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Article on fMRI and BPD… I had the pleasure of meeting Dr. Montague last year. Intersting guy…
Brain imaging gives new insight into mental disorders
HOUSTON — (August 25, 2010) — A new kind of psychiatry built on objective measures derived from functional magnetic resonance imaging (or fMRI) of the brain performed while patients play economic games could provide new insight into the diagnosis and, eventually, treatment of mental disorders, said researchers from Baylor College of Medicine in a review in the current issue of the journal Neuron.
(Media-Newswire.com) – HOUSTON — ( August 25, 2010 ) — A new kind of psychiatry built on objective measures derived from functional magnetic resonance imaging ( or fMRI ) of the brain performed while patients play economic games could provide new insight into the diagnosis and, eventually, treatment of mental disorders, said researchers from Baylor College of Medicine in a review in the current issue of the journal Neuron.
New tools, new field
These new tools will not only help produce new brain “signatures” associated with disorders such as autism, schizophrenia and borderline personality, they will also help identify the nature of normal variation in human decision making and the brain, said Dr. P. Read Montague, professor of neuroscience and director of the Computational Psychiatry Unit at BCM, and Dr. Kenneth T. Kishida, a postdoctoral fellow in the area.
Montague is a pioneer in a discipline that uses powerful fMRI machines to measure how blood flows in the brain while individuals play economic games that always involve choice and sometimes require cooperation between participants – a growing paradigm that has come to be known as neuroeconomics. The areas of greatest blood flow reveal what parts of the brain are involved during the decision-making process.
The two, along with Dr. Brooks King-Casas, assistant professor of neuroscience at BCM, describe a number of studies involving people with and without mental disorders in a review of the beginning of a new field – computational psychiatry.
Identifying disorders, defining “normal”
In a crucial prior study, King-Casas and others at BCM identified a characteristic fMRI “signal” that distinguished borderline personality disorder – a disorder that is extremely hard to diagnose – from psychologically healthy controls.
Not only do Montague and his colleagues seek to build a more concrete or objective method of diagnosis for mental disorders, they also seek to determine the range of what is considered healthy or “normal”.
“What is the nature of normal variation in these games,” said Kishida. “Can this help us measure the difference between what is considered healthy and what is pathologic?”
Augmenting assessment
Currently, most psychiatric diagnoses are descriptive, based on a cluster of symptoms recognized by professionals and codified in a standard guide called the Diagnostic and Statistical Manual of Mental Disorders. ( It is now known as the DSM-IV, and the DSM-V is scheduled for release in three years. )
Montague said their aim is not to replace psychiatrists or psychologists but “to augment their way of assessing people.”
Once scientists identify the brain signals associated with a particular pathology and the areas or tissues involved, they can then start to look for the genes associated with those patterns, said Montague and Kishida. That will involve scanning the brains of thousands of people, both those who are healthy and those with known pathologies.
Article that mentions BPD and Anna Nicole Smith….
Doctor: Anna Nicole Smith medication ‘overkill’
By LINDA DEUTSCH (AP) – 3 days ago
LOS ANGELES — A hospital psychiatrist testified Friday that medication given to Anna Nicole Smith by a doctor now on trial was “overkill” for the kind of pain she was describing.
Dr. Nathalie Maullin said she believed Smith had “a borderline personality disorder” and was addicted to prescription medications.
Maullin said she was on staff at Cedars-Sinai Medical Center in April 2006 when Smith was brought in pregnant and in withdrawal from anti-anxiety drug Xanax and the pain killer Methadone. The celebrity model told her she had gone “cold turkey,” discontinuing her medications all at once because she was concerned for the welfare of her expected baby.
By doing that, Maullin said, she had actually endangered the baby and herself. The doctor said she quickly resumed her medication with Methadone and began weaning her off Xanax, both of which had been prescribed by Dr. Sandeep Kapoor, a defendant in the drug conspiracy case.
“My thoughts were these were very hard core medications to be giving for the kind of pain she was demonstrating,” said Maullin. “She was on medication that seemed like overkill for the type of pain she was in.”
