Borderline personality disorder
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BORDERLINE PERSONALITY DISORDER I HATE YOU, PLEASE DON’T LEAVE ME Tori Collins BPD Borderline personality disorder (BPD) is a condition in which a person makes impulsive actions, has an unstable mood and chaotic relationships. BPD affects 1-2% of the general population Most common in young women “Borderline” between neurosis and psychosis DSM-IV Affective Criteria Periods of intense anger and difficulty controlling anger Chronic feelings of emptiness Affective instability: episodes of dysphoria, irritability, or anxiety lasting from a few hours to a few days Cognitive Criteria Transient paranoia/dissociation due to stress Unstable self image or sense of identity DSM-IV Behavioral Criteria Recurrent suicidal behavior, gestures, threats, or self- mutilation Impulsivity in at least two areas that are self-damaging that do not include the above (i.e. substance abuse) Interpersonal Criteria Frantic efforts to avoid real or imagined abandonment Unstable and intense relationships alternating between extremes of idealization/devaluation BPD Causal factors Childhood abuse is reported by many patients Genetic: sparse data 37% concordance rate for monozygotic twins (7% dizygotic) multivariate analysis reveals 47% heritability in “emotional dysregulation” Lieb, 2004 BPD Treatments Group and individual psychotherapy Antidepressants, mood stabilizers, antipsychotics Regulate 5HT/NE/GABA Dialectical behavior therapy developed specifically for treatment of BPD Teaches emotional regulation Tolerate distress Be more effective in interpersonal conflict Control attention to “be in the moment” BPD BPD is often comorbid with other psychiatric illnesses Major depression Eating disorders Anxiety disorders Other personality disorders Post-traumatic stress disorder 46-56% of BPD patients are diagnosed with PTSD BPD BPD and PTSD can both be caused by the experience of traumatic events BPD is considered by some to be a form of complex chronic PTSD BPD is often associated with childhood trauma Neglect, abuse Most frequently associated with sexual abuse Impulsive behavior puts those with BPD at greater risk for experiencing traumatic events such as driving accidents and physical or sexual assault REDUCED AMYGDALA AND HIPPOCAMPUS SIZE IN TRAUMA-EXPOSED WOMEN WITH BORDERLINE PERSONALITY DISORDER AND WITHOUT POSTTRAUMATIC STRESS DISORDER Godehard Weniger, MD; Claudia Lange, PhD; Ulrich Sachsse, MD; Eva Irle, PhD Background PTSD associated with reduced volume of the hippocampus and left amygdala and with reduced cognitive functions Small hippocampus and amygdala size are also seen in patients with PTSD and BPD Current study: are reduced amygdala and hippocampus volume and cognitive deficits present in patients with BPD and without PTSD? Methods 24 female in-patients exposed to severe physical and sexual childhood abuse 25 matched healthy controls Assessed for history of neurologic disease, MRI abnormalities, psychotic disorders, bipolar disorders, substance abuse, and dissociative disorders Diagnoses of BPD without PSTD based on DSM-IV criteria and SCID interviews Methods Comorbid disorders in subjects included major depression, alchohol-related disorders and eating disorders Patients had been medicated for at least 3 weeks prior to the study Some were given antidepressants and/or sedatives Methods Measured intracranial and total brain volume by MRI, separating the amygdala and hippocampus Measured intellectual, mnemonic and attentional function using the WAIS-R, WMS-R, Trail Making Test (TMT), and the subtest TAP. Results Groups: 10 patients met criteria for PTSD 14 met only 1 DSM-IV criterion for PTSD (5 are required) Results No difference between groups in neglect, physical abuse, disorder duration, depression severity, global psychological distress and alcohol consumption Patients without PTSD reported more sexual abuse and intrusion of traumatic material Results Patients with PTSD had significantly smaller total brain volumes and increased global atrophy (brain:skull ratio) when compared with controls 3 × 2 (group × hemisphere) ANCOVA comparing the amygdala volumes of patients with and without PTSD and controls indicated smaller amygdala volumes of trauma exposed patients Patients with and without PTSD did not differ significantly Results The overall 3 × 2 (group × hemisphere) ANCOVA comparing the hippocampus volumes of patients with and without PTSD indicated smaller hippocampus volumes of trauma-exposed patients post-hoc 2 × 2 (group × hemisphere) ANCOVA for each trauma-exposed group and the control group confirmed the results in both regions Results During ANCOVA testing of amygdala and hippocampus volumes while introducing IQ as a covariate, the results of all analyses remained the same except comparison of hippocampus volumes across the group with PTSD and controls, which did not yield a significant effect of group Results Neuropsychological patients with PTSD were significantly impaired on all intellectual and mnemonic measures except verbal memory and delayed recall patients without PTSD were unimpaired patients with PTSD had lower test scores Results Stats IQ (R2 = 0.261, p = 0.011), attention/concentration (WMS-R; R2 = 0.319, p = 0.004) and part B of the TMT (R2 = 0.217, p = 0.022) were significantly predicted by right hippocampus volume Larger hippocamus volume = better test performance Performance Discussion Overall 12% hippocampus size reduction in patients with BPD and PTSD 11% reduction in those without PTSD 34% amygdala size reduction in patients with BPD and PTSD 22% reduction in those without PTSD Discussion BPD, irrespective of traumatic exposure orsubsequent development of PTSD, has a negative impact on amygdala and hippocampus size. Studies of BPD without trauma exposure are needed Discussion Cognitive deficits have been repeatedly reported for patients with PTSD better cognitive performance in patients without PTSD; statistical significance? Total brain volumes of patients with PTSD were decreased, global atrophy increased Head trauma?
