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 Genetics in Borderline Personality Disorder I was reading an article called “Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others” and noticed a line in the article that said this: “Thus, in addition to high heritability of BPD (Torgersen et al., 2008), these results argue that environmental factors (e.g., trauma) contribute to disturbed social cognition in BPD. In summary, for the current study we expected PTSD to be a negative predictor of social cognition.” That intrigued me on two levels. One was the “high heritability” part, because often I see comments about BPD and how many people believe that it is mainly caused by childhood trauma (and/or invalidation). In WHINE I state this: As I said earlier, one of the causes of BPD is the “invalidating environment.” Now, it could be that it is not an actual “cause” (and that all the real causes of BPD are biological), but more a reinforcer of BPD. So, the second part of the article that intrigued me was the idea that “we expected PTSD to be a negative predictor of social cognition” – and the discussion and methodology of comorbid PTSD with BPD. What they found was that people with BPD (with or without comorbid PTSD) are less able to understand the intent, thoughts and motivations of social interactions in others – in other words, people with BPD can’t mentalize as well as controls. They also found that this lack of ability is more marked in people with BPD who also have comorbid PTSD. The fact that they mention comorbid PTSD at all is something of a revelation – or perhaps should be to us nons. Many people come to support lists and do research on the Internet and begin their “introduction” of their BPD person with a long list of childhood traumas that explains why the person has BPD. This current research would indicate that PTSD and BPD are clearly two separate disorders and that, while PTSD is a contributor to poorer functioning that BPD alone, BPD is in itself a highly inheritable disorder and biological in nature, yet “reinforced” or made more severe (especially in a social functioning sense) when PTSD is present.
Anyway, this research led me to another scientific study called “Familial Resemblance of Borderline Personality Disorder Features: Genetic or Cultural Transmission?” In which the researchers studied twins, siblings and parents of borderlines to determine the genetic underpinning of BPD or whether the environment and/or cultural influences could have more of an influence on the development of BPD. They found this: “In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017) and their siblings (N = 1,266), parents (N = 3,064) and spouses (N = 939) from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects.” and this: “There was no effect of cultural transmission from parents to offspring.”
Recently, in the ATSTP group, we have been discussing the idea that shame/honor-based cultures and whether that environment could be explanatory in some sense of the development of BPD. It appears (at least based on this 2009 study) that the development and transmission of BPD is NOT cultural. It is essentially genetic (mainly “additive”, meaning it is more than one gene involved) and the environment has an effect, yet cultural transmission was not apparent.
They do go on to say this: “Gene by environment interaction implies that genes determine the degree to which an individual is sensitive to an environment. In the presence of gene-environment interaction, individuals with a ‘sensitive’ genotype will be at greater risk of developing BPD if an undesirable environment is present, than individuals with an ‘insensitive’ genotype.” So, basically, although this interaction has not been fully studied, it appears that some sort of “sensitive” genotype is required to develop BPD.
An article that mentions BPD in the context of oxytocin….
Could ‘Love Hormone’ Oxytocin Cure Our Ills?
Published December 06, 2010 | LiveScience
In recent years, we’ve been bombarded with studies about the hormone oxytocin – researchers have demonstrated it increases trust and helps aid in social bonding. It has even garnered a reputation as the “love hormone.” But what good is it for? Despite all these findings, the hormone’s medical use remains limited to obstetrics – it is used to induce labor and aid in breastfeeding.
But researchers are now trying to apply these findings, and are investigating oxytocin as a treatment for psychiatric illnesses. They say its unique ability to adjust our wiring could remedy symptoms of schizophrenia, post-traumatic stress disorder (PTSD) and anxiety, and improve social abilities among those with autism.
A number of oxytocin studies have even reached the stage of clinical trials – which test the effectiveness and safety of a substance before it can become an approved drug – with promising findings.
“The idea of augmenting … the way we connect to and with each other, would just be so helpful for so many people,” said Dr. Kai MacDonald, an adjunct professor of psychiatry at the University of California, San Diego, who has studied oxytocin as a treatment for schizophrenia.
However, the results so far, while hopeful, have not been “earthshaking,” MacDonald said.
There are hurdles to such research. Because oxytocin is a large molecule, it doesn’t cross from the bloodstream into the brain very easily. It is also rapidly degraded in both the stomach and the blood.
