Good to keep in mind…

Application

Holy crap! I just applied for college again! I had to apply for Spring Semester because it’s so close to start of Fall semester. I’m hoping that since I’ll just be a part-time evening student that I’ll be able to start Fall though. I e-mailed the Psych academic advisor to set up a meeting for Monday to go over my transcripts, potential transfer credits, and possibility of Fall admission.

My Goal:

B.S. in Clinical Psychology with a focus in Art Therapy

Take a year off to meditate and paint in a Tibetan Monestary.

Come back for either my M.S. or PhD. in Clinical Psych.

Ok, maybe I won’t take a year off to go to Tibet but it’s absolutely what I want to do right now. I would love nothing more than to quit my job, pick up, and go live a zen existence for 6 months to a year.

I digress.

HOLY CRAP! It just felt like filling out any other form while I was doing it then like 10 minutes later it hit me that, yes, in fact, I just applied for college again!

Even if I have to wait until Spring semester I won’t be deterred. It will give me more time to really save up my money and ensure that I can afford this. Also eliminating any possibility that this is an impulsive decision.

I’m so very excited. I want work to be over so I can go run about 10 miles and burn off some of this excitable energy ::laughs::

Oh, and a buddy of mine bought me a stuffed giraffe because I wear my hair in weird little deedleybobbers sometimes. Giraffes have deedleybobbers. It’s so adorable.

The doodle-bobbers vs. deedleybobbers debate rages on

Lucid Analysis: Trials in Therapy – Free Your Mind

Lucid Analysis: Trials in Therapy

Yesterday was a double whammy. Maybe a triple or quadruple one considering how my moods swung. I had both an appointment with Psychiatrist and then another with Therapist.

First. I am now officially off medication; the Abilify anyways, I still have the Trazadone to help me sleep.  Psychiatrist was not incredibly thrilled with the idea but ultimately understanding. I was nearly in tears as I explained how much of a zombie I’ve felt like, how hard it’s been just to sit up and how absolutely functionless I’ve been because of these meds. She had 3 things to offer: 1. We could switch medication and try something new entirely, 2. We could try taking the Abilify at night so hopefully the tired would wear off before I woke up and it might help me sleep, or 3. I could go off meds completely. I outright refused option 1 (for now). Option #2 wasn’t unreasonable but if I feel like I zombie all day regardless, when I take it isn’t going to make much difference.  So I opted for 3. I’m so happy. My small confession is that I’d been forgetting to take my meds for a day or two already so I’m not bothering with the weaning off process. I know this is probably really bad, especially considering yesterday morning.

I woke up at 330a.m. and wanted to die. I was exhausted, uncomfortable in my own skin, I felt like I’d gained weight and just looking at myself made me want to tear out my insides. I was so frustrated with how weary and fatigued I was, that I knew I would get no sleep and be useless and ugly. I was sure I’d be fired for not being able to sit upright and get my work done. I didn’t want anyone to even look at me let alone speak to me or be near me. I considered calling off work. I wanted it all to end. Pointless, there was no point in going on if all my energy was gone and everything I do to make myself better only results in feeling the way I did right then. So what did I do? Miraculously, nothing. I managed to talk myself into taking it one minute at a time and hauled my ass to work. As I was sitting there typing up my post for yesterday, just forming the ideas of ways that I work to help myself I felt my energy begin to come back. By the end of my writing I can’t say I was ready to hit the gym, but sitting straight wasn’t a chore and my thoughts were in a completely different place of light outshining the darkness.

Moral: Don’t just stop taking your medication without first consulting your doctor.

Then I went and talked to Therapist. She’s being incredibly supportive of my decision to switch careers and go back to school. She did some research for me and found some authors I might enjoy concerning object relations and constancy (since these are big issues for me). That she thinks about me outside of our sessions is always a shock to me, then again, I wouldn’t have a lack of object constancy if it weren’t.

She’s also very supportive of my decision to go off of medication. She believes that my drive and self-awareness will make my disorder manageable without. She was very reassuring that she can tell the difference between the patients she sees that need to be on medication and those that do not need to be and she thinks that I’ll be just fine.

She said something funny to me. Every week she tells me how much she enjoys working with me (even when I’m crying and full of rage) because I’m intelligent and I make her think. Apparently how I approach my disorder and my daily problems help her evaluate how she approaches her own problems and make her reflect on the choices she makes. She says that’s a quality that comes naturally for me and she’s experienced with me often. It’s little statements like that which make me really believe that I’m making the right decision to follow a different path.

