Brain Scans Clarify BPD - Mount Sinai School of Medicine

[jandm]

Brain Scans Clarify Borderline Personality Disorder

By Rick Nauert PhD Senior News Editor

Reviewed by John M. Grohol, Psy.D. on September 4, 2009

"Using real-time brain imaging, a team of researchers have discovered that patients with Borderline Personality Disorder (BPD) are physically unable to regulate emotion. The findings, by Harold W. Koenigsberg, MD, professor of psychiatry at Mount Sinai School of Medicine suggest individuals with BPD are unable activate neurological networks that would help to control feelings. The research will be published in the journal Biological Psychiatry."

Using real-time brain imaging, a team of researchers have discovered that patients with Borderline Personality Disorder (BPD) are physically unable to regulate emotion.

The findings, by Harold W. Koenigsberg, MD, professor of psychiatry at Mount Sinai School of Medicine suggest individuals with BPD are unable activate neurological networks that would help to control feelings.

The research will be published in the journal Biological Psychiatry.

Using functional magnetic resonance imaging (fMRI), researchers viewed how the brains of people with BPD reacted to social and emotional stimuli.

Koenigsberg found that when people with BPD attempted to control and reduce their reactions to disturbing emotional scenes, the anterior cingulate cortex and intraparetical sulci areas of the brain that are active in healthy people under the same conditions remained inactive in the BPD patients.

“This research shows that BPD patients are not able to use those parts of the brain that healthy people use to help regulate their emotions,” said Dr. Koenigsberg.

“This may explain why their emotional reactions are so extreme. The biological underpinnings of the disordered emotional control systems are central to borderline pathology. Studying which areas of the brain function differently in patients with borderline personality disorder can lead to more targeted uses of psychotherapy and medications, and also provide a link to connect the genetic basis of the disorder.”

According to background information in the article, borderline personality disorder is a common condition, affecting up to two percent of all adults in the United States, mostly women.

Characteristics of BPD include being so emotionally overreactive that they suffer alternating bouts of depression, anxiety and anger, are interpersonally hypersensitive, and are impelled to self-destructive and even suicidal behavior.

Patients with BPD often exhibit other types of impulsive behaviors, including excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The disorder is found in 10 to 20 percent of people in psychiatric care, and about 10 percent of people with this condition ultimately die of suicide. Only recently have researchers begun to identify underlying biological factors associated with the condition.

[Abigail]

Jandm,

   Thanks for posting this.  We need more of this type of research.  Our doctor treats it as a medical disorder (physically unable to regulate their emotions) that also has secondary psychological problems (some of the defense mechanisms used such as splitting).  He has been able to manage several of the "biological" symptoms with the proper medication.  My husband, son and daughter all have the disorder and my sister was also recently diagnosed.  I can testify to the effectiveness of the proper medication.  There are still psychological issues to deal with, learning ways to reduce stress and changing lifetime patterns of negativity and incorrect thinking.  But the mood swings, emptiness, and chronic anger can be relieved along with additional medication for times of stress and dysphoria.  One important aspect is being able to recognize their moods so that they know when to take the additional medication when they begin to feel overwhelmed, stressed, angry or upset.

   

Abigail

[MomToOne]

Jandm, What an interesting and informative article. Thank you for posting it.

Abigail, It is wonderful that your family members have been able to find meds that work for them. What specific medications do they take?

[dados76]

really interesting article... also makes a lot of sense... thanks for posting

[cwotton]

My daughter received a serious whiplash injury when her car was rear-ended. This was about the time I noticed pronounced BPD tendencies in her - she was 30. Since then she has been rear-ended three more times! Last time she was told she had a "brain injury" - this was by a chiropractor, and I really didn't understand the diagnosis. Couldn't get many specifics out of my dtr. I wonder if this was the cause of the BPD, or just a coincidence.

