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A Oxitocina e o seu papel nas relações interpessoais na Perturbação da Personalidade Borderline Revisão sistemática de literatura
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Abstract(s)
Introdução: A Perturbação da Personalidade Borderline (PPB) é marcada por instabilidade
emocional, impulsividade e dificuldades relacionais, frequentemente associadas a histórias
de trauma precoce e/ou a padrões de vinculação inseguros. A oxitocina (OXT), uma neurohormona envolvida em processos da vinculação e cognição social, tem sido sugerida como
um potencial modulador dos sintomas interpessoais na PPB. Estudos recentes indicam que
disfunções no sistema oxitocinérgico podem estar associadas a dificuldades na regulação
emocional e à hiperreatividade a ameaças sociais, com evidências de que a administração
intranasal de OXT pode tanto melhorar como exacerbar comportamentos defensivos,
dependendo de fatores como a história de adversidade precoce e a variação genética no
recetor de oxitocina (OXTR).
Objetivo: Esta revisão sistemática visa sintetizar a literatura existente sobre o impacto da
OXT nas relações interpessoais e na cognição social em indivíduos com PPB, abordando o
papel da OXT na modulação de comportamentos de vinculação, confiança e empatia.
Métodos: Foram incluídos estudos de três bases de dados (PubMed, Elsevier Scopus e
PubPsych), que avaliaram a relação entre níveis de OXT e parâmetros sociais em doentes com
PPB, incluindo a influência de polimorfismos no gene OXTR e o papel do trauma infantil. De
forma a tornar a pesquisa o mais abrangente possível, foram incluídos estudos publicados na
última década (2014-2024, inclusive) e escritos em português, inglês e espanhol. Como
auxiliares, foram utilizadas as plataformas Rayyan e Microsoft Excel e esta revisão
sistemática seguiu a metodologia PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses). A população em estudo envolve adultos (idade igual ou
superior a 18 anos), com diagnóstico prévio de PPB, de acordo com critérios diagnósticos
estabelecidos (DSM-5-TR, CID-11).
Resultados: Dos 354 artigos inicialmente encontrados, após a aplicação dos critérios de
inclusão e exclusão, apenas 15 foram incluídos.
Os resultados sugerem que a OXT desempenha um papel complexo, com efeitos
heterogêneos, que dependem de múltiplos fatores psicossociais e biológicos. Há uma
diminuição dos níveis de OXT, tanto plasmáticos como no líquido cefalorraquidiano, e tal
diminuição está inversamente correlacionada com a gravidade dos traumas em idade
precoce. Pensa se que esta desregulação do sistema oxitocinérgico, consequente do trauma infantil, seja responsável pelas características centrais da perturbação como, a impulsividade,
o medo do abandono, a instabilidade emocional e afetiva.
Estudos apontam para a hipótese de que os fatores epigenéticos sejam a ponte entre as
adversidades precoces da vida e os baixos níveis de OXT. Os indivíduos expostos precoce e
repetidamente a fatores de stress psicossociais podem sofrer metilações no gene do OXTR e,
consequentemente, demonstrarem baixos níveis de OXT, característicos da PPB.
Já em relação à neurobiologia, evidenciou se uma hiperreatividade da amígdala e da ínsula,
diminuição dos volumes subcorticais das estruturas límbicas e alterações na conexão
frontolímbica.
Conclusão: Há evidências de que o sistema oxitocinérgico pode ser um sistema central em
vários aspetos comportamentais e relacionais presentes na apresentação clínica da PPB. No
entanto, apesar do crescente interesse no potencial terapêutico da OXT, os resultados ainda
são inconclusivos, refletindo a heterogeneidade clínica da PPB e os múltiplos fatores que
modulam a resposta à OXT, como traumas precoces e variações genéticas no OXTR. Como
tal, são necessárias futuras investigações que respondam a todas as perguntas ainda
existentes e que esclareçam o seu potencial terapêutico.
Ainda há um longo caminho a percorrer nesta temática e é imperativo a realização de futuros
trabalhos, de forma a encontrar novas estratégias terapêuticas que melhorem a qualidade de
vida dos indivíduos afetados por esta condição altamente debilitante.
