Dynamic functional connectivity in borderline personality disorder: associations with trauma, emotion regulation and symptom severity

BACKGROUND: Altered intrinsic functional connectivity is a well-established marker of borderline personality disorder (BPD). However, recent research suggests that investigating brain dynamics may offer a more detailed perspective on the neural signatures of BPD-related symptoms. METHODS: Resting-state fMRI data were analyzed in female patients with BPD (n = 47) and healthy controls (n = 28) to derive dynamic functional network connectivity (dFNC) indices using both meta-state and cluster-state approaches. Between-group comparisons assessed BPD-related dFNC alterations, while dimensional analyses explored associations between network dynamics and distinct symptom dimensions. RESULTS: Both meta-state and cluster-state analyses revealed strong associations between symptom dimensions and dynamic range and fluidity. Meta-state analysis indicated that greater emotion regulation difficulties corresponded to an expanded state repertoire, reflecting increased variability in large-scale network configurations. Cluster-state analysis showed that fewer state transitions were associated with heightened borderline symptom severity, greater childhood trauma exposure, and increased dissociative symptoms. Furthermore, childhood trauma and emotion regulation difficulties moderated the relationship between time spent in specific cluster-states and borderline symptom severity. CONCLUSION: These findings suggest that reduced dynamic flexibility but increased dynamic range in large-scale brain networks may contribute to core BPD symptoms, particularly in early trauma, emotion dysregulation as well as borderline symptom severity. The results highlight the association between aberrant dFNC and BPD and contribute to a more detailed characterization of neural dynamics relevant to the disorder.