Title:
标题

Brain structural and functional alterations in adolescents with borderline personality disorder: a systematic review and a research agenda
边缘型人格障碍青少年的大脑结构和功能改变：系统综述和研究议程

Xueying Wang ^1,2, Alessandro Grecucci³, Yan Fu¹, Jinfan Zhang¹, Liying Shen⁴, Han Wu⁷, Jing Wang^5*, Qian Xiao^4*, Xiaoping Yi^{1,2 *}, Bihong T. Chen⁶
Xueying Wang ^1,2 , Alessandro Grecucci ³ , Yan Fu ¹ , Jinfan Zhang ¹ , Liying Shen ⁴ , Han Wu ⁷ , Jing Wang ^5* , Qian Xiao ^4* , Xiaoping Yi ^{1,2 *} , Bihong T. Chen ⁶

1 Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, P. R. China
1 中南大学湘雅医院放射科，湖南长沙 410008

2 National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha 410008, Hunan, P.R. China
2 中南大学国家老年医学临床研究中心（湘雅医院），湖南长沙 410008

3 Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, Rovereto (TN) 38068, Italy
3 特伦托大学心理学和认知科学系（DiPSCo），意大利罗韦雷托（TN）38068

4 Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, P.R. China
4 中南大学湘雅医院精神卫生中心，湖南长沙 410008

5 Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, P.R. China
5 中南大学湘雅医院神经内科，湖南长沙 410008

6 Department of Diagnostic Radiology, City of Hope National Medical Center,
6 国家希望之城医疗中心放射诊断部、

Duarte, California 91010, USA
美国加利福尼亚州杜阿尔特 91010

7 Department of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
7 日本东京，东京大学医学研究生院国际卫生系

^*Corresponding Author:
^* 通讯作者：

Xiaoping Yi, MD, PhD
易小平，医学博士

Department of Radiology, Xiangya Hospital, Central South University
中南大学湘雅医院放射科

No. 87 Xiangya Road, P.R. China
中国湘雅路 87 号

Tel: (011)86-731-84327448
电话：(011)86-731-84327448

Fax: (011) 86-731-84327448
传真：（011）86-731-84327448

E-mail: yixiaoping@csu.edu.cn
电子邮件： yixiaoping@csu.edu.cn

Jing Wang, MD, PhD
王晶，医学博士

Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, P.R. China Tel: +86-731-84327448
中南大学湘雅医院神经内科，湖南长沙 410008 电话：+86-731-84327448

Fax: +86-731-84327448
传真：+86-731-84327448

E-mail: 844513686@qq.com
电子邮件844513686@qq.com

Qian Xiao M.D, Ph. D, Mental Health Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, P.R. China
钱晓，医学博士，中南大学湘雅医院精神卫生中心，湘雅路87号。

Telephone:(011)86-731-84327169; Fax:(011)86-731-84327169;

E-mail: xiaoqian851112@126.com
电子邮件： xiaoqian851112@126.com

Acknowledgments
致谢

We thank the staff members in the Department of Radiology, Mental Health Center and the Department of Neurology for their helpful discussions and assistance in the data analysis and manuscript preparation.
我们感谢放射科、精神卫生中心和神经科的工作人员在数据分析和稿件准备过程中提供的有益讨论和帮助。

Funding:
资金：

This study was funded by the Fundamental Research Funds for the Central Universities of Central South University (grant 2024ZZTS0876)., P.R. China.
本研究由中南大学中央高校基本科研业务费资助（2024ZZTS0876）。

Conflict of Interest:
利益冲突：

The authors declare no conflicts of interest.
作者声明没有利益冲突。

Abstract
摘要

Adolescent borderline personality disorder (aBPD) is linked to severe psychological problems and social dysfunction in the affected adolescents. The objective of this review was to summarize the current understanding of brain structural and functional alterations identified on neuroimaging and to propose future research directions. This systemic review identified alterations of three brain networks involved in aBPD, i.e., the prefrontal – executive network, the default mode network, and the affective network. We also presented a BPD model integrating the existing neural and psychological data to offer insights for future research and hypothesis testing. This proposed future research includes leveraging novel analytical techniques such as artificial intelligence methods to facilitate the identification of potential neuroimaging biomarkers for BPD. The potential for targeting these dysfunctional networks via neurostimulation methods is also discussed.
青少年边缘型人格障碍（aBPD）与受影响青少年的严重心理问题和社会功能障碍有关。本综述旨在总结目前对神经影像学发现的大脑结构和功能改变的理解，并提出未来的研究方向。这篇系统性的综述指出了三种大脑网络（即前额叶-执行网络、默认模式网络和情感网络）与 BPD 有关的改变。我们还提出了一个整合现有神经和心理数据的 BPD 模型，为未来的研究和假设检验提供启示。建议的未来研究包括利用新型分析技术（如人工智能方法）来促进确定潜在的 BPD 神经影像生物标志物。此外，还讨论了通过神经刺激方法靶向这些功能失调网络的潜力。

1. Introduction
1.导言

Borderline personality disorder (BPD) is a severe psychiatric condition characterized by a persistent pattern of emotional dysregulation, marked impulsivity, interpersonal disturbances, identity instability and persisting non-suicidal self-injury (NSSI). This disorder has a 3% prevalence in the general population (Grecucci et al., 2023; Lenzenweger, Lane, Loranger, & Kessler, 2007) and is associated with significant impairment of patients’ psychological functioning (De Panfilis et al., 2019). Adolescence is considered a critical period of time for patients with BPD (Ibraheim, Kalpakci, & Sharp, 2017), as early treatment starting in adolescence may decrease symptom severity (Chanen, Jackson, et al., 2008). However, early diagnosis has been challenging due to the lack of understanding of its pathophysiology with no specific biomarkers to guide clinical decision-making.
边缘型人格障碍（Borderline personality disorder，BPD）是一种严重的精神疾病，其特征是持续的情绪失调、明显的冲动、人际关系障碍、身份不稳定和持续的非自杀性自伤（NSSI）。这种疾病在普通人群中的发病率为 3%（Grecucci 等人，2023 年；Lenzenweger、Lane、Loranger 和 Kessler，2007 年），并与患者心理功能的严重受损有关（De Panfilis 等人，2019 年）。青春期被认为是 BPD 患者的关键时期（Ibraheim、Kalpakci 和 Sharp，2017 年），因为青春期开始的早期治疗可能会降低症状的严重程度（Chanen、Jackson 等人，2008 年）。然而，由于对其病理生理学缺乏了解，也没有特定的生物标志物来指导临床决策，因此早期诊断一直是个难题。

Diagnosing BPD precisely is often a complex and difficult process due to several factors (Grecucci et al., 2022; Rao et al., 2020). One issue is that patient symptoms tend to fluctuate significantly, with different degrees of vulnerability (Choi-Kain et al., 2020). Another challenge is that current classification manuals categorize personality disorders in a categorical manner, whereas personality traits can be viewed on a spectrum in key domains (Ashton, 2017). Furthermore, there is considerable overlap in symptoms across different personality disorder categories (Siefert et al., 2022). Lastly, diagnosing Borderline Personality Disorder (BPD) depends on observable behavior as no objective markers are available yet. An accurate early diagnosis is even more complex for aBPD, as adolescents are characterized by notable brain development with inherent brain alterations.
由于多种因素（Grecucci 等人，2022 年；Rao 等人，2020 年），精确诊断 BPD 通常是一个复杂而困难的过程。其中一个问题是，患者的症状往往波动很大，易感程度各不相同（Choi-Kain 等人，2020 年）。另一个挑战是，目前的分类手册以分类的方式对人格障碍进行分类，而人格特质在关键领域可以被视为一个谱系（Ashton，2017）。此外，不同人格障碍类别的症状有相当大的重叠性（Siefert 等人，2022 年）。最后，边缘型人格障碍（BPD）的诊断取决于可观察到的行为，因为目前还没有客观的标记。对边缘型人格障碍（BPD）而言，准确的早期诊断更为复杂，因为青少年的特点是大脑发育显著，并伴有固有的大脑改变。

Neuroimaging has emerged as a useful tool to assess structural and functional alterations of the brain (Bøen et al., 2014; Bruehl et al., 2013; de Araujo Filho et al., 2014), and has been recently applied to adults with BPD for identification of possible biomarkers (Grecucci et al., 2022). Most of the neuroimaging studies have whown gray and white matter alterations in aBPD patients (Jovev et al., 2008; Takahashi, Chanen, Wood, Yücel, et al., 2009). These studies demonstrated multiple brain volume and surface alterations associated with clinical symptomatology in patients with BPD (Jovev et al., 2008; Takahashi, Chanen, Wood, Yücel, et al., 2009). Beside structural studies, a few studies have used functional MRI (fMRI) to characterize brian anomalies in aBPD. However, the studies conducted so far have several limitations, such as small sample sizes, unmatched gender ratio, and lack of control subjects (Lotfinia, Soorgi, Mertens, & Daniels, 2020). Thus, previously reported brain changes may not be representative of the patients with BPD in general.
神经影像学已成为评估大脑结构和功能改变的有用工具（Bøen 等人，2014 年；Bruehl 等人，2013 年；de Araujo Filho 等人，2014 年），最近已应用于患有 BPD 的成年人，以确定可能的生物标记物（Grecucci 等人，2022 年）。大多数神经影像学研究都显示了躁狂症患者灰质和白质的改变（Jovev 等人，2008 年；Takahashi、Chanen、Wood、Yücel 等人，2009 年）。这些研究表明，多种脑容量和表面改变与 BPD 患者的临床症状相关（Jovev 等人，2008 年；Takahashi、Chanen、Wood、Yücel 等人，2009 年）。除结构研究外，也有少数研究使用功能磁共振成像（fMRI）来描述双臂异常的特征。然而，迄今为止进行的研究存在一些局限性，如样本量小、性别比例不匹配、缺乏对照对象等（Lotfinia, Soorgi, Mertens, & Daniels, 2020）。因此，之前报告的大脑变化可能并不能代表一般的 BPD 患者。

The aim of this systemic review is to assess the current understanding of brain structural and functional alterations identified by neuroimaging and to propose future research directions and clinical suggestions. By reviewing the studies conducted so far on aBPD, we were able to outline a possible network model of aBPD, and to suggest possible neurostimulation interventionsto target this network. We also discuss the possibility to use novel analytical techniques such as artificial intelligence methods to facilitate the identification of potential neuroimaging biomarkers for BPD.
本系统综述旨在评估目前对神经影像学所发现的大脑结构和功能改变的理解，并提出未来的研究方向和临床建议。通过回顾迄今为止有关 aBPD 的研究，我们能够勾勒出 aBPD 的可能网络模型，并提出针对该网络的可能神经刺激干预措施。我们还讨论了使用新型分析技术（如人工智能方法）来促进确定潜在的 BPD 神经影像生物标志物的可能性。