We talked about my relationship with Friend a bit. Things are nice and neutral here though I feel like I really need a break from him and his wife for a little while (fortunately I’m going on vacation next Friday). Therapist told me that I was really making excellent progress in dealing with my dissociation. That if it were possible to turn that aspect of my disorder to my advantage, I was doing it, in my ability to maintain a progressive friendship with Friend. My detachment and inability to connect preserved the aspects of myself that I needed to keep removed and safe from his emotional influence, while allowing me to remain friends with him to work on pushing past the incredible pain and grief that I felt afflicted with. It’s not perfect, or complete. Clearly he still does things that are confusing and conflicting, but I keep on trying and she says that’s admirable. Sometimes I think it’s just me being stubborn and masochistic but other times I can truly appreciate the aspects of our friendship that bring me as close to contentedness as I am able to recognize.  

Like, I finished my next light saber! It’s fully sculpted, the electronics are in and it works fabulously =) I’ll post pics when I remember.  The next one will be better.

I feel like lots of pictures today =)

The fact that our friendship has survived a complete devaluation and my hating him at points, to come back to a place where I can enjoy his company but no longer feel like I need him for my life to be complete, and even am looking forward to some time outside of his influence, is a major deal for me.

After therapy I went to the beach. I just sat and listened to the waves crashing on the sand. I had intended to stay longer but there were shrilling, screeching children that I wanted to feed poisoned candy to and I just couldn’t find the peace and quiet that I’d been hoping for. I know, it’s a terrible thought, but I don’t like kids (with few exception). Still, I left feeling more calm.  

I already feel better today. I woke up able to do a full ab workout. I am determined to go to the gym after work, no excuses. I can sit up straight without feeling like my gravity has been turned to 10. Now with any luck I should be able to get some costuming done this weekend!

Helping Yourself Heal: Treatment for Borderline Personality Disorder

One of the most overlooked methods of treating BPD, or any disorder, is that which we can do for ourselves. Self-Help for Borderline Personality Disorder is something I would recommend in addition to therapy.

I ‘managed’ my BPD, my depression, my anxiety, my everything, by myself, for most of my life. Some days it was better than others. Some days it was far from enough. Self-Help is not what I would consider the absolute best option of treatment. However, I do believe that it’s an important step in addition to therapy. I’m still on the fence about trying to medicate BPD, however, psychotherapy is essential. I believe this. However you can’t live in therapy 24/7. The rest of the time we have to work on ourselves. Some of the things that I find to be very helpful:

Increase your awareness. Increase your awareness of the disorder. Increase your awareness of Self. Read, research, and obtain as much information as you can about this problem so that you can gain an understanding of what it is you’re going through [like say, reading my blog =) ]. You might say, I’m living it, I already know what I’m going through. It’s badness. Well,  that badness probably has a name, and you’re probably not alone in how you feel. Putting a name to the feeling will help you gain a better ability to deal with it. Reach out, find some support, let others know you’re there. Your voice is important, just as the voices of others may be important to you. Your voices are important to me.

Create a support network. This could be as simple as friends and family. Allow the people you trust into your world. Share with them the knowledge you’ve gathered and don’t be afraid to ask for help when you need it. Voicing your issues, allows you take constructive action to work through them instead of Acting Out or Acting In. There are also a multitude of on-line support groups, forums, message boards, blogs… my blog =)  Say hi, let us know you’re out there and maybe we can be of assistance to each other before all else fails. Sometimes just knowing that you’re not alone is enough to get through a really rough moment.

Asking for help is hard. Trust me, I know this. It feels like admitting weakness. It’s not. Asking for help takes courage. Recognizing that you’re human and looking for support will only make you stronger. Sometimes you don’t need to ask for help explicitly. If you’re having a hard time being alone you don’t need to say, “Being alone is terrifying please help me”… just call a friend and ask to go grab some coffee. Small things make a world of difference.

Prevention is important, not just clean up after things fall apart.

How I deal when I’m not medicated? Call me old fashioned but I’m a fan of diet and exercise. No, not dieting. Diet. As in what you put in it, is important. Greasy, high fat, fast food garbage is going to make you look and feel exactly like the things which you take into yourself. Be kind to yourself and nourish your body. What you eat and drink affects your entire body, including your mind. A healthy diet leads to a healthier mind. I’m not just spewing new age-y vegan hippy crap here. It’s scientifically proven that the nutrients (or lack of) that your body metabolizes effect you in various ways. Good food = feeling energized and healthy. Bad food = feeling sluggish, slow, and unhealthy.

