The role of dysregulated amygdalic emotion in borderline personality disorder

Borderline personality disorder (BPD), is a condition that has a high morta lity and is associated with much distress for the sufferers as well as with difficult management problems for health professionals, Taking emotional d ysregulation as the core feature of BPD, the authors propose that the disor der arises from impaired modulation of subcortical inputs to consciousness. We hypothesize that the amygdaloid complex, and its connections with thala mus, cingulate cortex and insular cortex are critical in the development an d maintenance of the disorder. If this is the case, peptides such as galani n, somatostatin and cholecystokinin will be the most important neurotransmi tters, thus explaining the relative lack of efficacy of standard antipsycho tic and antidepressant drugs. (C) 2000 Harcourt Publishers Ltd.