The aim of this paper is to clarify how neural mechanisms at the
molecular level, specifically the serotonergic (5-HT) system and the
hypothalamic–pituitary–adrenal axis system (HPA) in
conjunction with early life stress may contribute to the emergence of
aggression, self-directed and otherwise, in borderline personality
disorder (BPD). Chronic dysregulation of these biological systems, which
function to regulate stress and emotion, may potentiate the development of
impulsive aggression in borderline personality conditions. Our central
premise in this paper is that brain development, stress regulation, and
early pathonomic experience are interactive and cumulative in their mutual
influence on the development of impulsive aggression in BPD. We review the
parameters of impulsive aggression in BPD, followed by a discussion of the
neurobiological and neuroendocrine correlates of impulsive aggression with
and without BPD. We then focus on the developmental continuities in BPD
with attention to brain maturation of 5-HT and HPA axis function during
the life span and the influence of early adverse experiences on these
systems. Finally, we comment on the data of the relative stability of
aggression in BPD, adolescence as a developmental stage of potential
vulnerability, and the course of aggressive behavior during the life
span.The authors thank Caroline Cozza,
Michael McCloskey, and Kurt Knoblett for their comments during the
preparation of this manuscript. This research was supported by research
funding from the American Foundation of Suicide Prevention (J.K.G.), Grant
MH066888-01 (R.L.), and the Borderline Personality Disorder Research
Foundation (E.F.C.).