A 26-year-old woman describes intense unstable relationships alternating between idealisation and devaluation, chronic feelings of emptiness, recurrent self-harm, and frantic efforts to avoid abandonment. She is diagnosed with Borderline Personality Disorder. Which neuroimaging finding is MOST consistently associated with BPD?
- A Frontal lobe atrophy with enlarged lateral ventricles
- B Amygdala hyperreactivity to emotional stimuli with reduced prefrontal regulatory control ✓
- C Reduced dopamine transporter density in the striatum
- D Hippocampal enlargement and enhanced memory consolidation
Explanation
The neurobiological substrate of BPD involves hyperreactivity of the amygdala (exaggerated emotional responses to interpersonal/emotional stimuli) combined with reduced activity of the medial prefrontal cortex and anterior cingulate cortex (impaired top-down emotional regulation). This amygdala-mPFC circuit dysfunction underlies emotional dysregulation, impulsivity, and the rapid emotional shifts characteristic of BPD. DBT works partly by strengthening prefrontal regulatory circuits. This pattern is distinct from schizophrenia (dopamine transporter findings) or dementia (atrophy/ventricular changes).
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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