Scientists Identify Brain Abnormalities Underlying Key Element Of Borderline PD

<font color="purple"> Scientists Identify Brain Abnormalities Underlying Key Element Of Borderline Personality Disorder

http://www.medicalnewstoday.com/articles/92493.php

Using new approaches, an interdisciplinary team of scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City has gained a view of activity in key brain areas associated with a core difficulty in patients with borderline personality disorder -- shedding new light on this serious psychiatric condition.

"It's early days yet, but the work is pinpointing functional differences in the neurobiology of healthy people versus individuals with the disorder as they attempt to control their behavior in a negative emotional context. Such initial insights can help provide a foundation for better, more targeted therapies down the line," explains lead researcher Dr. David A. Silbersweig, the Stephen P. Tobin and Dr. Arnold M. Cooper Professor of Psychiatry and Professor of Neurology at Weill Cornell Medical College, and attending psychiatrist and neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

The findings are featured in this month's issue of the American Journal of Psychiatry.

Borderline personality disorder is a devastating mental illness that affects between 1 to 2 percent of Americans, causing untold disruption of patients' lives and relationships. Nevertheless, its underlying biology is not very well understood. Hallmarks of the illness include impulsivity, emotional instability, interpersonal difficulties, and a preponderance of negative emotions such as anger -- all of which may encourage or be associated with substance abuse, self-destructive behaviors and even suicide.

"In this study, our collaborative team looked specifically at the nexus between negative emotions and impulsivity -- the tendency of people with borderline personality disorder to 'act out' destructively in the presence of anger," Dr. Silbersweig explains. "Other studies have looked at either negative emotional states or this type of behavioral disinhibition. The two are closely connected, and we wanted to find out why. We therefore focused our experiments on the interaction between negative emotional states and behavioral inhibition."

Advanced brain-scanning technologies developed by the research team made it possible to detect the brain areas of interest with greater sensitivity.

"Previous work by our group and others had suggested that an area at the base of the brain within the ventromedial prefrontal cortex was key to people's ability to restrain behaviors in the presence of emotion," Dr. Silbersweig explains.

Unfortunately, tracking activity in this brain region has been extremely difficult using functional MRI (fMRI). "Due to its particular location, you get a lot of signal loss," the researcher explains.

However, the Weill Cornell team used a special fMRI activation probe that they developed to eliminate much of that interference. This paved the way for the study, which included 16 patients with borderline personality disorder and 14 healthy controls.

The team also used a tailored fMRI neuropsychological approach to observe activity in the subjects' ventromedial prefrontal cortex as they performed what behavioral neuroscience researchers call "go/no go" tests.

These rapid-fire tests require participants to press or withhold from pressing a button whenever they receive particular visual cues. In a twist from the usual approach, the performance of the task with negative words (related to borderline psychology) was contrasted with the performance of the task when using neutral words, to reveal how negative emotions affect the participants' ability to perform the task.

As expected, negative emotional words caused participants with borderline personality disorder to have more difficulty with the task at hand and act more impulsively -- ignoring visual cues to stop as they repeatedly pressed the button.

But what was really interesting was what showed up on fMRI.

"We confirmed that discrete parts of the ventromedial prefrontal cortex -- the subgenual anterior cingulate cortex and the medial orbitofrontal cortex areas -- were relatively less active in patients versus controls," Dr. Silbersweig says. "These areas are thought to be key to facilitating behavioral inhibition under emotional circumstances, so if they are underperforming that could contribute to the disinhibition one so often sees with borderline personality disorder."

At the same time, the research team observed heightened levels of activation during the tests in other areas of the patients' brains, including the amygdala, a locus for emotions such as anger and fear, and some of the brain's other limbic regions, which are linked to emotional processing.

"In the frontal region and the amygdala, the degree to which the brain aberrations occurred was closely correlated to the degree with which patients with borderline personality disorder had clinical difficulty controlling their behavior, or had difficulty with negative emotion, respectively," Dr. Silbersweig notes.

The study sheds light not only on borderline personality disorder, but on the mechanisms healthy individuals rely on to curb their tempers in the face of strong emotion.

Still, patients struggling with borderline personality disorder stand to benefit most from this groundbreaking research. An accompanying journal commentary labels the study "rigorous" and "systematic," and one of the first to validate with neuroimaging what scientists had only been able to guess at before.

