Re: Scientists Identify Brain Abnormalities Underlying Key Element of Borderline

[Guest guest]

pb,

Thanks for posting this fascinating and helpful

information. It explains a lot and is a reminder

to me why I shouldn't try to have a relationship

with a BP.

One Non-BP Recovering Man

--- pblivingintheraw

wrote:

>

> Hi Everyone,

>

> I've been a member here for 3 1/2 years and

> rarely post but I found this

> article that I thought some of you would be

> interested in.

>

>

>

> Namaste!

>

>

>

> Pamela

>

>

>

> Scientists Identify Brain Abnormalities

> Underlying Key Element of

> Borderline Personality Disorder (12/26/2007)

>

>

>

> Using new approaches, an interdisciplinary team

> of scientists at

> NewYork-Presbyteria n 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. A. Silbersweig, the

> P. Tobin and Dr. Arnold

> M. Professor of Psychiatry and Professor

> of Neurology at Weill

> Cornell Medical College, and attending

> psychiatrist and neurologist at

> NewYork-Presbyteria n 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.

> Stern, as well as Dr.

> F. in, Dr. Goldstein, Dr. Otto

> F. Kernberg, Dr. Oliver

> Tuescher, Dr. N. Levy, Dr.

> Brendel, Dr. Hong Pan, Dr.

> Manfred Beutel, Dr. Jane Epstein, Dr. Mark F.

> Lenzenweger, Dr. Kathleen

> M. , Dr. I. Posner, and

> T. Pavony-all of

> NewYork-Presbyteria n Hospital/Weill Cornell

> Medical Center.

>

> Note: This story has been adapted from a news

> release issued by Cornell

> University

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