[MomToOne]

There is a poster on the "Raising children with BPD" board who has a son who had a bad fall, from very high up. He had BPD before the fall, but never wanted help from his mom to get treatment. Now he is determined to get help for the BPD. The mom is happy that he is willing to get help now, but she is sad that it took a serious injury to his head to make him see that.

Also, one of my neighbors had a terrible car accident. Her whole family was in the car, husband, daughter, son-in-law, grandkids. They all sustained serious injuries. Her daughter is recovered physically, but shortly after the accident, began acting erratically and was diagnosed as bipolar. She is on meds now, but it is still pretty difficult for her. She could not return to her job, and has trouble caring for her kids.

[Skip]

This is the source... .

New Mount Sinai Research Maps Brain and Gene Function in Patients With Borderline Personality Disorder

Mount Sinai Newsroom

(New York, NY – September 3, 2009) Mount Sinai researchers have found that real-time brain imaging suggests that patients with Borderline Personality Disorder (BPD) are physically unable to activate neurological networks that can help regulate emotion. The findings, by Harold W. Koenigsberg, MD, Professor of Psychiatry at Mount Sinai School of Medicine, were presented at the 11th International Congress of the International Society for the Study of Personality Disorders (ISSPD), held August 21 – 23 at The Mount Sinai Medical Center in New York. The research will also be published in the journal Biological Psychiatry.

Using functional magnetic resonance imaging (MRI), Dr. Koenigsberg observed how the brains of people with BPD reacted to social and emotional stimuli. He found that when people with BPD attempted to control and reduce their reactions to disturbing emotional scenes, the anterior cingulated cortex and intraparetical sulci areas of the brain that are active in healthy people under the same conditions remained inactive in the BPD patients.

"This research shows that BPD patients are not able to use those parts of the brain that healthy people use to help regulate their emotions," said Dr. Koenigsberg. "This may explain why their emotional reactions are so extreme. The biological underpinnings of the disordered emotional control systems are central to borderline pathology. Studying which areas of the brain function differently in patients with borderline personality disorder can lead to more targeted uses of psychotherapy and medications, and also provide a link to connect the genetic basis of the disorder."

Borderline Personality Disorder is a common condition, affecting up to two percent of all adults in the United States, mostly women. Characteristics of BPD include being so emotionally over-reactive that they suffer alternating bouts of depression, anxiety and anger, are interpersonally hypersensitive, and are impelled to self-destructive and even suicidal behavior. Patients with BPD often exhibit other types of impulsive behaviors, including excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. The disorder is found in 10 to 20 percent of people in psychiatric care, and about 10 percent of people with this condition ultimately die of suicide. Only recently have researchers begun to identify underlying biological factors associated with the condition.

Gene function and serotonin levels may also be contributing factors in BPD, according to research findings also presented at the ISSPD Congress by Larry Siever, MD, Professor of Psychiatry and Director of the Special Evaluation Program for Mood and Personality Disorders at Mount Sinai School of Medicine. Dr. Siever’s research demonstrates how genes related to serotonin and neuropeptides in the brain may be altered in serious personality disorders such as BPD.

Dr. Siever’s neuroimaging research suggests that a gene that controls production of a critical enzyme for the synthesis of serotonin, a brain chemical that modulates emotions and aggression, may be altered leading to reduced synthesis of serotonin in people with BPD and may be associated with increased aggression. This variant of gene may also be associated with reduced frontal lobe activation in the brain.

11th International Congress of the International Society for the Study of Personality Disorders

August 21 – 23

These studies were part of the 11th International Congress of the International Society for the Study of Personality Disorders, which took place August 21 – 23 at The Mount Sinai Medical Center in New York. More information about the Congress can be found at isspdcongress2009-nyc.com.

About The Mount Sinai Medical Center

The Mount Sinai Medical Center encompasses The Mount Sinai Hospital and Mount Sinai School of Medicine. The Mount Sinai Hospital is one of the nation’s oldest, largest and most-respected voluntary hospitals. Founded in 1852, Mount Sinai today is a 1,171-bed tertiary-care teaching facility that is internationally acclaimed for excellence in clinical care. Last year, nearly 50,000 people were treated at Mount Sinai as inpatients, and there were nearly 450,000 outpatient visits to the Medical Center.

Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and basic science research, as well as having an innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institute of Health (NIH) grants. For more information, please visit www.mountsinai.org

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[samsara]

Absolutely! thanks for posting.

[Abigail]

My daughter received a serious whiplash injury when her car was rear-ended. This was about the time I noticed pronounced BPD tendencies in her - she was 30. Since then she has been rear-ended three more times! Last time she was told she had a "brain injury" - this was by a chiropractor, and I really didn't understand the diagnosis. Couldn't get many specifics out of my dtr. I wonder if this was the cause of the BPD, or just a coincidence.

It is possible to develop BPD after a brain injury.  I couldn't say whether or not that is how your daughter developed it, but it is possible to develop it from a brain injury.

[lbjnltx]

my nephew also was dx with bi polar disorder after a near fatal car crash that resulted in a severe head trauma.  didn't ever link the 2 because his mom is bi polar as well  ?

his behavior got so bad that he left my mom and dad's home at 15 (they have had him since he was 3 after his dad ... my brother died) and went to live with his bio mom... .a convicted drug user/dealer.

what a mess!

abigail,

what are the medications that you have found to be affective for BPD and what specific issues do these meds seem to treat?


thanks

lbjnltx

[samsara]

My daughter received a serious whiplash injury when her car was rear-ended. This was about the time I noticed pronounced BPD tendencies in her - she was 30. Since then she has been rear-ended three more times! Last time she was told she had a "brain injury" - this was by a chiropractor, and I really didn't understand the diagnosis. Couldn't get many specifics out of my dtr. I wonder if this was the cause of the BPD, or just a coincidence.

It is possible to develop BPD after a brain injury.  I couldn't say whether or not that is how your daughter developed it, but it is possible to develop it from a brain injury.

I would not doubt that for one moment, and I do believe there is some research underway involving sports-related head injuries and the development of mental health issues (major depression, Parkinsons, etc.)

My uBPDbf had his first major head injury from a car accident in his early 20s (face meets car windshield), I can't help but wonder if his troubled childhood combined with this serious accident helped to contribute to his current struggles.

[Rose1]

Bi polar illness has a genetic pre-disposition, on more than one gene so the types of bi polar and the condition vary from person to person.  Although there is a genetic pre disposition, this disorder also is often affected or triggered by environmental factors as is schizophrenia.  Hence you may have some mild symptoms, abuse drugs or have an extremely stressful event and develop one of the forms of full blown bi polar or you can have it onset as a juvenile. There has been some discussion around triggers "turning genes on".  BPD is often associated with bi polar but also associated with severe abuse or sometimes with nothing obvious.  There is some evidence that it is learned behaviour either in response to surroundings, adult behaviour around the child, or perhaps a coping mechanism for bad emotional feelings that are part of bi polar, reinforced by the fact that the bad behaviour works - ie they get their own way.  Childhood abuse also is often present in PD's and my understanding is 100% present in MPD.  I suspect there are a lot of interlinking factors, none of which are well understood.

Certainly brain injury which damages the same areas that are impacted by bi polar, BPD etc could cause similar symptoms - uncontrolled anger and rage is common in brain injured people for example as it is in juvenile onset bi polar.

A lot of the above is from my psych text book.

Regards

Rose

[picturelady]

Wow, thanks so much for posting this.  Truly fascinating. 

Makes me wonder if reading this type of research has an impact on those of us leaving (or having left) BPD relationships?  In the past this may have sent me into a tailspin of guilt. 

But not anymore. 

I know that I can't live with it... .nor can my kids... .and I'm certainly not helping him by staying.

Anybody else care to share your thoughts on this?

Best,

PictureLady

[snakey]

Makes me wonder if reading this type of research has an impact on those of us leaving (or having left) BPD relationships?  In the past this may have sent me into a tailspin of guilt. 

