Peripheral inflammation is associated with emotional dysregulation, suicide attempts, and reduced microstructural integrity of white matter in young adults with borderline personality disorder

AI Summary

BPD patients show elevated peripheral inflammation, chiefly increased GM-CSF, which correlates with greater emotional dysregulation.
Individuals with suicide attempts exhibit higher inflammatory indices, notably elevated IL-5 and GM-CSF, versus controls and BPD without suicide attempts.
Higher inflammatory scores associate with reduced white-matter microstructural integrity in the anterior salience network involved in external stimulus processing.

Brain Behav Immun. 2026 Jun 1:106848. doi: 10.1016/j.bbi.2026.106848. Online ahead of print.

ABSTRACT

BACKGROUND: Borderline personality disorder (BPD) is a psychiatric condition characterized by functional impairment and high rates of suicide attempts. Although its pathophysiology is still unclear, emerging evidence suggests a role of peripheral inflammation. This study investigates the association between peripheral inflammatory markers and clinical, behavioural, and neuroimaging features in individuals with BPD.

METHODS: Seventy-nine BPD patients and 26 controls underwent a multidimensional clinical evaluation, including emotional dysregulation and suicide attempt assessment, and blood sampling for serum cytokine profiling. All the participants received 3 T diffusion-weighted MRI to assess white-matter microstructural integrity. A composite inflammatory index was computed from cytokines’ levels and white-matter microstructural integrity was examined in networks relevant to BPD, with a focus on the salience network (SN).

RESULTS: BPD patients showed a significantly elevated inflammatory index (z-score, p = 0.035) primarily driven by increased GM-CSF serum levels (p < 0.026), which in turn were associated with more severe emotional dysregulation (r > 0.26, p < 0.038). BPD individuals with a history of suicide attempts displayed higher inflammatory indices – particularly elevated IL-5 and GM-CSF – compared to both healthy controls and BPD participants without suicide attempts (p < 0.050). Finally, higher inflammatory scores correlated with reduced white-matter microstructural integrity in the anterior SN (r = 0.32, p = 0.043).

CONCLUSIONS: In young adults with BPD, peripheral inflammation is associated with emotional dysregulation, suicide risk, and disruptions of white-matter microstructural integrity of the network involved in external stimuli processing. These findings support a role for immune dysregulation in the neurobiological underpinnings of BPD and underscore the need for further mechanistic research.

PMID:42229704 | DOI:10.1016/j.bbi.2026.106848

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