A little while ago, I posted an study about the over-lap between Major Depressive Disorder and Borderline Personality Disorder. The last sentence of this study was “In the meantime, the clinician treating major depressive disorder would be wise to assess for borderline personality disorder, even as currently defined.” That was because the study found a large correlation between the two disorders. Today, I was reviewing an article by Marsha Linehan called “Two-Year Randomized Controlled Trialand Follow-up of Dialectical Behavior Therapyvs Therapy by Experts for Suicidal Behaviorsand Borderline Personality Disorder” which I had planned to write something up about. I’ll have to do that later, but the reason these thoughts of MDD and BPD came to mind is that in the first paragraph of Linehan’s article she states:
“SUICIDAL BEHAVIOR IS A BROAD term that includes death bysuicide and intentional, nonfatal, self-injurious acts committed with or without intent to die. It is associated with severalmental disorders, including depression, substance dependence, and schizophrenia. Borderline personality disorder (BPD) is 1 of only 2 DSM-IV diagnoses for which suicidal behavior is a criterion.“
The emphasis is mine. I thought “what’s the other disorder that suicidal behavior is a criterion?” The answer: Major Depressive Disorder. So, today I am posting the DSM criteria for Major Depressive Disorder. It’s fairly long and I’ve included the “Major Depressive Episode” to clarify. If you’d like to get the full criteria, follow the “continue reading” link.
I spoken about mentalization on this site before. Since I’ve lately been on a TED talk kick, mainly watching TED talks about neuroscience, I wanted to post this one from Rebecca Saxe which is called “How we read each other’s minds”. It is basically describing the process of mentalizing and how a certain part of the brain, the Right Temporo-Parietal Junction, is highly specialized for seeking to understand the motivations of others, the essence of mentalization. What is fascinating about this talk is her use of the pirate/cheese sandwich story with children of various ages. She demonstrates how the process of mentalization develops over time. I talked about another mentalization test (which is based on the same principles) in this post. I’d encourage all of my readers to watch this video. Although she doesn’t use the words mentalizing or mentalization, that is what she is describing. Additionally, I suppose that when someone with BPD experiences a “failure to mentalize”, that part of the brain is most likely dimmed.
Epigenetic inheritance of the negative impact of stressful events across generations
Depressive, impulsive and antisocial symptoms caused by severe chronic stress during childhood are transmitted epigenetically from one generation to the next. This has now been demonstrated by researchers at the University of Zurich and ETH Zurich.
Peter Rueegg
In human, chronic severe stress or traumatic experiences during childhood can lead to various psychological and mental disorders in adult life, such as borderline personality disorder and bipolar depression. A study carried out by a team under the supervision of the neuroscientist Isabelle Mansuy has used mice to demonstrate that such negative experiences can also have an impact on following generations. Mansuy holds a double professorship at the University of Zurich and ETH Zurich.
Stress during childhood, problems during adulthood
The scientists used mice as an experimental model, and exposed newborn pups to chronic and unpredictable maternal separation for two weeks. They also exposed the mother to additional unpredictable stress during the separation. This procedure was designed to induce extremely severe stress in the young mice, and is thought to simulate neglect and traumatic upbringing that children sometimes experience in uncaring, negligent or violent families. The young mice reacted so dramatically to the separation that they became depressive and impulsive as adult, and had social problems.
In particular, these animals were unable to deal appropriately with unfamiliar or adverse situations, and easily lost control of their behavior. For example, they lost their natural sense of caution when exploring new territories, and were no longer able to evaluate the potential risk of unfamiliar situations. They also reacted with apathy and despair in adverse conditions, and did not struggle for life in contrast to mice that grew up in normal conditions.
The traumatized mice retained these altered behaviours during their entire life and strikingly, «transmitted» these behaviours to their offspring. The researchers even provided evidence that transmission was across three generations, and that the offspring of that offspring was also affected.
Epigenetics determines behaviour
However, these behavioural changes are not attributable to mutations in the genetic make-up of the traumatized mice, since the genome is fixed and cannot be modified by stress. The researchers demonstrated that instead, stress interferes with the epigenome, in particular with the profile of methylation of certain genes in the brain and the sperm of male mice. This epigenetic plasticity is based on changes in chromatin structure, that alters the expression of the affected genes. In a way «Stress confuses the methylation machinery in the germline of the stressed pups, and the confusion persists and is transmitted», explains Isabelle Mansuy.