"The more that this type of work gets done, the more people will understand that mental illness is not the patient's fault -- that there are circuits in the brain that control these functions in humans and that these disorders are tied to fundamental disruptions in these circuits," Dr. Silbersweig says. "Our hope is that such insights will help erode the stigma surrounding psychiatric illness."

The research could even help lead to better treatment.

As pointed out in the commentary, the research may help explain how specific biological or psychological therapies could ease symptoms of borderline personality disorder for some patients, by addressing the underlying biology of impulsivity in the context of overwhelming negative emotion. The more scientists understand the neurological aberrations that give rise to the disorder, the greater the hope for new, highly targeted drugs or other therapeutic interventions.

"Going forward, we plan to test hypotheses about changes in these brain regions associated with various types of treatment," Dr. Silberswieg says. "Such work by ourselves and others could help confirm these initial findings and point the way to better therapies."

This work was funded by the Borderline Personality Disorder Research Foundation and the DeWitt Wallace Fund of the New York Community Trust.

Co-researchers include senior author Dr. Emily Stern, as well as Dr. John F. Clarkin, Dr. Martin Goldstein, Dr. Otto F. Kernberg, Dr. Oliver Tuescher, Dr Kenneth N. Levy, Dr. Gary Brendel, Dr. Hong Pan, Dr. Manfred Beutel, Dr. Jane Epstein, Dr. Mark F. Lenzenweger, Dr. Kathleen M. Thomas, Dr. Michael I. Posner, and Michelle T. Pavony -- all of NewYork-Presbyterian Hospital/Weill Cornell Medical Cente
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And this work proves what? That mental states are reflected in the brain? What a surprise!

It says nothing about how they originate. But, I think you can predict, claims to that effect will be made, by some at least, on the basis of such findings. I predict that some of those claims, which will include understanding from other approaches to mental "illness", will be of value, and some will not, leading further down a fruitless path of attribution to entirely "physical" or "biological" or "brain abnormality" origins of such distresses.

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leading further down a fruitless path of attribution to entirely "physical" or "biological" or "brain abnormality" origins of such distresses.

</div></font></blockquote><font class="post"> It can be upsetting indeed. Just drug them so they don't act out or feel anything........... never mind what mental distresses in one's young life started it all....... a "pill" will surely be the answer.

I know of many people that just take drugs and don't even see a therapist at all...... then after a short time the drugs don't work as well as they used to since the body readjusts itself, working hard to balance the foreign matter being put inside it. So meds are increased while talk therapy is often still ignored.

This finding(article) may be helpful if used in the right way.... but it can also be used to humanities detriment.

mandy

[/b] <font color="purple"> Someone might find it interesting/informative even if you don't [b]Grumpy Knickers </font>

Thanks for posting this article teejai! It is very informative.

sheesh! so defensive! don't think name calling was necessary.

I was only trying to have a conversation..... found the article interesting and perhaps could be helpful ..... here's part of what I said....
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This finding(article) may be helpful if used in the right way

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The idea that someone has a differing outlook on something doesn't have to mean one is being attacked.... they might just be wanting to converse, or show another view, or something they thought was helpful.

sheesh..........

mandy

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mandyfins said:
sheesh! so defensive! don't think name calling was necessary.


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I didn't think the initial tone of pachyderm's comment was necessary.
It came over as confrontational.

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teejai said:I didn't think the initial tone of pachyderm's comment was necessary.
It came over as confrontational.

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What you see as "confrontational" is in fact a result of fear: my fear of mental distresses (including my own) as being so badly misinterpreted as to cause further suffering. I, and I feel quite sure others, have experience with this.

No doubt you picked up, without realizing it, this fear.

I wonder what they would find if they tested the following:

- patients with paranoid delusions (when presented with words related to their delusions)
- patients with specific phobia (when presented with words related to their phobia)
- patients with OCD (when presented with words related to their obsessions / compulsions)

- normal controls (when presented with words that trigger an intense emotional response in them - perhaps words to do with racism / politics / religion)

I wonder whether these people would similarly respond 'impulsively' when the situation is emotionally charged.

I wonder whether 'normal' controls would similarly respond 'impulsively' when the situation is emotionally charged for them.

I think... They would.

As such... I think the study is showing the proximate neurological cause of the impulsive behaviour rather than some underlying brain pathology that is responsible for both the emotional experience AND the impulsive behaviour.

And... We knew that people who were in the grip of an intense emotional response were impulsive already. Thats kinda what emotions being MODULAR responses means...

