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Table 2 Studies investigating aggression in ♀ and/or ♂ BPD patients using neurobiological methods

From: Gender differences in aggression of borderline personality disorder

First Author Year Sample Methodology Key findings
Bertsch et al. 2013 39 ♂ BPD patients with comorbid ASPD (BPD-ASPD), 14 HC BPD: International Personaliy Disorder Examination (IPDE) ♂ BPD-ASPD patients displayed volume reduction in the left frontal pole, left orbital frontal cortex and right ventromedial prefrontal cortex compared to ♂ HC (all p < .05, ROI-analysis).
Neuroimaging: strucutural magnetic resonance imaging (stMRI), voxel based morphometry (VBM)
Brambilla 2004 10 BPD patients ((6 ♀, 4 ♂), 20 HC (gender ratio: n/a) BPD: IPDE BPD showed higher volume of the putamen (p = .002) compared with HC.
Neuroimaging: stMRI, manual tracing
Coccaro et al. 2007 31 ♂ personality-disorders subjects, including 4 BPD patients BPD: SCID-II Testosterone CSF concentration of ♂ personality disordered patients, including BPD, is not correlated with aggression (p = .34).
Aggression: Life History of Aggression (LHA), criteria for Intermittend Explosive Disorder
Neurochemistry: Cerebrospinal fluid (CSF) concentration of testosterone
Coccaro et al. 1998 26 personality-disordered subjects, including 7 BPD patients (8 ♀, 18 ♂) BPD: According to DSM-IV criteria In the personality-disordered patients, including BPD, vasopressin CSF concentration was positively correlated with aggression (r = .41, p = .04), which was stronger in ♂ (r = .65) than in ♀ subjects (r = .27).
Aggression: LHA
Neurochemistry: CSF concentration of vasopressin
Hazlett et al., 2005 50 BPD patients (23 ♀, 27 ♂), 50 HC (20 ♀, 30 ♂) BPD: Structured Interview for DSM-III-R Personality BPD showed reduced gray matter and more white matter volume in BA 24 and 31 of the cingulate compared with HC (all p < .01,ROI analysis).
Neuroimaging: stMRI, manual tracing
Hollander et al. 1994 12 BPD patients (8 ♀, 4 ♂), 15 HC (3 ♀, 12 ♂) BPD: SCID-II Diminished serotonergic responsivity in ♂, but not ♀ BPD patients compared to gender-matched HC (p = .010)
Neurochemistry: Serotonergic responsivity via m-chlorophenylpiperazine (m-CPP)
Martial et al. 1997 5 ♀ BPD patients BPD: DIB-R No diminished serotonergic responsivity of ♀ BPD patients.
Neurochemistry: Serotonergic responsivity via d-fenfluramine (FEN)
Minzenberg 2008 12 BPD-patients (5 ♀, 7 ♂), 12 HC (6 ♀, 6 ♂) BPD: Structured Interview for DSM-IV Personality BPD had reduced gray matter volume in the anterior cingulate (BA 24/32) compared to HC (p < .003-007, ROI analysis).
Neuroimaging: stMRI, VBM
New/Perez-Rodriguez et al. 2009/ 2012 38 BPD with comorbid intermittent-explosive-disorder (16 ♀, 22 ♂), 36 HC (18 ♀, 18 ♂) BPD: SCID-II No group x gender interaction in the OAS-M, BDHI and the AQ. ♀ BPD patients chose the “right” answer in the PSAP more often than ♀ HC. ♂ BPD patients chose the “right” answer in the PSAP less frequently than ♂ HC (p < 0.005). ♂ BPD displayed reduced glucose metabolism rate in the striatum when performing the PSAP compared to ♀ BPD and HC of both gender (p < .01). No gender differences in prefrontal and amygdala regions.
Aggression: modified Overt Aggression Scale (OAS-M),
Buss-Durkee Hostility Inventory (BDHI), AQ, PSAP
Neuroimaging: PET while performing PSAP
Niedtfeld et al. 2010 23 ♀ BPD patients, 26 ♀ HC BPD: International Personality Disorders Examination (IPDE) ♀ BPD patients displayed increased amygdala reactivity in response to neutral and negative emotional stimuli when compared to ♀ HC.