Also, researchers don’t know how big doses need to be, or how frequently it should be given to have a meaningful impact, MacDonald told MyHealthNewsDaily. Figuring out such dosing can be difficult.
Still, “if we could do it with any degree of precision, that would be a lovely therapeutic venue,” MacDonald said.
What is oxytocin?
Oxytocin is a hormone released by the pituitary gland that affects both the body and the brain. In the human body, it facilitates contractions of the uterus during labor and helps release milk during breastfeeding.
The hormone affects social interactions in a number of mammals, from mice and moles to dogs and monkeys, MacDonald said. For example, studies have shown that mice given oxytocin will huddle together, and monkeys given the hormone will spend longer grooming each other.
A barrage of studies over the last decade has indicated it has social effects on people as well.
One study found a nasal spray of oxytocin – a frequently used way to deliver the hormone, because it provides a direct route to the brain – made people more trusting. Participants were more willing to hand over money in an experimental game than those not given the spray.
Other researchers gave men oxytocin and found they more frequently looked to the eye region when shown pictures of human faces. People look to the eyes to read another’s emotional state and trustworthiness, MacDonald said. [Related: 11 Interesting Effects of Oxytocin]
It’s not clear that people who take oxytocin feel any different, MacDonald said. It may be that it acts subtly to change behavior or how we process social information, he said.
Though you can buy the hormone on websites that sell what they claim is an oxytocin nasal spray, whether it actually works is a different story. The claims need scientific scrutiny, a process still in its infancy, MacDonald said.
Under investigation
Oxytocin has not been approved to treat any psychiatric disorder, but evidence that it may be effective is building.
A small study published Oct. 1 in the journal Biological Psychiatry found that patients with schizophrenia who took oxytocin for three weeks along with their regular antipsychotic medication improved in their symptoms and hallucinated less than those who took a placebo with their antipsychotic.
While there were only 15 patients and the findings are preliminary, the results suggest oxytocin could treat patients with schizophrenia whose symptoms are not fully alleviated by their antipsychotics, said study researcher David Feifel, also of UCSD.
“The field of treating schizophrenia is kind of at an impasse,” Feifel told MyHealthNewsDaily. “All our drugs that we have to date work through the same mechanisms as they did when antipsychotic drugs were first discovered 50 years ago,” he said. “We are in desperate need of novel mechanisms that will improve symptoms through a different pathway, and oxytocin clearly is a novel mechanism.”
Considering oxytocin’s social effects, it makes sense to hypothesize it could treat autism, a condition characterized by having trouble interacting with others. And researchers have shown people with autism naturally have lower levels of oxytocin than those without autism.
A study published in 2007 in Biological Psychiatry found people with autism given oxytocin were able to determine the emotional tone of speech more consistently than those given a placebo.
Studies on other disorders have shown more mixed results. A paper published last year in the journal Psychoneuroendocrinology involving patients with social anxiety disorder found that oxytocin improved participants’ self-image when they gave a speech. However, after five weeks of treatment, which also included teaching the patients to confront their social fears, those given oxytocin did no better than patients given the placebo.
Oxytocin is also being tested in clinical trials as a treatment for depression, borderline personality disorder and alcohol withdrawal.
How does oxytocin work?
One hypothesis is that oxytocin dampens the activity of the brain’s fear center, the amygdala, thereby easing stress and anxiety.
A decline in anxiety could “allow people to attend to the social cues maybe they normally would avoid,” said Jennifer Bartz, a professor of psychiatry at Mount Sinai School of Medicine in New York, who is conducting a clinical trial testing oxytocin as a therapy for autism. There is evidence people with autism experience anxiety in social situations, she said.
Because of oxytocin’s proposed blunting effects on the amygdala’s activity, scientists have also hypothesized it would help those with PTSD, which is a disorder of fear, said Miranda Olff, head of the Center for Psychological Trauma at the University of Amsterdam in the Netherlands. In PTSD, the brain “still gives the fear response as if people are back in that situation again,” she said.
Olff is testing oxytocin’s use in patients with PTSD in addition to standard therapies.
“Adding another biological component to this intervention might speed up recovery, or might increase the number of patients that respond to treatment at all,” Olff said.
And oxytocin’s trust effect could help those with schizophrenia, making them less paranoid, Feifel said.
