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?