Introduction: Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsivity, and relational difficulties, often associated with early trauma histories and/or insecure attachment patterns. Oxytocin (OXT), a neurohormone involved in attachment processes and social cognition, has been suggested as a potential modulator of interpersonal symptoms in BPD. Recent studies indicate that dysfunctions in the oxytocinergic system may be linked to difficulties in emotional regulation and hyperreactivity to social threats, with evidence suggesting that intranasal administration of oxytocin can either improve or exacerbate defensive behaviors, depending on factors such as early adversity history and genetic variation in the oxytocin receptor (OXTR). Objective: This systematic review aims to synthesize existing literature on the impact of oxytocin on interpersonal relationships and social cognition in individuals with BPD, addressing oxytocin's role in modulating attachment behaviors, trust and empathy. Methods: Studies from three databases (PubMed, Elsevier Scopus, and PubPsych) that evaluated the relationship between oxytocin levels and social parameters in BPD patients were included, taking into account the influence of OXTR gene polymorphisms and the role of childhood trauma. To ensure comprehensive research, studies published within the last decade (2014–2024, inclusive) and written in Portuguese, English, and Spanish were included. Rayyan and Microsoft Excel platforms were used as tools, and this systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) methodology. The study population involved adults (aged 18 years or older) with a prior diagnosis of Borderline Personality Disorder, according to established diagnostic criteria (DSM-5, CID-11). Results: Of the 354 articles initially identified, only 15 were included after applying inclusion and exclusion criteria. The findings suggest that oxytocin plays a complex role with heterogeneous effects, depending on multiple psychosocial and biological factors. There is a decrease in oxytocin levels, both in plasma and cerebrospinal fluid, which inversely correlates with the severity of early trauma. It is hypothesized that this dysregulation of the oxytocinergic system, resulting from childhood trauma, is responsible for core characteristics of the disorder, such as impulsivity, fear of abandonment, and emotional and affective instability. Studies point to the hypothesis that epigenetic factors serve as the link between early life adversities and low oxytocin levels. Individuals exposed to early and repeated psychosocial stressors may experience methylation of the OXTR gene, consequently, exhibiting low oxytocin levels characteristic of Borderline Personality Disorder. Regarding neurobiology, hyperreactivity of the amygdala and insula, reduced subcortical limbic structure volumes, and alterations in frontolimbic connectivity have been observed. Conclusion: There is evidence that the oxytocinergic system may be a central system in various behavioral and relational aspects present in the clinical presentation of BPD. Despite the growing interest in the therapeutic potential of oxytocin, the results remain inconclusive, reflecting the clinical heterogeneity of BPD and the multiple factors that modulate the response to oxytocin, such as early trauma and genetic variations in the oxytocin receptor. So, further investigations are needed to address the many unanswered questions and clarify its therapeutic potential. This area of research is far from being fully explored, and it is imperative to conduct future studies to develop new therapeutic strategies that improve the quality of life for individuals affected by this highly debilitating condition.
Introduction: Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsivity, and relational difficulties, often associated with early trauma histories and/or insecure attachment patterns. Oxytocin (OXT), a neurohormone involved in attachment processes and social cognition, has been suggested as a potential modulator of interpersonal symptoms in BPD. Recent studies indicate that dysfunctions in the oxytocinergic system may be linked to difficulties in emotional regulation and hyperreactivity to social threats, with evidence suggesting that intranasal administration of oxytocin can either improve or exacerbate defensive behaviors, depending on factors such as early adversity history and genetic variation in the oxytocin receptor (OXTR). Objective: This systematic review aims to synthesize existing literature on the impact of oxytocin on interpersonal relationships and social cognition in individuals with BPD, addressing oxytocin's role in modulating attachment behaviors, trust and empathy. Methods: Studies from three databases (PubMed, Elsevier Scopus, and PubPsych) that evaluated the relationship between oxytocin levels and social parameters in BPD patients were included, taking into account the influence of OXTR gene polymorphisms and the role of childhood trauma. To ensure comprehensive research, studies published within the last decade (2014–2024, inclusive) and written in Portuguese, English, and Spanish were included. Rayyan and Microsoft Excel platforms were used as tools, and this systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) methodology. The study population involved adults (aged 18 years or older) with a prior diagnosis of Borderline Personality Disorder, according to established diagnostic criteria (DSM-5, CID-11). Results: Of the 354 articles initially identified, only 15 were included after applying inclusion and exclusion criteria. The findings suggest that oxytocin plays a complex role with heterogeneous effects, depending on multiple psychosocial and biological factors. There is a decrease in oxytocin levels, both in plasma and cerebrospinal fluid, which inversely correlates with the severity of early trauma. It is hypothesized that this dysregulation of the oxytocinergic system, resulting from childhood trauma, is responsible for core characteristics of the disorder, such as impulsivity, fear of abandonment, and emotional and affective instability. Studies point to the hypothesis that epigenetic factors serve as the link between early life adversities and low oxytocin levels. Individuals exposed to early and repeated psychosocial stressors may experience methylation of the OXTR gene, consequently, exhibiting low oxytocin levels characteristic of Borderline Personality Disorder. Regarding neurobiology, hyperreactivity of the amygdala and insula, reduced subcortical limbic structure volumes, and alterations in frontolimbic connectivity have been observed. Conclusion: There is evidence that the oxytocinergic system may be a central system in various behavioral and relational aspects present in the clinical presentation of BPD. Despite the growing interest in the therapeutic potential of oxytocin, the results remain inconclusive, reflecting the clinical heterogeneity of BPD and the multiple factors that modulate the response to oxytocin, such as early trauma and genetic variations in the oxytocin receptor. So, further investigations are needed to address the many unanswered questions and clarify its therapeutic potential. This area of research is far from being fully explored, and it is imperative to conduct future studies to develop new therapeutic strategies that improve the quality of life for individuals affected by this highly debilitating condition.
Description
Keywords
Cognição Social Oxitocina Perturbação da Personalidade Borderline Regulação Emocional Relaçõesinterpessoais Vinculação