2. Methods
2.方法

The present review adhered to the systematic review guidelines identified by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)(Moher, Liberati, Tetzlaff, & Altman, 2009). Several databases including the Web of Knowledge, PubMed and Medline were systematically searched using the following search terms: "Borderline personality disorder" AND "Adolescent" AND "MRI" for papers published between January 1, 2027 and December 31, 2023. Due to the lack of previous systematic reviews in the area, a more open search strategy was adopted to capture as many records as possible for assessment.
本综述遵循《系统综述和元分析首选报告项目》（Preferred Reporting Items for Systematic reviews and Meta-Analyses，PRISMA）（Moher, Liberati, Tetzlaff, & Altman, 2009）确定的系统综述指南。使用以下检索词对包括 Web of Knowledge、PubMed 和 Medline 在内的多个数据库进行了系统检索："边缘型人格障碍"、"青少年 "和 "核磁共振成像"，检索2027年1月1日至2023年12月31日期间发表的论文。由于该领域之前缺乏系统性综述，因此采用了更为开放的搜索策略，以获取尽可能多的记录进行评估。

For the paper to be eligible for inclusion in this review, the studies must have fulfilled the following criteria: diagnosis of BPD being made with a recognized assessment method based on the Diagnostic and statistical manual of mental disorders (DSM-IV or V) or International Classification of Diseases (ICD) criteria, study participants being 12 to 17 years old, having data with gray matter density or volume extraction, and within-group analysis being reported. Both manual tracing and automated processing protocols (e.g., voxel-based morphometry [VBM]) were included, as these methods of processing have been found not to affect outcomes of data analysis (O'Neill & Frodl, 2012). Articles not published in English, conference proceedings, single-case reports and dissertations were excluded.
论文必须符合以下标准才能被纳入本综述：根据《精神障碍诊断与统计手册》（DSM-IV 或 V）或《国际疾病分类》（ICD）标准，采用公认的评估方法对 BPD 进行诊断；研究参与者年龄在 12 至 17 岁之间；具有灰质密度或体积提取数据；并报告了组内分析。人工追踪和自动处理方案（如基于体素的形态测量[VBM]）均包括在内，因为这些处理方法被认为不会影响数据分析的结果（O'Neill & Frodl, 2012）。非英文发表的文章、会议论文集、单一病例报告和学位论文均被排除在外。

A list of articles from the initial search strategy was compiled, their titles and abstracts were assessed for eligibility. A subsequent screening was performed where the main body and the reference list of each article was reviewed, and additional papers were added from the reference section. Duplicates and papers without a reported within-group analysis were excluded. (SeeFigure 1)
根据最初的搜索策略编制了一份文章清单，并对其标题和摘要进行了资格评估。随后进行筛选，审查每篇文章的正文和参考文献目录，并从参考文献部分添加其他论文。重复和未报告组内分析的论文被排除在外。(见图 1）

3. Results
3.成果

The results from MRI studies reporting structural (gray matter and white matter) and functional (resting-state and task-based activation) brain alterations were extracted and were integrated. Figure 1 shows the flow chart of paper selection and identification. A final cohort of 23 papers was included in this review and their main findings were presented in Table 1. Out of the 23 articles included for this review of neuroimaging findings for BPD, 14 were pertained to VBM, 3 to diffusion tensor imaging (DTI), 3 to resting-state fMRI, and 3 to task-based fMRI. And all of these are based on studies of adolescents.
提取并整合了报告大脑结构（灰质和白质）和功能（静息态和基于任务的激活）改变的核磁共振成像研究结果。图 1 显示了论文筛选和鉴定流程图。本综述最终纳入了 23 篇论文，其主要研究结果见表 1。在这23篇关于BPD神经影像学发现的综述文章中，14篇涉及VBM，3篇涉及弥散张量成像（DTI），3篇涉及静息态fMRI，3篇涉及基于任务的fMRI。所有这些都是基于青少年的研究。

4. Structural evidence
4.结构证据

4.1. White matter alterations
4.1.白质改变

DTI is commonly used to study microscopic alterations of the white matter because it allows for measurement of the direction and magnitude of water diffusion in the white matter tracts (Siasios et al., 2016). There have been only three studies using DTI to evaluate aBPD (Maier-Hein et al., 2014; New et al., 2013; Sadek et al., 2021). A study by Sadek et al. (Sadek et al., 2021) found structural alterations in the genu and body of the corpus callosum (CC), suggesting reduced interhemispheric brain connectivity and prefrontal deficits being associated with BPD symptoms using DTI based on a region of interest (ROI) approach. Another study by New and colleagues (New et al., 2013) assessed the trajectory of white matter tracts in BPD using DTI based on a tract-based spatial statistics (TBSS)-whole brain approach in two cohorts of BPD patients (adolescents and adults) and two age- and sex-matched healthy control groups. They observed that the expected normal developmental “peak” in fractional anisotropy (FA) of the inverted U-shaped curve of white matter tracts seen in healthy controls was not achieved in the aBPD cohort. A study by Maier-Hein et al. (Maier-Hein et al., 2014), investigated the fornix, the cingulum and the uncinate fasciculus focused on both hypothesis-driven ROIs and exploratory TBSS analysis. Significant disorder-specific white matter alterations were found in the long association bundles interconnecting the hetero-modal association cortex and in connections between the thalamus and hippocampus. Figure 2 provides a summary of the brain regions identified by DTI highlighting the differences between the aBPD group and the healthy controls.
DTI 常用于研究白质的微观改变，因为它可以测量白质束中水扩散的方向和幅度（Siasios 等人，2016 年）。目前仅有三项研究使用 DTI 评估 aBPD（Maier-Hein 等人，2014 年；New 等人，2013 年；Sadek 等人，2021 年）。Sadek 等人的一项研究（Sadek 等人，2021 年）发现胼胝体（CC）的髓部和体部存在结构性改变，这表明使用基于感兴趣区（ROI）方法的 DTI，大脑半球间的连接性降低和前额叶缺陷与 BPD 症状有关。New 及其同事的另一项研究（New 等人，2013 年）在两组 BPD 患者（青少年和成人）和两组年龄和性别匹配的健康对照组中使用基于束空间统计（TBSS）-全脑方法的 DTI 评估了 BPD 白质束的轨迹。他们观察到，在健康对照组中白质束的倒 U 形曲线分数各向异性（FA）达到了预期的正常发育 "峰值"，但在 BPD 患者队列中却没有达到。Maier-Hein 等人的一项研究（Maier-Hein et al.在连接异模式联想皮层的长联想束以及丘脑和海马之间的连接中发现了明显的特定障碍白质改变。图 2 提供了通过 DTI 确定的大脑区域摘要，突出显示了 aBPD 组与健康对照组之间的差异。

4.2. Gray matter alterations
4.2.灰质改变

Fourteen studies using structural MRI (sMRI) were based on VBM. Eleven out of fourteen found the volume differences of brain regions between the aBPD patients and healthy controls. The remaining three studies showed the morphological alterations of the CC, olfactory sulcus, and midline brain structure, respectively. Figure 3 presents a summary of the brain regions with structural alterations showing alterations in aBPD individuals compared to healthy controls.
14项使用结构磁共振成像（sMRI）的研究以VBM为基础。14 项研究中有 11 项发现了 aBPD 患者与健康对照组之间大脑区域的体积差异。其余三项研究分别显示了CC、嗅沟和大脑中线结构的形态学改变。图 3 显示了 aBPD 患者与健康对照组相比出现结构改变的脑区摘要。

4.2.1. Brain volume
4.2.1.脑容量

There were no significant differences observed in the pituitary gland volume (PGV)
垂体容积（PGV）无明显差异 (Garner et al., 2007)
(加纳等人，2007 年）, insular volume
海岛容积 (Takahashi, Chanen, Wood, Yücel, et al., 2009), hippocampal volume
海马体积 (Chanen, Velakoulis, et al., 2008)
(Chanen、Velakoulis 等人，2008 年）。, amygdala volume
杏仁核体积 (Chanen, Velakoulis, et al., 2008)
(Chanen、Velakoulis 等人，2008 年）。, and volumes of the superior temporal gyrus (STG) subregions including the Heschl gyrus
和颞上回（STG）亚区（包括赫氏回）的体积 (HG) (BA 41/42) (Takahashi et al., 2010)
(高桥等人，2010 年）。 between aBPD patients and the healthy controls. However, one study showed a decreased volume in bilateral hippocampi and in right amygdala in aBPD patients when compared to healthy controls
之间的差异。然而，一项研究显示，与健康对照组相比，ABPD 患者双侧海马和右侧杏仁核的体积有所减小 (Richter et al., 2014)
(里希特等人，2014 年）. In another study, Yi et al.
.在另一项研究中，Yi 等人 (Yi et al., 2024)
(Yi 等人，2024 年） also found gray matter reduction in the right hippocampus. In addition, Brunner
也发现右侧海马的灰质减少。此外，布鲁纳 and colleagues
及其同事 (Brunner et al., 2010)
(布鲁纳等人，2010 年）。 found that patients with aBPD displayed a significantly decreased gray matter volume in
研究发现，脑瘫患者的大脑中的灰质体积明显减少。 the dorsolateral prefrontal cortex (DLPFC)
背外侧前额叶皮层 (DLPFC) bilaterally and in the left
双侧和左侧 orbitofrontal cortex (OFC)
眶额皮质 compared to the healthy controls.
与健康对照组相比。 On the opposite
在对面, one study showed a reversal of the normal (right>left) asymmetry of OFC gray matter in the BPD group
一项研究显示，在 BPD 组中，OFC 灰质的正常不对称（右>左）发生了逆转 (Chanen, Velakoulis, et al., 2008)
(Chanen、Velakoulis 等人，2008 年）。. There were reports of no differences in the DLPFC or OFC in adolescents with BPD and co-morbid major depression disorder (MDD) when compared to healthy adolescents
.有报告称，与健康青少年相比，患有 BPD 和合并重度抑郁障碍 (MDD) 的青少年的 DLPFC 或 OFC 没有差异。 (Goodman et al., 2011)
(古德曼等人，2011 年）. Moreover, those patients with BPD/MDD showed reduced gray matter in the BA24 portion of the anterior cingulate cortex (ACC) when compared with healthy adolescents. The left ACC was found to have reduced gray matter, but this reduction was not present on the right side
.此外，与健康青少年相比，BPD/MDD 患者前扣带回皮层 BA24 部分的灰质减少。研究发现，左侧扣带回皮层的灰质减少，而右侧则没有这种现象。 (Whittle et al., 2009)
(惠特尔等人，2009 年）. In addition, gray matter reduction in both limbic-cortical circuit and the default mode network (DMN) system were found in the adolescents with BPD as compared to the healthy controls
.此外，与健康对照组相比，发现患有 BPD 的青少年边缘皮层回路和默认模式网络（DMN）系统的灰质均有所减少 (Yi et al., 2024)
(Yi 等人，2024 年）. Richter
.里克特 and colleagues
及其同事 (Richter et al., 2014)
(里希特等人，2014 年） found that female adolescents with BPD had a decreased gray matter volume in the left superior parietal gyrus, the right frontal middle gyrus and in the orbital part of the left inferior frontal gyrus when compared to the healthy controls.
发现与健康对照组相比，患有 BPD 的女性青少年左顶叶上回、右额叶中回和左额叶下回眶部的灰质体积减少。