She said it was difficult to get a medical history from Smith because she was “putting on a show” and was deferring questions to her lawyer-boyfriend, Howard K. Stern, who was with her at all times.
Kapoor, Stern and Dr. Khristine Eroshevich have pleaded not guilty to conspiring to provide excessive opiates and sedatives to Smith. They are also charged with prescribing drugs to an addict, but are not charged with causing her 2007 overdose death.
Maullin said Stern told her Smith had been suffering from back pain for five years. She said the former Playboy model also complained of pain in her upper back and arm.
Another doctor who testified earlier this week said Smith suffered from chronic pain syndrome all over her body.
Maullin said she conferred with Kapoor by phone, gave him her plan for weaning Smith off Xanax and any drugs known as benzodiazopines which can be addictive. She said he agreed and told her he would leave the prescribing of Methadone to her.
“Did you see any pain that needed treatment with opiates?” asked the prosecutor.
“No,” Maullin said.
The problem was that Smith showed no enthusiasm for the plan, the doctor said.
“It was like pulling teeth to get some response from her,” she said. “She was compliant but not really interested. She was not wholehearted.”
Five days after Smith checked in to the hospital, Maullin said she received a page at midnight from a nurse that said Smith’s eyes had rolled back in her head.
That sounded like a drug reaction and a one-time dose of Benadryl was prescribed, Maullin said. However, the next day, she received another call saying Smith was having hallucinations.
“The nurse said that she was flossing her teeth with no floss and was out of it,” Maullin said. “This was a radical change.”
Under questioning by Deputy District Attorney David Barkhurst, Maullin said she did not consider this an emergency and she tended to other patients before going to see Smith five hours later.
“In psychiatry, we are used to seeing patients do strange things,” she said.
Upon her arrival, Stern told Maullin that Smith “was generally acting goofy.” Smith was angry and made no eye contact but seemed lucid, Maullin said.
The psychiatrist said she suggested that Smith go into an inpatient facility that deals with addicts. But Smith wasn’t interested and told Stern she wanted to leave the hospital.
Maullin said she informed Kapoor and he said he would go to her house.
“I thought that was unusual,” she said. “Physicians generally see patients in the office or the hospital. There was no reason she could not leave her home to come to see him. Just in terms of proper boundaries with patients, you see them in your office.
“She needed to participate in her care,” Maullin said. “It’s not a home delivery service.”
I have written quite a bit about the reason that people with BPD behave in a certain fashion. Much of the impulsive behavior is to stop the pain. Yet, the behavior can still be destructive to relationships, even when it is not the intention of the person with BPD to hurt the other person. Intention is often misread with BPD. Here is one message about that from the ATSTP list (written by me):
MANY times emotionally sensitive people will read intentions and states of mind into the other that are not aligned with reality. They might say that you’re being mean or trying to ruin their life. Clearing up intention can be a way to mentalize the interaction. That is, if my wife were to say that I did something to ruin her life I can come back with “it is not my intention to ruin your life. I’m not sure why that would be my intention. Can you help me understand how you thought that was my intention?” The purpose is to get a person to start thinking about the mental states of the other person more accurately. Consequence of BEHAVIOR is important. Intention, motivation, goals, desires, etc. of mental states is also important when you’re talking interpersonal relationships. As a friend of mine said about her BPD child: “people with BPD don’t read minds, they read INTO minds” – and because BPD is configured the way that it is (threat awareness, mistrust, fear of shame discovery and intense personalization) it is likely that the intention being read into by a person with BPD will be malevolent.
The flip-side of that idea (that malevolent intentions are misread), is the idea that if it is not your intention to hurt the other person, the other person has no “right” to feel hurt. However:
One must also remember that INTENTION DOES NOT NEGATE CONSEQUENCE, Just because you didn’t MEAN to hurt someone with a lie, just because you felt bad about yourself and lied (or bullshitted), it still can hurt the other person and their sense of trust. Just because you didn’t MEAN to burn down the house when you were playing with matches, doesn’t bring the house back.
All people, with BPD or not, need to know that, despite intention, behavior has consequences.
