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Related Experiment Video

Updated: Feb 1, 2026

Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder
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Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis.

Elisa Drews1, Eric A Fertuck2, Julian Koenig3

  • 1Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States.

Neuroscience and Biobehavioral Reviews
|December 1, 2018
PubMed
Summary

Borderline Personality Disorder (BPD) is linked to abnormal stress hormone (cortisol) levels, with higher continuous output and blunted responses to psychosocial stress observed in patients. Further research is needed to understand these HPA axis dysregulations.

Keywords:
Borderline personality disorderCortisolHypothalamic-pituitary-adrenal axisMeta-analysisStress response

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Endocrinology

Background:

  • Borderline Personality Disorder (BPD) is frequently associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis.
  • Existing research on HPA axis functioning in BPD presents inconsistent findings regarding cortisol levels and stress reactivity.

Purpose of the Study:

  • To systematically meta-analyze HPA axis functioning in BPD patients.
  • To quantify cortisol levels from singular and continuous assessments.
  • To evaluate cortisol reactivity to pharmacological and psychosocial stressors in BPD.

Main Methods:

  • Conducted a series of meta-analyses on case-control studies comparing adult BPD patients with healthy and clinical controls.
  • Included 37 studies with 803 BPD patients and 1092 controls.
  • Utilized random-effect models with standardized mean differences to analyze data.

Main Results:

  • BPD patients exhibited significantly elevated continuous cortisol output.
  • A blunted cortisol response was observed in BPD patients following psychosocial challenges.
  • No significant differences in singular cortisol assessments or cortisol response to pharmacological challenges were found.

Conclusions:

  • HPA axis functioning in BPD is characterized by elevated continuous cortisol and blunted responses to psychosocial stress.
  • Inconsistencies in reporting and small sample sizes limited some meta-analyses.
  • Further investigation into elevated continuous cortisol and blunted psychosocial stress responses in BPD is warranted due to the impact of stress-related symptoms.