Neuroimaging insights into Borderline Personality Disorder patients with and without suicide attempts: A multi-modal...

Borderline Personality Disorder (BPD) is characterized by emotional dysregulation and high-risk behaviors, including self-harm and suicide attempts. Despite the high prevalence of suicidal behavior in BPD, the neurobiological substrates underlying suicide vulnerability remain poorly understood. This study aimed to investigate differences in BPD and a history of suicide attempt (BPD-SA) with those without such a history (BPD-NA) using multimodal magnetic resonance imaging (MRI).

Neuroimaging data from 60 individuals with BPD were analyzed. Acquisitions included high-resolution T1-weighted, Fluid-Attenuated Inversion Recovery sequences, and Diffusion Weighted Imaging. Imaging features were compared between BPD-SA (n = 30) and BPD-NA (n = 30) subgroups, adjusting for alcohol and substance abuse. Pearson's correlation was used to examine associations between imaging features and clinical questionnaires, including childhood trauma and symptom severity.

Significant differences (p < 0.05) were found between BPD-SA and BPD-NA in brain volume, cortical thickness, and Fractional Anisotropy. The most pronounced changes were localized to limbic structures (hippocampus and fornix), the frontal cortex, corpus callosum, and cortico-thalamic pathways, with BPD-SA showing more severe white matter alterations. Correlation analyses revealed that imaging abnormalities in BPD-SA were negatively correlated with the Childhood Trauma Questionnaire (CTQ). In contrast, Zanarini Rating Scale (ZAN-BPD) scores were negatively correlated with MRI-assessed neurobiological alterations only in the BPD-NA subgroup.

This study provides preliminary evidence that BPD-SA may exhibit distinct patterns of structural and white matter alterations compared to BPD-NA. Such neuroimaging differences may reflect underlying neurobiological dimensions related to vulnerability, illness severity, and developmental risk exposure.