Tag: BPD

Borderline Personality Disorder Research and Treatment

Borderline personality disorder (BPD), characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, afflicts approximately 2 percent of the general population and is a leading cause of suicide. Eight to 10 percent of individuals with this disorder take their own lives.

“A common misapprehension by family, friends and often by clinicians is that patients with borderline personality disorder are not likely to commit suicide since suicidal behavior is seen as a bid for attention, misjudged as not serious. The prevalence is more than 400 times higher than in the general population,” said John Oldham, MD, MS, senior vice president and chief of staff, The Menninger Clinic, and professor of psychiatry and executive vice chair, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine.

Despite the prevalence of BPD, its diagnosis by therapists is often impeded by the lack of awareness and frequent co-occurrence with other conditions, such as depression, substance abuse and anxiety. To help therapists diagnose this disorder and build an alliance with their BPD patients, new ways of categorizing and defining BPD are in consideration. Dr. Oldham is one of the consultants on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), expected to be published in 2011.

BPD usually manifests itself in late adolescence or early adulthood, according to Dr. Oldham.

“Patients with borderline personality disorder often have a stormy course, punctuated with episodes of high-risk behavior. The patient’s symptom profile as well as coexisting conditions, such as substance abuse, influence an individual’s course. Due to the disabling nature of the disorder, accompanied by high levels of emotional pain and distress, patients generally seek treatment and if they adhere to treatment and overcome high-risk behavior, they may ultimately do quite well.”

Officially recognized in 1980 by the psychiatric community, borderline personality disorder is at least two decades behind in research treatment options and education compared to other serious mental illnesses. Congressional Resolution, H. Res. 1005, is awaiting final action to designate May as Borderline Personality Disorder Awareness Month. This resolution acknowledges the pressing burden of those afflicted with borderline personality disorder, confirms the widespread prevalence of this disorder and seeks to spread awareness of this under-recognized and often misunderstood mental illness.

This Menninger Continuing Education Conference, offering continuing education credit to health professionals, is co-sponsored by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) and The National Alliance on Mental Illness (NAMI) Metropolitan Houston. Topics and speakers include:

  • Borderline Personality Disorder: Overview of Recent Research Findings by John M. Oldham, MD, MS
  • Mentalizing in the Treatment of BPD by Jon G. Allen, PhD
  • Evidence-Based Treatment of BPD by Glen O. Gabbard, MD
  • Borderline Personality as a Self-Other Representational Disturbance by Donna S. Bender, PhD
  • New Developments in the Neurobiology of BPD by Larry J. Siever, MD
  • Borderline Personality Disorder in DSM-V by Andrew E. Skodal, MD

For conference information, see http://www.menningerclinic.com/calendar/BorderlineConf.pdf or call Menninger Education at 713-275-5060. The conference schedule and online registration form is also accessible at: MenningerClinic.com, Calendar, Conferences & Forums; NEABPD.org and NAMI.org, NAMI Metropolitan Houston Website.

The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 17 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S.News & World Report‘s annual ranking of America’s Best Hospitals

Talks With Kris Godinez

Covert Narcissists/Hermit BPD/ Passive Aggressiveness

No Empathy!

Research Links Borderline Personality Traits with Lowered Empathy

Photo by Abigail Keenan

Those with borderline personality disorder, or BPD, a mental illness marked by unstable moods, often experience trouble maintaining interpersonal relationships. New research from the University of Georgia indicates that this may have to do with lowered brain activity in regions important for empathy in individuals with borderline personality traits.

The findings were recently published in the journal Personality Disorders: Theory, Research and Treatment.

“Our results showed that people with BPD traits had reduced activity in brain regions that support empathy,” said the study’s lead author Brian Haas, an assistant professor in the Franklin College of Arts and Sciences psychology department. “This reduced activation may suggest that people with more BPD traits have a more difficult time understanding and/or predicting how others feel, at least compared to individuals with fewer BPD traits.”

Credit: University of Georgia
Brian Haas is an assistant professor in the University of Georgia’s psychology department.