4.3.2. Cortical thickness
4.3.2.皮质厚度

Two studies (Richter et al., 2014; Xiao, Fu, et al., 2023) found altered cortical thickness inside the DMN in the adolescents with BPD when compared to the healthy controls. In particular, there was a decreased cortical thickness in the right precuneus and right supramarginal gyrus, while an increase in cortical thickness in the bilateral para-hippocampal gyrus and left medial OFC(Xiao, Fu, et al., 2023). Decreased cortical thickness was also observed in the limbic–cortical circuit involving the bilateral occipital gyrus, left lingual gyrus, right superior frontal gyrus and bilateral inferior temporal lobe (Xiao, Fu, et al., 2023). However, no between-group differences in cortical thickness were identified in a cohort of female adolescents with BPD compared to healthy controls (Richter et al., 2014).
两项研究（Richter等人，2014年；肖、傅等人，2023年）发现，与健康对照组相比，患有BPD的青少年DMN内部的皮质厚度发生了改变。其中，右侧楔前回和右侧边际上回的皮质厚度减少，而双侧海马旁回和左侧内侧 OFC 的皮质厚度增加（Xiao，Fu，et al.，2023）。在涉及双侧枕回、左侧舌回、右侧额上回和双侧颞下叶的边缘-皮质回路中，也观察到皮质厚度减少（Xiao，Fu，et al.，2023）。然而，与健康对照组相比，在患有 BPD 的女性青少年群组中未发现皮质厚度的组间差异（Richter 等人，2014 年）。

4.2.3. Brain morphology
4.2.3.大脑形态

Other studies focused on the morphology of the CC (size, shape), of the olfactory sulcus and of the midline brain structures. For example, Takahashi et al. (Takahashi et al., 2019) revealed that the adolescents with BPD, especially those with traumatic experiences, had a significantly shallower right olfactory sulcus. However, no difference was detected in the anterior-posterior length of the right olfactory sulcus compared with healthy controls. In an earlier report, Takahashi and colleagues (Takahashi, Chanen, Wood, Walterfang, et al., 2009) investigated the length of the inter-thalamic adhesion (IA) and cavum septum pellucidum (CSP) as well as the third ventricular volume. Although the CSP length did not differ between the groups, the IA was significantly shorter in BPD patients than in controls. Furthermore, the BPD patients had a significantly larger third ventricle than the controls (Takahashi, Chanen, Wood, Walterfang, et al., 2009). However, Walterfang and colleagues (Walterfang et al., 2010) reported no significant differences in total callosal area, length or curvature between BPD patients at first presentation and controls, nor any differences in the callosal shape or ventricular volume.
其他研究侧重于CC的形态（大小、形状）、嗅沟和大脑中线结构。例如，Takahashi等人（Takahashi et al., 2019）发现，患有BPD的青少年，尤其是有创伤经历的青少年，其右侧嗅沟明显较浅。然而，与健康对照组相比，右嗅沟的前后长度没有发现差异。高桥及其同事（Takahashi，Chanen，Wood，Walterfang，et al.，2009）在较早的报告中调查了丘脑间粘连（IA）和透明隔腔（CSP）的长度以及第三脑室的容积。虽然 CSP 长度在各组间没有差异，但 BPD 患者的 IA 明显短于对照组。此外，BPD 患者的第三脑室明显大于对照组（Takahashi、Chanen、Wood、Walterfang 等人，2009 年）。然而，Walterfang 及其同事（Walterfang 等人，2010 年）报告称，初次发病的 BPD 患者与对照组在胼胝体总面积、长度或曲率方面没有明显差异，在胼胝体形状或脑室容积方面也没有任何差异。

5. Functional evidence
5.功能证据

Seven studies were found using fMRI and three of them were based on resting-state, while the other four were task-based. Figure 4 provides a summary of the brain regions with functional alterations between the aBPD patients and the healthy controls.
有七项研究使用了 fMRI，其中三项基于静息态，另外四项基于任务。图 4 提供了 aBPD 患者与健康对照组之间存在功能改变的脑区汇总。

5.1. Resting-state fMRI
5.1.静息态 fMRI

A study by Hall and Hallquist (Hall & Hallquist, 2023) assessed the stability of emotion-related impulsivity by exploring the dissociation of the basolateral and the central amygdala effective connectivity. They found that the inputs from the basolateral amygdala (BLA) and the ventromedial prefrontal cortex (vmPFC) compete to influence the activity of the central amygdala (CeN). In adolescents and young adults with BPD, BLA activity overshadowed the CeN activity, while in healthy controls the ability of the CeN to influence the activity of the BLA predicted more rapid reductions in emotion-related impulsivity. In another study, Yi et al. (Yi et al., 2023) assessed the alterations in regional homogeneity (ReHo) in adolescents with BPD. Compared with healthy controls, adolescents with BPD showed reduced ReHo values in the frontal cortex (including the left inferior OFC and the bilateral superior frontal cortex) as well as in the left precuneus of the DMN. Adolescents with BPD also had higher ReHo values in several cortical regions, such as the right middle temporal gyrus, the right cuneus, the right precentral gyrus and the left middle occipital gyrus. Another study (Xiao, Yi, et al., 2023) reported a significant amplitude of low-frequency fluctuation (ALFF) alterations in the limbic-cortical circuit and inside the DMN regions in adolescents with BPD. Compared with healthy controls, adolescents with BPD showed a decreased amplitude of ALFF in cortical regions such as the left superior frontal gyrus and right middle occipital gyrus, as well as in the DMN. Adolescents with BPD also showed enhanced ALFF in the limbic system (left hippocampus, insula, thalamus) (Xiao, Yi, et al., 2023).
霍尔和霍尔奎斯特（Hall & Hallquist, 2023年）的一项研究通过探索杏仁核基外侧和中央有效连接的分离，评估了情绪相关冲动的稳定性。他们发现，基底外侧杏仁核（BLA）和腹内侧前额叶皮层（vmPFC）的输入会竞争性地影响中央杏仁核（CeN）的活动。在患有BPD的青少年和年轻人中，BLA的活动掩盖了CeN的活动，而在健康对照组中，CeN影响BLA活动的能力预示着情绪相关冲动性的更快降低。在另一项研究中，Yi 等人（Yi et al., 2023）评估了患有 BPD 的青少年区域同质性（ReHo）的改变。与健康对照组相比，患有 BPD 的青少年在额叶皮层（包括左侧下 OFC 和双侧上额叶皮层）以及 DMN 左侧楔前区的 ReHo 值降低。患有 BPD 的青少年在几个皮层区域的 ReHo 值也较高，如右颞中回、右楔状回、右侧中央前回和左枕中回。另一项研究（肖怡等，2023 年）报告了 BPD 青少年边缘-皮层回路和 DMN 区域内低频波动振幅（ALFF）的显著变化。与健康对照组相比，患有 BPD 的青少年在左侧额上回和右侧枕中回等皮层区域以及 DMN 中的 ALFF 振幅降低。患有 BPD 的青少年在边缘系统（左侧海马、脑岛、丘脑）的 ALFF 也有所增强（Xiao、Yi 等人，2023 年）。

5.2. Task-based fMRI
5.2.基于任务的 fMRI

Task-based fMRI studies show divergent results, which depend on the task paradigms used. A study by Brown et al. (Brown et al., 2017) evaluated the differences in neural responses to situations of social inclusion and exclusion among adolescents with NSSI, young adults with BPD and NSSI, and their age-matched controls. The authors found that when compared to age-matched controls, the BPD group showed enhanced activation in the ventral ACC during social exclusion, and enhanced activation in the DLPFC and dorsomedial prefrontal cortex, and the anterior insula during social inclusion. Another study showed that female adolescents with BPD had increased activation in the left posterior insula and left dorsal striatum, as well as in the left inferior frontal cortex, during the rejection-based anger induction and the imagination of aggressive reactions (Krauch et al., 2018).
基于任务的fMRI研究显示了不同的结果，这取决于所使用的任务范式。布朗等人的一项研究（Brown et al.，2017）评估了患有NSSI的青少年、患有BPD和NSSI的年轻成年人及其年龄匹配对照组对社会包容和排斥情况的神经反应差异。作者发现，与年龄匹配的对照组相比，BPD 组在社交排斥时腹侧 ACC 的激活增强，而在社交包容时 DLPFC 和背内侧前额叶皮层以及前脑岛的激活增强。另一项研究表明，患有BPD的女性青少年在基于拒绝的愤怒诱导和攻击性反应的想象过程中，左侧后脑岛和左侧背侧纹状体以及左侧额叶下皮层的激活增强（Krauch等人，2018）。

Another line of research has evaluated the perception of facial emotional expressions in patients with BPD. For example, LeBoeuf et al. (LeBoeuf, Guilé, Labelle, & Luck, 2016) found that aBPD patients observing negative pictures had greater activation in limbic regions (amygdala and right hippocampus and para-hippocampal areas) as well as in the superior frontal gyrus, right precentral gyrus, and cerebellum. Whereas, viewing positive pictures, compared with neutral pictures, led to increased activation of the left hippocampus and both para-hippocampal regions, as well as the middle cingulate cortex, superior temporal gyrus, and cerebellum.
另一项研究评估了 BPD 患者对面部情绪表达的感知。例如，LeBoeuf 等人（LeBoeuf, Guilé, Labelle, & Luck, 2016）发现，观察负面图片的 aBPD 患者边缘区域（杏仁核、右侧海马和海马旁区域）以及额上回、右侧前脑回和小脑的激活程度更高。而与中性图片相比，观看正面图片会导致左侧海马区、海马旁区、扣带回中层、颞上回和小脑的激活增加。

In a different study, female adolescents with BPD and matched healthy controls underwent fMRI during the performance of 1-back and 2-back versions of the n-back working memory task (Salgado-Pineda et al., 2023). Compared to controls, BPD patients failed to de-activate a region of the medial frontal cortex in the 2-back > 1-back comparison. Of note, a subgroup of 30 BPD patients never-medicated showed a failure to de-activate the right hippocampus in the 2-back versus baseline contrast.
在另一项研究中，患有BPD的女性青少年和相匹配的健康对照组在进行1-back和2-back版本的n-back工作记忆任务时接受了fMRI检查（Salgado-Pineda等人，2023年）。与对照组相比，BPD 患者在 2-back > 1-back 的比较中未能去激活内侧额叶皮层的一个区域。值得注意的是，30 名从未接受过治疗的 BPD 患者组成的亚组显示，在 2 回与基线对比中，右侧海马区未能去激活。

6. Discussion
6.讨论

In this section, we combine all brain alterations in patients with aBPD reviewed so far, and discuss the main results according to specific brain structure and its function.
在本节中，我们将综合迄今为止对 aBPD 患者的所有脑部改变进行回顾，并根据具体的脑部结构及其功能讨论主要结果。

