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Sleep disturbances and circadian CLOCK genes in borderline personality disorder

  • Biological Psychiatry - Review article
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Abstract

Borderline personality disorder (BPD) is characterised by a deep-reaching pattern of affective instability, incoherent identity, self-injury, suicide attempts, and disturbed interpersonal relations and lifestyle. The daily activities of BPD patients are often chaotic and disorganized, with patients often staying up late while sleeping during the day. These behavioural patterns suggest that altered circadian rhythms may be associated with BPD. Furthermore, BPD patients frequently report suffering from sleep disturbances. In this review, we overview the evidence that circadian rhythms and sleep are disturbed in BPD, and we explore the possibility that personality traits that are pertinent for BPD may be associated with circadian typology, and perhaps to circadian genotypes. With regards to sleep architecture, we review the evidence that BPD patients display altered non-REM and REM sleep. A possible cue to a deeper understanding of this temporal dysregulation might be an analysis of the circadian clock at the molecular and cellular level, as well as behavioural studies using actigraphy and we suggest avenues for further exploration of these factors.

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References

  • Adan A, Natale V, Caci H, Prat G (2010) Relationship between circadian typology and functional and dysfunctional impulsivity. Chronobiol Int 27:606–619

    Article  PubMed  Google Scholar 

  • Archer SN, Robilliard DL, Skene DJ, Smits M, Williams A, Arendt J, von Schantz M (2003) A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference. Sleep 26:413–415

    PubMed  Google Scholar 

  • Asaad T, Okasha T, Okasha A (2002) Sleep EEG findings in ICD-10 borderline personality disorder in Egypt. J Affect Disord 71:11–18

    Article  PubMed  Google Scholar 

  • Baird AL, Coogan AN, Siddiqui A, Donev RM, Thome J (2011) Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Mol Psychiatry. doi:10.1038/mp.2011.149

  • Barclay NL, Eley TC, Mill J, Wong CC, Zavos HM, Archer SN, Gregory AM (2011) Sleep quality and diurnal preference in a sample of young adults: associations with 5HTTLPR, PER3, and CLOCK 3111. Am J Med Genet B Neuropsychiatr Genet 156B:681–690

    PubMed  Google Scholar 

  • Basset D (2012) Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review. Aust NZ J Psychiatry 46(4):327–339

    Article  Google Scholar 

  • Bastien CH, Guimond S, St-Jean G, Lemelin S (2008) Signs of insomnia in borderline personality disorder individuals. J Clin Sleep Med 4(5):462–470

    PubMed  Google Scholar 

  • Battaglia M, Ferini-Strambi L, Smirne S, Bernardischi L, Bellodi L (1993) Ambulatory polysomnography of never-depressed borderline subjects: a high-risk approach to rapid eye movement latency. Biol Psychiatry 33:326–334

    Article  PubMed  CAS  Google Scholar 

  • Battaglia M, Ferini-Strambi L, Bertella S, Bajo S, Bellodi L (1999) First-cycle rem density in never-depressed subjects with borderline personality disorder. Biol Psychiatry 45:1056–1058

    Article  PubMed  CAS  Google Scholar 

  • Bell J, Lycaki H, Jones D, Kelwala S, Sitaram N (1983) Effect of preexisting borderline personality disorder on clinical and EEG sleep correlates of depression. Psychiatry Res 9:115–123

    Article  PubMed  CAS  Google Scholar 

  • Benson KL, King R, Gordon D, Silva AJ, Zarcone VP Jr (1990) Sleep pattern in borderline personality disorder. JAD 18:267–273

    Article  CAS  Google Scholar 

  • Bohus M (2009) Borderline Persönlichkeitsstörung. In: Margraf J (ed) Lehrbuch der Verhaltenstherapie, 3rd edn. Springer, Heidelberg, pp 534–559

  • Bouchard TJ Jr, Loehlin JC (2001) Genes, evolution and personality. Behav Genet 31(3):243–273

    Article  PubMed  Google Scholar 

  • Broese T, Riemann D, Hein L, Nissen C (2012) α-Adrenergic receptor function, arousal and sleep: mechanisms and therapeutic implications. Pharmacopsychiatry (in press)

  • Caci H, Robert P, Boyer P (2004) Novelty seekers and impulsive subjects are low in morningness. Eur Psychiatry 19:79–84