I’m strict vegetarian (which I would never impose on anyone) and it works well for me though it also very easy to be healthy while still consuming animal products. I do still worry about getting proper nutrients though so I take my vitamins too. Here’s my miracle combination: Multi-vitamin, B-complex, Calcium, Iron, and occasionally Biotin. This has worked better for me than any of the medication I’ve been on thus far. Don’t believe me? Try it for a month.

Next. Exercise. Get your body moving. You don’t have to run a marathon or be a tri-athlete to be healthy and in good shape. And don’t give me any of this ‘round is a shape’ business. Take care of you. Regular exercise increases energy, improves concentration & focus, lowers stress, boosts your immune system and a multitude of other mental and physical benefits. If there’s one thing in your day that you really should make time for it’s at least 30 minutes of movement, more if you can manage it.

My confession is that since I started my Abilify I just haven’t had the energy or will to move like I normally do and as a result I can feel the fatigue seeping into my bones.  I hate it. Normally: I’m a runner, I weight train, I do yoga/pilates, and I’m a dancer (traditional Middle Eastern dance). When I’m physically active I am so much more mentally healthy it’s astounding.

So even if you’re not medicated and not in therapy, there are plenty of things you can do to help yourself out. I can’t make medication recommendations, nor would I even if I could. I absolutely recommend therapy. In the meantime, and in addition to, I recommend everything I’ve just mentioned. I KNOW it helps because it’s always how I’ve managed. I won’t lie and say that it’s always enough. I’ve already mentioned that it’s not always enough, but it’s something. And that something can be the difference between being functional and being hospitalized or worse.  

Be Mindful. Be Still.

I’ve never been much of a yoga fan, but since I started working at the Laboratory I do yoga on lunch every Wednesday. My body is fatigued. My brain is exhausted. I can barely  sit upright, and yet…

It’s a very mellow exercise. Not strenuous. Calming for a turbulent mind.

As rushed and as hectic, as tired and exhausted as I am, I go. I change out of my work clothes for an hour. Slip into the cool room lit only by sun through partially curtained windows and I wait. I lie down on my mat, allow the cool air to wash over me and listen as the instructor puts on quiet, peaceful music.

We start with basic stretches, gradually progressing to yoga poses, and the cool down. We conclude with meditation and then lying down in corpse pose.

I allow my mind to roam freely, flitting where it will, until my thoughts are released and I am blissfully blank.

I go back upstairs and change into my work clothes to return to my office.

The calm stays with me.

My entire body feels lighter, a little more energy… at peace.

There will always be things to return to, but rarely are they ever so pressing as we perceive them. It’s important to take time to relax, be mindful, and be still.   

Treatment of Borderline Personality Disorder: Medication

Something that has been on my mind a lot lately. Treatment. So let’s take a leap down the rabbit hole and see where treatment for Borderline Personality Disorder takes us.

There are 4 basic strategies that are utilized for treatment of Borderline Personality Disorder: Psychotherapy, Medication, Hospitalization, and Self-Help strategies. Over the next few days I’ll start on the last 3 and then I’ll just take a dive into some of the therapeutic techniques that my therapist specializes in, what we work on, and what is beneficial for Borderline…. And not. Because let’s face it, every person is different, every disorder is different, and some strategies just don’t work well enough on their own to be effective for every case.

Psychotherapy forms the foundation of treatment for borderline personality disorder with medications playing a lesser role. While there is no known medication that can target Borderline Personality Disorder on its own, prescription medications can address many of the common symptoms of BPD. This is something my Psychiatrist told me upon diagnosis. There is no medical cure for Borderline Personality Disorder. However, we can work to manage some of the symptoms and co-morbid occurring issues in order to improve quality of life and aid psychotherapy so that treatment will be successful.

Medications typically used in the treatment of BPD include antidepressants, mood stabilizers, anti-anxiety drugs, and antipsychotics.

 Antidepressants Used for the Treatment of BPD Symptoms

A variety of antidepressants have been studied for use in treating the low moods, sadness, and depression that can occur with BPD, including the following:

–          Fluoxetine (Prozac)** <~~~~ Check

–          Sertraline (Zoloft) <~~~~ Check

–          Citalopram (Celexa)

–          Escitalopram (Lexapro) <~~~~ Check

Mood Stabilizers Used for the Treatment of BPD Symptoms

Medications with mood-stabilizing properties, such as lithium and some anticonvulsant (anti-seizure) medications, can help address the impulsive behavior and rapid emotional changes associated with BPD.

