The hypothalamic-pituitary-adrenal axis in borderline personality disorder: a review

Harv Rev Psychiatry. 2009;17(3):167-83. doi: 10.1080/10673220902996734.


Background: borderline personality disorder (BPD) is a psychiatric diagnosis characterized by high exposure, reactivity, and vulnerability to stress. Given these abnormalities in stress reactivity in BPD, there is a question of whether the hypothalamic-pituitary-adrenal (HPA) axis functions normally in BPD, since the activation of the HPA axis normally occurs to coordinate both behavioral and physiologic responses to stress. Several studies have investigated the functioning of the HPA axis in BPD and have shown varied results. This review seeks to summarize and interpret the findings of this growing literature.

Methods: Pubmed search for English language articles on borderline personality disorder and hypothalamic-pituitary-adrenal axis.

Results: findings are mixed but suggest that important variables relevant to between-group differences include comorbid depression, comorbid posttraumatic stress disorder, dissociative symptoms, and history of childhood abuse.

Discussion: comorbid diagnoses and clinical features such as trauma history and symptom severity may have variable, interacting influences on the psychoneuroendocrine profile in BPD. Also explored here are the implications of these findings for developing possible models of HPA-axis dysfunction in BPD, for identifying potential targets for treatment, and for improving the methodology of future studies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Function Tests
  • Biomarkers
  • Borderline Personality Disorder / metabolism*
  • Corticotropin-Releasing Hormone / metabolism
  • Humans
  • Hydrocortisone / metabolism
  • Hypothalamo-Hypophyseal System / metabolism*
  • Pituitary-Adrenal System / metabolism*
  • Stress, Psychological / metabolism*


  • Biomarkers
  • Corticotropin-Releasing Hormone
  • Hydrocortisone