Why Do Teenagers With Borderline Personality Disorder See Themselves Differently?
- Feb 11
- 4 min read
This study investigated how the brains of adolescents with borderline personality disorder function during self-reflection tasks. The results show that areas linked to cognitive control are less activated when these young women think about themselves, which may explain the instability of identity in the disorder. The findings reinforce the importance of understanding BPD as a condition of brain development and of identifying the disorder early.
Borderline personality disorder, also known as BPD, is a mental health condition marked by very intense emotions, impulsivity, difficulty maintaining stable relationships, and a confused or unstable sense of who the person is. Although for a long time it was seen as a disorder exclusive to adulthood, today we know that it can emerge and be reliably diagnosed in adolescence.
This early recognition is important because BPD seems to be linked to brain development and the emotional and psychological changes typical of this phase of life.
Several studies have already shown that biological factors play an important role in borderline personality disorder. Studies using genetics and brain imaging indicate that the brains of people with the disorder function differently in some situations. Until now, most of this research has focused on how the brain reacts to negative emotions, such as fear, anger, or sadness, since difficulty regulating emotions is one of the hallmarks of the disorder.
These studies have shown that, when faced with emotional stimuli, people with borderline personality disorder tend to have less activation in brain areas linked to rational control and decision-making, especially in the prefrontal cortex.
At the same time, regions associated with intense emotions, such as the amygdala, tend to be more active. This imbalance helps explain why these people feel emotions so intensely and have difficulty controlling them.
However, another central aspect of borderline personality disorder has received far less attention: the issue of identity. Many people with the disorder report not knowing exactly who they are, frequently changing their goals, or feeling that their "self" is unstable. One way to study this is to observe what happens in the brain when someone thinks about themselves, a process known as self-reflection.
In people without the disorder, thinking about themselves or others activates a specific brain network, which includes areas of the medial frontal cortex, the posterior cingulate cortex, and regions linked to consciousness and social perception. Interestingly, thinking about oneself and thinking about others activates very similar, though not exactly identical, brain regions.
Until recently, only one study had investigated this type of self-reflection in people with borderline personality disorder, and it was conducted with adults. The results indicated that patients with borderline personality disorder activated different areas of the brain when thinking about themselves, suggesting that this process occurs in an altered way in the disorder.
However, data on adolescents, a phase in which identity is still being formed, were still lacking.
Therefore, this study analyzed female adolescents with borderline personality disorder, all without medication and without other associated psychiatric disorders. During functional magnetic resonance imaging (fMRI) scans, they answered questions about themselves and other people, as well as neutral control tasks. This allowed for a comparison of how the brain reacted in each situation.
The figure shows how a region of the brain linked to social thought and personal meaning, the ventral medial prefrontal cortex (vmPFC), reacts when adolescents think about other people or deal with neutral facts, comparing young people with borderline personality disorder (BPD) and young people without the disorder. The areas in red indicate the region analyzed, and the graphs show how much this area was more or less active in each task. In both groups, the vmPFC was less active during both tasks, which is normal and indicates that the brain is adjusting its functioning to the type of information processed. However, during the neutral facts task, adolescents without BPD showed a greater deactivation of this region than those with BPD, suggesting that the control group is better able to "switch off" areas linked to personal and social thoughts when they are not needed, while adolescents with BPD tend to keep this region more active even in neutral situations.
The results showed that, when thinking about themselves, adolescent girls with borderline personality disorder exhibited less activation in important brain areas related to cognitive control, planning, and thought organization.
This suggests that they have more difficulty organizing and regulating thoughts about their own identity. When thinking about other people, the differences were smaller and seemed to be linked to difficulties in "switching off" certain brain areas during neutral tasks. These findings help to better understand why identity is so fragile in borderline personality disorder and reinforce the importance of early diagnosis and intervention.
READ MORE:
Brain functional abnormality in drug naïve adolescents with borderline personality disorder during self- and other-reflection
Pilar Salgado-Pineda, Marc Ferrer, Natàlia Calvo, Juan D. Duque-Yemail, Xavier Costa, Àlex Rué, Violeta Pérez-Rodriguez, Josep Antoni Ramos-Quiroga, Cristina Veciana-Verdaguer, Paola Fuentes-Claramonte, Raymond Salvador, Peter J. McKenna, and Edith Pomarol-Clotet
Translational Psychiatry, volume 15, Article number: 157 (2025)
Abstract:
A disturbed sense of identity is one of the major features of borderline personality disorder (BPD), which manifests early in the course of the disorder, and is potentially examinable using functional imaging during tasks involving self-reflection. Twenty-seven medication-naïve adolescent female patients with BPD, who had no psychiatric comorbidities, and 28 matched healthy female controls underwent fMRI while answering questions either about themselves or acquaintances. Control conditions consisted of answering questions involving factual knowledge and a low-level baseline (cross fixation). When self-reflection was compared to fact processing, BPD patients exhibited reduced activation in the right dorsolateral prefrontal cortex (DLPFC), as well as in the left parietal and calcarine cortex and the right precuneus. In contrast, other-reflection was associated with relatively lower activation in the medial frontal cortex in BPD patients, with further analysis revealing that this change reflected a failure of de-activation during the fact processing condition. There were no differences between the BPD patients and controls when self- and other-processing was examined against low-level baseline. This study provides evidence of reduced DLPFC activation during self-reflection in adolescent females with BPD, which may reflect diminished top-down cognitive control of this process, but not other-reflection in the disorder.
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