 Tough Love and BPD Tough Love is not an effective approach with children and teenagers with Borderline Personality Disorder. Although some therapists and self-help authors recommend tough love as what should be done with BPD, it is ultimately detrimental to the borderline and to your relationship with the borderline. The problem comes in regarding the nature of the disorder. While behavioral therapies can work, those based on reinforcement and shaping, those therapies usually include acceptance strategies and non-judgmental approaches. The nature of BPD is that the individual with the disorder is in deep emotional pain because of the dysregulation of the emotional system. They are exquisitely sensitive to emotional experiences and many of these experiences are physical in nature, especially with children. There is intense physical pain and social rejection (to which borderlines are also intensely aware) causes more pain. The borderline will then seek to end the pain in any way they can, including substance abuse, casual sex, thrill-seeking and other dangerous methods. While these methods will stop the pain temporarily, the pain always comes back.
OK, now back to why tough love doesn’t work. A person with borderline personality disorder wants more than anything to communicate his/her pain with those with whom he/she has an attachment relationship. Understand that BPD is not just a case of the person “behaving badly”. The behavior has a function and generally that function is to either stop the pain or to communicate the pain. If you try to deal with behavior with tough love (rules, contracts, boundaries, punishments, etc.), the person with BPD will feel more rejected, more abandoned and unable to communicate the pain. This causes MORE pain and requires more pain-quelling behavior. It causes more of what made you start using tough love to begin with.
A little while ago, I was speaking with someone about a friend of my daughter’s. This girl probably has BPD. Her behavior was totally off the charts – drugs, turning tricks, running away, cutting herself, suicide attempts, etc. When the person I was speaking with expressed sympathy for the girl’s mother, I responded like this: “I think what happened with [girl’s name] was that she was in a lot of pain and didn’t know why. All she really wanted was for her mother to see her pain. All she ever wanted was for her mother to understand her and her pain. But her mother only saw bad behavior and tried to deal with that. So, the girl tried anything and everything to stop her pain.”
The word compassion actually means “to suffer alongside” (or co-suffering). If you’re a parent of a person with BPD, are you seeing and understanding their pain? Or are you fed-up with their “bad behavior”? Developing non-reactive compassion is the answer, not tough love. Tough love sends a message that the borderline can’t communicate their pain. Are you co-suffering? Or are you punishing the borderline for doing anything to stop the pain?
I decided to share my video in slide form on slide share. Here is the 4 X 4 presentation that I used for the video on slide share.
http://www.slideshare.net/bondobbs/the-4-x-4-of-bpd
I am also sharing another presentation that talks about the I-AM-MAD emotional validation skill.
Here is the I-AM-MAD presentation:
Article about empathy and coping with BPD:
Moran: Inspiration through empathy: Living with mental illness
Published: July 22, 2010 6:00 PM
Updated: August 05, 2010 8:00 AM
For Lorelei Andrews (not her real name), volunteering to offer support to local individuals living with mental illness is cornerstone to her daily life.
I had a chance to talk with her about her story and the current state of services in Kelowna for individuals living with mental illness.
She has worked as a server, a wedding planner, a full-time student (earning two degrees), and a bridal consultant.
In fact, she started one bridal gallery in Vancouver that has now become the largest in Canada, which may even be the venue for an upcoming television reality show.
However, about five years into her whirlwind career, she began experiencing anxiety.
“I was used to delivering 100 per cent all the time, I required it of myself,” recalled Lorelei.
She came to the point that with so much pressure, she started to think of the sale instead of the client. As a very thoughtful and empathetic person, she felt her self-worth sliding.
What began as a dip in productivity ended up with her entering “self-preservation mode,” and being prescribed various medications to balance out—resulting in a near comatose state for several months.
Lorelei is living with a mental illness. As productive and successful as she was, it struck her where she least expected it. It can happen to anyone: the successful executive, the homeless man asking for change, the young woman serving your coffee.
In fact, one in three Canadians will experience some form of mental illness in their lifetime—one in five will experience it this year.
After several rounds with psychiatrists, hospitalization and group therapy sessions, Lorelei was diagnosed first with bipolar disorder, which involves extreme mood swings.
