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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by schleprock on February 17, 2013, at 1:11:52
Does anyone know if there is any kind of neurological basis for BPD? If so, would it have any effect on medication effectiveness, or contribute to treatment resistance?
Posted by SLS on February 17, 2013, at 8:42:11
In reply to Borderline Personality Disorder and Neurology., posted by schleprock on February 17, 2013, at 1:11:52
> Does anyone know if there is any kind of neurological basis for BPD? If so, would it have any effect on medication effectiveness, or contribute to treatment resistance?
Your questions are perfectly logical and extremely important. Unfortunately I can't really answer them.
I read recently that there are indeed biomarkers associated with BPD. However, I think there is a confluence of both biological and psychological factors contributing to its etiology. I have seen a combination of Zyprexa and Trileptal work very well for one woman I got to know pretty well. She also profited greatly from CBT. At some point, she had to discontinue the Zyprexa due to excessive weight gain. I don't recall if another AP was eventually chosen for her, but the Trileptal alone seemed to maintain her improvements. That childhood trauma and psychosocial stress might be the causative factors leading to pathological changes in neurodevelopment make BPD no less biological to conceptualize and treat. I am guessing that there is a neurological substrate present from birth that allows for BPD to develop when the brain is stressed by chronic trauma. Some people develop PTSD. Some people develop bipolar disorder. Some people develop OCD. Some people develop GAD. Some people develop BPD. I am guessing that the same history of abuse will lead a different clinical outcomes based upon distinctly different biological vulnerabilities.
- Scott
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Pol Merkur Lekarski. 2011 Oct;31(184):252-5.
[The main directions of research on the causes conditioning the occurrence of the borderline personality disorders].
Ogłodek E, Araszkiewicz A.
Source
Uniwersytet im. Mikołaja Kopernika w Toruniu, Collegium Medicum w Bydgoszczy, Katedra Psychiatrii. maxeve@interia.pl
AbstractCurrently, there are two main directions of explaining the occurrence of the borderline personality disorders (BPD). The first of them attempts to explain them upon the constitutional basis, finding the causes in the genetic conditioning, biological and organic factors. The other one underline a role of the psychological developmental categories. A significant role is ascribed to traumatic childhood mental experiences such as: harassment and sexual abuse, as well as neglect of emotional and developmental needs of a child. About 40-71% of the infirm with the borderline personality admits to have been sexually abused. It was observed that there is a connection between the extent of sexual abuse of an individual in childhood and the intensification of the disorders proper for the borderline personality. One should, however, point out that sexual abuse, although they are regarded as a risk factor, are not seen as specific to the infirm with the borderline personality disorders. Moreover, there is a third direction referred to in the literature, seeking the causes of the occurrence of the borderline personality in a significant influence of social-cultural and environment factors. It was noticed that there is a significant correlation between the social situation and the degree of dissemination of those disorders. The borderline personality disorders are more frequent among the people of the low social status background and with relatively low level of education. More and more frequently, theorists and clinical personnel adhere to the view that the development of that disorder is caused by a combination of neurobiological and social factors, together with the pathological qualities of early-childhood development.
PMID:
22097186
[PubMed - indexed for MEDLINE]--------------------------------------
Posted by Emme_V2 on February 17, 2013, at 9:21:36
In reply to Re: Borderline Personality Disorder and Neurology. » schleprock, posted by SLS on February 17, 2013, at 8:42:11
Do you think abuse or trauma is necessary for these illnesses to develop? I can imagine that abuse or trauma would set things in motion if there's an underlying vulnerability. I also know people with depression or bipolar disorder who weren't subjected to abuse or trauma as far as I can tell. Is ordinary life stress or perhaps stress that is only a little above average sometimes enough? It probably depends upon the person. Just thoughts.
As far as Schleprock's question, I wish I had more wisdom to offer. I know the traditional thinking is that medication doesn't help that condition, but I do know someone who was treated for BPD with medication. I think she was tried on Abilify, Zyprexa, and Wellbutrin (probably not at the same time). She was being treated at a well-respected medical center. I don't know what her experience was like with the medications, though, and whether she thought they were helpful.
