Symptom correlates of white matter pathology in borderline personality disorder: A narrative review of a structured pubmed search.

BACKGROUND

Borderline personality disorder (BPD) is a common psychiatric illness with a significant burden of disease. Using diffusion tensor imaging (DTI), researchers have demonstrated shared patterns of white matter pathology across BPD patients. White matter changes have mapped onto prominent symptoms of BPD as well. We have conducted this review to examine recent literature on white matter findings in BPD and the correlating significant symptoms.

METHODS

A literature search was conducted on the Pubmed database in alignment with PRISMA guidelines. Relevant articles published from April 2018 - May 2026 surrounding BPD and DTI findings were included.

RESULTS

8 studies were included in the final review. BPD subjects displayed significant white matter pathology across multiple brain regions, with the corpus callosum, differing regions around the cingulate cortex and superior longitudinal fasciculus being recurrent findings. Correlates to symptomatology were noted as well, with the corpus callosum's relationship with anxiety and the relevance of the triple network's white matter connectivity to suicidal and aggressive behavior being of special interest.

DISCUSSION: BPD is associated with significant white matter pathology across multiple brain regions, with symptoms correlating to impaired white matter in specific areas. Further prospective studies should be done to evaluate the ability of DTI to predict psychological and behavioral disturbances.