Violence and aggressiveness in borderline disorder: A systematic review

Borderline Personality Disorder (BPD) affects 1 to 3% of the general population and up to 20% of psychiatric inpatients. It is characterized by emotional dysregulation, impaired interpersonal relationships, and impulsive behaviors. This systematic review aims to identify psychopathological mechanisms, comorbidities, and gender differences associated with violence in BPD.

This review followed PRISMA guidelines and included studies published in English or French with no time restriction. Literature searches were conducted in PubMed and Ovid using the search equation: ((violence [MeSH Terms]) or (aggression [MeSH Terms])) and (borderline personality disorder [MeSH Terms]) and (psychiatry). Of 502 initial publications, 28 were included in the final analysis.

Aggressiveness in BPD was found to be associated with emotional dysregulation and impulsivity, influencing violent behaviors (β=0.25 to 0.52). Comorbidities such as bipolar disorder, substance use, or co-occurring personality disorders exacerbated aggression (OR=2.1 to 3.2). Suicidal and self-harming behaviors affected 78% of adolescents and 73% of adults with BPD. Women accounted for 75% of BPD diagnoses and presented more self-directed aggression (suicide, self-harm), whereas men more frequently exhibited outwardly directed aggression. Finally, childhood trauma and dysfunctional family environments were seen as major predictors of aggressive and suicidal behaviors in adulthood (OR=3.9 to 5.8).

Findings highlighted the central role of emotional dysregulation, impulsivity, and early trauma in BPD-related aggression. Clinical implications include the need for targeted therapies (e.g., DBT, MBT), early screening for trauma, and gender-sensitive approaches. This review underscores the interaction between biological, psychological, and social factors in BPD-associated violence and calls for personalized interventions and the integration of longitudinal research designs.