Supplemental Materials
Aggression in Borderline Personality Disorder - a Multidimensional Model
by F. Mancke et al., 2014, Personality Disorders: Theory, Research, and Treatment
http://dx.doi.org/10.1037/per0000098
Table S1
Studies Empirically Investigating the Biobehavioral Dimensions Underlying Aggression in Borderline Personality Disorder (BPD)
First Author / Year / Sample / Methodology / Key FindingsBarnow / 2012 / 33 female BPD-patients, 26 female healthy controls (HC) / BPD: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)
Psychophysiology: electromyographic activity and skin conductance / Female BPD showed greater skin conductance, compared with HC (p = .032).
Bertsch / 2013 / 40 female BPD-patients, 41 female HC / BPD: International Personality Disorders Examination (IPDE)
Behavioral task: facial emotion recognition task while eye-movements were measured
Neuroimaging: Functional magnetic resonance imaging (fMRI)
Neurochemistry: double blind placebo controlled between subject design; intranasal oxytocin (24 I.U.) administration. / Behavioral tasks: BPD made faster (p < .01) and more (p < .10) reflexive fixation changes to the eyes of angry faces compared with HC.
Functional Neuroimaging: Faster fixation changes to the eyes of angry faces were related to increased right posterior amygdala responses in BPD (r = -.4, p < .05) but not in HC.
Neurochemistry: Oxytocin administration normalized abnormal behavioral and neural patterns in BPD.
Bertsch / 2013 / 13 male offenders with BPD and antisocial personality disorder (BPD-ASPD), 12 male offenders with ASPDand high psychopathic traits (ASPD-PP), 14 male HC non-offenders / BPD, ASPD: IPDE
Psychopathy: Psychopathy Checklist Revised
Neuroimaging: strucutural magnetic resonance imaging (stMRI), voxel based morphometry (VBM) / BPD-ASPD displayed volume reduction in the ventromedial prefrontal cortex (puncorr . .003) and the orbitofrontal cortex (p < .10, Region of Interest (ROI) analysis), compared with ASPD-PP
ASPD-PP showed reduction in cortical midline structures such as dorsomedial prefrontal cortex (puncorr = .005), postcentral gyrus (puncorr = .001) and the precuneus (puncorr = .01-.002) compared with BPD-ASPD.
Bertsch / 2013 / 34 female BPD patients , 40 female HC / BPD: IPDE
Aggression: Assessment of Factors of Aggression
Neurochemistry: analysis of plasma oxytocin levels / Female BPD showed lower plasma oxytocin levels compared with HC (p < .001). Plasma oxytocin levels were negatively related with trait aggressiveness (r > -.39, p < .001).
Black / 2007 / 220 offenders (198 men, 22 women) / BPD: Structured Interview for DSM-IV Personality / 65 offenders (29.5%) met criteria for BPD.
Blackwood / 1986 / 14 female BPD-patients, 25 clinical controls (various axis-I disoders, 14 women), 59 HC (32 women) / BPD: DSM-III criteria, Diagnostic Interview for Borderlines, Borderline Ego Functions Inventory
Psychophysiology: Auditory P300 event-related potential (ERP) in a two tone discrimination task / BPD showed a smaller P300 amplitude compared with the clinical controls and HC (p .01).
Brunner / 2010 / 20 female adolescent BPD-patients, 20 clinical controls with mixed psychiatric diagnoses, 20 female HC / BPD: SCID-II
Neuroimgaing: stMRI, VBM / Female adolescent BPD showed volume decreases in the right (pfwe-corrected .01) and left (pfwe-corr = .02) dorsolateral frontal gyrus and the left orbitofrontal gyrus (p = .02), compared with HC.
Chanen / 2008 / 20 adolescent BPD-patients (15 women), 20 HC (15 women) / BPD: SCID-II
Neuroimaging: stMRI, functional automated segmentation tool and manual tracing / BPD showed reduced orbitofrontal gray matter (puncorr = .006) compared with HC.
