Impulsive aggression in borderline personality disorder.

Impulsive aggressive behaviors that include physical aggression directed towards others, self-mutilation, suicide attempts, domestic violence, substance abuse, and property destruction account for a substantial portion of the morbidity and mortality associated with personality disorders, in particular borderline personality disorder (BPD). Recent genetic, neurobiologic, and diagnostic studies suggest a dimensional approach to BPD symptomatology with impulsive aggression as one of the core dimensions for the disorder. The underlying biologic basis for impulsive aggression is centered on the serotonin hypothesis; that central 5-HT function is inversely related to aggression and suicidality. More recent research refines the theory to include associated brain regions, receptor types and neuromodulators potentially involved in the etiology of aggressivity. Treatment utilizes this information with substantial progress in well-designed placebo-controlled studies of selective serotonin reuptake inhibitors such as fluoxetine, and open-label series of atypical neuroleptics, mood stabilizers, and opioid antagonists