lunes, 25 de septiembre de 2017

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domingo, 23 de julio de 2017

Causes of Borderline Personality Disorder (BPD)

Causes of Borderline Personality Disorder (BPD)
Linehan's Dialectical Behavior Therapy Looks at What Causes BPD
It is believed that biology and patterns of interaction in families combine to cause Borderline Personality Disorder. Marsha Linehan's DBT success seems to confirm this.

The biosocial theory of Borderline Personality Disorder developed by Marsha Linehan sees the causes of Borderline Personality as threefold: biological, social, and the interaction between these two things. In response, Linehan developed Dialectical Behavior Therapy (DBT), which is quite successful in helping people with Borderline Personality Disorder get relief from suffering.
What are the Biological Causes of Borderline Personality Disorder According to Linehan?
There are two types of biological causes of BPD:
  1. emotional vulnerabilty and
  2. difficulty modulating emotions.
Emotional Vulnerability as a BPD Cause
Someone who is emotionally vulnerable is someone whose body is very highly physically sensitive to emotions. This person may be more likely to develop Borderline Personality Disorder if certain social/family circumstances, described later in this article, also exist.
Physical sensitivity to emotions means that
  • the person's sympathetic nervous system is easily triggered by emotions;
  • the reaction in the body is very intense; and
  • it takes a long time for the person's bodily response to "go back to normal" after being triggered.
This is one reason why people with Borderline Personality Disorder may experience panic attacks and other mood swings.

Emotional Modulation Problems in Causing Borderline Personality
Difficulty modulating emotions is the second biological cause of Borderline PersonalityDifficulty modulating emotions means:
  • finding it difficult to not act immediately in response to strong emotion, even if the action is destructive;
  • being unable to continue working towards goals in the face of strong emotions;
  • being unable to make oneself feel better in the face of strong emotions;
  • being unable to distract oneself from strong emotions.
There is no single cause for these two biological, predispositions for Borderline Personality. For some, it could be hereditary but for others there could be other, acquired causes.
What are the Social/Family Causes of Borderline Personality Disorder as Described by Linehan?
The type of early family environment that is seen to contribute to Borderline Personality Disorder is called, "the invalidating environment." An invalidating environment is described by the following examples:
  • If a child reports that he is hungry he is told that he is not hungry, he just ate. i.e. his inner experience is invalidated.
  • When a child expresses upset, the family does not pay attention, or tells him he's making a big deal about it.
  • The child's beliefs, thoughts and preferences and ideas are not sought or taken seriously.
  • The child's emotions are not considered to be important communications and are not responded to or do not result in the child's needs getting met.
  • The child is blamed for her painful experiences and such experiences are trivialized.
  • The child is discriminated against based on arbitrary characteristics such as gender.
  • Punishment is used to control behavior, from criticism up to physical and sexual abuse. A history of sexual abuse is seen in approximately 75% of people with Borderline Personality Disorder, according to Marsha Linehan.
Some of the elements of the invalidating environment (but not abuse) can actually be useful and helpful to some children at some times. But Borderline Personality is seen to be caused by the combination of a biological vulnerability as described above, with ongoing invalidation as described here.
The presence of a high physical sensitivity to emotions and difficulty modulating emotions predisposes people to Borderline Personality Disorder. When the family environment is invalidating, the physical sensitivity and invalidating environment interact with each other and can cause Borderline Personality Disorder. Effective treatment, especially Dialectical Behavior Therapy is available.
Related article: Do I Have Borderline Personality Disorder? This article explains the symptoms experienced by those with Borderline Personality Disorder.
Source: Linehan, Marsha M. Skills Training Manual for Treating Borderline Personality Disorder, New York: The Guilford Press, 1993.
This article is for general information only. Anyone experiencing troubling symptoms should consult a mental health professional in person.

The copyright of the article Causes of Borderline Personality Disorder (BPD) in Borderline Personality is owned by Lisa C. DeLuca. Permission to republish Causes of Borderline Personality Disorder (BPD) in print or online must be granted by the author in writing. 
Borderline Personality Disorder Brain Anatomy
Neuroanatomical Studies of Borderline Personality Disorder (BPD)
© Tami Port 
A study recently appearing in the May 2007 issue of Journal of Psychiatry and Neuroscience reviews what we know about brain structure of BPD patients.

