the amygdala, orbitofrontal cortex, anterior cingulate, posterior cingulate, hippocampus, and superior temporal gyrus. […] Antisocial personality disorder is more common among first-degree biological relatives than in the general population. […] The traditional intervention for borderline personality disorder is psychotherapy.
#65 Personality Disorders: Diagnosis | CAMH
https://www.camh.ca/en/professionals/treating-conditions-and-disorders/personality-disorders/personality-disorders—diagnosis
Underlying all of the personality disorders is a deep-seated maladaptive style that is part of the persons personality. This maladaptive style is pervasive and longstanding, from the teenage years onward. […] Narcissistic personality disorder features a pervasive pattern of grandiosity, a need for admiration and a lack of empathy beginning in early adulthood and presenting in various contexts. […] According to DSM-5, features of a personality disorder usually begin to manifest during adolescence and early adulthood. […] One strategy for clarifying the presence of a personality disorder versus an Axis I diagnosis is to review whether the patient has a longstanding history of negative maladaptive behaviours, or whether these behaviours are restricted to when the Axis I diagnosis began.
#66 Science Pub | The Nature of Personality Disorder | Season 2021 | PBS
https://www.pbs.org/video/the-nature-of-personality-disorder-iml2cc/
The Lilienfeld model emphasizes fearless dominance, impulsive antisocial behaviors, and a cold-heartedness. […] The Patrick model’s a little different. It emphasizes boldness, disinhibition and meanness. […] So it’s a nice unifying model. […] This has been, I know a high-speed overview treatment of these three broad domains, a very serious psychopathology. […] One in 10 people in the population has some form of personality disorder.
#67 A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial | BJPsych Open | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-open/article/mechanismbased-grouppsychotherapy-approach-to-aggressive-behaviour-in-borderline-personality-disorder-findings-from-a-clusterrandomised-controlled-trial/61A3C2867479369A2BD994BC1F7BA271
Aggression in BPD is usually triggered by real or perceived social threat, frustration or social provocation. […] Based on behavioural and neurobiological data from our own and other research groups, we recently proposed a model according to which reactive aggression in BPD arises from several mechanisms: (a) social threat hypersensitivity, that is, hypervigilance to social threat cues, biased negative perception of others, and a failure to recognise social safety signals; (b) approach rather than avoidance of social threat cues; (c) maladaptive anger regulation, with emotion dysregulation and anger sequentially mediating the relationship between BPD and aggression; (d) low capacity to adequately mentalise the intentions, cognitions and emotions of others; and (e) excessive emotional imitation and contagion.
#68 A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial | BJPsych Open | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-open/article/mechanismbased-grouppsychotherapy-approach-to-aggressive-behaviour-in-borderline-personality-disorder-findings-from-a-clusterrandomised-controlled-trial/61A3C2867479369A2BD994BC1F7BA271
Aggression in BPD is usually triggered by real or perceived social threat, frustration or social provocation. […] Based on behavioural and neurobiological data from our own and other research groups, we recently proposed a model according to which reactive aggression in BPD arises from several mechanisms: (a) social threat hypersensitivity, that is, hypervigilance to social threat cues, biased negative perception of others, and a failure to recognise social safety signals; (b) approach rather than avoidance of social threat cues; (c) maladaptive anger regulation, with emotion dysregulation and anger sequentially mediating the relationship between BPD and aggression; (d) low capacity to adequately mentalise the intentions, cognitions and emotions of others; and (e) excessive emotional imitation and contagion.
#69 A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial | BJPsych Open | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-open/article/mechanismbased-grouppsychotherapy-approach-to-aggressive-behaviour-in-borderline-personality-disorder-findings-from-a-clusterrandomised-controlled-trial/61A3C2867479369A2BD994BC1F7BA271
Starting from the theory that therapy development should be attuned to the pathogenetic mechanisms which underlie a specific psychopathology, we composed an aggression-specific psychotherapeutic intervention programme called mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets these mechanisms.
#70 Personality disorders: Overview of pharmacotherapy – UpToDate
https://www.uptodate.com/contents/personality-disorders-overview-of-pharmacotherapy
Personality disorders cause significant distress and impairment of social, occupational, and role functioning. They are associated with high rates of psychiatric comorbidity and high risks of morbidity and mortality. […] First-line treatment of these disorders is psychotherapy; however, patients with personality disorders may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. In the absence of comprehensive trials assessing efficacy and/or comparing medications, there is limited information to guide adjunctive pharmacotherapy. Preliminary evidence from meta-analyses of clinical trials provides an early basis to guide treatment and limit the practice of polypharmacy. However, the evidence remains limited by lack of published studies and limitations in study design and sample size. Therefore, clinical practice is largely guided by expert opinion and experience, which support the assessing the relative risks and benefits for individual patients of low-dose antipsychotics and mood stabilizers when applied to specified symptom domains. […] On overview of pharmacotherapy for personality disorders are reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis and treatment of individual personality disorders are reviewed separately.