6.1. Affective network and emotional dysregulation
6.1.情感网络和情绪失调

The VBM structural studies found a clear involvement of multiple regions of the limbic system in patients with aBPD. The bilateral OFC has been repeatedly noted to be reduced in aBPD (Brunner et al., 2010; Chanen, Velakoulis, et al., 2008). The OFC is largely connected with cortical and subcortical areas and may stand at the crossroad between affective and cognitive functions. The OFC is also involved in the inhibition and regulation of emotional responses (Fettes et al., 2017; Wolfe et al., 2012). A recent meta-analysis (Yu et al., 2019) demonstrated that structural reductions are present in adult BPD compared to healthy controls. Other studies have reported a negative relationship between the gyrification of the OFC and impulsivity in BPD (Ding et al., 2021). Furthermore, the OFC and the inferior frontal gyrus are known to play an important role in anger and its regulation (Sorella et al., 2021), which is known to be altered in patients with BPD.
VBM 结构研究发现，aBPD 患者边缘系统的多个区域明显受累。研究多次发现，aBPD 患者的双侧 OFC 功能减退（Brunner 等人，2010 年；Chanen、Velakoulis 等人，2008 年）。OFC 在很大程度上与皮层和皮层下区域相连，可能处于情感和认知功能的交叉路口。OFC 还参与情绪反应的抑制和调节（Fettes 等人，2017 年；Wolfe 等人，2012 年）。最近的一项荟萃分析（Yu 等人，2019 年）表明，与健康对照组相比，成人 BPD 存在结构性降低。其他研究报告称，OFC回旋与BPD患者的冲动性之间存在负相关（Ding等人，2021年）。此外，众所周知，OFC 和额叶下回在愤怒及其调节中发挥着重要作用（Sorella 等人，2021 年），而这在 BPD 患者中也有所改变。

Decreased gray matter volumes were also found in the bilateral hippocampi and in the right amygdala in adolescent girls with BPD (Richter et al., 2014), consistent with a meta-analysis on adult BPD (Yu et al., 2019). Regarding the hippocampus, a recent study has linked this structure to emotional regulation (Ghoumroudi et al., 2023): higher gray matter concentration within the hippocampal-OFC network was associated with greater use of reappraisal to reframe emotional situations. BPD patients are known to be deficient in regulating their emotions, and the reduced gray matter in this network may be partially responsible for this clinical symptomatology.
在患有BPD的少女中，双侧海马和右侧杏仁核的灰质体积也有所减少（Richter等人，2014年），这与一项关于成人BPD的荟萃分析（Yu等人，2019年）一致。关于海马体，最近的一项研究将这一结构与情绪调节联系起来（Ghoumroudi et al.众所周知，BPD 患者在调节情绪方面存在缺陷，而该网络灰质的减少可能是导致这种临床症状的部分原因。

Regarding the amygdala, prior studies have reported alterations of this structure in BPD patients (Schultze et al., 2016, Ding et al., 2021). The amygdala has a fundamental role in decoding affective information and in generating emotional and behavioral responses (Adolphs, 2010; Roy et al., 2009). Alterations of the amygdala may be related with the hypersensitivity of patients with BPD to emotionally salient stimuli, especially negatively valenced stimuli (Schultze et al., 2016), and also to the typical rapid-cycling mood changes in the patients with BPD (Grecucci et al., 2022). Thus, both the amygdala and the OFC may be important brain regions for BPD (Grecucci et al., 2022; Zanarini et al., 2002).
关于杏仁核，先前的研究报告称，BPD 患者的杏仁核结构发生了改变（Schultze 等人，2016 年；Ding 等人，2021 年）。杏仁核在解码情感信息以及产生情感和行为反应方面发挥着重要作用（Adolphs，2010；Roy等人，2009）。杏仁核的变化可能与躁狂症患者对情绪显著刺激，尤其是负价值刺激的过敏性有关（Schultze 等人，2016 年），也与躁狂症患者典型的快速周期性情绪变化有关（Grecucci 等人，2022 年）。因此，杏仁核和OFC都可能是BPD的重要脑区（Grecucci等人，2022年；Zanarini等人，2002年）。

The ACC has been reported to be altered in a complex way: female patients showed reduced volume of the left, but not right (Whittle et al., 2009). Another study reported that BPD/MDD patients had reduced BA24 gray matter volume (Goodman et al., 2011). This result aligns with findings from adult BPD in which a reduction of the ACC has been reported (Grecucci et al., 2023; Irle et al., 2005; Wreghe et al., 2019). The ACC is known to play a role in emotional regulation (Ghoumroudi et al., 2023; Vanderhasselt et al., 2013) and its size is positively correlated with the use of reappraisal to reframe emotional situations (Giuliani et al., 2011). BPD patients are known to be less able to regulate their emotions compared to controls (Grecucci et al., 2022;2023; Langerbeck et al., 2023). This might explain the relationship between the two. Furthermore, we mentioned it earlier that the bilateral OFC has been noted to be reduced in aBPD, while we’ve known that the OFC is involved in the regulation of emotional responses. These two findings are consistent.
据报道，ACC 会以一种复杂的方式发生改变：女性患者的左侧灰质体积减少，但右侧却没有（Whittle 等人，2009 年）。另一项研究报告称，BPD/MDD 患者的 BA24 灰质体积减少（Goodman 等人，2011 年）。这一结果与成人 BPD 的研究结果一致，后者报告了 ACC 的减少（Grecucci 等人，2023 年；Irle 等人，2005 年；Wreghe 等人，2019 年）。众所周知，ACC 在情绪调节中发挥作用（Ghoumroudi 等人，2023 年；Vanderhasselt 等人，2013 年），其大小与使用重新评估来重塑情绪状况呈正相关（Giuliani 等人，2011 年）。众所周知，与对照组相比，BPD 患者调节情绪的能力较弱（Grecucci 等人，2022；2023；Langerbeck 等人，2023）。这或许可以解释两者之间的关系。此外，我们之前提到过，双侧 OFC 在 aBPD 中的功能减弱，而我们已经知道 OFC 参与了情绪反应的调节。这两个发现是一致的。

Volume differences in the limbic system previously found in adult patients with BPD (Dadomo et al., 2022; Grecucci et al., 2023; Grecucci et al., 2022) were interpreted as being related with the duration of illness and the side effects of psychotropic medications known to alter brain morphometry (Weinberger & McClure, 2002). However, the fact that such alterations are already present in adolescents with BPD, in which the onset of pathology is quite new and the use of psychotropic drugs is absent or minimal, supports a model wherein OFC deficits being related to the pathology itself rather than due to neurotoxic effects of drugs.
之前在BPD成年患者中发现的边缘系统体积差异（Dadomo等人，2022年；Grecucci等人，2023年；Grecucci等人，2022年）被解释为与病程长短和已知会改变大脑形态的精神药物副作用有关（Weinberger和McClure，2002年）。然而，患有 BPD 的青少年已经出现了这种改变，而他们的病症刚刚出现，并且没有使用或很少使用精神药物，这支持了一种模型，即 OFC 缺陷与病症本身有关，而不是由于药物的神经毒性作用。

6.2 Central Executive network and lack of regulation
6.2 中央执行网络和缺乏监管

Adolescents with BPD showed reduced gray matter in the DLPFC (Brunner et al., 2010). This finding is consistent with the structural MRI studies performed in adults with BPD (Bozzatello, Morese, Valentini, Rocca, & Bellino, 2021; Hazlett et al., 2005; Langerbeck, Baggio, Messina, Bhat, & Grecucci, 2023; Tebartz van Elst et al., 2003), as well as with fMRI studies, which revealed hypometabolism inside the DLPFC (Goethals et al., 2005; Soloff, Kelly, Strotmeyer, Malone, & Mann, 2003).
患有 BPD 的青少年显示 DLPFC 灰质减少（Brunner 等人，2010 年）。这一发现与对患有 BPD 的成年人进行的结构磁共振成像研究（Bozzatello, Morese, Valentini, Rocca, & Bellino, 2021; Hazlett 等人, 2005; Langerbeck, Baggio, Messina, Bhat, & Grecucci, 2023; Tebartz van Elst 等人, 2003）以及 fMRI 研究一致，后者显示 DLPFC 内的代谢不足（Goethals 等人, 2005; Soloff, Kelly, Strotmeyer, Malone, & Mann, 2003）。

The DLPFC, together with the lateral posterior parietal cortex (PPC), is part of the so-called central executive network (CEN). This network plays a fundamental role in executive control during goal-directed behavior and for maintaining and manipulating information inside the working memory (Menon, 2011). In a recent study, and colleagues (2022) found widespread alterations in the white matter of the CEN in adult BPD patients, possibly due to reduced myelin development (Quattrini et al., 2022). This result may be related to the deficits in top-down control displayed by BPD patients. These patients were not able to control their impulses and anger reactions and were unable to resist self-destructive behaviors when emotions were hyperactivated (Grecucci et al., 2023). The DLPFC and the CEN are activated to control and down regulate emotions (Ghoumroudi et al., 2023) and deficiencies would be expected to reduce emotional regulation.
DLPFC 与侧后顶叶皮层（PPC）是所谓的中央执行网络（CEN）的一部分。该网络在目标导向行为过程中的执行控制以及在工作记忆中维护和操纵信息方面发挥着重要作用（Menon，2011 年）。在最近的一项研究中，Quattrini 及其同事（2022 年）发现成年 BPD 患者的 CEN 白质发生了广泛改变，这可能是由于髓鞘发育减少所致（Quattrini 等人，2022 年）。这一结果可能与 BPD 患者自上而下控制能力的缺陷有关。这些患者无法控制自己的冲动和愤怒反应，当情绪被过度激活时也无法抵制自我毁灭行为（Grecucci 等人，2023 年）。DLPFC 和 CEN 被激活以控制和下调情绪（Ghoumroudi et al.

