Impulsivity in borderline personality disorder: A scoping review of affective, neurobiological and methodological findings.
Impulsivity is a defining feature of borderline personality disorder (BPD), yet it remains unclear whether it reflects a stable deficit in inhibitory control or a context-dependent breakdown in behavioural regulation under conditions of emotional arousal. Existing models variably emphasise trait, cognitive or affective mechanisms, with limited integration of contextual influences. This scoping review synthesised empirical evidence examining affective mechanisms, neurobiological and methodological accounts of impulsivity in BPD.
Following PRISMA-ScR guidelines, CINAHL, EMBASE, EMCARE, MEDLINE, and PsycINFO were searched for studies published between 1980 to November 2025. Forty-six studies meeting inclusion criteria were synthesised across affective, neurobiological, and methodological domains. Study designs included cross-sectional/correlational investigations (n = 17), experimental or task-based paradigms (n = 13), neuroimaging studies (n = 11), lesion or quasi-experimental designs (n = 3), and randomised controlled trials (n = 2).
Impulsive behaviour in BPD was most consistently associated with affective instability, with negative urgency emerging as the most robust correlate. Self-report measures showed consistent elevations, whereas behavioural measures of inhibitory control under neutral conditions yielded heterogeneous findings, with several studies indicating preserved performance. Impairments were more reliably observed under emotionally salient or stress-inducing conditions. Neurobiological findings converged on dysregulation within frontolimbic and salience networks, particularly amygdala-prefrontal circuitry. Convergence across measurement modalities was limited, highlighting substantial heterogeneity.
Evidence supports a model in which impulsivity in BPD reflects affect-modulated, context-dependent behavioural dyscontrol rather than a pervasive trait-level deficit. Heightened negative urgency and disrupted amygdala-prefrontal regulation appears central, linking affective instability to impulsive behaviour. These findings support mechanism-informed and context-sensitive approaches to assessment and intervention.
Following PRISMA-ScR guidelines, CINAHL, EMBASE, EMCARE, MEDLINE, and PsycINFO were searched for studies published between 1980 to November 2025. Forty-six studies meeting inclusion criteria were synthesised across affective, neurobiological, and methodological domains. Study designs included cross-sectional/correlational investigations (n = 17), experimental or task-based paradigms (n = 13), neuroimaging studies (n = 11), lesion or quasi-experimental designs (n = 3), and randomised controlled trials (n = 2).
Impulsive behaviour in BPD was most consistently associated with affective instability, with negative urgency emerging as the most robust correlate. Self-report measures showed consistent elevations, whereas behavioural measures of inhibitory control under neutral conditions yielded heterogeneous findings, with several studies indicating preserved performance. Impairments were more reliably observed under emotionally salient or stress-inducing conditions. Neurobiological findings converged on dysregulation within frontolimbic and salience networks, particularly amygdala-prefrontal circuitry. Convergence across measurement modalities was limited, highlighting substantial heterogeneity.
Evidence supports a model in which impulsivity in BPD reflects affect-modulated, context-dependent behavioural dyscontrol rather than a pervasive trait-level deficit. Heightened negative urgency and disrupted amygdala-prefrontal regulation appears central, linking affective instability to impulsive behaviour. These findings support mechanism-informed and context-sensitive approaches to assessment and intervention.
Authors
Cholakians Cholakians, Chen Chen, Jenkins Jenkins, Thomas Thomas, Gurvich Gurvich
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