When I was researching NPD and BPD co-morbidity, I stumbled on this interesting blog post about the self-proclaimed NPD expert Sam Vaknin. I don’t do much in the NPD world because I believe that BPD and NPD is essentially incompatible, despite what other people on the Internet say and despite even some studies. The experts that I’ve spoken with basically agree with me, but not all of them. I think there’s something of a split on the subject. Anyhow, here is an excerpt from the blog post (it’s long so I didn’t copy all of it).
Are you sick of seeing the same Psychopath posting all over the web when researching Narcissistic Personality Disorder? Did you get sucked into his boards, forums, books, speeches?
Or are you one of the victims who adore Sam Vaknin, Look up to him and hold him up on a pedestal as your life saver?
if so let’s take a closer look at the supposed “Dr Sam Vaknin PhD”
In one of his repetitively & compulsively posted online articles, Vaknin reveals in his own words the reason he really runs the Narcissism ‘Support’ Groups all over the net and so on….
‘There is nothing to be learned from the answers to these questions because each individual has her own threshold. No, I simply enjoy the momentary ability to inflict traumatic pain (emotional pain – I am not the physical type and will never harm a woman physically). It is as close as I can get to omnipotence. It is the perfect gender revenge.’…
‘As a Jew I would have done the same to Nazis. As a victim of a woman, I celebrate with unrestrained glee my ability to degrade women, to humiliate them, to frustrate them, to make them beg for life itself, for they see their (often imagined) relationship with me as life itself. This is why I abstain from sex. This is why I dazzle them with my intellect and charm and wit and knowledge, with unprecedented intrusive interest in their petty, boring, housewivish lives – and then I let go abruptly. At this stage, they are so brittle, so vulnerable that they crash to a million shreds with the crystalline sound of agony.’
Is this really a man you want to give you advice and support on Narcissism, Psychopathy or on your relationships? . Imagine for a moment, you have left your Narcissistic partner/spouse/family and have finally seen the light. You stumble across Sam Vaknin and drink in everything he has written on the subject.
You have just walked out on one Narcissist into the world of another.
Imagine, as an abuse survivor of someone with malignant narcissism or narcissistic personality disorder, giving your life over to a psychopath, and doing it with trust and a firm belief in his authority. What if said psychopathic conman, was advising victims? It seems absurd, that an abuser would advise the abused. It seems even more absurd, that the abused would take the advice to heart.
Vaknin is now a DIAGNOSED PSYCHOPATH – not a Narcissist!
“Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.” – from the interview
Bon: I found an interview with Dr. Leland Heller about Borderline Personality Disorder. He does a good job explaining the pain associated with the disorder… Here are some excerpts. The entire interview can be read here.
Diagnosing Borderline Personality Disorder And Finding Treatment That Works
Dr Heller: Good evening, It’s great to be here. I have a way of explaining the Borderline Personality Disorder in layman’s terms that might be useful. It’s how I explain it to patients and their families.
Imagine you had a pet dog and it runs into the street and by accident it’s hit by a car. The dog’s leg is broken and it limps off into an alley to lick it’s wounds. A friend of yours sees the dog and comes over to help. The dog is now feeling trapped and cornered – a “wounded animal” – and misinterprets the friend’s attempts to help. The dog snaps at the friend’s hand who is trying to help. The BPD (Borderline Personality Disorder) is a malfunction in the brain’s trapped or “cornered” animal area. Under stress, a seizure develops in that area. That’s why under stress, while raging, a borderline will say to him or herself: “Why am I doing this” – yet be unable to stop it. It’s a seizure – nerve cells firing inappropriately and out of control.
David: And the cause of Borderline Personality Disorder?
Dr Heller: The BPD has many causes including head trauma and brain infections, but it appears that emotional hurts literally damage the brain. Most likely the brain’s support cells – the 90% of brain cells called “glial cells” – are damaged by traumas, causing the person to overreact to stress once puberty strikes. During puberty the brain’s limbic system goes into “overdrive” and adolescents are at their highest risk of seizures in their lifetime. “Sticks and stones may break my bones…but names cause brain damage.” So does incest, abuse, severe trauma, head injuries, attention deficit disorder, and other causes.