6.3. Default Mode network, inner dialogue and identity disturbances
6.3.默认模式网络、内心对话和身份干扰

Compared with healthy controls, adolescents with BPD showed altered resting-state activity in the precuneus and the temporal and medial frontal regions. These regions
与健康对照组相比，患有 BPD 的青少年楔前叶、颞叶和内侧额叶区域的静息态活动有所改变。这些区域 collectively belong to the DMN
共同属于 DMN (Xiao, Yi, et al., 2023; Yi et al., 2023)
(Xiao, Yi 等人，2023；Yi 等人，2023）。. These findings align
.这些研究结果与 with the ones observed in adult BPD
与在成年 BPD 中观察到的 (Langerbeck et al., 2023)
(兰格贝克等人，2023 年）。 (Quattini et al., 2022
夸蒂尼等人，2022 年), in which functional and structural alterations of the DMN have been consistently associated with BPD
)，其中DMN的功能和结构改变一直与BPD有关. DMN alterations may be used to predict BPD traits in a subclinical population
.DMN 改变可用于预测亚临床人群的 BPD 特征 (Langerbeck et al., 2023)
(兰格贝克等人，2023 年）。. The DMN is activated during rest and self-referential thoughts. It consists of major hubs, corresponding to the
.DMN 在休息和自我参照思考时被激活。它由几个主要中心组成，分别对应于 posterior cingulate cortex (PCC
后扣带回皮层（PCC), the hippocampus, the precuneus, the medial prefrontal cortex
海马体、楔前区、内侧前额叶皮层(mPFC) and temporal regions. These regions are known to play a role in semantic memories, internal thought and inner dialogue, and self-monitoring and emotional regulation (
和颞叶区域。众所周知，这些区域在语义记忆、内部思维和内心对话以及自我监控和情绪调节方面发挥着作用 (Grecucci et al., 2022; Menon, 2011
Grecucci 等人，2022 年；Menon，2011 年). All these processes are known to be altered in BPD patients
).已知所有这些过程在 BPD 患者中都会发生改变 (Xiao, Fu, et al., 2023)
(肖、傅等人，2023 年）。. In particular, distorted inner dialogue and negative thinking related to the self are all clear marks of BPD pathology. Moreover, the DMN seems to play a key role in regulating emotions: the hyperactivity of this network at rest is consistent with difficulties in both interpersonal and affective regulation (
.特别是，扭曲的内心对话和与自我有关的消极思维都是BPD病理的明显标志。此外，DMN 似乎在调节情绪方面发挥着关键作用：这一网络在静息状态下的过度活跃与人际关系和情绪调节方面的困难是一致的 (Ruocco et al., 2013; Koenigsberg et al., 1999
Ruocco 等人，2013 年；Koenigsberg 等人，1999 年), and from a structural point of view its structural integrity predicts usage of reappraisal for emotional regulation (
从结构的角度来看，其结构的完整性预示着重新评价在情绪调节中的应用 (Ghoumroudi et al., 2023
Ghoumroudi 等人，2023 年). Notably, the hypothesis of the “triple network” has been recently put forward to understand the patients with BPD.
).值得注意的是，最近有人提出了 "三重网络 "假说，以了解 BPD 患者。 The Triple Network Model, which consists of the default mode network (DMN), the central executive network (CEN), and the salience network (SN)
三重网络模型，由默认模式网络（DMN）、中央执行网络（CEN）和显著性网络（SN）组成, is used to analyze
用于分析 and interpret
并解释 the studies on cognitive and affective dysregulation
关于认知和情感失调的研究. According to this hypothesis, BPD patients may show functional impairment inside the DMN, the SN, and the CEN (
根据这一假说，BPD 患者可能会在 DMN、SN 和 CEN 中表现出功能障碍 (Doll et al., 2013
多尔等人，2013 年). We found only partial evidence of SN alterations in aBPD, especially for what entails the anterior insula for which contrasting evidence was reported
我们只发现了部分证据表明，神经元在 aBPD 中发生了改变，尤其是在涉及前脑岛的部分，有报道称这部分的证据截然相反 (Xiao, Yi, et al., 2023)
(Xiao, Yi 等人，2023 年）。 (Takashi et al., 2023
Takashi 等人，2023 年). One possibility is that alterations inside this network become more visible at a later stage of development.
).一种可能的情况是，这一网络内部的变化在发育的后期阶段会更加明显。

6.3. BPD model for pathophysiology and potential targets for intervention
6.3.BPD 病理生理学模型和潜在干预目标

In this section, we outline a tentative BPD model to assist future research. We found evidence of three potential networks associated with aBPD: 1) deficient frontal control of impusles and emotions in the form of both reduced structural and functional activity of regions partially associated with the CEN; 2) an altered internal dialogue and thinking style in the form of hyperactivity of the DMN; 3) functional hyperactivity and reduced structural morphometry of several regions of the Affective network (e.g. amygdala, cingulate, OFC). These considerations align to the evidence from adult BPD studies (Grecucci et al., 2022).
在本节中，我们将概述一个暂定的 BPD 模型，以帮助未来的研究。我们发现了与 BPD 相关的三个潜在网络的证据：1）对冲动和情绪的前额控制不足，表现为与 CEN 部分相关的区域的结构和功能活动减少；2）内部对话和思维方式改变，表现为 DMN 的过度活跃；3）情感网络（如杏仁核、扣带回、OFC）的几个区域的功能过度活跃和结构形态减少。这些考虑因素与成人 BPD 研究的证据一致（Grecucci 等人，2022 年）。

Based on this model, potential interventions to target these brain regions may be suggested. We hypothesize that by increasing the activity of the CEN, the ability to regulate emotions, impulses, anger, and self-destructive behaviors should improve. Non-invasive neurostimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) may be helpful to this aim. Another possibility is with the same methodology, to reduce the activity of the DMN. As a consequence, symptoms like the distorted identity, representation of others and negative self-referential thought may be reduced. In addition, by reducing the activity of this network, anxious and depressive symptoms should also be reduced. Furthermore, the hyperactivity of the affective network may be modulated with pharmacological intervention or with specific deep stimulation interventions. Future studies may be performed along the thoughts of this proposed BPD model.
根据这一模型，可以提出针对这些脑区的潜在干预措施。我们假设，通过提高 CEN 的活性，调节情绪、冲动、愤怒和自我毁灭行为的能力应该会得到改善。经颅磁刺激（TMS）和经颅直流电刺激（tDCS）等非侵入性神经刺激技术可能有助于实现这一目标。另一种可能是采用同样的方法，减少 DMN 的活动。因此，身份扭曲、他人表征和消极的自我参照思维等症状可能会减轻。此外，通过减少该网络的活动，焦虑和抑郁症状也会减少。此外，可以通过药物干预或特定的深层刺激干预来调节情感网络的过度活跃。未来的研究可能会沿着这个拟议的 BPD 模型的思路进行。

6.4. Limitations of prior studies and suggestions for future research
6.4.以往研究的局限性和对未来研究的建议

The studies discussed in the present review about aBPD present some limitations that we would like to discuss here to provide suggestions for future research. One of the main limitations of the literature on aBPD is the limited sample size of the existing studies. The studies described here range from 13 to 50 BPD patients. This number needs to be substantially increased to improve the reliability of the neuroimaging findings. Also, some of the studies used unbalanced gender distributions (usually with more females), which may have biased the results. We advocate more balanced studies to improve the understanding of BPD pathophysiology.
本综述中讨论的有关 aBPD 的研究存在一些局限性，我们希望在此讨论这些局限性，以便为今后的研究提供建议。有关 aBPD 的文献的主要局限性之一是现有研究的样本量有限。本文所描述的研究从 13 到 50 名 BPD 患者不等。为了提高神经影像学研究结果的可靠性，需要大幅增加样本数量。此外，一些研究采用了不平衡的性别分布（通常女性较多），这可能会使结果产生偏差。我们主张进行更均衡的研究，以增进对 BPD 病理生理学的了解。

Despite the efforts to study aBPD, the translation of research findings into clinical applications is scarce (Prata, Mechelli, Kapur, 2014). One of the main impediments to translational applications is that there have been few attempts to generalize the results obtained by those studies to new cases. As such, the results obtained by those studies cannot be used to predict new cases or to guide clinical decisions. The statistical approaches used in the studies assume that the results obtained in their sample can be generalized to the general population, but this assumption is not empirically tested. Machine learning (ML), a subfield of artificial intelligence, can help to overcome this problem as it provides algorithms capable of building predictive models (Mitchel 1997). These models are empirically tested in their power to predict new unobserved cases (Domingos, 2012). This shift towards predictive models heralds a new era in clinical practice, facilitating earlier and more accurate diagnoses. Recent advancements in adult BPD confirm the ability of ML approaches to assist in clinical decision making (see for example, (Langerbeck et al., 2023)Grecucci et al., 2022.
尽管人们努力研究 aBPD，但将研究成果转化为临床应用的情况却很少（Prata、Mechelli、Kapur，2014 年）。转化应用的主要障碍之一是，很少有人尝试将这些研究获得的结果推广到新的病例中。因此，这些研究获得的结果不能用于预测新病例或指导临床决策。研究中使用的统计方法假设在样本中获得的结果可以推广到一般人群中，但这一假设并没有经过经验检验。机器学习（ML）是人工智能的一个子领域，它提供的算法能够建立预测模型（Mitchel，1997 年），因此有助于克服这一问题。这些模型在预测未观察到的新案例方面的能力是经过经验检验的（Domingos，2012 年）。向预测模型的转变预示着临床实践进入了一个新时代，有助于更早、更准确地做出诊断。最近在成人 BPD 方面取得的进展证实了 ML 方法协助临床决策的能力（参见 Langerbeck 等人，2023 年；Grecucci 等人，2022 年）。

One additional limitation of prior studies relies on the lack of integration between multiple imaging modalities. Multimodal imaging or data fusion approaches, as known in the ML field, can improve the understanding of the neural mechanisms of BPD by integrating different modalities (such as MRI and electroencephalogram, or genetics and electroencephalogram) (Baggio et al., 2023; Grecucci et al., 2024). Different imaging modalities can be used to evaluate the same pathological mechanisms from different perspective (Baggio et al., 2023) and if combined, a multimodal approach can increase the sensitivity to detect pathological processes and to provide a more comprehensive understanding of BPD. The prior studies on adolescent BPD were limited by their correlational analyses of brain alterations with psychological deficits. Correlation analysis, although meaningful, may not be meaningful to for predicting deficits from unobserved cases. ML methods can be used to extract predictive models of symptoms of psychological deficits and neural features (See for example Grecucci et al., 2023 for adult BPD). These methods outperform the frequentist approaches such as correlation, as they can be used to predict the individual performance of a single patient based on his/her neural features. This may potentially allow the clinician to make accurate predictions for precision medicine and tailored interventions for patients with BPD.
以往研究的另一个局限性在于缺乏对多种成像模式的整合。众所周知，多模态成像或数据融合方法（ML 领域）可以通过整合不同模态（如核磁共振成像和脑电图，或遗传学和脑电图）来提高对 BPD 神经机制的理解（Baggio 等人，2023 年；Grecucci 等人，2024 年）。不同的成像模式可用于从不同角度评估相同的病理机制（Baggio 等人，2023 年），如果结合使用，多模式方法可提高检测病理过程的灵敏度，并提供对 BPD 更全面的了解。之前关于青少年 BPD 的研究受到大脑改变与心理缺陷相关性分析的限制。相关性分析虽然有意义，但对于预测未观察到的病例的缺陷可能意义不大。ML 方法可用于提取心理缺陷症状和神经特征的预测模型（参见 Grecucci 等人，2023 年关于成人 BPD 的研究）。这些方法优于相关性等频数主义方法，因为它们可用于根据单个患者的神经特征预测其个体表现。这有可能让临床医生为精准医疗做出准确预测，并为 BPD 患者提供量身定制的干预措施。

Another challenge in interpreting the literature on aBPD is the large number of comorbidities in patients with BPD. In the published studies, psychiatric comorbidity was a common confounding variable (Bozkurt, Duzman Mutluer, Kose, & Zoroglu, 2015; Rao & Broadbear, 2019). The control groups were rarely used, limiting the ability to separate neural differences that were specific to BPD from those that were common with other psychological disorders.
解读有关ABPD文献的另一个挑战是BPD患者存在大量合并症。在已发表的研究中，精神疾病合并症是一个常见的混杂变量（Bozkurt, Duzman Mutluer, Kose, & Zoroglu, 2015; Rao & Broadbear, 2019）。对照组很少使用，这限制了将BPD特有的神经差异与其他心理障碍常见的神经差异区分开来的能力。