Scientists don’t know how much oxytocin goes into the brain when it is administered as a spray, or whether it even gets there, Feifel said. There is no way to see the hormone in the brain. But the effects it produces – such as a reduction in hallucinations – would require brain changes, so researchers have reason to believe it reaches the brain, he said.
It’s also possible that an oxytocin dose simply triggers the brain to make more of it, MacDonald said.
Future research
While oxytocin’s effects so far have been subtle rather than drastic, it could still become an important therapy. MacDonald said that most studies have looked at effects on patients after only a single dose. If Prozac, the widely-prescribed antidepressant, were administered that way, its effects would seem more subtle as well, he said.
The side effects of oxytocin have so far been benign, MacDonald said. But while it’s something the body produces naturally, researchers don’t know whether upping the body’s natural amount, or giving it over long periods of time, could ultimately be harmful.
It also remains to be seen whether oxytocin affects men and women differently. It may present health risks to women because of its role in birth – inducing contractions of the uterus. Most studies to date have been conducted in men.
Besides mental disorders, researchers are investigating oxytocin’s potential benefit for a number of other ailments, including headaches, constipation and skin damage.
For those who think they might benefit from an oxytocin boost, MacDonald noted that you don’t need a spray to prompt the hormone’s production.
“Given that some of the things that are suspected of triggering oxytocin – massage, sex, touch, eye contact – given that those are uniformly likable, it’s hard not to recommend them,” he said.
Read more: http://www.foxnews.com/health/2010/12/06/love-hormone-oxytocin-cure-ills/#ixzz17XrvhZ6I
 How much do feelings of emptiness matter in BPD? Recently Rajkumar Kalapatapu, et al., released a report in which they hosted an Internet-based survey to ask people with BPD what they wanted to see in the next version of the DSM with respect to BPD. As many of you know, scores of people find BPD (Borderline Personality Disorder) stigmatizing and confusing, since the term “borderline” was adopted to indicate “on the border between neurosis and psychosis” (although some indicate that it refers to “borderline schizophrenia” – although no correlation between BPD and schizophrenia exists as far as I am aware) and “personality” often connotes a “character-flaw” or something that is immutable and incurable. The only part of the name that seem to be in agreement is “disorder” – although even that can be called into question given a spectrum emotional regulation, impulsivity and other factors that play a role in BPD. I mean, NAAA and Bridget Grant published an epidemiological study that showed a 5.9% lifetime occurrence of BPD. Is that possible? Or is there something else afoot here?
In the Internet survey/study, the researchers asked self-identified people with BPD their ideas on a name and criteria change for BPD. I was forwarded a copy of the study findings because ATSTP hosted a link to the study and encouraged our readers with BPD to fill it out. The most-mentioned alternative names for BPD included were (not surprisingly since the DBT community has been advocating some change like this for years) “emotion” (or emotional) and “regulation” (or dysregulation) with Emotional Regulation Disorder (or similar form) mentioned in 21.4% of the cases. Again, not surprising considering the idea has been in the DBT community for years. A total of 53.3% of accepted responses indicated that a name change is desired.
There were a couple of things that I noticed in this survey data that actually piqued my interest. One was the most common symptom (based on the current DSM criteria) mentioned was emptiness (92.9%), not emotional instability. While unstable relationships was very high on the list, even higher was the “self image” aspects of BPD – emptiness and questions of identity. Personally, as someone who has for several years paid devotion to the “altar” of DBT, those aspects are not as noted within the clinical framework that is DBT. In fact, the idea of “systems-level” issues (emotional system, impulse control system) seems to be the most common way of approaching BPD, once you get out of the psychoanalytic backwater and into the CBT/DBT state of the art. Yet, these self-reporting people with BPD report emptiness and questions of identity as the most common symptoms (at 92.9% and 91.8% respectively) and relationship-based issues (fear of abandonment, unstable relationships) in a close second (each at 91.8%). I guess I am wondering then if a name change to “emotional regulation disorder”, while it is certain much less stigmatizing than BPD, would actually capture the crux of the issue? And what would instead? Frankly, I don’t really think the name matters all that much (if the stigma was expunged).
