OBJECTIVE: To review and reformulate the concept of borderline personality disorder in the light of advances in neuroscience and infant development. METHOD: Medline was searched using the key words: borderline personality, attachment, affect regulation, neurobiology, childhood sexual abuse, mood stabilizers. RESULTS: There are genetic predispositions to specific personality traits which appear central to the concept of borderline personality disorder. These traits combine with impaired attachment relationships and childhood abuse to give rise to the constellation of difficulties known as borderline personality disorder. CONCLUSION: Borderline personality disorder is a psychobiological disorder of affect regulation caused by genetic and interpersonal factors. CLINICAL IMPLICATIONS: Prevention should be directed towards the early childhood environment and the quality and availability of attachment figures. The focus of treatment should be the regulation of affect by means of medication, psychotherapy and skills training. Basic research on the relationship between neuropeptides and serotonin could lead to new approaches to psychopharmacological intervention. LIMITATIONS: Neuroscientific research is based primarily on animal experimentation and may not be fully extrapolated to humans. There are very few randomized controlled trials of antidepressants and mood stabilizers in borderline personality disorder. Due to the vastness of the neuroscientific and clinical literature, this review is selective in focus.
Borderline personality disorder; personality dimensions; attachment; neurobiology; childhood sexual abuse; mood stabilizers; oxytocin