More Information from Randi Kreger

[Guest guest]

Yesterday, I passed along news that researchers discovered that an area of the

brain typically triggered in games of economic fairness was activated

differently in healthy subjects and in those with borderline personality

disorder. This has implications for the differing way people with BPD give and

receive trust. The study in receiving major attention because, among other

things, in is one in a series of study that demonstrates that BPD has its

origins in biology.

Today, there are news reports about the study that are easier to follow than the

actual study. This web site from the Baylor College of Medicine has links to

several short videos about the study:

http://www.bcm.edu/news/item.cfm?newsID=1177

Below my sig is an article from Science Daily.

Randi Kreger

BPDCentral.com

Welcome to Oz Community Owner

Stop Walking on Eggshells and the SWOE Workbook

The Essential Family Guide to BPD (October, 2008)

Science Daily (www.sciencedaily.com/)

7 Aug 08

Doctors are learning more about one of the most common psychiatric disorders --

and a novel type of " game " may be helping them.

Researchers at Baylor monitored subjects playing an economic trust game. What

they found was that patients with borderline personality disorder (BPD), an

oft-misunderstood and misdiagnosed mental illness that may affect as many as 2

percent of all Americans, exhibited distinct differences in the way they played

the game -- as well as differences in brain patterns while they were playing it.

" We see this as a first step towards destigmatizing the disease, " said P. Read

Montague, a neuroscientist and director of the Human Neuroimaging Lab at Baylor.

BPD is characterized by a number of social difficulties, including difficulty

controlling moods, impulsiveness and difficulties in relationships with other

people.

To conduct their trial, the researchers had both healthy subjects and people

with BPD play a trust game that involved one player, known as the " investor, "

give an amount of money to a second player, known as the " trustee " to invest.

The investment then returned triple the amount, and the trustee chose how much

to return to the investor.

Optimally, in this type of game, the trustee has an incentive to give a fair

share to the investor so that they will continue to invest. If, for some reason,

the trustee breaks from that pattern, they will typically try to repair that

breach by giving larger returns to encourage a larger investment in the future.

While the researchers found that to be the case with the healthy subjects, they

found that subjects with BPD were more likely to break the trust and were less

likely to take steps to repair it and increase the amount of money they could

make.

" When the borderlines play this game, cooperation breaks down and they don't

repair it, " said Montague. " There's a sense in which they don't perceive the

right signals coming to them. "

Using the brain scans, the researchers saw that an area of the brain known as

the insula, which is typically triggered in games of economic fairness, was

activated differently in healthy subjects and in those with BPD. In the subjects

with BPD, the insula was activated similarly whether they were being dealt with

fairly or not, leading the researchers to conclude that they were not picking up

social cues the way healthy subjects would.

This made it difficult to determine how the subjects with BPD actually felt

about how they were dealt with in the game, said Montague. " They probably see

all gestures as being threatening and grossly unfair. "

Montague expressed the hope that his study, which appears in the most recent

issue of Science, would help people understand that BPD has biological origins,

and is not the result of someone being difficult.

" These have not traditionally been considered organic problems with the brain, "

he said.

He also speculated that this study might help with diagnosis and treatment of

BPD in the future.

While he called the findings interesting, Dr. Black, a psychiatrist at

the University of Iowa who frequently treats patients with BPD, expressed

skepticism regarding how soon, if at all, the study's results could be put into

practice.

" It's a potentially important finding, but right now it's at the level of a

research finding that is unlikely to have a practical implication anytime soon. "

At the same time, he hoped it would bring more attention to the illness.

" I don't want to minimize the importance either, because BPD is a brain disorder

and probably has a genetic basis as well, " he said. " A lot of psychiatrists and

researchers tend to trivialize it, but it's widespread and pretty disabling.

" We need better ways to treat these patients. I think this study is consistent

with that viewpoint and may spur additional research. "

A Common Illness, Commonly Ignored

Much of the difficulty in getting doctors to treat BPD, according to Black, lies

in the fact that there is no specific pill or course of treatment.

" That tends to make doctors uncomfortable, " he said. " They often prefer

diagnoses that are associated with specific treatments. "

Also, said Black, because of the constellation of symptoms that can affect

patients with BPD, the doctor may diagnose it as something else, like bipolar

disorder or major depression.

" I think because of the constellation of symptoms that it has, to some doctors,

suggests other conditions, " he said. " From my perspective, those doctors are

certainly picking out the various pieces of the puzzle, but they're not

assembling the puzzle. They're seeing various pieces, not the whole thing. "

Black said that while the origins of BPD are unknown, there is likely a strong

genetic component. The Baylor study, he said, is only the most recent of a

series of studies that show BPD to have a biological explanation.

And Montague is hopeful that people will quickly understand that BPD is not the

fault of the patient.

" The content of what we found was remarkable and very clear, " he said.

" It's a real problem. It's just like schizophrenia. You wouldn't blame someone

who is schizophrenic for acting paranoid.

" I think it would be hard to say that they're being willfully difficult at this

point. "

R.

Manager, The Welcome to Oz Online Community for Family Members with a Borderline

Loved One