Neural predictors of psychotherapy response in borderline personality disorder: a mini review of neuroimaging studies.

Although psychotherapy is the first-line treatment for borderline personality disorder (BPD), a substantial set of patients shows limited improvement, underscoring the need for reliable predictors to guide personalized interventions. Neurobiological markers have emerged as promising candidates, yet a comprehensive synthesis of neural predictors is lacking. This mini-review examined six structural and functional magnetic resonance imaging (MRI) studies investigating pre-treatment brain features associated with psychotherapy response in BPD. The studies varied in design, including structural MRI and task-based functional MRI paradigms assessing emotion regulation, inhibitory control, autobiographical memory, affective interference, and attachment-related processing. They also differed in therapy type (primarily Dialectical Behavior Therapy), outcome measures (ranging from global symptom severity, affective instability, emotion regulation, to impulsivity), and analytic approaches, including univariate approaches and machine-learning predictive models, using region-of-interest or whole-brain analyses. Across studies, converging evidence highlights the salience network, particularly the amygdala and anterior cingulate cortex, as central predictor of treatment response. Despite promising findings, current evidence is constrained by small samples, heterogeneous methodologies, and limited follow-up. Larger, longitudinal, and multimodal studies are needed to establish robust neurobiological predictors and support the development of precision-tailored treatments for BPD.