She has since been more correctly diagnosed with pervasive post-traumatic stress disorder with symptoms of borderline personality disorder.
Lorelei was lucky. She had the drive and motivation to pick herself up and learn about her illness.
After the incorrect diagnosis, she began to self-advocate and attend various meetings and courses regarding mental illness.
While in Vancouver, she was offered a position in providing wellness and recovery planning for individuals with mental illness. “I found I had a talent for translating the doctor talk to regular people” said Lorelei.
She is now living completely organic. With her newfound skill set, she came to Kelowna and started a peer support group session that occurs once a week at the Kelowna and District Branch of the Canadian Mental Health Association.
“Our group is passionate, loving and empathetic, and they are so good to each other. A lot of us are hypersensitive, and with that comes great responsibility to control and manage our emotions,” said Lorelei, who maintains a positive outlook.
“It keeps me well and grounded and balanced; if I’m not living what I’m teaching, things don’t go well.”
What makes this group unique is the focus on mental health, rather than mental illness, which is steeped in stigma. Peers learn how to self-soothe and tolerate stress, as well as about the impact of mental illness in living a happy, healthy life.
“I’m inspired by what I see when I help someone change their perspective about what’s been bothering them. It’s the same thing I used to see in a girl’s eyes when she realized she was wearing the dress she was getting married in.”
To learn more about living with mental illness, and to hear stories such as Lorelei’s, visit the CMHA Kelowna website at www.kelowna.cmha.bc.ca.
***
CMHA Kelowna, in partnership with Interior Health, is also holding a community forum regarding the state of mental health and addictions services, which occurs July 28, 5:30 p.m., at 504 Sutherland Ave.
For more information or to register, contact Charly Sinclair at 250-861-3644 or email charly.sinclair@cmha.bc.ca.
Watch for another story of another member of our community who is living with mental illness in Sunday’s edition of the Capital News and online at www.kelownacapnews.com. The Canadian Mental Health Association is a charitable association, which promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness.
Jamie Moran is the director of promotion and development for the Okanagan branch of the CMHA.
An article that came across the wire about BPD and eating disorders:
Body of anorexic woman lay undiscovered in flat for up to two weeks
Weight obsession blamed for death
THE body of a 31-year-old anorexic woman lay undiscovered in her flat for up to 13 days, because care workers and relatives thought she was on holiday in Egypt.
Annette Rogers, who weighed just 7st 4lb and had a body mass index (BMI) of 16.4 – the healthy range being 18.5 to 24.9 – had packed her bags to leave on June 18, 2009.
But she never left her Hanley flat and her body was discovered on June 29.
It was so badly decomposed that a cause of death could not be given and she could only be identified by dental records.
Now her family has made a complaint to the parliamentary and health service ombudsman about her treatment.
They believe Annette should have been sectioned under the Mental Health Act and force-fed, despite health professionals saying her BMI was not low enough.
Speaking after yesterday’s inquest into Annette’s death, mother June Bradbury, of Moss Green Road, Berry Hill, said: “I don’t want this to happen to anyone else. I feel she was left to die.”
North Staffordshire coroner Ian Smith had earlier recorded an open verdict.
The inquest heard Annette had previously suffered from cardiac arrest from the strain the anorexia put on her heart.
At the time of her death she was taking laxatives and slimming tablets and was drinking just 300 millilitres a day.
She also suffered from obsessive compulsive disorder and borderline personality disorder and heard voices which told her not to eat and drink.
She would also try to lose extra pounds by obsessively exercising and using sunbeds to help her dehydrate.
The inquest heard Annette had started losing weight at 18 after becoming involved with her married driving instructor.
But Mrs Bradbury said her daughter, who had taken overdoses and been sectioned in the past, had been looking forward to her Egypt holiday, which was being paid for through a care fund.
Mrs Bradbury said: “Once I knew she was going to Egypt I was against it because it was such a hot country but she wanted to go and that was it.”
Annette was last seen alive at her Bucknall Old Road flat on June 16.