7. Conclusion
7.结论

 This systematic review summarizes the current understanding of brain structural and functional alterations identified on neuroimaging. Three network were found to be altered in aBPD: the CEN the DMN and the AN. Future research should be directed to identification of non-invasive imaging biomarkers to assist in early diagnosis and treatment in adolescents with BPD. AI application with big data and multicenter approach should help to improve our understanding of BPD and thus achieve our overarching goal of providing personalized treatment to the vulnerable adolescents with BPD.
这篇系统性综述总结了目前对神经影像学发现的大脑结构和功能改变的理解。研究发现，青少年抑郁症患者的三个网络发生了改变：CEN、DMN 和 AN。未来的研究应着眼于确定非侵入性成像生物标志物，以帮助患有 BPD 的青少年进行早期诊断和治疗。人工智能在大数据和多中心方法中的应用应有助于提高我们对BPD的认识，从而实现为患有BPD的脆弱青少年提供个性化治疗的总体目标。

Tables and figures legends:
表格和数字图例：

Table 1. Summary of studies on adolescent borderline personality disorder (BPD) included in this systematic review.
表 1.纳入本系统综述的有关青少年边缘型人格障碍（BPD）的研究摘要。

Abbreviations: F, female; M,male; SD, standard deviation; IQR, interquartile range; NSSI, non-suicidal self-injury; HC, healthy controls; sMRI, Structural MRI; Fmri, functional MRI; DTI, diffusion tensor imaging; VBM, Voxel-based morphometry; FA, fractional anisotropy; MD, mean diffusivity; DMN, default mode network; BLA, the basolateral amygdala; CCG, clinical control group; vmPFC, the ventromedial prefrontal cortex; CeN, the central executive network; CC, the corpus callosum; ROI, region of interest; TBSS, the tract-based spatial statistics; PGV, pituitary gland volume; AD, axial diffusivity; RD, radial diffusivity; OFC, orbitofrontal cortex; ACC, the anterior cingulate cortex; MDD, major depression disorder; BA24, anterior cingulate; SPG, superior parietal gyrus; CSP, cavum septum pellucidum. .
缩写：缩写：F，女性；M，男性；SD，标准差；IQR，四分位数间距；NSSI，非自杀性自伤；HC，健康对照组；sMRI，结构性 MRI；Fmri，功能性 MRI；DTI，弥散张量成像；VBM，基于体素的形态测量；FA，分数各向异性；MD，平均扩散率；DMN，默认模式网络；BLA，杏仁核基外侧；CCG，临床对照组；vmPFC，腹内侧前额叶皮层；CeN，中央执行网络；CC，胼胝体；ROI，感兴趣区；TBSS，基于束的空间统计；PGV，垂体体积；AD，轴向扩散率；RD，径向扩散率；OFC，眶额皮层；ACC，前扣带回皮层；MDD，重度抑郁障碍；BA24，前扣带回；SPG，顶叶上回；CSP，透明隔腔。.

Please add more abbreviations such as M, F, fMRI, ROI, and the ones listed in Nancy’s comment. I tried to highlight all the abbreviations in the table for you to add in the footnote.
请添加更多缩写，如 M、F、fMRI、ROI 以及南希评论中列出的缩写。我试图在表格中突出显示所有缩写，以便您在脚注中添加。

Figure 1. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram for identification and screening of reports on adolescent borderline personality disorder (BPD).
图 1.用于识别和筛选青少年边缘型人格障碍 (BPD) 报告的系统综述和元分析首选报告项目 (PRISMA) 流程图。

Figure 2. Brain regions identified on diffusion tensor imaging (DTI) being associated with adolescent patients with borderline personality disorder (BPD).
图 2.通过弥散张量成像（DTI）确定的与边缘型人格障碍（BPD）青少年患者相关的脑区。

Figure 3. Brain regions with structural abnormalities in adolescent patients with borderline personality disorder (BPD) based on structural MRI (sMRI). Abbreviations: OFC, orbitofrontal cortex; LPFC, lateral prefrontal cortex; OC, occipital gyrus.
图 3.基于结构磁共振成像（sMRI）的边缘型人格障碍（BPD）青少年患者结构异常的脑区。缩写：缩写：OFC，眶额皮层；LPFC，外侧前额皮层；OC，枕回。

Figure 4. Brain regions with functional abnormalities in adolescent patients with borderline personality disorder (BPD) based on functional MRI (fMRI). Abbreviations: OFC, orbitofrontal cortex; OC, occipital gyrus.
图 4.基于功能磁共振成像（fMRI）的边缘型人格障碍（BPD）青少年患者功能异常的脑区。缩写：缩写：OFC，眶额皮层；OC，枕回。

References
参考资料

Adolphs R. What does the amygdala contribute to social cognition? Ann N Y Acad Sci. (2010) 1191:42–61. doi: 10.1111/j.1749-6632.2010.05445.x
Adolphs R. 《杏仁核对社会认知有何贡献？Ann N Y Acad Sci. (2010) 1191:42-61. doi: 10.1111/j.1749-6632.2010.05445.x

Baggio, T., Grecucci, A., Meconi, F., Messina, I. (2023). Anxious brains: A combined data fusion machine learning approach to predict trait anxiety from morphometric features. Sensors, 23,2.
Baggio, T., Grecucci, A., Meconi, F., Messina, I. (2023)。焦虑的大脑：从形态特征预测特质焦虑的数据融合机器学习方法。传感器，23,2。

Bøen, E., Westlye, L. T., Elvsåshagen, T., Hummelen, B., Hol, P. K., Boye, B., . . . Malt, U. F. (2014). Regional cortical thinning may be a biological marker for borderline personality disorder. Acta Psychiatr Scand, 130(3), 193-204. doi:10.1111/acps.12234
Bøen, E., Westlye, L. T., Elvsåshagen, T., Hummelen, B., Hol, P. K., Boye, B., .. .Malt, U. F. (2014)。区域皮质变薄可能是边缘型人格障碍的生物学标志。Acta Psychiatr Scand, 130(3), 193-204. doi:10.1111/acps.12234

Bozkurt, H., Duzman Mutluer, T., Kose, C., & Zoroglu, S. (2015). High psychiatric comorbidity in adolescents with dissociative disorders. Psychiatry Clin Neurosci, 69(6), 369-374. doi:10.1111/pcn.12256
Bozkurt, H., Duzman Mutluer, T., Kose, C., & Zoroglu, S. (2015)。解离性障碍青少年的高精神并发症》（High psychiatric comorbidity in adolescents with dissociative disorders.精神病学临床神经科学》（Psychiatry Clin Neurosci），69（6），369-374。

Bozzatello, P., Morese, R., Valentini, M. C., Rocca, P., & Bellino, S. (2021). How Interpersonal Psychotherapy Changes the Brain: A Study of fMRI in Borderline Personality Disorder. J Clin Psychiatry, 83(1). doi:10.4088/JCP.21m13918
Bozzatello, P., Morese, R., Valentini, M. C., Rocca, P., & Bellino, S. (2021)。人际心理治疗如何改变大脑：边缘型人格障碍的 fMRI 研究》。Doi:10.4088/JCP.21m13918

Brown, R. C., Plener, P. L., Groen, G., Neff, D., Bonenberger, M., & Abler, B. (2017). Differential Neural Processing of Social Exclusion and Inclusion in Adolescents with Non-Suicidal Self-Injury and Young Adults with Borderline Personality Disorder. Front Psychiatry, 8, 267. doi:10.3389/fpsyt.2017.00267
Brown, R. C., Plener, P. L., Groen, G., Neff, D., Bonenberger, M., & Abler, B. (2017).非自杀性自伤青少年和边缘型人格障碍青少年对社会排斥和包容的不同神经处理。Doi:10.3389/fpsyt.2017.00267

Bruehl, H., Preißler, S., Heuser, I., Heekeren, H. R., Roepke, S., & Dziobek, I. (2013). Increased prefrontal cortical thickness is associated with enhanced abilities to regulate emotions in PTSD-free women with borderline personality disorder. PLoS One, 8(6), e65584. doi:10.1371/journal.pone.0065584
Bruehl, H., Preißler, S., Heuser, I., Heekeren, H. R., Roepke, S., & Dziobek, I. (2013)。无创伤后应激障碍的边缘型人格障碍女性的前额叶皮质厚度增加与情绪调节能力增强有关。Doi:10.1371/journal.pone.0065584.

Brunner, R., Henze, R., Parzer, P., Kramer, J., Feigl, N., Lutz, K., . . . Stieltjes, B. (2010). Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: is it disorder specific? Neuroimage, 49(1), 114-120. doi:10.1016/j.neuroimage.2009.07.070
Brunner, R., Henze, R., Parzer, P., Kramer, J., Feigl, N., Lutz, K., .. .Stieltjes, B. (2010)。边缘型人格障碍女性青少年的前额叶和眶额叶灰质减少：这是特定障碍吗？神经影像》，49（1），114-120。doi:10.1016/j.neuroimage.2009.07.070

Chanen, A. M., Jackson, H. J., McCutcheon, L. K., Jovev, M., Dudgeon, P., Yuen, H. P., . . . McGorry, P. D. (2008). Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. Br J Psychiatry, 193(6), 477-484. doi:10.1192/bjp.bp.107.048934
Chanen, A. M., Jackson, H. J., McCutcheon, L. K., Jovev, M., Dudgeon, P., Yuen, H. P., .. .McGorry, P. D. (2008)。使用认知分析疗法对患有边缘型人格障碍的青少年进行早期干预：随机对照试验。Br J Psychiatry, 193(6), 477-484. Doi:10.1192/bjp.bp.107.048934

Chanen, A. M., Velakoulis, D., Carison, K., Gaunson, K., Wood, S. J., Yuen, H. P., . . . Pantelis, C. (2008). Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder. Psychiatry Res, 163(2), 116-125. doi:10.1016/j.pscychresns.2007.08.007
Chanen, A. M., Velakoulis, D., Carison, K., Gaunson, K., Wood, S. J., Yuen, H. P., .. .Pantelis, C. (2008)。首次出现边缘型人格障碍的青少年的眼眶额叶、杏仁核和海马体积。精神病学研究》，163（2），116-125。doi:10.1016/j.pscychresns.2007.08.007

Dadomo, H., Salvato, G., Lapomarda, G., Ciftci, Z., Messina, I., & Grecucci, A. (2022). Structural Features Predict Sexual Trauma and Interpersonal Problems in Borderline Personality Disorder but Not in Controls: A Multi-Voxel Pattern Analysis. Front Hum Neurosci, 16, 773593. doi:10.3389/fnhum.2022.773593
Dadomo, H., Salvato, G., Lapomarda, G., Ciftci, Z., Messina, I., & Grecucci, A. (2022)。结构特征预测边缘型人格障碍患者的性创伤和人际交往问题，而非对照组：A Multi-Voxel Pattern Analysis.doi:10.3389/fnhum.2022.773593.