What further got me interested in this data was the biographical data. Of 646 included responses (1,186 were excluded), 88.5% of the population was female, 88.7% was Caucasian, the mean age was 36 (the median 35) and 45.2% of the respondents were single/never been married (with over 18% in the divorced or separated category). So what we have here is a group of white, 30-something women who are generally not married or not attached to another person – and almost half have NEVER been so attached, even though their biological clock is ticking (at 36). Plus, they feel empty and have unstable relationships and fear people will leave them. Granted, I am making assumptions based on this data and I am generalizing and “averaging the averages” at some level, but if this is the picture of a borderline person, it makes sense as to why she would be angry and fearful and shameful.
Recently, I started working with several men who want to get their BPD girlfriends back. And the picture of a thirty-something, white, never-before-married woman with BPD has arisen in several of these cases. That got me thinking about this person with BPD and how she must feel about her life. Here she is: empty, sad, distrusting, childless (when her friends probably have kids), unmarried (no one will truly love her), with a history of broken relationships thrown aside (if it doesn’t work out I’ll feel horrible, best to end it now). I rarely see a non-BPD man in a relationship with such a woman who actually thinks about how it must feel to be in her shoes. I think it would be quite beneficial to the men in the lives of these women with BPD to consider how it feels to be in that situation – empty, unmarried, childless, in your mid-30s, etc. I think if one were really to ponder and meditate on what that must feel like, the behavior might become less confusing and more compassion could flow into the relationship.
Only 23% of the British Population is not personality disordered?
Personality pathology recorded by severity: national survey
Min Yang, MD, MPH
Division of Psychiatry, School of Community Health Science, University of Nottingham, Nottingham
Jeremy Coid, MD, FRCPsych
Queen Mary College, London, Forensic Psychiatry Research Unit, St Bartholomew’s Hospital, London
Peter Tyrer, MD
Centre for Mental Health, Imperial College, London, UK
Correspondence: Correspondence: Professor Peter Tyrer, Centre for Mental Health, Imperial College, St Dunstan’s Road, London W6 8RP, UK. Email: p.tyrer@imperial.ac.uk
Declaration of interest
P.T. is the Chair of the World Psychiatric Association Section on Personality Disorders and the Chair of the World Health Organization Personality Disorder Working Group for the ICD–11 Classification. He is also Editor of the British Journal of Psychiatry but had no part in any decisions about this paper.
Background
Current classifications of personality disorders do not classify severity despite clinical practice favouring such descriptions.
Aims
To assess whether an existing measure of severity of personality disorder predicted clinical pathology and societal dysfunction in a community sample.
Method
UK national epidemiological study in which personality status was measured using the screening version of the Structured Clinical Interview for DSM–IV Personality Disorders (SCID–II) and reclassified to five levels using a modified severity index. Associations between levels of severity of personality pathology and social, demographic and clinical variables were measured.
Results
Of 8391 individuals interviewed and their personality status assessed, only a minority (n = 1933, 23%) had no personality pathology. The results supported the hypothesis. More severe personality pathology was associated incrementally with younger age, childhood institutional care, expulsion from school, contacts with the criminal justice system, economic inactivity, more Axis I pathology and greater service contact (primary care and secondary care, all P<0.001). Significant handicap was noted among people with even low levels of personality pathology. No differences contradicted the main hypothesis.
Conclusions
A simple reconstruction of the existing classification of personality disorder is a good predictor of social dysfunction and supports the development of severity measures as a critical requirement in both DSM–V and ICD–11 classifications.
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.
 Anti-depressants and Depression I believe that it has. Why? Well, there are a number of reasons that depression is a catch-all diagnosis. One certainly is the influence of the pharmaceutical industry given that billions of dollars are spent on anti-depressants each year. Also, doctors who are not mental health professionals (like GP’s) are prescribing anti-depressants if their patients are “depressed”.
Unfortunately, sometimes depression is not accurate. Many times when people say “I’m feeling depressed” they are really expressing that they are feeling emotional pain. Sometimes emotional pain is normal, sometimes a great deal of emotional pain is not normal and becomes problematic. When someone is feeling too much emotionally, it is not depression.
Depression is usually a problem when someone is feeling a strong lack of emotions – causing a lack of interest in the usual activities (including sex) that once gave us pleasure. Although many configurations of “depression” exist (because it is a non-specific term nowadays), the configuration in which one lacks emotions is alexythimia, although if one lives without pleasure it’s called anhedonia. I suspect that most people, when they describe being “depressed” are really describing a combination of anhedonia (where they can’t enjoy anything anymore) and social anxiety.