#71 Personality disorders: Overview of pharmacotherapy – UpToDate
https://www.uptodate.com/contents/personality-disorders-overview-of-pharmacotherapy
Personality disorders cause significant distress and impairment of social, occupational, and role functioning. They are associated with high rates of psychiatric comorbidity and high risks of morbidity and mortality. […] First-line treatment of these disorders is psychotherapy; however, patients with personality disorders may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. In the absence of comprehensive trials assessing efficacy and/or comparing medications, there is limited information to guide adjunctive pharmacotherapy. Preliminary evidence from meta-analyses of clinical trials provides an early basis to guide treatment and limit the practice of polypharmacy. However, the evidence remains limited by lack of published studies and limitations in study design and sample size. Therefore, clinical practice is largely guided by expert opinion and experience, which support the assessing the relative risks and benefits for individual patients of low-dose antipsychotics and mood stabilizers when applied to specified symptom domains. […] On overview of pharmacotherapy for personality disorders are reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis and treatment of individual personality disorders are reviewed separately.
#72 Personality disorders: Overview of pharmacotherapy – UpToDate
https://www.uptodate.com/contents/personality-disorders-overview-of-pharmacotherapy
Personality disorders cause significant distress and impairment of social, occupational, and role functioning. They are associated with high rates of psychiatric comorbidity and high risks of morbidity and mortality. […] First-line treatment of these disorders is psychotherapy; however, patients with personality disorders may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. In the absence of comprehensive trials assessing efficacy and/or comparing medications, there is limited information to guide adjunctive pharmacotherapy. Preliminary evidence from meta-analyses of clinical trials provides an early basis to guide treatment and limit the practice of polypharmacy. However, the evidence remains limited by lack of published studies and limitations in study design and sample size. Therefore, clinical practice is largely guided by expert opinion and experience, which support the assessing the relative risks and benefits for individual patients of low-dose antipsychotics and mood stabilizers when applied to specified symptom domains. […] On overview of pharmacotherapy for personality disorders are reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis and treatment of individual personality disorders are reviewed separately.
#73 Personality Disorders: Review and Clinical Application in Daily Practice | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1201/p1253.html
Personality disorders have been documented in approximately 9 percent of the general U.S. population. […] Personality disorders are classified into clusters A, B, and C. […] Patients with borderline personality disorder may benefit from the use of omega-3 fatty acids, second-generation antipsychotics, and mood stabilizers. […] Patients with antisocial personality disorder may benefit from the use of mood stabilizers, antipsychotics, and antidepressants. […] Several studies have shown that personality disorders commonly occur with axis I diagnoses, which impact function and clinical prognosis. […] The Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev. (DSM-IV-TR), defines personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.
#74 Personality Disorders: Review and Clinical Application in Daily Practice | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1201/p1253.html
Personality disorders have been documented in approximately 9 percent of the general U.S. population. […] Personality disorders are classified into clusters A, B, and C. […] Patients with borderline personality disorder may benefit from the use of omega-3 fatty acids, second-generation antipsychotics, and mood stabilizers. […] Patients with antisocial personality disorder may benefit from the use of mood stabilizers, antipsychotics, and antidepressants. […] Several studies have shown that personality disorders commonly occur with axis I diagnoses, which impact function and clinical prognosis. […] The Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev. (DSM-IV-TR), defines personality disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.
#75 Personality disorders | EBSCO Research Starters
https://www.ebsco.com/research-starters/psychology/personality-disorders
Various theories have been developed to explain the etiology of personality disorders. The biological perspective examines the roles of genetics and brain functioning in the development of personality disorders. Evidence suggests that the cluster A disorders (paranoid, schizoid, and schizotypal personality disorders) are more prevalent among first-degree relatives of individuals experiencing schizophrenia, suggesting a possible genetic commonality among those disorders. […] The underlying symptoms of borderline personality disorder (impulsivity and emotionality) are inherited. […] Genetic factors may be influential in the development of antisocial personality disorder, as children of biological parents who engage in criminal behavior are more likely to engage in criminal behavior themselves. […] Researchers have found that low levels of antipsychotic medications are effective in alleviating some symptoms of schizotypal personality disorder.