Mood stabilizers used to treat the symptoms of BPD may include:

–          Divalproex sodium (Depakote)

–          Lithium carbonate (Lithobid)

–          Lamotrigine (Lamictal)  <~~~~~~ Check

Anti-anxiety Medications Used for the Treatment of BPD Symptoms

Anti-anxiety (anxiolytic) medications can help with the intense anxiety some people with BPD may experience. However, there isn’t much research that supports the use of anti-anxiety drugs to treat BPD. Some research actually indicates that one class of anti-anxiety drug — benzodiazepines (e.g., Ativan, Klonopin) — may actually worsen BPD symptoms for some people.

Examples of anti-anxiety medications used to treat the symptoms of BPD include:

–          Alprazolam (Xanax) <~~~~~ Check

–          Clonazepam (Klonopin) <~~~~~ Check

–          Lorazepam (Ativan)

–          Diazepam (Valium)

–          Buspirone (Buspar)

Antipsychotic Medications Used for the Treatment of BPD Symptoms

Antipsychotic medications can help address occasional breaks from reality as well as the paranoia, anger, or hostility that people with BPD may experience.

Some antipsychotics used to treat BPD include:

–          Olanzapine (Zyprexa)** <~~~~ Check  

–          Risperidone (Risperdal) <~~~~ Check

–          Aripiprazole (Abilify) <~~~~ Check

–          Haloperidol (Haldol)

–          Paliperidone (Invega)

** Symbyax was the atypical anti-psychotic Psychiatrist had me on. It’s a combination of Olanzapine and fluoxetine.

My medication-go-round has been a bit exhausting. And by a bit, I mean, I am more tired and have less energy now than I have ever had in my life, even in my worst depression. At my lowest point I’m still a very high-functioning person and could at least stick to my routines of get up, go to work, go to the gym, shower, eat, bed. At the very least. I no longer have the energy to go to the gym, which makes me have even less energy to do anything else. I have begun to lose my motivation for the things I love. I just feel weighed down by everything. The weather has even cooled down a little so there’s no attributing it to the heat. My only conclusion is that it’s the medication because, surprise, that’s when I started to feel so off.

I understand why Psychiatrist put me on the Symbyax even though it ended up exacerbating my eating disorder. I was harming myself and bordering on suicidal and he wanted something that would help me immediately. Unfortunately this was not good for me in the long run. The Lamictal didn’t work at all. Because of the issues with the Symbyax I’m afraid of anti-psychotics but agreed to the Abilify.

I do feel a little more stable, but I also feel deadened and weighed down. Nothing is as fun, nothing is as beautiful, being with people is not as enjoyable, I don’t feel love and I can’t get swept away. This is not the kind of stability I’m looking for. I’m constantly fatigued. Getting out of bed and sitting upright are a chore. I’m losing my desire to do things I love. I look forward to the day ending so I can sleep. Then when I wake up all I want to do is continue sleeping. This. Is not me.  This has never been me. I refuse to accept that this is how I should be. Friend once told me that the meds might just be making me ‘normal’, “now you’re just not a superwoman, you have a normal person’s energy, you’ll get used to it”. If this is the energy level that normal people have than no wonder our country is so slow. I hate it. I am not a slow person. I think sometimes they like me on these meds because they don’t feel so bad being lazy themselves. The meds are bringing me down to their level and it makes them feel better about their own short comings. Screw that. Or I’m paranoid. (indicator of meds not working? Eh?) Whatever.

I’d rather be a little crazy but fully functional, then mostly ‘normal’ and utterly immobile.

I’m going to talk to Psychiatrist tomorrow about going off medication. At least for the rest of the summer. Give it a trial run. See if my energy ramps back up. If it does, then it’s definitely the medication that’s slowing me down and I’ll know. Which means what I’m on is not ok for me. If I continue to feel this way off the medication than there’s something else going on and I may have to go back to two sessions of therapy a week to work on stuff. It’s a process. I’m still open to the possibility of medication, but right now I feel I need to reestablish my baseline and get myself back to a healthy normal for my body. The funny thing about taking care of your body, your mind usually follows….

Thoughts from across the Borderline

               Honesty is a funny thing. Especially when your truths change.

Smash365: Fear

Since it appears that the #Trust30 writing challenge is up that I’ve been doing over at within Asylum ::sigh:: I have decided to try the Smash365 writing prompt instead. I don’t usually cross post but today seemed somewhat relevant. Today’s is:

Smash365: Fear

Jul 26, 2011 by cara moulds

“Fearlessness comes from a habit of doing lots of little things that constantly put you out of your comfort zone.” – Marty Wilson

What are you doing today to take you out of your comfort zone?

