Botox Reduces Treatment-Resistant Symptoms of BPD

May 7, 2018

NEW YORK CITY—A single treatment of botulinum toxin injections vastly improved treatment-resistant symptoms of borderline personality disorder (BPD) in at least 10 consecutive cases, according to research presented at the American Psychiatric Association’s annual meeting.

“About half of patients sought repetition of the treatment months later, which led to a replication of the clinical improvement,” reported poster presenter Tillmann Kruger, MD, and coauthor M. Axel Wollmer, MD, at a May 7 poster session.

“In all patients, previous and current pharmacological and psychotherapeutic (including dialectic behavioral therapy) treatment attempts had been insufficient, and treatment with botulinum toxin had been offered as compassionate use,” they explained.

Lamotrigine Ineffective in Borderline Personality Disorder

Patients at Hannover Medical School and Asklepios Clinic North-Ochsenzoll in Germany received 29 U of onabotulinumtoxinA at 5 injection sites in the glabellar region of the face, between the eyebrows. Previous studies had demonstrated the effectiveness of such injections in alleviating symptoms of major depression, possibly by interrupting a facial feedback loop in which contraction of the glabellar muscles reinforces depressed mood.

Dr. Kruger and Dr. Wollmer theorized botulinum toxin injections would ease additional negative emotions linked with a variety of psychiatric diagnoses, such as anger and fear, because they are also expressed through glabellar muscles.

“In this case, borderline personality disorder could represent an ideal new target for botulinum toxin injections because patients suffer from excessive negative emotions of any kind,” they explained.

Asymmetrical Brain Regions Linked With Borderline Personality Disorder

Indeed, 2-6 weeks after injections, patient scores on the Zanarini Rating Scale for Borderline Personality Disorder and the Borderline Symptom List improved between 50% and 90% from baseline. Patients also showed improvement in impulsivity, self-harming behavior, agitation, concomitant depressive symptoms, and social functioning, according to the study.

“With regard to the facial feedback theory…, botulinum toxin may diminish the entire spectrum of negative emotions and thereby calm down the pathognomonic emotional instability of borderline personality disorder,” Dr. Kruger and Dr. Wollmer wrote. “Consequently, botulinum toxin may also help to control impulsivity derived from overwhelming affect and also correct the negative bias in facial emotion recognition characterized by hyperreactivity of the amygdala.”

Researchers are conducting a randomized control trial to confirm the findings.

—Jolynn Tumolo


“Can botulinum toxin alleviate symptoms of borderline personality disorder?” Abstract presented at: the American Psychiatric Association Annual Meeting; May 7, 2018; New York, NY.