Neuroimaging: functional magnetic resonance (fMRI) during presentation of emotional & neutral pictures
Prehn et al. 2013 15 ♂ BPD-ASPD, 17 ♂ HC BPD: IPDE ♂ BPD-ASPD displayed increased amygdala activity exclusively in response to high, but not neutral and low emotional stimuli when compared to ♂HC.
Neuroimaging: fMRI during presentation of emotional & neutral pictures
Rinne et al. 2000 12 ♀ BPD patients, 9 ♀ HC BPD: Structured Interview for DSM III-R Personality ♀ BPD patients displayed diminished serotonergic responsivity than ♀ HC (p < .05).
Disorders
Neurochemistry: Serotonergic responsivity via m-CPP
Soloff et al. 2003 64 BPD patients (44 ♀, 20 ♂), 57 HC (21 ♀, 36 ♂) BPD: IPDE ♂ BPD patients showed higher scores in the BDHI (p = 0.03) and the BG-LHA (p = .002) than the ♀ BPD patients. ♂, but not ♀, BPD patients, had significantly lower delta-prl (p < .02), peak-prl (p < .001) and AUC-prl (p < .003) compared to gender-matched HC. In ♂, but not ♀, BPD patients serotonergic responsivity was inversely correlated with scores of the LHA (p < .05)
Aggression: BDHI, Brown-Goodwin Lifetime History of aggression (BG-LHA)
Neurochemistry: Serotonergic responsivity via FEN
Soloff et al. 2005 22 BPD patients (15 ♀, 7 ♂), 24 HC (14 ♀, 10 ♂) BPD: IPDE, DIB-R ♀, but not ♂, BPD patients displayed reduced glucose metabolism rate in the prefrontal cortex during baseline condition compared to gender-matched HC (p < .05). When tested for serotonergic responsivity ♂ BPD patients, but not ♀ BPD patients, showed decreased glucose metabolization in the lt. temporal and frontal lobe (p < .05)
Aggression: BG-LHA
Neurochemistry: serotonergic responsivity via FEN Neuroimaging: PET during baseline and serotonergic responsivity condition
Soloff et al. 2008 34 BPD patients (22 ♀, 12 ♂); among them 2 ♀ BPD-ASPD and seven ♂ BPD-ASPD, 30 HC (19 ♀, 11 ♂) BPD: IPDE ♂ BPD patients had higher scores in the BG-LHA than ♀ BPD patients (p = .03). ♀, but not ♂, BPD patients showed a gray volume reduction the amygdala, hippocampus bilaterally compared to gender-matched HC (all pfwe < .05). ♂, but not ♀, BPD patients showed a gray matter volume reduction in the anterior cingulate cortex (pcluster = .001) and a gray matter volume increase in the right putamen (pcluster = .024) when compared to gender-matched HC.
Aggression: BG-LHA
Neuroimaging: stMRI, VBM
Völlm et al. 2009 7 ♂ BPD patients, 6 ♂ HC BPD: SCID-II ♂ BPD patients showed gray matter volume reduction in the medial, middle and superior frontal gyrus, bilaterally, and the left orbitofrontal cortex and right anterior cingulate cortex compared to ♂ HC (all at least puncorr. < .001).
Neuroimaging: stMRI, VBM
  1. The studies are listed in alphabetical order based on the author’s first name.
  2. Abbreviations:: BG-LHA: Brown-Goodwin Lifetime History of aggression, BPD-ASPD: BPD patients with comorbid ASPD, BDHI: Buss-Durkee Hostility Inventory, CSF: cerebrospinal fluid, DIB-R: Diagnostic Interview for Borderlines- Revised, International Personality Disorders Examination, fMRI: functional magnetic resonance imaging, LHA: Life History of Aggression,, m-CPP: m-chlorophenylpiperazine, PSAP: Point Subtraction Aggression Paradigm SCID-II: Structured Clinical Interview for DSM-IV Axis II Personality Disorders, OAS-M: modified Overt Aggression Scale SIDP-IV: Structured Interview for DSM-IV Personality, stMRI: structural magentic resonance imaging, PET: positron emission tomography, ROI: region of interest, VBM: voxel based morphometry.