I feel like I’ve been in a rut for a while. Or like things don’t take me out of my comfort zone. Or that I’m always out of my comfort zone. All at the same time.

Work is my lease comfortable person. She exists in an environment that is not comfortable for her. That does not suit her personality, that makes her want to crawl out of her own skin. Every day here is an attempt to push myself just one more day beyond my boundaries of tolerance. And make others believe that I do, in fact, belong here.

The pretending has an odd effect. I feel split to my core. That this is not some place I belong or should be. On the other, the playing a part for 9 hours a day I occasionally slip fully into the roll, even for just a moment or two I feel like I belong in a meeting, talking to a vendor, performing my analysis. The disconnect comes in the fact that I am very capable of doing all of these things, though they do not feel like my true calling. They are something I am good at, not something I am passionate about…. Which is where this place is both comfortable, because it is not challenging, and not because it takes me away from my identity.

This however, is not what the prompt cues.

Going back to school. Again, both in and out of my comfort zone. I will be embarking on a challenge into a field that is  utterly new. It doesn’t completely feel like it’s pushing me out of my comfort zone because I thrive in an academic environment and clearly I have gone to school before. Also, the psych field I have dabbled in amatuerly. However to do it with the mindset of becoming a professional in the field, now that, is pushing the bounds of what I am accustomed to. It’s a field where I do not know how to go about finding my footing. I have no idea of the field work, interactive processes that accompany preparing you for the working world in this field. Engineering is cut and dry. Do the work, get an internship, do what you’re told, graduate, get a job. It’s all very objective. Psychology is a little less rigid. It seems more subjective. I’m intrigued. It will be a way to use my brain in a field that is utterly foreign in a way that I do not get to normally.

It’s a little scary to take the step outside of my established environment. Scary, but exhilarating.

Side note: I cleared up the hold on my transcripts and hopefully I’ll be able to arrange a meeting with an academic advisor by Friday =)

I also wonder if I even have a comfort zone. I don’t seem to be comfortable anywhere, at any time, save for brief moments of it where my mind is taken to places of fleeting peace. When I feel like I’m floating outside of my Self it’s difficult to settle into my own skin long enough to obtain that sense of comfortable calm. The best I can usually hope for is to occupy my mind so much so that I forget my malaise. This is why I constantly push myself, try new things, explore new avenues of adventure and information. Perhaps this is why I do not often feel outside of my ‘comfort zone’ because every chance I get I push my limits into a new venue. Nothing seems foreign to me, because often everything is. Who I am, what I’m doing, where I’m going, how I go about doing it… every time I try something new, it makes going outside of my comfort zone, a comfort.

x-posted: Asylum

Evidence of Abnormal Amygdala Functioning in BPD

I found an interesting little study paper titled: Evidence of Abnormal Amygdala Functioning in

Borderline Personality Disorder: A Functional MRI Study

Background: Intense and rapidly changing mood states are a major feature of BPD; however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates for abnormal emotional processing have been identified so far.

Methods: Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (FMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order.

Results: Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects.

Conclusions: Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects’ perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.

Borderline personality disorder is thought to arise from affective vulnerability. The inability to regulate one’s affective responses leads to marked, rapidly changing mood states and predisposes patients to various kinds of self-destructive behavior. However, there have been very few medical studies that support this. In this study BPD subjects were checked to ensure that they were neither suffering from additional Axis-I disorders or signs of current alcohol/drug abuse. This was important because the conclusion that this is a BPD trait can be reached, and not a co-morbid symptom attributed to something else. Before each study all the BPD and control patients were assessed to be in a similar baseline emotional state, loaded into an fMRI machine, and shown both neutral and stimulating slides. Brian scans were taken after each slide. The signal intensity was show to be significantly higher in the patients with BPD and not activated at all in the control group. When shown the negative stimuli, the BPD patients showed intense activation patterns in the amygdala. This was not found at all in the control group. The group went on to compare their study findings with other research and found that enhanced amygdala activation is similar to other psychiatric disorders like those noted with Post Traumatic Stress Disorder and Obsessive Compulsive Disorder. From this and other studies it’s suggested that not only is the amygdala active directly by sensory information but also by thoughts and memories. Activation of the amygdala may be regarded as a manifestation of a neurobiological fear reaction. As a conclusion the activation of the amygdala could be a biological indicator of intense unpleasant emotions, especially in relation to certain {perceived negative} stimuli.