Coccaro / 1997 / 22 personality-disordered patients (8 women, 3 BPD-patients), 12 HC (8 women) / BPD: Structured Interview for DSM-III-R Personality
Aggression: Buss-Durkee Hostility Inventory, Life History of Aggression
Neurochemistry: Analysis of platelet serotonin-2a-receptor density and dissociation constant / Platelet serotonin-2a-receptor density (r = .39, p = .038) and dissociation constant (r = .55, p= .008) correlated positively with scores of the Buss-Durkee Hostility Inventory in the personality-disordered patients but not in the HC.
Coccaro / 1989 / 20 male personality-disordered patients (8 BPD-patients), 25 depressive male patients, 18 normal male control patients / BPD: Structured Interview for DSM-III-R Personality
Neurochemistry: serotonergic functionality via stimulation with d-fenfluramine
Aggression: Buss-Durkee Hostility Inventory, Brown–Goodwin lifetime history of aggression, Psychopathic deviance scale of the Minnesota Multiphasic Personality Inventory / BPD showed reduced serotonergic functionality compared with other personality-disordered patients (p .012) or HC (p .002). In male personality-disordered patients, but not HC reduced serotonergic functionality was correlated with ratings of aggression (Buss-Durkee Hostility Inventory, p .002).
Coccaro / 1998 / 26 personality-disordered subjects (8 women, 7 BPD-patients) / BPD: According to DSM-IV criteria
Aggression: Life History of Aggression
Neurochemistry: cerebrospinal fluid (CSF) concentration of vasopressin / In the personality-disordered patients, including BPD, vasopressin CSF concentration was positively correlated with aggression (r = .41, p = .04).
Coccaro / 2007 / 31 male personality-disorders subjects (4 BPD-patients) / BPD: SCID-II
Neurochemistry: CSF concentration of testosterone:
Aggression: Life History of Aggression and research criteria for Intermittent Explosive Disorder / Testosterone CSF concentration of male personality disordered patients, including BPD is not correlated with aggression (Life history of aggression: p = .34)
Costa / 2008 / 130 intimate aggressive men, 48 non aggressive men / BPD: Millon Clinical Multiaxial Inventory-III
Intimate partner aggression: Revised Conflict Tactics Scale, General Violence Questionnaire
Articulated thoughts: Articulated Thoughts in Simulated Situations Paradigm / Jealousy correlated positively with BPD-traits (r = .13, p < .05).
Critchfield / 2004 / 92 BPD-patients (85 women) / BPD: IPDE
Impulsivity: Barratt Impulsivity Scale, version 11
Aggression: Inventory of Personality Organization, Anger, Irritability, Assault Questionnaire, Overt Aggression Scale—Modified / No significant correlation between the aggression and impulsivity (r = –.18, ns).
Critchfield / 2008 / 92 BPD-patients (91 women) / BPD: IPDE
Aggression: Multidimensional Personality Questionnaire, the Inventory of Personality Organization, the Anger, Irritability, Assault Questionnaire, the Overt Aggression Scale-Modified for Outpatient, the Suicide Attempt Self Injury Interview
Attachment style: Experiences in Close Relationships Scale / In BPD, the attachment patterns associated with interpersonal hypersensitivity, i.e. fearful attachment patterns (simultaneous presence of relationship anxiety and avoidance) are related to aggression.
Domes / 2009 / 174 BPD-patients (156 women) / Study: review of the literature / Results indicate an enhanced perception of social threat cues in BPD.
Domes / 2008 / 25 female BPD-patients / BPD: IPDE
Behavioral task: facial emotion recognition task / BPD perceived ambiguous blends of facial expressions as more angry, particularly for 50 % anger and 50% disgust (p = .020) and 40% anger: 60% happiness (p = .016).
Dougherty / 1999 / 14 female BPD-patients , 17 female HC / BPD: SCID-II
Aggression: Point Subtraction Aggression Paradigm / BPD showed more aggression in the Point Subtraction Aggression Paradigm compared with HC (p = .044).
