Borderline personality disorder
Borderline personality disorder (BPD) is characterized by intense and rapidly changing mood states and impulsivity, self-injurious behaviours, fear of abandonment, unstable relationships, and unstable self-image. Early life adversities are highly prevalent and childhood trauma is a major antecedent for BPD. Several studies suggest alterations in the HPA axis in patients with BPD (Wingenfeld and Wolf, 2015) but MR function is mostly neglected in these studies. However, MR and GR sensitivity did not differ in a study between BPD patients and controls (Fischeret al. , 2014), albeit with a small sample size. Fludrocortisone treatment led to improved working memory performance in BPD patients (Wingenfeld et al. , 2015). In contrast, verbal and visuospatial memory were impaired in BPD women compared to controls (Wingenfeldet al. , 2015). Interestingly, an earlier study found the GR and MR activating hydrocortisone to enhance memory retrieval in BPD patients (Wingenfeld et al. , 2013). In sum, differences between patients and healthy individuals were only seen in hippocampus-associated cognitive domains.
BPD symptoms are exacerbated by stressful interpersonal events and in patient social cognition and emotional empathy scores deteriorated after stress. Similar to healthy controls, patients had higher emotional empathy scores after MR stimulation (Wingenfeld et al. , 2014). However, stress per se impaired social empathy scores. These findings are interpreted as a stress-induced “fight-and-flight” response pattern in BPD patients leading to symptoms such as increased impulsivity as compared to a prosocial behavioural pattern observed in healthy individuals. Thus, the role of the MR in the context of stress effects on social cognition might be of high clinical relevance in BPD.