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.
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.
Neurobiology Informs Successful Psychotherapy for BPD
Mark Moran
A common feature of all psychotherapies for borderline personality disorder is activation of the prefrontal cortex through reappraisal of painful affect states generated by a hyperactive amygdala.
Neurobiological research can help psychotherapists tailor talking therapies to the individual characteristics of patients with borderline personality disorder (BPD).
That’s what Glen Gabbard, M.D., told psychiatrists at this year’s APA annual meeting in Honolulu in an address titled, “Neurobiologically Informed Psychotherapy of Borderline Personality Disorder.”
A prominent psychoanalyst and psychodynamic therapist, Gabbard said he believes the theoretical constructs of psychoanalysis—drives and conflicts—find expression in, and can be interpreted within, a patient’s individual neurobiology. “You can see psychoanalytic meaning at the same time you are looking at biology,” he said. “This was the dream of Freud, to build bridges between psychoanalytic concepts and a neurobiological science of the brain.”
He is the Brown Foundation Professor of Psychoanalysis and professor and director of the Baylor Psychiatry Clinic.
In the case of BPD, Gabbard stressed the role of hyper-reactivity of the amygdala, and a corresponding inactivity of the prefrontal cortex, as well as emerging evidence that patients with BPD have an opioid deficiency. These neurobiological characteristics account for the emotional dysregulation and impulsivity common in BPD (see Key Points Concerning Neurobiology and Psychotherapy for BPD).
Key Points Concerning Neurobiology and Psychotherapy for BPD
There are common therapeutic elements in all of the psychotherapies for BPD, most notably activation of the prefrontal cortex to bring “thinking” to bear on unbearable affects produced by amygdala hypersensitivity.
An opioid deficit appears to be prominent in BPD. Patients with BPD
○ have difficulty deriving satisfaction from intimate relationships,
○ often say they experience emotional pain as physical pain,
○ often resort to cutting themselves for release of endogenous opioids,
○ show a high rate of opioid abuse.
Neurobiological research can help clinicians tailor psychotherapies to the needs of individual patients. Some evidence has emerged indicating that BPD patients with dissociative symptoms may not respond as well to dialectical behavior therapy as other patients, suggesting that other treatments may be needed for this subgroup.
“What’s exciting to me is that the neurobiological research gives us an opportunity to get more specific about tailoring psychotherapies to specific borderline patients,” Gabbard said. “There is a spectrum to BPD, and one of the principles we learn in medical school is to adjust the treatment to the patient, not the patient to the treatment.
“Our psychotherapeutic theories are often like churches or belief systems, and the more we can get science involved in knowing how to tailor therapies to the individual’s neurobiology, the more we are a science rather than a religion.”
He noted, as an example, that recent research indicates that BPD patients with dissociative symptoms may not respond as well to dialectical behavior therapy, suggesting that this subgroup of patients may need to be treated with a different approach.
Gabbard said the psychotherapies that have been proven effective in the treatment of BPD probably all “speak” to common neurobiological processes, but one especially prominent feature is the activation of the prefrontal cortex through active reappraisal of emotions generated by an overactive amygdala. “A feature common to all of the therapies is the emphasis on self-reflection and mindfulness in which one is trying to look inward and manage painful affect states,” he said. “If you are actively reappraising, that appears to cause activation of the prefrontal cortex, which then modulates the amygdala” (Psychiatric News, April 1).
And he added that patients will often experience emotional pain in a physical way that is unbearable. Research by Prossin and colleagues published in the American Journal of Psychiatry in May 2010 implicates an opioid deficiency in BPD, possibly accounting for the high rate of opioid abuse among patients, as well as the high number of borderline patients among those who seek out opioids from physicians and hospitals or from illicit sources. And it is likely that the phenomenon of “self-cutting,” so common in borderline patients, is related to the release of endogenous opioids that accompanies cutting.
“Opioids are involved in emotion regulation and social functioning, so it makes conceptual sense that deficits in endogenous opioids could be related to the ubiquitous dysfunction in social and interpersonal relationships,” he said.
Also intriguing is the fact that patients with BPD report feeling euthymic—as opposed to euphoric—when using opioids, suggesting the neurobiologically determined difficulty they may have experiencing pleasure.
“This means satisfaction in intimacy is going to be challenging and is linked to the insecure attachment that patients experience over and over,” Gabbard said. “So when we see these people having difficulty forming a therapeutic alliance, it is so important that therapists not think of them as ‘difficult’ or ‘bad’ patients, but as people who are struggling with a biological deficit they are trying to overcome in order to link up with someone in a way they may never have experienced.”
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
(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.
Can BPD be inherited? Here’s an article on the biological aspects of BPD.
Genetic studies of monozygotic and dizygotic twins suggest that there may be genetic factors for these dimensions of emotional reactivity and impulsive aggression, while there does not appear to be a heritability for BPD as a category. Family members of BPD patients are more likely to demonstrate affective instability or impulsivity, although not necessarily both. Impulsivity and aggression seem to be heritable in studies of normal twins as well. It is noteworthy that in the studies of prolactin responses to fenfluramine, blunted prolactin response to fenfluramine in a patient is a better predictor of impulsivity and aggression in their relatives than was impulsive aggression as a behavior in itself in the patient. These results would suggest that what is inherited is not the behavior, but an alteration in the serotonergic system that may at times be expressed in a propensity to impulsive aggression.
So, according to this article, it’s not BPD that’s inherited, only the traits of BPD (impulsive aggresion). On a personal note, I have twins (dizygotic or fraternal) and one seems to have the emotionality and impulse control issues, the other does not.http://www.mhsanctuary.com/borderline/siever.htm
Loading ...