#76 Personality disorders: Overview of pharmacotherapy – UpToDate
https://www.uptodate.com/contents/personality-disorders-overview-of-pharmacotherapy
Personality disorders cause significant distress and impairment of social, occupational, and role functioning. They are associated with high rates of psychiatric comorbidity and high risks of morbidity and mortality. […] First-line treatment of these disorders is psychotherapy; however, patients with personality disorders may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. In the absence of comprehensive trials assessing efficacy and/or comparing medications, there is limited information to guide adjunctive pharmacotherapy. Preliminary evidence from meta-analyses of clinical trials provides an early basis to guide treatment and limit the practice of polypharmacy. However, the evidence remains limited by lack of published studies and limitations in study design and sample size. Therefore, clinical practice is largely guided by expert opinion and experience, which support the assessing the relative risks and benefits for individual patients of low-dose antipsychotics and mood stabilizers when applied to specified symptom domains. […] On overview of pharmacotherapy for personality disorders are reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis and treatment of individual personality disorders are reviewed separately.
#77 Borderline Personality Disorder: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/913575-overview
Some studies have suggested that patients with borderline personality disorder (BPD) might have increased rates of soft neurologic signs, as well as learning disorders, attention-deficit/hyperactivity disorder (ADHD), and abnormal electroencephalographic (EEG) findings. Reports also indicate that adults with BPD have increased impulsivity, cognitive inflexibility, and poor self-monitoring and perseveration, which may be indicators of frontal lobe dysfunction. […] The pathogenesis of BPD, like those of most psychiatric disorders, is likely to include an organic predisposition as well as psychosocial and environmental factors. Some researchers postulate the presence of an underlying affective instability to which the individual responds with maladaptive behaviors. […] Most theories about the cause or pathogenesis of borderline personality disorder (BPD) include the notion of a biologic predisposition along with psychological and environmental factors. One theory posits that neurobiologic development is affected by a combination of disruption of early attachments and subsequent trauma leading to hyperresponsiveness of the attachment system.
#78 Borderline Personality Disorder: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/913575-overview
Some studies have suggested that patients with borderline personality disorder (BPD) might have increased rates of soft neurologic signs, as well as learning disorders, attention-deficit/hyperactivity disorder (ADHD), and abnormal electroencephalographic (EEG) findings. Reports also indicate that adults with BPD have increased impulsivity, cognitive inflexibility, and poor self-monitoring and perseveration, which may be indicators of frontal lobe dysfunction. […] The pathogenesis of BPD, like those of most psychiatric disorders, is likely to include an organic predisposition as well as psychosocial and environmental factors. Some researchers postulate the presence of an underlying affective instability to which the individual responds with maladaptive behaviors. […] Most theories about the cause or pathogenesis of borderline personality disorder (BPD) include the notion of a biologic predisposition along with psychological and environmental factors. One theory posits that neurobiologic development is affected by a combination of disruption of early attachments and subsequent trauma leading to hyperresponsiveness of the attachment system.
#79 Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1383-2
According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experiences during childhood. […] We prove the role of alterations in Hypothalamic-Pituitary-Adrenal (HPA) axis, in neurotrasmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD; we also confirm the presence of morphological changes in several BPD brain areas and in particular in those involved in stress response. […] A better comprehension of the biological and epigenetic mechanisms, affected by childhood trauma and altered in BPD patients, could allow to identify at high risk subjects and to prevent or minimize the development of the disease later in life.
#80 Contours of a causal feedback mechanism between adaptive personality and psychosocial function in patients with personality disorders: a secondary analysis from a randomized clinical trial | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1365-4
A relatively new research area focuses on changeable components of personality more specifically (mal)adaptiveness in order to assess treatment effects. […] Such studies have revealed that therapy can improve (mal)adaptive personality functioning. […] A change in psychosocial function could consist of additive contributions across various components. […] A crude label like mental flexibility could describe such a mechanism. […] If adaptiveness can be improved by therapy, how much gain in psychosocial function can be achieved as a result of this improvement? […] An improved understanding of such a reciprocal association could inform the choice of interventions, such as therapy, vocational counseling, or a combination. […] The marginal structural model (MSM) was developed in the statistical and epidemiological literature for the purpose of causal inference. […] This study is a re-analysis of data from a randomized clinical trial. […] The present study indicates that persistent impairment in psychosocial function can be addressed through a causal pathway of personality functioning and strengthens the optimism for treatment of PD patients.