Posted by Phillipa on February 17, 2013, at 9:58:22
In reply to Re: Borderline Personality Disorder and Neurology. » SLS, posted by Emme_V2 on February 17, 2013, at 9:21:36
I was always taught in school and from my experiences in working both in adolescent and adult psych inpatient units that the behavior was almost "normal" in adolescents. Usually it is outgrown. But there is a wide range in the behaviors. Normal might be acting out as in temper tantrums banging a wall as example of the normal end. Then the other end would be acting out with self harm gestures for attention getting. Just like splitting is a way for a person to create chaos between staff members. I think this behavior is more common in adults who did not outgrow it and go on to possibly also use drugs and then suicidal gestures not meant to committ suicide. Now this is all off the top of my head. Which is hard headed. Phillipa
Posted by SLS on February 17, 2013, at 10:29:57
In reply to Re: Borderline Personality Disorder and Neurology. » SLS, posted by Emme_V2 on February 17, 2013, at 9:21:36
> Do you think abuse or trauma is necessary for these illnesses to develop?
I would have to say no. I think it would be fair to view the relative contributions of nature and nurture for each case as being positioned uniquely along a spectrum. Bipolar disorder is probably more apt to develop in the absence of psychosocial triggers than is unipolar disorder. It also develops at a much earlier age. It may not be a popular idea, but bipolar disorder does emerge in young children. It is critical to treat these children as soon as possible, even when medication is to be avoided. If it were my child, and psychotherapeutic modalities proved ineffective, I wouldn't hesitate to agree to treatment using low-dose lithium, Depakote, or Trileptal.
- Scott
Posted by schleprock on February 17, 2013, at 21:26:56
In reply to Borderline Personality Disorder and Neurology., posted by schleprock on February 17, 2013, at 1:11:52
Thanks everyone. But I was really only wondering if BPD could interfere with treatment for major depression. Wasn't really looking for treatment for BPD itself. I'm actually pretty fine with the BPD (if that's what I have.) Just concerned about it only in relation to potential recovery from MDD.
Posted by Dinah on February 18, 2013, at 5:36:19
In reply to Borderline Personality Disorder and Neurology., posted by schleprock on February 17, 2013, at 1:11:52
Certain aspects of borderline personality disorder do seem to have a biological basis. I've looked at the affective instability portion, which is what affects me.
I was writing about it on Babble at some point.
http://www.dr-bob.org/babble/20110728/msgs/992671.html
Unfortunately some of my best bookmarks aren't working, but if you google physostigmine and borderline personality, you should come up with some updated ones.
http://www.borderlinepersonalitytoday.com/main/clinicians/siever.htm
http://www.ncbi.nlm.nih.gov/pubmed/9326751
It would seem likely that there would be an effect on medication chosen. Have you tried an AP? For me, it was great for affective instability though there are of course side effects - particularly at larger doses.
And of course the gold standard would be medication combined with psychotherapy. Marsha Linehan's DBT therapy seems to have a lot of support for its effectiveness.
Posted by Deneb on February 18, 2013, at 16:39:06
In reply to Re: Borderline Personality Disorder and Neurology., posted by Phillipa on February 17, 2013, at 9:58:22
I kind of agree that a lot of borderline behaviours can be normal for teenagers and that some adults just don't outgrow it.
I think for me, it just took longer than normal to outgrow the behaviours.
I don't have any of those behaviours now really.
Posted by SLS on February 18, 2013, at 16:44:58
In reply to Re: Borderline Personality Disorder and Neurology., posted by Deneb on February 18, 2013, at 16:39:06
> I kind of agree that a lot of borderline behaviours can be normal for teenagers and that some adults just don't outgrow it.
>
> I think for me, it just took longer than normal to outgrow the behaviours.
>
> I don't have any of those behaviours now really.Which behaviors do you feel are normal for teenagers that would qualify as BPD?
It is a joy to watch you move forward in life.
Take care.
- Scott
This is the end of the thread.
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