Dziobek / 2011 / Behavioral study: 21 female BPD-patients, 21 female HC
Neuroimaging: 30 female BPD-patients, 20 female HC / BPD: Mini-International Neuropsychiatric Interview, SCID-II
Empathy: Interpersonal Reactivity Index, The Multifaceted Empathy Test
Neuroimaging: fMRI / Behavioral study: BPD showed lower scores on the Interpersonal Reactivity Index (subscales: personal distress: p .00 empathic concern: p .06 and perspective taking: p .07) and the Multifaceted Empathy Test [cognitive empathy: (p .03) and affective empathy: (p .04)], compared with HC.
Neuroimaging: BPD showed hypoactivation in the superior temporal sulcus/gyrus during cognitive empathy compared with HC (p .001, ROI analysis). BPD showed hypoactivation in the insula during affective empathy compared with HC (p .005, ROI analysis).
Ebner-Priemer / 2007 / 50 female BPD-patients (10 non-medicted and 40 medicated), 50 female HC / BPD: IPDE
Psychophysiology: 24-hour ambulatory monitoring of physical activity and heart rate / Non-medicated BPD showed greater additional heart rate, i.e. that part of heart rate increase that does not directly result from physical or metabolic activity, compared with HC (p = .011).
Ebner-Priemer / 2005 / 22 female BPD-patients, 21 female HC / BPD: SCID-II, Revised Diagnostic Interview for the Borderlines
Psychophysiology: startle-response as assessed by orbicularis oculi electromyogram / BPD-patients showed an augmentated startle response compared with HC (p=.007).
Fertuck / 2009 / 30 BPD-patients (26 women) 29 HC (15 women) / BPD: SCID-II
Empathy: Reading the Mind in the Eyes task / BPD-patients outperformed HC in a test involving cognitive and affective empathic strategies (p .001).
Fossati / 2004 / 747 university students (482 women) / BPD: Personality Diagnostic Questionnaire-4
Aggression: Buss-Durkee Hostility Inventory / BPD-traits were predicted by the emotional subdimensions of aggression (p .0045).
Frankle / 2005 / 10 Impulsive aggressive patients, (5 women, 7 with BPD), 10 HC (5 women) / BPD: SCID-II f
Neurochemistry: density of serotonin transporter via radiotracer [11C]McN 5652
Neuroimaging: positron emission tomography (PET) / Impulsive aggressive patients, including BPD, showed reduced serotonin transporter density in the anterior cingulate cortex, as noted by differences in both binding potential (p = .04, ROI analysis) and Specific-to-Nonspecific Partition Coefficient (p < .02, ROI analysis), compared with HC.
Frick / 2012 / 21 female BPD-patients, 20 female HC / BPD: SCID-II
Empathy: Reading Mind in the Eyes task
Neuroimaging: fMRI / BPD outperformed HC in a test involving cognitive and affective empathic strategies (p .009). BPD showed hypoactivation in the right superior temporal gyrus during the Reading Mind in the Eyes Test, compared with HC (pfwe-corr .05).
Gardner / 2012 / 206 subjects from educational institutions (141 women) divided in adults (age: 19-28) and adolescents: (age: 16-18) / BPD: Personality Diagnostic Questionnaire-4
Aggression: Reactive–Proactive Aggression Questionnaire / BPD-traits correlated positively with reactive aggression in adults (r = .24, p .05) and adolescents (r =.21, p .05).
Emotional coping mediated the relationship between BPD-traits and reactive aggression in adults (CI 95%, .009-.124).
Gardner / 1991 / 46 BPD-patients (39 women), 27 HC (22 women) / BPD: Structured Interview for DSM-III-R Personality, Diagnostic Interview for the Borderlines
Aggression: Buss-Durkee Hostility Inventory / BPD showed higher aggression scores compared with HC (p .0001).
Hallquist / 2012 / 362 clinical and nonclinical subjects (256 women, 94 BPD-patients) / BPD: dimensional score based on DSM-IV-criteria
Aggression: dimensional score based on DSM-IV-criteria for antisocial personality disorder, 9 Items from the Inventory of Interpersonal Problems specifically measuring aggressiveness / The best model revealed four BPD-subgroups, including one subgroup with co-occurring anger proneness and aggression (p .001).
Harari / 2010 / 20 BPD-patients (18 women), 22 HC (19 women) / BPD: Revised Diagnostic Interview for Borderlines
Empathy: Interpersonal Reactivity Index / BPD were significantly impaired in cognitive (p = .038), but not affective empathy (p = .205) compared with HC.