What Is Borderline Personality Disorder?
BPD is a type of psychological personality disorder that interferes with an individual’s ability to regulate emotion. It affects as many as 1% to 2% of the general population.
The characteristic emotional instability of BPD results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships. Highly sensitive to rejection, those with BPD fear abandonment to such an extreme that it often results in frantic efforts to avoid being left alone, such as suicide threats and attempts (APA 2000). Nearly all BPD patients have experienced thoughts of suicide while nearly 10% commit suicide by adulthood (Skodol 2002).
The Brain and BPD
The few studies that have examined the Borderline brain have found differences in the volume and activity in brain structures related to emotion and impulsivity between individuals who have BPD and those who do not.
This study’s objective was to examine existing research on the neurological differences between individuals with and without BPD as well as the genetics that may play a role in development of this disorder.
This Suite101 summary focuses on the neuroanatomical differences that were found. For physiological differences, see Suite101 article Metabolism in the BPD Brain.

Study Methods 
Using databases of academic articles, the investigators looked for relevant research published between 1980 and 2006 and found 49 journal articles describing original research about the brain and/or genetics of BPD patients.
BPD Research Findings
The use of neuroimaging in the study of BPD dates back only a few years. Overall, BPD has been linked to the amygdala and limbic systems of the brain, the centers that control emotion and, particularly, rage, fear and impulsive automatic reactions.
Studies have shown that the hippocampus and amygdala may be as much as 16% smaller in people with BPD and have suggested that experiences of trauma may lead to these neuroanatomical changes.
BPD Biological Abnormalities
Immature Coordination of Neural Networks
Working from the hypothesis that people with BPD have impaired maturation of higher-order consciousness, research suggests that abnormalities may indicate a general failure of coordination among networks of the brain. BPD patients were found to exhibit neural response patterns of people younger than themselves, perhaps indicating a failure of maturation and development of sense of self.
Abnormalities in Limbic System
MRI studies of those with BPD show abnormalities in limbic structures, particularly areas involved in negative affect (experience of feeling emotion).
Abnormalities Related to Impulsivity
Patients with BPD or APD show reduced blood flow in the right lateral temporal cortex and the right prefrontal cortex. These areas of the brain have been linked to impulsivity.
Serotonin Transporter Gene 5-HTT
Research has strongly implicated the serotonin transporter gene 5-HTT in development of BPD. Shorter alleles (pair of genes) have been associated with lower levels of serotonin and greater impulsive aggression.
Study Conclusions
Imaging technology has shown that brain structures with reduced volume in BPD patients may show hypermetabolism. Perhaps some of the lost volume in these structures (such as the amygdala) may be due to loss of inhibitory neurons; lost inhibition leading to the impulsive behavior and overly negative interpretation of others. Perhaps different developmental abnormalities lead to different clinical manifestations of BPD.
Other Resources on BPD
There are numerous on-line and in print resources with additional information on the treatment of Borderline Personality Disorder, including: Psychology Prof OnlineBPD Resource Center and the Suite101 articles Personality Disorders: Brief Summary of the Ten Disorders of Personality, and Borderline PD Information.
This Suite 101 article is a brief summary of a portion of one study of BPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.
Sources
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Lis, E., Greenfield, B., Henry, M., Guile, J.M. and Dougherty, G. (2007) Neuroimaging and genetics of borderline personality disorder: a review. Journal of Psychiatry and
Neuroscience, 32, 3.

The copyright of the article Borderline Personality Disorder Brain Anatomy in Borderline Personality is owned by Tami Port. Permission to republish Borderline Personality Disorder Brain Anatomy in print or online must be granted by the author in writing. 





Understanding Borderline Personality Disorder
Symptoms Include Depression, Anxiety, Anger and Delusions
An initial diagnosis of Borderline Personality Disorder (BPD) can be both frightening and isolating. However, understanding the condition in more depth can really help.

Borderline Personality Disorder (BPD) is categorised as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
What are the Criteria and Symptoms of Borderline Personality Disorder
The DSM-IV states that an essential feature of BPD is a pervasive pattern of instability of relationships and self image and marked impulsivity that is present in a variety of contexts, as indicated by five (or more) of the following symptoms:
  1. Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation.
  3. Identity disturbance, markedly and persistently unstable self image or sense of self.
  4. Impulsivity in at least two areas that are potentially self damaging (e.g. over spending, sex, drug abuse).
  5. Recurrent suicidal behaviour, gestures or threats or self mutilating behaviour.
  6. Affective instability due to a marked reactivity of mood (irritability or anxiety).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger of difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress related paranoid ideation or severe dissociative symptoms.
Getting to Grips with Borderline Personality Disorder
The word "personality" refers to an ongoing pattern of thoughts, behaviours and feelings that define who a person is. The diagnosis for BPD is very controversial as it often implies that the personality as a whole if flawed instead of just one aspect of it. This in turn can increase the feelings of low self esteem and depression, which can escalate the problem.
Some people find it difficult to come to terms with a diagnosis of BPD and feel that the "label" or stigma associated with this condition isolates them from society. However, other people have found that having a diagnosis and therefore being able to further understand in-depth about BPD is their first step to control and self management.
What Causes Borderline Personality Disorder
Research is still continuing into possible causes of BPD. Many (but not all) people who are diagnosed with BPD are found to have had traumatic experiences in early life and childhood. These experiences can be, but are not limited to the death or a parent, sexual abuse, neglect or physical/mental abuse.