Mrs Bradbury added: “She looked really skeletal and her eyes were fixed. I said you should not be going to Egypt, I might never see you again.”
The inquest heard experts expressed concern about the trip but could not stop Annette going as she was an adult and the respite grants can be spent on holidays.
A psychiatrist and social worker had assessed Annette on June 5, but could not justify detaining her under the Mental Health Act – doctors can force-feed patients if their BMI drops below 13.
Annette’s care co-ordinator Judith Dolman said: “We weren’t in a position to take any further action. She agreed to meet me on June 30. She was positive and looking forward to her holiday.”
Psychiatrist Catherine Thompson said: “We would all wish things would have turned out differently. But I don’t think we could have made any different decision.”
Delivering his verdict, Mr Smith said: “I am not sure how much more the medics could have done.”
After the inquest, Annette’s sister Debbie Bradbury, aged 29,said: “The health professionals said they wouldn’t do anything differently but I find that very hard to face. All the boxes were ticked, but what about treating her as a person?”
When new members “wash up on the shores” of the ATSTP list, they are confused, angry, helpless and exhausted. One thing I also noticed is that new members are emotionally entangled with their loved ones with BPD. Sometimes when people speak of “boundaries,” they use the phrase “where you end and I begin.” The word boundary has many meanings, and have talked about effective boundaries a lot on this blog. Yet, this idea of “where you stop and I begin” is very important when you’re entangled in another person’s emotions. A Non-BPD must learn to heal, to unpack emotional baggage, to acquire the emotional skills to help to detangle the morass of emotional issues that may be keeping him/her in confusion and pain.
If your emotional well-being is dependent upon a loved one’s behavior, you’re in a difficult and painful situation – one in which you have little control over. This leads to a feeling of helplessness because you have no ability to direct your emotional life since your feelings are dependent on another person’s words or actions. Instead, you can state: “My emotional well-being will be whatever it will be no matter what he/she does/says.” Easier said than done, I know, especially when the other person is telling you you’re a loser or a failure or whatever other insults that may have been foisted upon you. Ask yourself: Is my emotional well-being dependent on his/her behavior?
Here’s a quote about this subject from the I-Ching which a member of the ATSTP list posted on this subject:
Here the source of a man’s strength lies not in himself but in his relation to other people. No matter how close to them he may be, if his center of gravity depends on them, he is inevitably tossed to and fro between joy and sorrow. Rejoicing to high heaven, then sad unto death-this is the fate of those who depend upon an inner accord with other persons whom they love. Here we have only the statement of the law that this is so. Whether this condition is felt to be an affliction or the supreme happiness of love, is left to the subjective verdict of the person concerned.
The only reason I posted this here is because Britney Spears actually started my foray into discussing Borderline Personality Disorder a nd celebrities. I only do it because I would like for some celeb to come out of the closet (or “off the couch”) and just admit that they have the disorder. To me it would go a long way to removing the stigma. The only one who has come close is Megan Fox. She mentioned borderline when referring to herself, but she has not been diagnosed – well, not that we know of. Anyway, old Mel Gibson seems to have some sort of disorder and some people have mentioned borderline. Now we have 2 potential BPD celebs talking with one another. I have to say though, Britney Spears certainly got the right (and skillful) people around her. We have not heard much about her “bad behavior” in years. Good for her!
Mel Gibson seems to have found the most unlikely counsellor in his attempt to regain his reputation and it is no other than the troubled pop-star Britney Spears, media reports said.
Gibson’s reputation has been badly damaged following the release of several tape recordings which purportedly feature him hurling abuse and vile threats at ex-girlfriend Oksana Grigorieva during phone calls.
The Toxic singer, 28, has been telling her friends that Mel Gibson, 54, has been pouring his heart out to her — confiding that he fears for his sanity and is convinced he’s destroyed his once-hot career.
The In Touch magazine quoted a friend of Britney as saying that they speak on the phone all the time, usually late at night.
Her friends also say that Britney is just returning the favour because apparently Gibson went out of his way to help her when she went through her own breakdown.
Britney’s friend said that Britney wants people to give him a second chance — just like he gave her one when everyone else turned away.
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