For the study, Haas recruited over 80 participants and asked them to take a questionnaire, called the Five Factor Borderline Inventory, to determine the degree to which they had various traits associated with borderline personality disorder. The researchers then used functional magnetic resonance imaging to measure brain activity in each of the participants. During the fMRI, participants were asked to do an empathetic processing task, which tapped into their ability to think about the emotional states of other people, while the fMRI measured their simultaneous brain activity.

In the empathetic processing task, participants would match the emotion of faces to a situation’s context. As a control, Haas and study co-author Joshua Miller also included shapes, like squares and circles, that participants would have to match from emotion of the faces to the situation.

“We found that for those with more BPD traits, these empathetic processes aren’t as easily activated,” said Miller, a psychology professor and director of the Clinical Training Program.

Haas chose to look at those who scored high on the Five Factor Borderline Inventory, instead of simply working with those previously diagnosed with the disorder. By using the inventory, Haas was able to obtain a more comprehensive understanding of the relationship between empathic processing, BPD traits and high levels of neuroticism and openness, as well as lower levels of agreeableness and conscientiousness.

“Oftentimes, borderline personality disorder is considered a binary phenomenon. Either you have it or you don’t,” said Haas, who runs the Gene-Brain-Social Behavioral Lab. “But for our study, we conceptualized and measured it in a more continuous way such that individuals can vary along a continuum of no traits to very many BPD traits.”

Haas found a link between those with high borderline personality traits and a decreased use of neural activity in two parts of the brain: the temporoparietal junction and the superior temporal sulcus, two brain regions implicated to be critically important during empathic processing.

The research provides new insight into individuals susceptible to experiencing the disorder and how they process emotions.

“Borderline personality disorder is considered one of the most severe and troubling personality disorders,” Miller said. “BPD can make it difficult to have successful friendships and romantic relationships. These findings could help explain why that is.”

In the future, Haas would like to study BPD traits in a more naturalistic setting.

“In this study, we looked at participants who had a relatively high amount of BPD traits. I think it’d be great to study this situation in a real life scenario, such as having people with BPD traits read the emotional states of their partners,” he said.

An abstract of the study, “Borderline Personality Traits and Brain Activity During Emotional Perspective Taking,” is available at http://www.ncbi.nlm.nih.gov/pubmed/26168407.

Borderline Personality Disorder—as Scientific Understanding Increases, Improved Clinical Management Needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition.

The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

Borderline Personality Disorder—Research Advances, Emerging Clinical ApproachesAlthough the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at www.nimh.nih.gov/health/topics/borderline-personality-disorder)

The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:• A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD—possibly including early intervention to curb the neurobiological responses to chronic stress.• The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.• The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.• The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

The special issue also addresses the critical issue of resident training—preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

About the Harvard Review of PsychiatryThe Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

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Borderline Mother and Autism (Part 1)

Credit Photo Velizar Ivanov

By Fabrizio Catalfamo

“I would like to point out that this is not an article to blame mothers but a simple (non-technical) analysis, the result of personal experiences, therefore to be read in a narrative and non-scientific way, on the other hand I would not have the necessary qualifications.”

I am the father of three splendid boys, two of those born of a second marriage. One of the two youngest will turn twelve in four days, diagnosed in autism spectrum when he was 3 years old. The mother, never diagnosed (also because she refuses every test) in my opinion with deep teenage borderline wounds.

Borderline Personality Disorder (BPD)

Is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.

This difficulty can lead to impulsivity, poor self-image, stormy relationships and intense emotional responses to stressors. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).

It’s estimated that 1.4% of the adult U.S. population experiences BPD. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression. 

Autism is related to emotional disorder

I lived for more than 10 years with the mother of my 2 children and after the first apparently “normal” times, the borderline personality manifested itself.
This led me to try to understand the reasons and the causes of all this, reading and informing myself, about this type of disorder that destroyed the relations of this woman at the same speed as everyone could fall in love with her.

Over time, I learned to recognize this kind of personality and at the same time for obvious reasons, I met parents of other autistic children. The thing that struck me at the beginning was that, the most part of the parents were single parents and those that were not, presented with evidence the presence of the man, subordinate to the woman. Clearly in the rare cases of couples, the man appeared as a second-rate figure.
I wouldn’t want to bore you too much with this story, I promise you I’ll follow up on the next posts.
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