Understanding Anxiety in Borderline Personality Disorder

There is substantial evidence that borderline personality disorder and anxiety disorders not only co-occur but also mutually influence their outcomes and treatment responses. Both share a significant neurobiological overlap including abnormalities in the limbic system, hypothalamic pituitary adrenal axis, serotoninergic transporter and glucocorticoid transporter genes, and an atypical regulation of the autonomic nervous system. Anxiety should be systematically assessed in patients with borderline personality disorder using dimensional instruments that capture not only the psychological aspects of the disorder but also the bodily and the somatic complaints as they are extremely common in these patients. Little is known about the treatment of this comorbidity but there is some evidence about the effect of antidepressants and some psychotherapies like cognitive or dialectical behavioral therapy, but new non-pharmacological strategies are emerging. Future lines of research should explore the role of new neurobiological treatments like oxytocin, or the emerging field of nutritional psychiatry and the role of the microbiome. Ultimately, more efforts are needed to understand the role of body perception and autonomic dysfunction in this comorbidity, as it could be the key to developing more specific treatment approaches. © 2017, Springer International Publishing AG.