There is also some school of thought that indicates some people are predisposed to BPD and as such some stressful or traumatic event can begin the onset of symptoms.
Treatments for Personality Disorders
Psychotherapy or counselling is nearly always used in cases of Borderline Personality Disorder. These are sessions of talking through feelings, thoughts and emotions with a qualified psychiatrist/counsellor to investigate the roots of any childhood problems and also to learn techniques for dealing with some of the debilitating symptoms.
Anti-depressants work to increase levels of serotonin in the brain which helps to counteract the feelings of depression, anxiety and emptiness.
Anti-psychotic medications are often prescribed to help with the feelings of disassociation, paranoia and thoughts or feelings of unreality.

The copyright of the article Understanding Borderline Personality Disorder in Borderline Personality is owned by Catherine Roberts. Permission to republish Understanding Borderline Personality Disorder in print or online must be granted by the author in writing. 
Disorder 

Borderline Personality Disorder
Overview of the Symptoms, Diagnosis and Treatment of BPD
© Tami Port 
Those with BPD have difficulty regulating their emotions and can be very self-destructive. But there is promising treatment for those suffering from this disorder.

What Is Borderline Personality Disorder?
According to the DSM-TR-IV, psychology's diagnostic "bible," BPD is a type of psychological personality disorder that interferes with an individual's ability to regulate emotion. The characteristic emotional instability results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships.
People with this disorder are prone to unpredictable outbursts of anger, which sometimes manifest in self-injurious behavior. Borderlines are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such as suicide threats and attempts.
Borderline Behavior
Those suffering from BPD are also prone to other impulsive behaviors, such as excessive spending, binge eating, risky sex, and drug and alcohol abuse. They often exhibit additional psychiatric problems, particularly bipolar disorder, depression, anxiety, and other personality disorders. Symptoms typically begin in early adulthood, and once present, can interfere with relationships, work performance, long-term planning, and the individual's sense of self-identity.
BPD or Emotional Regulation Disorder?
The term "borderline" was originally used to describe mental health patients that appeared to be on the border between neurosis and psychosis. The diagnostic label has been long subject to misuse, and is occasionally used as a "catch-all" diagnosis for individuals who are difficult to diagnose (Friedel 2004). The disorder is also referred to as Emotional Regulation Disorder (ERD), which many feel more accurately describes the true nature of the illness.
Diagnosis of Borderline Personality Disorder
According to the Diagnostic and Statistical Manual of Mental Disorders, a patient must fit the following criteria in order to be diagnosed with BPD:

A pervasive pattern of instability of interpersonal relationships, self-image, and affect, marked b impulsivity beginning by early adulthood, as indicated by five (or more) of the following:
  • frantic efforts to avoid real or imagined abandonment
  • pattern of unstable and intense interpersonal relationships 
  • identity disturbance: markedly and persistently unstable self-image
  • impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  • recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  • affective instability due to a marked reactivity of mood (extreme changes in mood typically lasting a few hours and only rarely more than a few days).
  • chronic feelings of emptiness
  • inappropriate, intense anger or difficulty controlling anger
  • transient, stress-related paranoid ideation or severe dissociative symptoms
Prevalence of BPD
Borderline Personality Disorder affects approximately 2% of the general population. About 10% of those seen in outpatient mental health clinics, and 20% of psychiatric inpatients are diagnosed borderline, with women being three times more likely to have the disorder than men. There appears to be a genetic component to the disease, as BPD is nearly five times more common among immediate family members of those with the disorder than in the general population (Oldham 2004).
Treatment of BPD
Those with BPD commonly utilize mental health resources, either through their own volition, or at the insistence of loved ones. Impairment from the disorder and risk of suicide are greatest during young-adulthood and gradually wane with advancing age. During their 30s and 40s, most attain greater stability in their emotions and their life.
There have been advancements in the treatments for BPD in recent years. Group and individual psychotherapy are at least partially effective for many patients. Dialectical Behavior Therapy (DBT) and Transference-Focused Psychotherapy (TFP) are two therapeutic approaches developed specifically to treat BPD (Clarkin 2007). Medication may also be helpful for relief of some aspects of the disorder. Brief hospitalization is sometimes required, especially in cases involving psychotic episodes or suicide threats or attempts.
More Information on BPD
There are numerous on-line and in print resources with additional information on the treatment of Borderline Personality Disorder, including: Psychology Prof OnlineBPD Resource Center and the article Personality Disorders: Brief Summary of the Ten Disorders of Personality.
This Suite 101 article is a brief summary of BPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.
Additional BPD Resources
Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychaiatry,164, 6.
Friedel, R. O. Hoffman, P. D., Penney, D. and Woodward, P. (2004) Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD. Marlowe & Co.
Oldham, J. (2004) Borderline Personality Disorder: An Overview. Psychiatric Times, 21, 8.
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