    Article  PubMed  Google Scholar 

  • Cervena K, Matousek M (2005) Sleep disturbance in patients treated for panic disorder. Sleep Med 6(2):149–153

    Article  PubMed  Google Scholar 

  • Chang AM, Buch AM, Bradstreet DS, Klements DJ, Duffy JF (2011) Human diurnal preference and circadian rhythmicity are not associated with the CLOCK 3111C/T gene polymorphism. J Biol Rhythms 26:276–279

    Article  PubMed  CAS  Google Scholar 

  • Coogan AN, Thome J (2011) Chronotherapeutics and psychiatry: setting the clock to relieve the symptoms. World J Biol Psychiatry 12(Suppl 1):40–43

    PubMed  Google Scholar 

  • Cowdry RW, Gardner DL, O’Leary KM, Leibenluft E, Rubinow DR (1991) Mood variability: a study of four groups. Am J Psychiatry 148:1505–1511

    PubMed  CAS  Google Scholar 

  • Dagan Y, Eisenstein M (1999) Circadian rhythm sleep disorders: toward a more precise definition and diagnosis. Chronobiol Int 16:213–222

    Article  PubMed  CAS  Google Scholar 

  • Dagan Y, Sela H, Omer H, Hallis D, Dar R (1996) High prevalence of personality disorders among circadian rhythm sleep disorders (CRSD) patients. J Psychosom Res 41:357–363

    Article  PubMed  CAS  Google Scholar 

  • Dalby AM (1975) Behavioral effects of carbamazepine. Adv Neurol 11:331–344

    PubMed  CAS  Google Scholar 

  • De la Fuente JM, Lotstra F (1994) A trial of carbamazepine in borderline personality disorder. Eur Neuropsychopharmacol 4(4):479–486

    Article  PubMed  Google Scholar 

  • De la Fuente JM, Bobes J, Vizuete C, Mendlewicz J (2001) Sleep-EEG in borderline patients without concomitant major depression: a comparison with major depressives an normal control subjects. Psychiatry Res 105:87–95

    Article  PubMed  Google Scholar 

  • De la Fuente JM, Bobes J, Vizuete C, Mendlewicz J (2002) Effects of carbamazepine on dexamethasone suppression and sleep electroencephalography in borderline personality disorder. Neuropsychobiology 45(3):113–119

    Article  PubMed  Google Scholar 

  • De la Fuente JM, Bobes J, Morlan I, Bascaran MT, Vizuete C, Linkowski P et al (2004) Is the biological nature of depressive symptoms in borderline patients without concomitant Axis I pathology idiosyncratic? Sleep EEG comparison with recurrent brief, major depression and control subjects. Psychiatry Res 129:65–73

    Article  PubMed  Google Scholar 

  • Distel MA, Trull TJ (2009) The five-factor model of personality and borderline personality disorder: a genetic analysis of comorbidity. Biol Psychiatry 66(12):1131–1138

    Article  PubMed  Google Scholar 

  • Ellis J, von Schantz M, Jones KH, Archer SN (2009) Association between specific diurnal preference questionnaire items and PER3 VNTR genotype. Chronobiol Int 26(3):464–473

    Article  PubMed  CAS  Google Scholar 

  • Franken P, Dijk DJ (2009) Circadian clock genes and sleep homeostasis. Eur J Neurosci 29:1820–1829

    Article  PubMed  CAS  Google Scholar 

  • Golder SA, Macy MW (2011) Diurnal and seasonal mood vary with work, sleep, and daylength across diverse cultures. Science 333:1878–1881

    Article  PubMed  CAS  Google Scholar 

  • Hampp G, Ripperger JA, Houben T, Schmutz I, Blex C, Perreau-Lenz S, Brunk I, Spanagel R, Ahnert-Hilger G, Meijer JH, Albrecht U (2008) Regulation of monoamine oxidase A by circadian-clock components implies clock influence on mood. Curr Biol 18:678–683

    Article  PubMed  CAS  Google Scholar 

  • Harty L, Duckworth R, Thompson A, Stuewig J, Tangney JP (2010) Are inmates’ subjective sleep problems associated with borderline personality, psychopathy, and antisocial personality independent of depression and substance dependence? J Forens Psychiatry Psychol 21(1):23–39