David: From my understanding, one of the biggest difficulties facing individuals who have BPD is maintaining stable relationships. This is a great cause of consternation for those people who are on the other side of the relationship. What causes this?
Dr Heller: There are a number of problems. The three most significant are 1) inappropriate mood swings; 2) misinterpretation of motives; and 3) remembering those misinterpreted motives as real. Oftentimes self-fulfilling prophecies occur, and self-hate eventually leads to a significant other coming to the same conclusion – that the individual isn’t worth being with.
…
janet: Would you please tell us more about the self-hate characteristic and how that damages the BPD or his/her relationships?
Dr Heller: Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.
crazy32810: How is self-injury related to BPD?
Dr Heller: We all injure ourselves to stop noxious neurological sensations. Interestingly we do it in a linear manner, ripping the skin. A common noxious neurological sensation is the toxins released with an insect bite. BPD dysphoria is about as bad as it gets. The pain is horrible. Many individuals have broken major bones and declared the pain of the fracture was nowhere as severe as dysphoria. When an individual with the BPD discovers that self-mutilation, or other techniques of self injury, work to temporarily stop the pain of dysphoria – they’ll do what it takes to stop it. This is no different than the individual with a fracture wants pain medication. I broke my shoulder last December and I tried to deal with it without taking narcotics. I was foolish and wrong. The pain was so bad it needed to be treated medically. Once individuals with the BPD have their chronic symptoms stabilized, and have safe medication options that work for dysphoria, the self-destructive patterns are no longer needed to stop their pain.
No Matter What the Problem, There Are Only Four Things You Can Do
By KARYN HALL, PHD
When faced with a difficult problem, you might find yourself paralyzed over deciding what to do. Emotionally sensitive people often have difficulty making decisions, tend to ruminate about issues and can become increasing upset as a result of thinking about the issue over and over.
Searching and searching for the right solution, perhaps one that won’t upset others or cause pain or loss, adds to anxiety and upset. How can someone find just the right solution and know what the right solution is?
Marsha Linehan, the creator of Dialectical Behavior Therapy, outlined strategies for any problem that you face. Remembering these options can help decrease the struggle of not knowing what to do. The four options are Solve the Problem, Change Your Perception of the Problem, Radically Accept the Situation, or Stay Miserable.
Here is a Ted Talk by Michael Shermer on the pattern-finding power of the human brain. After I watched this video, I was struck that this is probably why people with Borderline Personality Disorder or just highly sensitive people develop the belief that people are out to hurt them or that they are being judged and degraded by others.
You can purchase a copy of his latest book at Amazon below.
Most people with borderline personality disorder (BPD) are not violent, contrary to the overwhelming body of research, which has unduly focused on those already in the justice system, a systematic review has found.
Most people with borderline personality disorder (BPD) are not violent, contrary to the overwhelming body of research, which has unduly focused on those already in the justice system, a systematic review has found.
“Although this may be the case in some patients, they are likely the minority of individuals with BPD,” the researchers from the University of Toronto wrote in Current Psychiatry Reports. “The diagnosis of BPD may be less useful in predicting violence than one might suspect, and violence in BPD may not be as strongly determined by impulsivity as is commonly held.”
Most research had been conducted in unrepresentative samples including prisoners, people undergoing mandated psychiatric treatment, psychiatric patients, substance abusers and delinquent youths, the report noted.
“Clinical lore holds that patients are at risk of committing violence, especially in the context of perceived or feared loss or abandonment in interpersonal relationships,” the researchers said. However, this and other contextual factors needed to be examined more closely. Continue reading Borderline patients unfairly labelled violent →
In psychiatry we have a a whole recipe book of diagnoses called the DSM IV-TR, soon to be replaced by the DSM-V. The original DSM was derived from an army handbook used by psychiatrists in WWII, much of which was taken from handbooks developed by German psychiatrists from their observations in the late 19th century. The rest of the army handbook was derived from psychoanalytic thinking — the theories of Freud and his followers. In the DSM I (1952), there were two kinds of illnesses, for the most part, psychosis and neurosis. Psychotic illnesses were defined by a break from reality (as in paranoid or religious delusions in schizophrenia or manic psychosis), and neurotic illnesses were considered to be reactions to psychological stressors and events.
