The Emerging Circadian Phenotype of Borderline Personality Disorder: Mechanisms, Opportunities and Future Directions

Abstract

Purpose of Review We review the recent evidence suggesting that circadian rhythm disturbance is a common unaddressed feature of borderline personality disorder (BPD); amelioration of which may confer substantial clinical benefit. We assess chronobiological BPD studies from a mechanistic and translational perspective and highlight opportunities for the future development of this hypothesis. Recent Findings The emerging circadian phenotype of BPD is characterised by a preponderance of comorbid circadian rhythm sleep-wake disorders, phase delayed and misaligned rest-activity patterns and attenuated amplitudes of usually well-characterised circadian rhythms. Such disturbances may exacerbate symptom severity, and specific maladaptive personality dimensions may produce a liability towards extremes in chronotype. Pilot studies suggest intervention may be beneficial, but development is limited. Summary Endogenous and exogenous circadian rhythm disturbances appear to be common in BPD. The interface between psychiatry and chronobiology has led previously to novel efficacious strategies for the treatment of psychiatric disorders. We believe that better characterisation of the circadian phenotype in BPD will lead to a directed biological target for treatment in a condition where there is a regrettable paucity of accessible therapies.

Sleep Quality After Quetiapine Augmentation in Patients With Treatment-Resistant Depression and Personality Disorders

“…It is possible that the impaired circadian regulation of sleep requires longer time to recover, especially in PDs. In confirmation of this hypothesis, recent evidence suggests that circadian rhythm disturbance is a common unaddressed feature of borderline PD, and circadian rhythm restoration may be a target for the therapeutics of PDs 73 …”

“…In confirmation of this hypothesis, recent evidence suggests that circadian rhythm disturbance is a common unaddressed feature of borderline PD, and circadian rhythm restoration may be a target for the therapeutics of PDs. 73…”

Subjective and objective sleep in young people with borderline personality disorder features

“…Later chronotype has been associated with greater insomnia symptoms and poorer subjective sleep quality (Ong et al, 2007; Selvi et al, 2012), suggesting that these factors might be interrelated in young people with BPD features. Chronotype disturbances warrant specific clinical attention as they exacerbate BPD features and have been identified as an important, unmet, treatment need for adults with BPD (McGowan & Saunders, 2021). Overall, subjective sleep findings were consistent with hypotheses and previous research (Jenkins, Thompson, et al, 2021), and indicate that subjective sleep is disturbed in young people with BPD features.…”

Accelerated epigenetic aging in women with emotionally unstable personality disorder and a history of suicide attempts

“…However, even accounting for this and death by other unnatural causes such as accidents, substantial excess mortality has been observed [9]. Additionally, EUPD is associated with a wide variety of medical conditions, such as hypertension and other cardiovascular diseases, sexually transmitted diseases, arthritis, obesity, physical pain and sleep disturbances [10][11][12]. Previous studies also demonstrate that EUPD is associated with a high prevalence of poor health habits, i.e., smoking, physical inactivity, and overconsumption of medicine [13].…”