As I said above, another configuration that is referred to as “depression” is when the emotional pain becomes too overwhelming. In this case the person is feeling too much and would possibly beg for anhedonia because, while the pleasure would not be present, at least the pain would go away. I think that BPD probably involves more of this kind of “depression” than other disorders. The constant emotional pain leads people to doing anything to stop it (thus, this site’s name), including substance abuse, sexual promiscuity, risk-taking, self-injury and other seemingly self-defeating behaviors.
How can this be explained? How can someone be in such emotional pain all the time? One explanation comes from the study of u-opiods in the brain. A recent study by Stanley and Siever showed that people with BPD have too few u-opiods (the precursor for natural pain-killing neuro-chemicals) AND have over-active u-opiod receptors. This combination provides a baseline of pain and, when opiods are added, the brain feasts on these pain-killing substances with the over-active receptors. This is why some people with BPD can ingest large quantities of pain killers to seemingly little effect (or less effect than those without the disorder). I have heard people with BPD say they only feel “normal” while taking pain killers.
So, the question here is two-fold: First, are anti-depressants an appropriate treatment for emotional pain that is not really “depression”? And secondly, if not, what is? Low-dose pain-killers?
On the director’s blog at the NIMH (National Institute of Mental Health), Director Dr. Thomas Insel discusses the name of borderline personality disorder:
Director’s Blog
April 19, 2010
What’s in a Name? — The Outlook for Borderline Personality Disorder
Thomas Insel
In Shakespeare’s “Romeo and Juliet,” the question is posed to illustrate that a name doesn’t define a person’s feelings or intent. In psychiatry, the same may be said of that which we call borderline personality disorder. Noted primarily for symptoms such as impaired mood regulation, unstable relationships with others, and self-harming behaviors, the name “borderline personality disorder,” fails to capture the essence of this serious mental illness.
As currently defined, borderline personality disorder is considered a reflection of an essential aspect of a person’s character that influences his or her way of seeing and being seen in the world. Recent research, however, has shown that symptoms of the disorder aren’t constant and may not always be as enduring as some researchers and clinicians may think. Yet fluctuating moods and behavior also happen to define another mental illness, bipolar disorder, with which borderline personality disorder may be confused….
He concludes with this:
…Whatever the outcome of reclassification efforts, however, we must keep in mind the essence of the question — that “borderline personality disorder” by any other name would still be as real, as disabling, and as necessary to treat, as other serious mental illnesses.
Read the whole post here.
When perusing the Internet and the recent research on BPD, I discovered a study from Dr. Harold Koenigsberg, et al. that seeks to understand the neural correlates of “distancing strategies” of Borderline Personality Disorder (BPD) patients. The study focuses on the use of “distancing” when faced with strong negative emotional pictures. The study analyzed brain activation – particularly in several emotional areas of the brain and the brain response to distancing. It says (HC means “healthy controls”):
… we aimed to better understand sources of emotional dysregulation in BPD by comparing the neural correlates of the passive processing of social emotional cues and of cognitive reappraisal of these cues in BPD and healthy control (HC) subjects. There are two main kinds of cognitive reappraisal strategies, known as reinterpretation and distancing. The former entails reinterpreting stimuli in a less disturbing manner, whereas distancing entails viewing stimuli from the perspective of a detached and objective observer.
What they found was this:
… BPD patients do not engage the cognitive control regions to the extent that HCs do when employing a distancing strategy to regulate emotional reactions, which may be a factor contributing to the affective instability of BPD.
So, as loved ones, what are we to make of this? It detachment an appropriate strategy for us? How does the person with BPD view it? I’m open for discussion of experiences.
To exist or not to exist. This I ponder – Hamlet in e Prime
A little while ago, while researching Borderline Personality Disorder and, more specifically, how a Non-BP can heal themselves, I stumbled onto a new language. Well, actually this language modifies English. The creator of the language named it “e Prime”. How does “e Prime.” E Prime seeks to modify English removing the verb “to be.” Why bother? In the case of healing, recovery and support, we bother because too often we get sloppy with the verb “to be.” We use it generally in such a way that introduces judgment (often unknowingly) into our relationships and into our own self-image. If you really look carefully at it, the verb “to be,” in many forms, labels situations in such a way that we begin to think rigidly. Purging “to be” from our lexicon makes things extremely difficult. We use the verb so often that to remove it becomes a huge effort. Yet, the reasons to remove the verb (at least in certain forms) improves our thinking, clarifies the current situation and helps to hone our understanding of a situation.
