Cerebellar metabolic alterations and childhood physical abuse as biomarkers in bipolar disorder with comorbid borderline personality disorder.

Our study investigated the neuropsychological mechanisms underlying BD comorbid with BPD by examining childhood trauma and metabolic changes in the cerebellum. We found that BD & BPD patients reported higher levels of physical abuse and demonstrated distinct cerebellar metabolic profiles characterized by elevated NAA/Cr and Cho/Cr ratios in the right cerebellum compared to BD patients without BPD. Notably, these ratio changes were driven by significantly increased absolute NAA concentrations and decreased creatine levels, whereas absolute choline concentrations and NAA/Cho ratios remained unchanged. Physical abuse was inversely correlated with the right cerebellar Cho/Cr ratio. These findings suggest that childhood trauma may interact with cerebellar energy metabolic dysfunction-characterized by neuronal hypermetabolism (elevated NAA) and compromised energy buffering (reduced Cr)-in the pathophysiology of this comorbidity. This study provides new insights into the biological underpinnings linking early-life adversity and cerebellar neurochemical alterations in BD & BPD.