Hazlett / 2005 / 50 BPD patients (23 women), 50 HC (20 women) / BPD: Structured Interview for DSM-III-R Personality
Neuroimaging: stMRI, manual tracing / 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).
Hazlett / 2007 / 27 BPD-patients (9 women) , 21 HC (10 women) / BPD: Structured Interview for DSM-IV Personality
Psychophysiology: startle-response as assessed by orbicularis oculi electromyogram during the presentation of unpleasant, borderline-salient (e.g., “hate”), and neutral (e.g., “view”) words / BPD showed greater startle potentiation for unpleasant words but for the neutral words compared with HC (p = .01).
Herpertz / 2001 / 18 male BPD-inmates, 25 male psychopathic inmates, 24 male HC / BPD: IPDE
Psychopathy: screening version of the Psychopathy Checklist
Subtype of aggression: procedure by the use of the formal records / Psychopathic inmates showed more instrumental aggression than BPD-inmates (p .05).
Herr / 2013 / Community sample of 124 subjects (83 women, 35 BPD-patients) / BPD: McLean Screening Instrument for Borderline Personality Disorder, The Personality Assessment Inventory Borderline Features subscale
Aggression: The weekly diary included a six-item behavior checklist that measured whether or not participants endorsed engaging in various aggressive behaviors over the previous 24 hr.
Negative interpersonal events: The Inventory of Small Life Events
Study design: longitudinal design, participants completed an online diary measure, at baseline and once per week for 4 weeks / Negative interpersonal events in the week prior to aggressive actions partially mediated the relationship between baseline noninterpersonal BPD symptoms and aggressive behavior (p < .001).
Hines / 2008 / 14154 university-students (10100 women) / BPD: Personal and Relationships Profile
Aggression: physical aggression, psychological aggression, and sexual aggression scales of the revised Conflict Tactics Scales / BPD traits predicted physical, psychological and sexual intimate aggression (all p .001).
Holtzworth / 2000 / 102 intimate aggressive men, 62 non aggressive men / BPD: Millon Clinical Multiaxial Inventory-III
Intimate partner aggression: Revised Conflict Tactics Scale, Generality of Violence Questionnaire / Four clusters of violent men, including a “borderline-dysphoric” group characterized by high measures on dependency, jealousy, impulsivity and hostility towards women
Izurieta / 2014 / 36 female BPD-patients, 29 female HC / BPD: IPDE
Psychophysiology: visual event-related potentials in a facial recognition task with blends of happy versus angry faces / BPD showed an increased occipital P100 amplitude (p = .098) and reduced parietal P300 amplitudes (p < .01), with strongest difference for predominantly happy faces compared with HC.
Koch / 2007 / 8 female patients with BPD, 9 female HC / BPD: the Diagnostic Interview for Borderlines
Neurochemistry: availability of serotonin transporter via ADAM (2-([2-([dimethylamino]methyl)phenyl]thio)).
Neuroimaging: single photon emission computed tomography / BPD showed higher serotonin transporter availability in the hypothamalus compared with HC (p = .049, ROI-analysis).
Koenigsberg / 2001 / 152 personality-disordered patients (85 women, 41 BPD-patients) / BPD: Structured Interview for the Diagnosis of Personality Disorders
Impulsivity: Barratt Impulsivity Scale, version 7B
Aggression: Buss-Durkee Hostility Inventor / Impulsivity and aggression in BPD loaded on the same factor (p .00625).
Kuhlmann / 2013 / 30 female BPD-patients and 33 female HC / BPD: IPDE
Traumatization: Childhood Trauma Questionnaire
Neuroimaging: stMRI, VBM / Female BPD had larger gray matter volume in the left hypothalamus (p = .023, ROI analysis) and the cerebellar vermis (puncorr = .002) compared to HC. Childhood Trauma Questionnaire scores were positively correlated with hypothalamic gray matter volume (r = .58, p = .001).
Leyton / 2001 / 13 BPD-patients (8 women), 11 HC (5 women) / BPD: Diagnostic Interview for Borderline Patients—Revised