    Article  PubMed  Google Scholar 

  • Hogben AL, Ellis J, Archer SN, von Schantz M (2007) Conscientiousness is a predictor of diurnal preference. Chronobiol Int 24(6):1249–1254

    Article  PubMed  Google Scholar 

  • Huynh C, Guilé JM, Breton JJ, Desrosiers L, Cohen D, Godbout R (2010) Is it possible to study sleep-wake patterns in adolescent borderline personality disorder? An actigraphic feasibility study. Int J Adolesc Med Health 22:547–560

    Article  PubMed  Google Scholar 

  • Huynh C, Guilé JM, Godbout R (2012) Polysomnographic studies on sleep in adult borderline personality disorder. Presse Med 41(2):e63–e75

    Article  PubMed  Google Scholar 

  • Johansson C, Willeit M, Smedh C, Ekholm J, Paunio T, Kieseppä T, Lichtermann D, Praschak-Rieder N, Neumeister A, Nilsson LG, Kasper S, Peltonen L, Adolfsson R, Schalling M, Partonen T (2003) Circadian clock-related polymorphisms in seasonal affective disorder and their relevance to diurnal preference. Neuropsychopharmacology 28:734–739

    Article  PubMed  CAS  Google Scholar 

  • Johansson AS, Brask J, Owe-Larsson B, Hetta J, Lundkvist GB (2011) Valproic acid phase shifts the rhythmic expression of Period2:luciferase. J Biol Rhythms 26:541–551

    Article  PubMed  CAS  Google Scholar 

  • Katzenberg D, Young T, Finn L, Lin L, King DP, Takahashi JS, Mignot E (1998) A clock polymorphism associated with human diurnal preference. Sleep 21:569–576

    PubMed  CAS  Google Scholar 

  • Kendler KS, Myers J, Reichborn-Kjennerud T (2011) Borderline personality disorder traits and their relationship with dimension of normative personality: a web-based cohort and twin study. Acta Psychiatr Scand 123(5):349–359

    Article  PubMed  CAS  Google Scholar 

  • King DP, Zhao Y, Sangoram AM, Wilsbacher LD, Tanaka M, Antoch MP et al (1997) Positional cloning of the mouse circadian clock gene. Cell 89(4):641–653

    Article  PubMed  CAS  Google Scholar 

  • Lieb K, Rexhausen JE, Kahl KG, Schweiger U, Philipsen A, Hellhammer DH, Bohus M (2004) Increased diurnal salivary cortisol in women with borderline personality disorder. J Psychiatr Res 38:559–565

    Article  PubMed  Google Scholar 

  • McNamara E, Reynolds CF III, Soloff PH, Mathias R, Rossi A, Spiker D (1984) EEG sleep evaluation of depression in borderline patients. Am J Psychiatry 141(2):182–186

    PubMed  CAS  Google Scholar 

  • Mishima K, Tozawa T, Satoh K, Saitoh H, Mishima Y (2005) The 3111T/C polymorphism of hClock is associated with evening preference and delayed sleep timing in a Japanese population sample. Am J Med Genet B Neuropsychiatr Genet 133B:101–104

    Article  PubMed  Google Scholar 

  • Muro A, Gomà-i-Freixanet M, Adan A, Cladellas R (2011) Circadian typology, age, and the alternative five-factor personality model in an adult women sample. Chronobiol Int 28:690–696

    Article  PubMed  Google Scholar 

  • Osland TM, Bjorvatn BR, Steen VM, Pallesen Sl (2011) Association study of a variable-number tandem repeat polymorphism in the clock gene PERIOD3 and chronotype in Norwegian university students. Chronobiol Int 28:764–770

    Article  PubMed  CAS  Google Scholar 

  • Philipsen A, Feige B, Al-Shajlawi A, Schmahl Ch, Bohus M, Richter H et al (2005) Increased delta power and discrepancies in objective and subjective sleep measurement in borderline personality disorder. J Psychiatr Res 39:489–498

    Article  PubMed  Google Scholar 

  • Plante DT, Zanarini MC, Frankenburg FR, Fitzmaurice GM (2009) Sedative-hypnotic use in patents with borderline personality disorder and axis II comparison subjects. J Pers Disord 23(6):563–571

