Repetitive Transcranial Magnetic Stimulation Versus Theta Burst Stimulation on Impulsivity, Emotional Dysregulation, and Non-Suicidal Self-Injury in Borderline Personality Disorder Patients (TMS and TBS)

November 1, 2026 updated by: Dina ussein, Ain Shams University

Effect of Repetitive Transcranial Magnetic Stimulation Versus Theta Burst Stimulation on Impulsivity, Emotional Dysregulation, and Non-Suicidal Self-Injury in a Sample of Patients With Borderline Personality Disorder: A Randomized Controlled Trial

the goal of this randomized clinical trial is to evaluate the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) in patients with borderline personality disorder (BPD). The study aims to assess whether these brain stimulation techniques can reduce symptoms of emotional dysregulation, impulsivity, and non-suicidal self-injury.

The main questions it aims to answer are:

Does high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) improve emotional dysregulation, impulsivity, and non-suicidal self-injury in patients with BPD? Does intermittent theta-burst stimulation (iTBS) over the left DLPFC produce similar therapeutic effects? How does the efficacy of rTMS and iTBS compare to sham stimulation after completing the treatment course?

Participants will be randomly assigned to one of three groups:

  1. High-frequency rTMS group
  2. Intermittent theta-burst stimulation (iTBS) group
  3. Sham stimulation group Each participant will receive 15-20 stimulation sessions over the left DLPFC. Changes in emotional dysregulation, impulsivity, and non-suicidal self-injury symptoms will be evaluated before and after treatment.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional dysregulation, impulsivity, and recurrent non-suicidal self-injury (NSSI).

Although psychotherapy and pharmacological interventions remain the mainstay of treatment, many patients continue to experience severe emotional instability and impulsivity. Neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) have recently shown promise in modulating fronto-limbic circuits involved in emotion regulation.

This prospective, randomized, double-blind, controlled clinical trial aims to evaluate and compare the therapeutic efficacy of high-frequency rTMS and intermittent theta-burst stimulation (iTBS) applied over the left dorsolateral prefrontal cortex (DLPFC) in patients diagnosed with BPD. The interventions are expected to enhance prefrontal modulation of limbic activity, thereby improving emotional regulation, reducing impulsivity, and decreasing non-suicidal self-injury behaviors.

Participants will be randomly assigned to one of three groups:

Group 1: High-frequency rTMS (5 Hz, 1200 pulses/session, 80-110% RMT, 21 min total) Group 2: Intermittent theta-burst stimulation (iTBS, 50 Hz bursts, 600 pulses/session, 80-120% RMT, 21 min total) Group 3: Sham stimulation (matched duration and sound without magnetic output) All participants will continue their standard therapy for BPD, including weekly Dialectical Behavior Therapy (DBT) sessions during the study. Each participant will receive 20 sessions over 4 weeks (5 sessions per week). Allocation concealment will be ensured using sealed, numbered envelopes prepared by an independent administrator, and both participants and assessors will be blinded to group assignment.

Clinical assessments will include:

Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) for BPD diagnosis General Health Questionnaire (GHQ-28) to screen for psychiatric comorbidities Difficulties in Emotion Regulation Scale - Short Form (DERS-16) Barratt Impulsiveness Scale (BIS) Deliberate Self-Harm Inventory (DSHI) Measurements will be taken at baseline (pre-intervention) and after completion of the stimulation sessions (post-intervention).

Safety procedures will follow international TMS safety guidelines (Rossi et al., 2009; Lefaucheur et al., 2020). Adverse effects such as transient headache or scalp discomfort will be monitored, and any serious adverse events (e.g., seizures) will be immediately reported to the Research Ethics Committee.

This study seeks to determine whether rTMS or iTBS is more effective than sham stimulation in improving emotion regulation, reducing impulsivity, and decreasing self-harm behaviors. It will also explore whether iTBS, with its shorter session duration, provides a comparable or superior therapeutic benefit to conventional rTMS.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
45

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Egypt
    • Cairo Governorate
      • Cairo, Cairo Governorate, Egypt, 11252
        • Recruiting
        • Ainshams University Hospitals
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

21 years to 50 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • 1. Age range: 21-50 years old. 2. Gender: males and females 3. Borderline personality disorder diagnosis

Exclusion Criteria:

- 1. Presence of other uncontrolled mental illness that precludes the ability to provide informed consent (e.g.; acute psychosis, bipolar disorder currently in manic episode, major depressive disorder with recent suicidal attempt).

2. Patients with contraindications to TMS as cardiac patients with pacemakers, metallic implants as cochlear implants, aneurysm clips, stents, and deep brain stimulation electrodes.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Repetitive Transcranial Magnetic Stimulation

Participants receive 15-20 sessions of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC). Each session lasts approximately 21 minutes.
Device: Repetitive Transcranial Magnetic Stimulation

rTMS will be delivered at 5 Hz frequency, 1200 pulses per session, at 80-110% of the individual's resting motor threshold (RMT). Stimulation will be applied to the left DLPFC (F3 according to the 10-20 EEG system) using a figure-of-eight coil. Each session includes 18 minutes of active stimulation followed by 3 minutes of sham stimulation on the target site. Sessions are administered 5 days per week for 4 weeks (total 20 sessions).

Other Names:
  • rTMS
Active Comparator: Intermittent Theta-Burst Stimulation Group

Participants receive 15-20 sessions of intermittent theta-burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Each session lasts approximately 21 minutes.
Device: Intermittent Theta-Burst Stimulation

iTBS will be delivered as 50 Hz bursts (three pulses per burst, 5 Hz bursts) at 80-120% of resting motor threshold, totaling 600 pulses per session. Stimulation will be applied over the left DLPFC (F3 site, 10-20 EEG system). Each session includes 3 minutes of active iTBS and 18 minutes of sham stimulation. Sessions are administered 5 days per week for 4 weeks (total 20 sessions).

Other Names:
  • iTBS
Sham Comparator: Sham Stimulation Group

Participants receive sham stimulation sessions identical in duration and sound to the active conditions but without active magnetic output.
Device: Sham Stimulation

Sham stimulation will be delivered using the same coil orientation and acoustic cues as the active conditions, but with the magnetic field output disabled. Each session includes 18 minutes of sham rTMS and 3 minutes of sham TBS over the left DLPFC (F3 site). Sessions are administered 5 days per week for 4 weeks (total 20 sessions).

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
improvement of impulsivity in BPD as assessed by barratt impulsivity scale (BIS)
Time Frame: 20 sessions given over 1 month

Improvement of results of The barratt impulsivity scale (BIS) measured before starting sessions and after finishing 20 sessions
20 sessions given over 1 month

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
improvement of emotional dysregulation as per Difficulties in Emotion Regulation Scale(DERS)
Time Frame: 20 sessions1 month

Improvement of results of DERS measured before starting sessions and after finishing 20 sessions
20 sessions1 month
improvement of non-suicidal self injury
Time Frame: 20 sessions given in 1 month

Improvement of results of The Deliberate Self-Harm Inventory (DSHI) measured before starting sessions and after finishing 20 sessions
20 sessions given in 1 month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Ain Shams University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Study Director: mohamed F professor Dr, MD of psychiatry, ainshams university

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 1, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 1, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 1, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 1, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 5, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 5, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 1, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • FMASU MD169/2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

de-identified individual participant data will be available upon reasonable request after publication of the primary results

IPD Sharing Time Frame

5 years after publication

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ICF
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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