What does the idea of speaking without “to be” mean? Let ‘s start with some examples that can illustrate the benefits of e Prime…
Old way - New Way
He’s a liar - He lied to me
She’s a thief – She took my notebook without asking
I am a failure – I failed at that task
E Prime refines the way we think about ourselves, others and, perhaps most importantly, time. Rather than saying he/she IS (always) a [whatever], we focus on actions in the moment. We focus on measureable events. People with BPD and those that love them can tend to do label others (and themselves) in blanket statements about what the other group IS. The problem with “to be” seems to be that it introduces a label, it introduces rigidity.
If I were asked what I do for a living, I could say, “I am a lawyer.” However, rather than define myself that way, I could also say “I practice law.” Sure, it seems clunky and ridiculous at times, so, how do you benefit?
You benefit by honing your thought process – about yourself and about your loved one. The label of BP (or borderline or BPD) can serve as an impediment to effective behavior. How one thinks about the world can affect how one behaves. So, if you, as someone who cares about a person with BPD, start to think in a calcified way, those thoughts can spill over into the relationship. Even more importantly, if you decide to think about yourself in a “to be” fashion – i.e. “I am a loser,” “I am co-dependent,” “I am the right one here” or “I am stuck,” then you ending up labeling yourself and sticking yourself in time. You don’t take into consideration the flexibility of the moment or that you have the ability to change.
Let’s take an example… First, one for yourself and then one in an interaction with your loved one with BPD….
Rather than thinking: “I must be a failure or stupid to have her do that to me again.” You think “I feel that I failed at that because she did that to me again.” This functions to reframe the interaction toward locally in time, rather than expanding it through identification.
Now for a loved one: “You are manipulating me by threatening to leave right now.” You can think: “I feel uncomfortable with your behavior because it feels as if you’re trying to manipulate me.” The difference again is in the identification. By removing “to be” from the lexicon, we localize particular events and we also seek not to misidentify, label or otherwise create a calcification around a particular label.
Your thoughts?
(BTW I wrote this using e Prime and found it difficult!)
In researching the implications of shame in BPD, I found this research study:
Shame and Implicit Self-Concept in Women With Borderline Personality Disorder
* Nicolas Rüsch, M.D., Klaus Lieb, M.D., Ines Göttler, M.D.,
Christiane Hermann, Ph.D., Elisabeth Schramm, Ph.D., Harald Richter, Ph.D.,
Gitta A. Jacob, Ph.D., Patrick W. Corrigan, Psy.D., and Martin Bohus, M.D. *
*OBJECTIVE: *Shame is considered to be a central emotion in borderline personality disorder and to be related to self-injurious behavior, chronic suicidality, and anger-hostility. However, its level and impact on people with borderline personality disorder are largely unknown. The authors examined levels of self-reported shame, guilt, anxiety, and implicit shame-related self-concept in women with borderline personality disorder and assessed the association of shame with self-esteem, quality of life, and anger-hostility.
*METHOD: *Sixty women with borderline personality disorder completed self-report measures of
shame- and guilt-proneness, state shame, anxiety, depression, self-esteem, quality of life, and clinical symptoms. Comparison groups consisted of 30 women with social phobia and 60 healthy women. Implicit shame-related self-concept (relative to anxiety) was assessed by the Implicit Association Test.
*RESULTS: *Women with borderline personality disorder reported higher levels of shame- and guilt-proneness, state shame, and anxiety than women with social phobia and healthy comparison subjects. The implicit self-concept in women with borderline personality disorder was more shame-prone (relative to anxiety-prone) than in women in the comparison groups. After depression was controlled for, shame-proneness was negatively correlated with self-esteem and quality of life and positively correlated with anger-hostility.
*CONCLUSIONS: *Shame, an emotion that is prominent in women with borderline personality disorder, is associated with the implicit self-concept as well as with poorer quality of life and self-esteem and greater anger-hostility. Psychotherapeutic approaches to borderline personality disorder need to address explicit and implicit aspects of shame.
http://ajp.psychiatryonline.org/cgi/content/abstract/164/3/500
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