de Araujo Filho, G. M., Abdallah, C., Sato, J. R., de Araujo, T. B., Lisondo, C. M., de Faria Á, A., . . . Jackowski, A. P. (2014). Morphometric hemispheric asymmetry of orbitofrontal cortex in women with borderline personality disorder: a multi-parameter approach. Psychiatry Res, 223(2), 61-66. doi:10.1016/j.pscychresns.2014.05.001
de Araujo Filho, G. M., Abdallah, C., Sato, J. R., de Araujo, T. B., Lisondo, C. M., de Faria Á, A., .. .Jackowski, A. P. (2014)。边缘型人格障碍女性眶额皮层的形态半球不对称：一种多参数方法。精神病学研究》，223（2），61-66。doi:10.1016/j.pscychresns.2014.05.001

De Panfilis, C., Schito, G., Generali, I., Gozzi, L. A., Ossola, P., Marchesi, C., & Grecucci, A. (2019). Emotions at the border: Increased punishment behavior during fair interpersonal exchanges in borderline personality disorder. J Abnorm Psychol, 128(2), 162-172. doi:10.1037/abn0000404
De Panfilis, C., Schito, G., Generali, I., Gozzi, L. A., Ossola, P., Marchesi, C., & Grecucci, A. (2019).边界情绪：边缘型人格障碍患者在公平人际交往中的惩罚行为增加。J Abnorm Psychol, 128(2), 162-172. doi:10.1037/abn0000404

Garner, B., Chanen, A. M., Phillips, L., Velakoulis, D., Wood, S. J., Jackson, H. J., . . . McGorry, P. D. (2007). Pituitary volume in teenagers with first-presentation borderline personality disorder. Psychiatry Res, 156(3), 257-261. doi:10.1016/j.pscychresns.2007.05.001
Garner, B., Chanen, A. M., Phillips, L., Velakoulis, D., Wood, S. J., Jackson, H. J., .. .McGorry, P. D. (2007)。首次出现边缘型人格障碍的青少年的脑垂体容量。精神病学研究》，156（3），257-261。doi:10.1016/j.pscychresns.2007.05.001

Goethals, I., Audenaert, K., Jacobs, F., Van den Eynde, F., Bernagie, K., Kolindou, A., . . . Van Heeringen, C. (2005). Brain perfusion SPECT in impulsivity-related personality disorders. Behav Brain Res, 157(1), 187-192. doi:10.1016/j.bbr.2004.06.022
Goethals, I., Audenaert, K., Jacobs, F., Van den Eynde, F., Bernagie, K., Kolindou, A., .. .Van Heeringen, C. (2005)。冲动相关人格障碍的脑灌注 SPECT。行为脑研究》，157（1），187-192。doi:10.1016/j.bbr.2004.06.022

Goodman, M., Hazlett, E. A., Avedon, J. B., Siever, D. R., Chu, K. W., & New, A. S. (2011). Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression. J Psychiatr Res, 45(6), 803-807. doi:10.1016/j.jpsychires.2010.11.011
Goodman, M., Hazlett, E. A., Avedon, J. B., Siever, D. R., Chu, K. W., & New, A. S. (2011)。边缘型人格障碍合并重度抑郁症青少年的前扣带回体积减少。J Psychiatr Res, 45(6), 803-807. doi:10.1016/j.jpsychires.2010.11.011

Grecucci, A., Dadomo, H., Salvato, G., Lapomarda, G., Sorella, S., & Messina, I. (2023). Abnormal Brain Circuits Characterize Borderline Personality and Mediate the Relationship between Childhood Traumas and Symptoms: A mCCA+jICA and Random Forest Approach. Sensors (Basel), 23(5). doi:10.3390/s23052862
Grecucci, A., Dadomo, H., Salvato, G., Lapomarda, G., Sorella, S., & Messina, I. (2023)。边缘型人格的异常脑回路特征及童年创伤与症状之间的中介关系：mCCA+jICA and Random Forest Approach.传感器（巴塞尔），23（5）。

Grecucci, A., Lapomarda, G., Messina, I., Monachesi, B., Sorella, S., & Siugzdaite, R. (2022). Structural Features Related to Affective Instability Correctly Classify Patients With Borderline Personality Disorder. A Supervised Machine Learning Approach. Front Psychiatry, 13, 804440. doi:10.3389/fpsyt.2022.804440
Grecucci, A., Lapomarda, G., Messina, I., Monachesi, B., Sorella, S., & Siugzdaite, R. (2022)。与情感不稳定性相关的结构特征可正确分类边缘型人格障碍患者。一种监督机器学习方法。Doi:10.3389/fpsyt.2022.804440.

Hall, N. T., & Hallquist, M. N. (2023). Dissociation of basolateral and central amygdala effective connectivity predicts the stability of emotion-related impulsivity in adolescents and emerging adults with borderline personality symptoms: a resting-state fMRI study. Psychol Med, 53(8), 3533-3547. doi:10.1017/s0033291722000101
Hall, N. T., & Hallquist, M. N. (2023).基底外侧和中央杏仁核有效连接的分离可预测有边缘型人格症状的青少年和新成人情绪相关冲动的稳定性：静息态 fMRI 研究。Doi:10.1017/s0033291722000101

Hazlett, E. A., New, A. S., Newmark, R., Haznedar, M. M., Lo, J. N., Speiser, L. J., . . . Buchsbaum, M. S. (2005). Reduced anterior and posterior cingulate gray matter in borderline personality disorder. Biol Psychiatry, 58(8), 614-623. doi:10.1016/j.biopsych.2005.04.029
Hazlett, E. A., New, A. S., Newmark, R., Haznedar, M. M., Lo, J. N., Speiser, L. J., .. .Buchsbaum, M. S. (2005).边缘型人格障碍的前扣带回和后扣带回灰质减少。生物精神病学》，58（8），614-623。doi:10.1016/j.biopsych.2005.04.029

Ibraheim, M., Kalpakci, A., & Sharp, C. (2017). The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls. Borderline Personal Disord Emot Dysregul, 4, 1. doi:10.1186/s40479-017-0052-x
Ibraheim, M., Kalpakci, A., & Sharp, C. (2017)。边缘型人格障碍青少年情绪失调的特异性：与精神疾病和健康对照组的比较》（Borderline Personal Disord Emot Dysregul, 4, 1.doi:10.1186/s40479-017-0052-x

Jovev, M., Garner, B., Phillips, L., Velakoulis, D., Wood, S. J., Jackson, H. J., . . . Chanen, A. M. (2008). An MRI study of pituitary volume and parasuicidal behavior in teenagers with first-presentation borderline personality disorder. Psychiatry Res, 162(3), 273-277. doi:10.1016/j.pscychresns.2007.12.003
Jovev, M., Garner, B., Phillips, L., Velakoulis, D., Wood, S. J., Jackson, H. J., .. .Chanen, A. M. (2008)。首次出现边缘型人格障碍的青少年脑垂体容量和寄生行为的核磁共振成像研究》。精神病学研究》，162（3），273-277。doi:10.1016/j.pscychresns.2007.12.003

Krauch, M., Ueltzhöffer, K., Brunner, R., Kaess, M., Hensel, S., Herpertz, S. C., & Bertsch, K. (2018). Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder-A Script-Based fMRI Study. Front Behav Neurosci, 12, 57. doi:10.3389/fnbeh.2018.00057
Krauch, M., Ueltzhöffer, K., Brunner, R., Kaess, M., Hensel, S., Herpertz, S. C., & Bertsch, K. (2018)。边缘型人格障碍女性青少年愤怒和攻击行为的显著性增强--基于脚本的 fMRI 研究》（Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder-A Script-Based fMRI Study.doi:10.3389/fnbeh.2018.00057

Langerbeck, M., Baggio, T., Messina, I., Bhat, S., & Grecucci, A. (2023). Borderline shades: Morphometric features predict borderline personality traits but not histrionic traits. Neuroimage Clin, 40, 103530. doi:10.1016/j.nicl.2023.103530
Langerbeck, M., Baggio, T., Messina, I., Bhat, S., & Grecucci, A. (2023)。边缘阴影：形态特征可预测边缘型人格特质，但不能预测组织型人格特质。doi:10.1016/j.nicl.2023.103530.

LeBoeuf, A., Guilé, J. M., Labelle, R., & Luck, D. (2016). [Functional Neuroimaging Pilot Study of Borderline Personality Disorder in Adolescents]. Sante Ment Que, 41(1), 141-162.
LeBoeuf, A., Guilé, J. M., Labelle, R., & Luck, D. (2016)。[青少年边缘型人格障碍的功能神经影像试点研究]。Sante Ment Que，41（1），141-162。

Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry, 62(6), 553-564. doi:10.1016/j.biopsych.2006.09.019
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007).DSM-IV 人格障碍在全国合并症调查中的复制》（National Comorbidity Survey Replication.Doi:10.1016/j.biopsych.2006.09.019.

Lotfinia, S., Soorgi, Z., Mertens, Y., & Daniels, J. (2020). Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res, 128, 5-15. doi:10.1016/j.jpsychires.2020.05.006
Lotfinia, S., Soorgi, Z., Mertens, Y., & Daniels, J. (2020)。具有分离体验的精神病患者的大脑结构和功能改变：磁共振成像研究的系统回顾。J Psychiatr Res, 128, 5-15. doi:10.1016/j.jpsychires.2020.05.006

Maier-Hein, K. H., Brunner, R., Lutz, K., Henze, R., Parzer, P., Feigl, N., . . . Stieltjes, B. (2014). Disorder-specific white matter alterations in adolescent borderline personality disorder. Biol Psychiatry, 75(1), 81-88. doi:10.1016/j.biopsych.2013.03.031
Maier-Hein, K. H., Brunner, R., Lutz, K., Henze, R., Parzer, P., Feigl, N., .. .Stieltjes, B. (2014)。青少年边缘型人格障碍的白质改变。生物精神病学》，75（1），81-88。doi:10.1016/j.biopsych.2013.03.031

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7), e1000097. doi:10.1371/journal.pmed.1000097
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009).系统综述和荟萃分析的首选报告项目：PRISMA 声明。PLoS医学，6（7），e1000097。DOI:10.1371/journal.pmed.1000097

New, A. S., Carpenter, D. M., Perez-Rodriguez, M. M., Ripoll, L. H., Avedon, J., Patil, U., . . . Goodman, M. (2013). Developmental differences in diffusion tensor imaging parameters in borderline personality disorder. J Psychiatr Res, 47(8), 1101-1109. doi:10.1016/j.jpsychires.2013.03.021
New, A. S., Carpenter, D. M., Perez-Rodriguez, M. M., Ripoll, L. H., Avedon, J., Patil, U., .. .古德曼，M. （2013）。边缘型人格障碍患者弥散张量成像参数的发育差异。J Psychiatr Res, 47(8), 1101-1109. doi:10.1016/j.jpsychires.2013.03.021

Rao, S., & Broadbear, J. (2019). Borderline personality disorder and depressive disorder. Australas Psychiatry, 27(6), 573-577. doi:10.1177/1039856219878643
Rao, S., & Broadbear, J. (2019)。边缘型人格障碍与抑郁障碍》。澳大利亚精神病学》，27（6），573-577。

Richter, J., Brunner, R., Parzer, P., Resch, F., Stieltjes, B., & Henze, R. (2014). Reduced cortical and subcortical volumes in female adolescents with borderline personality disorder. Psychiatry Res, 221(3), 179-186. doi:10.1016/j.pscychresns.2014.01.006
Richter, J., Brunner, R., Parzer, P., Resch, F., Stieltjes, B., & Henze, R. (2014)。边缘型人格障碍女性青少年皮质和皮质下体积减少。精神病学研究》，221（3），179-186。doi:10.1016/j.pscychresns.2014.01.006