The copyright of the article Borderline Personality Disorder in Borderline Personality is owned by Tami Port. Permission to republish Borderline Personality Disorder in print or online must be granted by the author in writing. 





Disorder Brain Anatomy 

Borderline Personality Disorder Brain Anatomy
Neuroanatomical Studies of Borderline Personality Disorder (BPD)
© Tami Port 
A study recently appearing in the May 2007 issue of Journal of Psychiatry and Neuroscience reviews what we know about brain structure of BPD patients.

What Is Borderline Personality Disorder?
BPD is a type of psychological personality disorder that interferes with an individual’s ability to regulate emotion. It affects as many as 1% to 2% of the general population.
The characteristic emotional instability of BPD results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships. Highly sensitive to rejection, those with BPD fear abandonment to such an extreme that it often results in frantic efforts to avoid being left alone, such as suicide threats and attempts (APA 2000). Nearly all BPD patients have experienced thoughts of suicide while nearly 10% commit suicide by adulthood (Skodol 2002).
The Brain and BPD
The few studies that have examined the Borderline brain have found differences in the volume and activity in brain structures related to emotion and impulsivity between individuals who have BPD and those who do not.
This study’s objective was to examine existing research on the neurological differences between individuals with and without BPD as well as the genetics that may play a role in development of this disorder.
This Suite101 summary focuses on the neuroanatomical differences that were found. For physiological differences, see Suite101 article Metabolism in the BPD Brain.

Study Methods 
Using databases of academic articles, the investigators looked for relevant research published between 1980 and 2006 and found 49 journal articles describing original research about the brain and/or genetics of BPD patients.
BPD Research Findings
The use of neuroimaging in the study of BPD dates back only a few years. Overall, BPD has been linked to the amygdala and limbic systems of the brain, the centers that control emotion and, particularly, rage, fear and impulsive automatic reactions.
Studies have shown that the hippocampus and amygdala may be as much as 16% smaller in people with BPD and have suggested that experiences of trauma may lead to these neuroanatomical changes.
BPD Biological Abnormalities
Immature Coordination of Neural Networks
Working from the hypothesis that people with BPD have impaired maturation of higher-order consciousness, research suggests that abnormalities may indicate a general failure of coordination among networks of the brain. BPD patients were found to exhibit neural response patterns of people younger than themselves, perhaps indicating a failure of maturation and development of sense of self.
Abnormalities in Limbic System
MRI studies of those with BPD show abnormalities in limbic structures, particularly areas involved in negative affect (experience of feeling emotion).
Abnormalities Related to Impulsivity
Patients with BPD or APD show reduced blood flow in the right lateral temporal cortex and the right prefrontal cortex. These areas of the brain have been linked to impulsivity.
Serotonin Transporter Gene 5-HTT
Research has strongly implicated the serotonin transporter gene 5-HTT in development of BPD. Shorter alleles (pair of genes) have been associated with lower levels of serotonin and greater impulsive aggression.
Study Conclusions
Imaging technology has shown that brain structures with reduced volume in BPD patients may show hypermetabolism. Perhaps some of the lost volume in these structures (such as the amygdala) may be due to loss of inhibitory neurons; lost inhibition leading to the impulsive behavior and overly negative interpretation of others. Perhaps different developmental abnormalities lead to different clinical manifestations of BPD.
Other Resources on BPD
There are numerous on-line and in print resources with additional information on the treatment of Borderline Personality Disorder, including: Psychology Prof OnlineBPD Resource Center and the Suite101 articles Personality Disorders: Brief Summary of the Ten Disorders of Personality, and Borderline PD Information.
This Suite 101 article is a brief summary of a portion of one study of BPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.
Sources
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Lis, E., Greenfield, B., Henry, M., Guile, J.M. and Dougherty, G. (2007) Neuroimaging and genetics of borderline personality disorder: a review. Journal of Psychiatry and
Neuroscience, 32, 3.