    Article  PubMed  Google Scholar 

  • Prasko J, Houbova P, Novak, Zalesky R, Espa-Cervena K, Paskova B (2005) Influence of personality disorder on the treatment of panic disorder—comparison study. Neuro Endocrinol Lett 26(6):667–674

    PubMed  Google Scholar 

  • Prasko J, Brunovsky M, Latalova K, Grambal A, Raszka M, Vyskocilova J et al (2010) Augmentation of antidepressants with bright light therapy in patients with comorbid depression and borderline personality disorder. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 154(4):355–361

    PubMed  Google Scholar 

  • Sansone RA, Edwards HC, Forbis JS (2009) Sleep quality in borderline personality disorder: a cross-sectional study. Prim Care Copanion J Clin Psychiatry 12(5). doi:10.4088/PCC.09m00919

  • Saper CB, Lu J, Chou TC, Gooley J (2005) The hypothalamic integrator for circadian rhythms. Trends Neurosci 28:152–157

    Article  PubMed  CAS  Google Scholar 

  • Semiz UB, Basoglu C, Ebrinc S, Cetin M (2008) Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry Clin Neurosci 62:48–55

    Article  PubMed  Google Scholar 

  • Steiner M, Links PS, Korzekwa M (1988) Biological markers in borderline personality disorder: an overview. Can J Psychiatry 33:350–354

    PubMed  CAS  Google Scholar 

  • Susman EJ, Dockray S, Schiefelbein VL, Herwehe S, Heaton JA, Dorn LD (2007) Morningness/eveningness, morning-to-afternoon cortisol ratio, and antisocial behavior problems during puberty. Dev Psychol 43:811–822

    Article  PubMed  Google Scholar 

  • Terracciano A, Sanna S, Uda M, Deiana B, Usala G, Busonero F et al (2010) Genome-wide association scan for five major dimensions of personality. Mol Psychiatry 15(6):647–656

    Article  PubMed  CAS  Google Scholar 

  • Verkes RJ, Kerkhof GA, Beld E, Hengeveld MW, van Kempen GM (1996) Suicidality, circadian activity rhythms and platelet serotonergic measures in patients with recurrent suicidal behaviour. Acta Psychiatr Scand 93:27–34

    Article  PubMed  CAS  Google Scholar 

  • Voinescu BI, Coogan AN (2012) A variable number tandem repeat polymorphism in PER3 is not associated with chronotype in a population with self-reported sleep problems. Sleep Biol Rhythm 10:23–26

    Article  Google Scholar 

  • Wingenfeld K, Driessen M, Adam B, Hill A (2007) Overnight urinary cortisol release in women with borderline personality disorder depends on comorbid PTSD and depressive psychopathology. Eur Psychiatry 22:309–312

    Article  PubMed  Google Scholar 

  • Wirz-Justice A (2006) Biological rhythm disturbances in mood disorders. Int Clin Psychopharmacol 21(Suppl 1):S11–S15

    Article  PubMed  Google Scholar 

  • Wulff K, Gatti S, Wettstein JG, Foster RG (2010) Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci 11:589–599

    Article  PubMed  CAS  Google Scholar 

  • DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association, Washington DC

  • Yin L, Wang J, Klein PS, Lazar MA (2006) Nuclear receptor Rev-erbalpha is a critical lithium-sensitive component of the circadian clock. Science 311:1002–1005

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Hospital Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany

    Monika Fleischer, Michael Schäfer & Johannes Thome

  2. Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland

    Andrew Coogan

  3. Department of Child and Adolescent Psychiatry, Psychotherapy and Neurology, University Hospital Rostock, Rostock, Germany

    Frank Häßler

  4. College of Medicine, Swansea University, Swansea, UK

    Johannes Thome

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  1. Monika Fleischer
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  2. Michael Schäfer
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  3. Andrew Coogan
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  4. Frank Häßler
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  5. Johannes Thome
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Correspondence to Johannes Thome.

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Fleischer, M., Schäfer, M., Coogan, A. et al. Sleep disturbances and circadian CLOCK genes in borderline personality disorder. J Neural Transm 119, 1105–1110 (2012). https://doi.org/10.1007/s00702-012-0860-5

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