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alexandra_k said:
I wonder what they would find if they tested the following:

- patients with paranoid delusions (when presented with words related to their delusions)
- patients with specific phobia (when presented with words related to their phobia)
- patients with OCD (when presented with words related to their obsessions / compulsions)

- normal controls (when presented with words that trigger an intense emotional response in them - perhaps words to do with racism / politics / religion)

I wonder whether these people would similarly respond 'impulsively' when the situation is emotionally charged.




I wonder whether 'normal' controls would similarly respond 'impulsively' when the situation is emotionally charged for them.



I think... They would.


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Interesting point. I think there would be a heightened response but not sure if it would be 'impulsive' in nature.

Though it might depend on how you are defining 'impulsiveness'.


More likely accentuate the paranoia,phobic anxiety etc.

I read an article in the July 2007 Scientific American titled The Memory Code by a Chinese researcher named Joe Tsien. His group did some studies on mice with implanted electrodes, and recorded synapse impulses while the mice were subjected to experiences that the researchers assumed would be frightening to the mice. One of them was a simulated earthquake. They found that the patterns of firings of the neurons repeated after the experiments were over, indicating apparently that the mice were remembering or re-experiencing their frightening experiences.

For the purposes of the above study 'impulsivity' was operationalized as follows:

> ignoring visual cues to stop as they repeatedly pressed the button.

I'm wondering whether the same 'impulsivity' (and active brain regions) would be found in controls who were similarly experiencing an intense emotional experience.

Without that data... Hard to know what to conclude from the study really...

If the findings aren't specific to borderlines (as opposed to subjects with phobia, delusions, or normal controls who are similarly triggered into an intense emotional response) then they haven't found out anything about borderline personality. Instead, they would have found something about NORMAL or TYPICAL neurological processing and behavioral response to intense emotional experiences.

Though you would need to make sure that the mice didn't have that same pattern BEFORE they had been exposed to the earthquake...

The way the study is explained, the control subjects would have had to been explosed to the same situations, including use of emotional language or whatever it was, as the borderline subjects, and a difference still detected. It didn't say that the normal subjects weren't affected by intense emotion, but that those with BPD were more affected.

That physiological differences can be seen says nothing about the cause of the differences. Other studies have shown that a history of abuse shows up in the brain with differences that resemble disorders that are thought to be genetic.

I find studies like this validating because it says that there are legitimate reasons that some things are harder for us. We need to be cautious though not to interpret it as "I can't" control my emotions and behavior. We still can. I would like to see a follow-up study after the Borderline subjects are successfully treated, to see if the same differences show up in someone who was Borderline but no longer meets criteria and/or has learned control.

I also would bet that similar effects would be shown with subjects with related disorders, including PTSD, and any disorders that involve impulse control problems. That woud also be an interesting study.

The thing is...

That I think it is fairly common sense that different people would have an intense emotional response to different stimuli. We know this about emotional responses - the triggers for them vary considerably across cultures, for example.

People with borderline personality disorder might have an intense emotional response to stimuli such as the word 'abandonment'. No surprises there - that is part of the criteria for the disorder! It is almost true-by-definition.

People with phobia of heights or spiders might have an intense emotional response to stimuli such as the word 'falling' or 'spiders'. No surprises there either - once again that is part of the criteria for the disorder. Studies have found this to be the case (though of course we didn't need studies to be done because it is true by definition)

People with OCD might have an intense emotional response to stimuli such as the word 'dirty' or 'vomit' or 'the oven is on'. Wouldn't be surprising if this stimuli made them very anxious.

People who count as 'normal controls' might have an intense emotional response to stimuli such as the word 'terrorist' or 'pedophile' or whatever.

IF it were found that people have similar impulse control problems when presented with triggering words and IF it were found that similar brain areas were active... THEN the study doesn't show us anything at all about borderline personality disorder. It simply shows us... Something about human beings in general when those human beings are triggered.

I find it more validating to consider myself a human being rather than being limited or constrained or predictable on the basis of dx.

:-)

> I would like to see a follow-up study after the Borderline subjects are successfully treated...

You would have to have some measure of "success" in treatment that was independent of the study finding the brain effects.

That's interesting stuff, teejai. It's good to know, but my own personal feeling about this is:

So what!

It means nothing to me when I am (we are) still in so much pain.

It's like reading about all the so-called breakthroughs that are being made in cancer research, yet the standard treatments of chemo, radiation and surgery are still the only options available.

Sorry if I am not so enthused at this information, as I know it was provided to offer hope.

Unfortunately, I have none.

God they'll do anything to create a new drug to push.