The copyright of the article Borderline Personality Disorder Brain Anatomy in Borderline Personality is owned by Tami Port. Permission to republish Borderline Personality Disorder Brain Anatomy in print or online must be granted by the author in writing. 





Borderline Personality Disorder Brain Metabolism
Neurophysiological Studies of Borderline Personality Disorder (BPD)
© Tami Port 
A study recently appearing in the May 2007 issue of Journal of Psychiatry and Neuroscience reviews what we know about brain physiology of BPD patients.

What Is Borderline Personality Disorder?
According to the DSM-TR-IV (2000), psychology's diagnostic "bible," BPD is a type of psychological personality disorder that interferes with an individual's ability to regulate emotion.
People with this disorder are prone to unpredictable outbursts of anger, which sometimes manifests as self-injurious behavior. Borderlines are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such as suicide threats and attempts.
The Brain and BPD
Primarily over the past 30 years, researchers have examined the Borderline brain and found abnormalities in anatomy and physiological response.
In this study, Lis et al (2007) set out to examine existing research on the neurological differences between individuals with and without BPD as well as the genetics that may play a role in development of this disorder.
This Suite101 summary focuses on the metabolic differences that were found. For anatomical or biological differences, see Suite101 article Anatomy of the BPD Brain.

Study Methods 
Using databases of academic articles, the investigators looked for relevant research published between 1980 and 2006 and found 49 journal articles describing original research about the brain and/or genetics of BPD patients.
BPD Research Findings
The use of neuroimaging in the study of BPD dates back only a few years. Overall, BPD has been linked to the amygdala and limbic systems of the brain, the centers that control emotion and, particularly, rage, fear and impulsive automatic reactions.
BPD Metabolic Abnormalities
Reduced Brain Metabolism
Neurological studies using positron emission tomography (PET) and magnetic resonance imaging (MRI) suggest that, in BPD patients, areas of the brain used to regulate and control emotion are hypometabolic (have reduced metabolic activity) and, in contrast, activation of limbic areas, when it occurs, is excessive (hypermetabolic).
This might reflect a failure of rational thought to control emotional thought, leading to the emotional instability that is characteristic of BPD.
NAA Concentrations
Patients with BPD also show deficiencies in N-acetyl-aspartate (NAA) concentrations in the dorsolateral prefrontal cortex, suggesting a lower density of neurons and disturbed neuronal metabolism.
NAA is the second most highly concentrated molecule in the brain. It’s made in the neurons, and although scientists are not certain as to its function, NAA is believed to be related to: fluid balance in the brain; lipid and myelin synthesis (myelin is the “insulation” that surrounds neural axons and enables efficient neuron-to-neuron communication); creation of N-Acetylaspartylglutamate; and perhaps in the production of energy in neuronal mitochondria.
Study Conclusions
Imaging technology such as PETs and MRIs have shown that brain structures with reduced volume in BPD patients may show hypermetabolism (increased metabolic activity).
Perhaps some of the lost volume in these structures may be due to reduced numbers of inhibitory neurons resulting in lost inhibition and ultimately the impulsive behavior and overly negative interpretation of others that is associated with BPD.
Other Resources on BPD
There are numerous on-line and in print resources with additional information on the treatment of Borderline Personality Disorder, including: Psychology Prof Online, BPD Resource Center and the Suite101 articles Personality Disorders: Brief Summary of the Ten Disorders of Personality, and Borderline PD Information.
This Suite 101 article is a brief summary of a portion of one study of BPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling. 
Sources
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Lis, E., Greenfield, B., Henry, M., Guile, J.M. and Dougherty, G. (2007) Neuroimaging and genetics of borderline personality disorder: a review. Journal of Psychiatry and Neuroscience, 32, 3.

The copyright of the article Borderline Personality Disorder Brain Metabolism in Borderline Personality is owned by Tami Port. Permission to republish Borderline Personality Disorder Brain Metabolism in print or online must be granted by the author in writing.