borderline personality disorder i hate you, please don’t leave me tori collins
TRANSCRIPT
BORDERLINE PERSONALITY DISORDERI 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 INTRAUMA-EXPOSED WOMEN WITH BORDERLINE PERSONALITYDISORDER 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 Performance 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
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?