Sadek, M. N., Ismail, E. S., Kamel, A. I., Saleh, A. A., Youssef, A. A., & Madbouly, N. M. (2021). Diffusion tensor imaging of corpus callosum in adolescent females with borderline personality disorder. J Psychiatr Res, 138, 272-279. doi:10.1016/j.jpsychires.2021.04.010
Sadek, M. N., Ismail, E. S., Kamel, A. I., Saleh, A. A., Youssef, A. A., & Madbouly, N. M. (2021)。边缘型人格障碍青少年女性胼胝体的弥散张量成像。J Psychiatr Res，138，272-279。doi:10.1016/j.jpsychires.2021.04.010

Salgado-Pineda, P., Ferrer, M., Calvo, N., Costa, X., Ribas, N., Lara, B., . . . Pomarol-Clotet, E. (2023). Brain functional abnormality in drug treated and drug naïve adolescents with borderline personality disorder: Evidence for default mode network dysfunction. J Psychiatr Res, 161, 40-47. doi:10.1016/j.jpsychires.2023.03.012
Salgado-Pineda, P., Ferrer, M., Calvo, N., Costa, X., Ribas, N., Lara, B., .. .Pomarol-Clotet, E. (2023)。边缘型人格障碍青少年接受药物治疗和未接受药物治疗时的大脑功能异常：默认模式网络功能障碍的证据。J Psychiatr Res，161，40-47。doi:10.1016/j.jpsychires.2023.03.012

Siasios, I., Kapsalaki, E. Z., Fountas, K. N., Fotiadou, A., Dorsch, A., Vakharia, K., . . . Dimopoulos, V. (2016). The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review. Neurosurg Focus, 41(3), E12. doi:10.3171/2016.6.Focus16192
Siasios, I., Kapsalaki, E. Z., Fountas, K. N., Fotiadou, A., Dorsch, A., Vakharia, K., .. .Dimopoulos, V. (2016)。弥散张量成像和分数各向异性在特发性正常压力脑积水患者评估中的作用：文献综述。doi:10.3171/2016.6.Focus16192

Soloff, P. H., Kelly, T. M., Strotmeyer, S. J., Malone, K. M., & Mann, J. J. (2003). Impulsivity, gender, and response to fenfluramine challenge in borderline personality disorder. Psychiatry Res, 119(1-2), 11-24. doi:10.1016/s0165-1781(03)00100-8
Soloff, P. H., Kelly, T. M., Strotmeyer, S. J., Malone, K. M., & Mann, J. J. (2003).边缘型人格障碍患者的冲动性、性别和对芬氟拉明挑战的反应。精神病学研究》，119（1-2），11-24。doi:10.1016/s0165-1781（03）00100-8

Takahashi, T., Chanen, A. M., Wood, S. J., Walterfang, M., Harding, I. H., Yücel, M., . . . Pantelis, C. (2009). Midline brain structures in teenagers with first-presentation borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry, 33(5), 842-846. doi:10.1016/j.pnpbp.2009.03.035
Takahashi, T., Chanen, A. M., Wood, S. J., Walterfang, M., Harding, I. H., Yücel, M., .. .Pantelis, C. (2009)。首次出现边缘型人格障碍的青少年的中线大脑结构。doi:10.1016/j.pnpbp.2009.03.035

Takahashi, T., Chanen, A. M., Wood, S. J., Yücel, M., Kawasaki, Y., McGorry, P. D., . . . Pantelis, C. (2010). Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder. Psychiatry Res, 182(1), 73-76. doi:10.1016/j.pscychresns.2009.10.014
Takahashi, T., Chanen, A. M., Wood, S. J., Yücel, M., Kawasaki, Y., McGorry, P. D., .. .Pantelis, C. (2010)。首次出现边缘型人格障碍的青少年的颞上回体积。精神病学研究》，182（1），73-76。doi:10.1016/j.pscychresns.2009.10.014

Takahashi, T., Chanen, A. M., Wood, S. J., Yücel, M., Tanino, R., Suzuki, M., . . . McGorry, P. D. (2009). Insular cortex volume and impulsivity in teenagers with first-presentation borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry, 33(8), 1395-1400. doi:10.1016/j.pnpbp.2009.07.017
Takahashi, T., Chanen, A. M., Wood, S. J., Yücel, M., Tanino, R., Suzuki, M., .. .McGorry, P. D. (2009)。首次出现边缘型人格障碍的青少年的岛叶皮质体积和冲动性。doi:10.1016/j.pnpbp.2009.07.017.

Takahashi, T., Nishikawa, Y., Velakoulis, D., Suzuki, M., McGorry, P. D., Pantelis, C., & Chanen, A. M. (2019). Olfactory sulcus morphology in teenagers with first-presentation borderline personality disorder. Psychiatry Res Neuroimaging, 292, 1-4. doi:10.1016/j.pscychresns.2019.08.006
Takahashi, T., Nishikawa, Y., Velakoulis, D., Suzuki, M., McGorry, P. D., Pantelis, C., & Chanen, A. M. (2019)。首次出现边缘型人格障碍的青少年的嗅沟形态。精神病学研究神经影像学》，292，1-4。doi:10.1016/j.pscychresns.2019.08.006

Tebartz van Elst, L., Hesslinger, B., Thiel, T., Geiger, E., Haegele, K., Lemieux, L., . . . Ebert, D. (2003). Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry, 54(2), 163-171. doi:10.1016/s0006-3223(02)01743-2
Tebartz van Elst, L., Hesslinger, B., Thiel, T., Geiger, E., Haegele, K., Lemieux, L., .. .Ebert, D. (2003)。边缘型人格障碍患者的前边缘脑异常：容积磁共振成像研究。生物精神病学》，54（2），163-171。DOI：10.1016/s0006-3223（02）01743-2

Walterfang, M., Chanen, A. M., Barton, S., Wood, A. G., Jones, S., Reutens, D. C., . . . Pantelis, C. (2010). Corpus callosum morphology and relationship to orbitofrontal and lateral ventricular volume in teenagers with first-presentation borderline personality disorder. Psychiatry Res, 183(1), 30-37. doi:10.1016/j.pscychresns.2010.04.001
Walterfang, M., Chanen, A. M., Barton, S., Wood, A. G., Jones, S., Reutens, D. C., .. .Pantelis, C. (2010)。首次出现边缘型人格障碍的青少年的胼胝体形态及与眶额叶和侧脑室体积的关系》（Corpus callosum morphology and relationship to orbitofrontal and lateral ventricular volume in teenagers with first-presentation borderline personality disorder.精神病学研究》，183（1），30-37。doi:10.1016/j.pscychresns.2010.04.001

Weinberger, D. R., & McClure, R. K. (2002). Neurotoxicity, neuroplasticity, and magnetic resonance imaging morphometry: what is happening in the schizophrenic brain? Arch Gen Psychiatry, 59(6), 553-558. doi:10.1001/archpsyc.59.6.553
Weinberger, D. R., & McClure, R. K. (2002)。神经毒性、神经可塑性和磁共振成像形态测量：精神分裂症患者的大脑在发生什么？Arch Gen Psychiatry，59（6），553-558。doi:10.1001/archpsyc.59.6.553

Whittle, S., Chanen, A. M., Fornito, A., McGorry, P. D., Pantelis, C., & Yücel, M. (2009). Anterior cingulate volume in adolescents with first-presentation borderline personality disorder. Psychiatry Res, 172(2), 155-160. doi:10.1016/j.pscychresns.2008.12.004
Whittle, S., Chanen, A. M., Fornito, A., McGorry, P. D., Pantelis, C., & Yücel, M. (2009)。首次出现边缘型人格障碍的青少年的前扣带回体积》（Anterior cingulate volume in adolescents with first-presentation borderline personality disorder.精神病学研究》，172（2），155-160。doi:10.1016/j.pscychresns.2008.12.004

Xiao, Q., Fu, Y., Yi, X., Ding, J., Han, Z., Zhang, Z., . . . Chen, B. T. (2023). Altered cortical thickness and emotional dysregulation in adolescents with borderline personality disorder. Eur J Psychotraumatol, 14(1), 2163768. doi:10.1080/20008066.2022.2163768
Xiao, Q., Fu, Y., Yi, X., Ding, J., Han, Z., Zhang, Z., .. .Chen, B. T. (2023).边缘型人格障碍青少年皮层厚度改变与情绪失调。doi:10.1080/20008066.2022.2163768.

Xiao, Q., Yi, X., Fu, Y., Jiang, F., Zhang, Z., Huang, Q., . . . Chen, B. T. (2023). Altered brain activity and childhood trauma in Chinese adolescents with borderline personality disorder. J Affect Disord, 323, 435-443. doi:10.1016/j.jad.2022.12.003
Xiao, Q., Yi, X., Fu, Y., Jiang, F., Zhang, Z., Huang, Q., .. .Chen, B. T. (2023).中国边缘型人格障碍青少年大脑活动的改变与童年创伤。J Affect Disord, 323, 435-443. doi:10.1016/j.jad.2022.12.003

Yi, X., Fu, Y., Ding, J., Jiang, F., Han, Z., Zhang, Y., . . . Chen, B. T. (2024). Altered gray matter volume and functional connectivity in adolescent borderline personality disorder with non-suicidal self-injury behavior. Eur Child Adolesc Psychiatry, 33(1), 193-202. doi:10.1007/s00787-023-02161-4
Yi, X., Fu, Y., Ding, J., Jiang, F., Han, Z., Zhang, Y., .. .Chen, B. T. (2024).青少年边缘型人格障碍伴非自杀性自伤行为的灰质体积和功能连接性改变。欧洲儿童青少年精神病学》，33（1），193-202。doi:10.1007/s00787-023-02161-4

Yi, X., Fu, Y., Zhang, Z., Jiang, F., Xiao, Q., & Chen, B. T. (2023). Altered regional homogeneity and its association with cognitive function in adolescents with borderline personality disorder. J Psychiatry Neurosci, 48(1), E1-e10. doi:10.1503/jpn.220144
Yi, X., Fu, Y., Zhang, Z., Jiang, F., Xiao, Q., & Chen, B. T. (2023)。边缘型人格障碍青少年区域同质性改变及其与认知功能的关系》。精神病学杂志，神经科学，48（1），E1-E10。

Yu, H., Meng, Y. J., Li, X. J., Zhang, C., Liang, S., Li, M. L., . . . Li, T. (2019). Common and distinct patterns of grey matter alterations in borderline personality disorder and bipolar disorder: voxel-based meta-analysis. Br J Psychiatry, 215(1), 395-403. doi:10.1192/bjp.2019.44
Yu, H., Meng, Y. J., Li, X. J., Zhang, C., Liang, S., Li, M. L., .. .Li, T. (2019).边缘型人格障碍和双相情感障碍灰质改变的共同和不同模式：基于体素的荟萃分析。Doi:10.1192/bjp.2019.44