It concludes with saying that these findings are consistent with the suggestion that the amygdala serves as a rapid, transient information processing pathway for stimuli that affects behavior. For people with BPD this adaptation may be disturbed which causes emotional reactions to take longer to return to an emotional baseline.

This fear reaction, I find interesting. For those of us with BPD we quite obviously have a fear of abandonment {amongst other things}. But what causes this particular fear itself? To me the answer to this would most likely be found in the childhood/adolescent environment. So is it the environment that alters the development of the brain function, or the brain function that makes one more receptive to certain environmental factors?

Emotion-Regulating Circuit Weakened in Borderline Personality Disorder

I found this article from the National Institute of Mental Health and thought it was interesting. It’s an older article from 2008. As I read more current articles maybe I will eventually compare/contrast them all to see how research has changed over the past few years, or show how it continues to support developing theories.

Emotion-Regulating Circuit Weakened in Borderline Personality Disorder

Grey Matter Changes Linked to Runaway Fear Hub

  

Differences in the working tissue of the brain, called grey matter, have been linked to impaired functioning of an emotion-regulating circuit in patients with borderline personality disorder (BPD). People with BPD had excess grey matter in a fear hub deep in the brain, which over-activated when they viewed scary faces. By contrast, the hub’s regulator near the front of the brain was deficient in grey matter and underactive, effectively taking the brakes off a runaway fear response, suggest researchers supported in part by NIMH.

The imaging studies are the first to link structural brain differences with functional impairment in the same sample of BPD patients. Similar changes in the same circuit have been implicated in mood and anxiety disorders, hinting that BPD might share common mechanisms with mental illnesses that have traditionally been viewed through the lens of biology.

Michael Minzenberg, M.D., of the University of California, Davis, and NIMH grantees Antonia S. New, M.D., and Larry J. Siever, M.D., of Mount Sinai School of Medicine, and colleagues, reported on their magnetic resonance imaging (MRI) findings in the July, 2008 issue of the Journal of Psychiatric Research Their functional imaging findings were reported in the August 2007 issue of Psychiatric Research Neuroimaging.

Accounting for up to 20 percent of psychiatric hospitalizations, BPD affects up to 1.4 percent of adults in a year. It is characterized by intense bouts of anger, depression, and anxiety that may last only hours, often in response to perceived rejection. People with this difficult to treat disorder typically experience tumultuous work and family life and may engage in risky, impulsive behaviors. Cutting, burning and other forms of self-harm are common. The completed suicide rate in BPD approaches 10%, and at least 75% of afflicted individuals attempt suicide at least once.

Previous findings of lower-than-normal grey matter matter – neurons and their connections – in the regulator hub, called the anterior cingulate cortex (ACC), hinted that this might affect the way the brain works in BPD.

To find out, the researchers first used functional magnetic resonance imaging (fMRI), to compare responses of 12 adult BPD patients with those of 12 healthy controls to pictures of faces with fearful, angry and neutral expressions. In response to fearful faces, the amygdala, the fear hub, showed exaggerated activity in the BPD patients, while the ACC was relatively underactive. Since ACC activity would normally increase to dampen an overactive amygdala, this suggested weak regulation of emotion in the circuit.

Suspecting that this functional impairment mirrors structural differences — as has been found in depression — the researchers next used anatomical MRI to compare grey matter in the same patients and healthy controls. Consistent with the fMRI results and the earlier findings, grey matter density was increased in parts of the amygdala and decreased in parts of the ACC, in BPD patients relative to controls. This suggested an abnormality in the number or architecture of neurons in these key components of the emotion-regulating circuit, which other evidence links to impaired functioning of the serotonin chemical messenger system.

Patients with borderline personality disorder had significantly lower density of grey matter, the brain’s working tissue, in the anterior cigulate cortex, an area (yellow, at right) that regulates the brain’s fear hub (below). MRI scan data shows the difference between patients and controls.

Patients with borderline personality disorder had significantly higher density of grey matter, the brain’s working tissue, in the brain’s fear hub, the amygdala (red areas). MRI scan data shows where patients and controls differed.

An area (anterior  cigulate cortex; orage at the right) that regulates the brain’s fear hub underactivated in patients with borderline personality when they viewed faces with fearful expressions. fMRI scan data reflects differences in activation between patients and controls.

————————

It’s almost comforting to know that there may be defective regulators in our brains. At the very least it indicates an actual problem and not just something we could potentially be seen as making up.