There is also currently a category of illness that has to do with coping skills and temperament called the “personality disorders.” It’s not a particularly good term, and I wish they had thought of another — “I’m sorry, your diagnosis is a disordered personality” is not a particularly useful approach to helping people.
For the longest time, it was thought that psychotic illnesses were more genetic/organic, and neurotic illnesses (such as depressive illness, or post-traumatic stress disorder) were reactions to stress and more amenable to treatment by psychotherapy. A type of personality disorder called “borderline personality disorder” was an exception to the neurotic rule – those afflicted tended to unravel and even appear to be psychotic while receiving the old-fashioned on the couch free association type of therapy called psychoanalysis. That’s where the name “borderline” came from in the first place – it was thought to be on the “borderline” between psychosis and neurosis.
What is borderline personality disorder? It describes a type of temperament and coping, usually in women but found in men also, where someone is highly sensitive, prone to dramatic relationships, depression, anxiety, addiction, eating disorders, and self-injurious behavior such as cutting. It is very common, with nearly 6% of the population affected. Unlike depression which tends to come and go over the years, personality disorder symptoms are more stable and chronic, though for most people, borderline symptoms do tend to get better over the decades as we live and learn.
Borderline personality disorder most often develops in someone who was abused as a child, but people can have it without ever being abused. Usually it happens in those cases when there is a mismatch of temperament between parent and child. More modern types of therapy can be helpful for the symptoms, but you can only imagine what it must have been like to have borderline personality disorder and to feel unsure and anxious, free associating on the couch while your therapist said very little back in the psychoanalytic days. That kind of therapy would be like re-experiencing the neglect and abuse of childhood in its own way, and that is why psychoanalysis could make borderline personality disorder worse. Ultimately, borderline and some of the other personality disorders can get better as people learn to feel worthy and loved. Continue reading Love and Opium. Borderline Personality Disorder and pain-killers →
An Emotionally Sensitive Person is one who experiences more intense emotions than most other people do. When someone is emotionally sensitive, they often hear statements like “Stop overreacting,” or “You’re so dramatic.” Many are labeled as being “too sensitive” because their emotional reactions are quicker, last longer, and are stronger than other people expect.
Life is so complicated that we typically try to simplify it, often by putting people and events into black and white categories. But like much of what we tend to simplify in that way, being an emotionally sensitive person is not a you-are or you-are-not kind of descriptor.
Despite the emphasis our culture has on logic and self-control, the emotional part of everyone’s brain is pretty powerful, particularly given the right circumstances. Jonathan Haidt, in The Happiness Hypothesis, talks about the brain being like an elephant with a rider. Picture a huge six-ton elephant, with a rider on top. This represents the two basic systems in our brains.
Haidt says the rider is the logical, rational part of the brain that is reflective, it’s the part of you that deliberates and analyzes and plans for the future. The elephant represents the emotional system, the one that is instinctive, that feels pleasure and pain and wants gratification right now. But the rider is so small relative to the elephant, anytime the six-ton elephant and the rider disagree about which direction to go, the rider is going to lose. And that happens more than you might realize.
Anyone who has eaten a bag of potato chips when they said they would only have twelve, or who has compulsively called an ex when they vowed they wouldn’t, or who has said angry words they later wished they hadn’t, understands the power of emotion. And that’s just for everyday issues, not for the really big, this-matters-to-the-core kind of situations. For people who are emotionally sensitive, the elephant (the emotional part of the brain) is even more skittish and more difficult to manage.
Some individuals may have a focused sensitivity. This means they are noticeably more emotional than most people about a certain issue, like their weight or their children, or that they may be emotionally sensitive at certain times. Some may have always been emotionally sensitive and some may have experienced events that have led to or added to their sensitivity. Continue reading The Emotionally Sensitive Person (ESP) →
Out-of-Control: A Dialectical Behavior Therapy (DBT) - Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior
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