By Dr. David Woo - June 5, 2023

Borderline personality disorder (BPD) is a mental health condition characterized by emotional instability, poor self-image, and impulsive, self-destructive behavior. It occurs in around 1-3% of the population (1). BPD patients experience hard-to-control symptoms that can seriously impact quality of life, but it is treatable.

You might have heard of rTMS for borderline personality disorder as a potential treatment option. Transcranial magnetic stimulation (TMS), also known as repetitive transcranial magnetic stimulation (rTMS), is a relatively new treatment for BPD that works by using a head-mounted device to send tiny magnetic pulses to specific areas of the brain associated with BPD symptoms. 

To know if this treatment may be right for you, it’s necessary to understand the causes behind BPD symptoms and how brain stimulation can help.

What Causes BPD?

Like many mood disorders, BPD is at least partly rooted in our brain chemistry. Recent research suggests that BPD patients have reduced volume in certain areas of the brain associated with regulating emotion and stress, such as the hippocampus, amygdala, and medial temporal lobe (2).

Individuals with BPD also show higher levels of cortisol, a stress hormone, than the general population (3). Around 71% of people with BPD suffered from childhood trauma, which can sometimes affect the development of the hypothalamus, pituitary gland, and adrenal glands (HPA) to overproduce cortisol (4,5).

Irregularities in the parts of the brain that regulate emotion and stress contribute to the characteristic symptoms of BPD, including:

• Feelings of intense loneliness or emptiness
• Unstable relationships
• Distorted self-image
• Impulsivity and risky behavior
• Self-harm and suicide attempts
• Extreme mood swings, including intense anger and aggression
• Fear of abandonment
• Short-lived episodes of paranoia

Talk therapy can help BPD patients manage their emotions and stressors, but there is also a treatment that directly addresses the brain irregularities behind BPD in the form of TMS.

rTMS For Borderline Personality Disorder

The magnetic pulses transmitted by TMS help stimulate the regions of the brain associated with BPD symptoms, restoring the natural electrochemical activity of the brain and giving the patient the power to better regulate stress, emotion, and judgment. 

TMS has a great success rate in treating depression, OCD, ADHD, and anxiety, and research has shown it to be also effective in treating BPD symptoms.

A recent study on the efficacy of rTMS for BPD showed that patients experienced connectivity changes related to the amygdala and insula that helped reduce BPD symptoms such as impulsivity, depression, and anxiety (6). This backs up similar results from earlier case studies on individuals in which BPD severity was found to be reduced after a 10-session course of TMS (7). The latest systematic review of existing research on the use of TMS for BPD notes that, although larger studies are needed, TMS has been shown to be safe and effective for BPD patients (8).

Recovery from BPD can seem like an uphill struggle, but TMS in its various forms can help stimulate a healthy brain connectivity that makes it easier for the patient. A review of TMS along with other brain stimulation (called neuromodulation) treatments has shown that patients can expect clinical improvement in executive dysfunction, impulsivity, emotional regulation and aggression (9).

TMS in NYC for BPD

If you think that you or a loved one may be experiencing symptoms of BPD, it is important to seek treatment as soon as possible. Failure to seek professional help may lead to a worsening of symptoms.

At Madison Avenue TMS & Psychiatry, we can offer therapy and TMS for the treatment of BPD and other disorders. To make an appointment, contact us online or call (212) 731-2033.

Sources:

1. Biskin RS: The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60(7):303-308. 10.1177/070674371506000702. Accessed May 11, 2023.
2. Thomas N, Gurvich C, Kulkarni J. Borderline personality disorder, trauma, and the hypothalamus-pituitary-adrenal axis. Neuropsychiatr Dis Treat. 2019;15:2601-2612. Link. Accessed May 11, 2023.
3. Mainali P, Rai T, Rutkofsky I H. From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: Exploring the Neuromorphological and Epigenetic Pathway. Cureus. 2020;12(7). Link. Accessed May 11, 2023.
4. Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand. 2020;141(1):6-20. Link. Accessed May 11, 2023.
5. Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry. 2017;17(1):221. Link. Accessed May 11, 2023.
6. Sverak, T., Linhartova, P., Gajdos, M., Kuhn, M., Latalova, A., Lamos, M., Ustohal, L., & Kasparek, T. Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder. Frontiers in Psychiatry. 2022;12. Link. Accessed May 11, 2023.
7. Arbabi M, Hafizi S, Ansari S, Oghabian MA, Hasani N. High frequency TMS for the management of Borderline Personality Disorder: a case report. Asian J Psychiatr. 2013;6(6):614-7. Link. Accessed May 16, 2023.
8. Konstantinou GN, Trevizol AP, Downar J, McMain SF, Vila-Rodriguez F, Daskalakis ZJ, Blumberger DM. Repetitive transcranial magnetic stimulation in patients with borderline personality disorder: A systematic review. Psychiatry Res. 2021;304:114145. Link. Accessed May 16, 2023.
9. Yahya ASd, Khawaja S, Williams PS, Naguib M. Neuromodulation approaches for borderline personality disorder. Progress in Neurology and Psychiatry. 2022;21,(1). Link. Accessed May 16, 2023.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.