Anxiety sensitivity, psychological vulnerability, and brain volumes in borderline personality disorder

This study compared AS, psychological vulnerability, and brain volumes in BPD and healthy controls and examined clinical-volumetric associations within BPD.

Twenty-seven patients with BPD and 28 healthy controls completed the Anxiety Sensitivity Index-3 and the Psychological Vulnerability Scale. Three-dimensional T1-weighted images were acquired using a 1.5-Tesla MRI scanner, and regional volumes were calculated.

In raw analyses, the BPD group had higher psychological vulnerability and total, cognitive, and social AS scores. After covariate adjustment, only social AS remained significant (p = 0.035). Bilateral putamen, anterior insula, caudate, nucleus accumbens, and total gray matter volumes were larger in the BPD group, persisting after adjustment (all p ≤ 0.018). Differences in left amygdala, posterior and total insula, posterior cingulate gyrus, and white matter volumes lost significance after adjustment. In the BPD group, posterior insula volumes were negatively correlated with total and social AS scores, remaining significant after controlling for confounders (r=-0.471 to -0.611; p = 0.004-0.036). Psychological vulnerability and cognitive AS were not associated with regional volumes.

Social AS may represent a specific dimension of BPD. Group-level differences in anterior insula and striatal volumes, together with dimensional associations between posterior insula volumes and AS, suggest distinct roles for insular subregions in BPD-related clinical and structural processes.