Makes those of us forced to leave feel slightly better(?) though perhaps.

Doesn't stop the hurt or diminish the damage sustained but this sort of article can help in recovery perhaps? Certainly in understanding.

Difficult still, but important, these people have such a significant impact on our lives, however you wind up feeling about them, reading and researching this kind of thing is good for us. Whether you ever see your SO again or not, the chances are you'll think about them all the time and, regardless of whatever abuse you suffered at the time, there will always be pangs of guilt/longing/love and whatever else the FOG brings.

What if I'd done/said that instead? etc and ladeda!

Great article.

If it's so prevalent though why aren't professionals trained better in how to treat it?

Here in the UK trying to get help is like banging your head against a wall.

[StillBarbM]

has a son who had a bad fall, from very high up. He had BPD before the fall, but never wanted help from his mom to get treatment. Now he is determined to get help for the BPD. The mom is happy that he is willing to get help now, but she is sad that it took a serious injury to his head to make him see that.

I believe I am the mom referred to here.  My son does have traumatic brain injury and there are many things that are different about him since that injury.  Most better, some the same, some worse.  He actually is more outwardly emotional than he ever was before, other emotions besides anger.  That is a good thing.  He still struggles.  But he doesn't seem to get as angry as he used to and when he does, or feels rage coming on, he leaves wherever he is and goes off on his own until he feels better again rather than exploding and vomiting emotionally on anyone in his path.

TBI causes so many changes in the brain.  Some that can be overcome with time and healing, some that cannot, and no one knows who will recover and who won't or how much.  It is thought to be the trigger in some instances for personality disorder/mental illness.  Especially with frontal injuries.  In my son's instance, the problems he was having were in the frontal part of his brain.  Seizure activity was found during functional MRI BEFORE his injury.  Seizures that caused impulsive behaviors rather than motor problems.  Not anymore.

Same with his father.  Seizure activity causing acting out, lack of impulse control.

Both were treated with anticonvulsants, depakote and tegretol, and their behavior was more controlled, less impulsive.

I'm really glad to see that they have found some real hard scientific evidence to maybe demystify this illness.  Then maybe better medications can be found to control the symptoms better while behavior modification and therapy works from that angle.

Interesting article.  Thanks again, Barb

[Indigo Sky]

This research news is fantastic. First it shows that BPD is starting to have more general awareness... .but most importantly with the number of people affected with BPD, doctors, scientists and the drug companies will probably start ramping up their R&:) to find a cure... .now that makes me so happy!

[sosadandone]

google Phineas Gaga

famous story, RR worker in the last century who was mild mannered, nice guy

until a RR spike went thru his pre-frontal cortex and he drastically changed

Siever has spoken about him in various articles. Worth the read

[LOAnnie]

Think of it as having a high temperature.  There are many things that can cause a high temperature, for example, a polio virus can give a person a high temperature, or a bacterial pneumonia can give a person a high temperature.  I believe even having a broken leg can result in a fever.   Entirely different causes can create the same symptom: a fever.

In the same way, the symptoms of wild emotional swings, cognitive distortions, and negative acting-out behaviors can be caused by a personality disorder or by a traumatic brain injury.  Two different causes, same result.  So whether the behaviors are due to a genetic predisposition, or to some in-utero or perinatal exposure to a virus, or a bacteria, or an allergic reaction, or malnutrition, or poisoning,  or are due to a brain injury, these symptoms do seem to have something to do with some kind of physical, organic brain wiring problem or brain chemistry problem.

At least, that's the way I interpret the studies.

-LOAnnie

My daughter received a serious whiplash injury when her car was rear-ended. This was about the time I noticed pronounced BPD tendencies in her - she was 30. Since then she has been rear-ended three more times! Last time she was told she had a "brain injury" - this was by a chiropractor, and I really didn't understand the diagnosis. Couldn't get many specifics out of my dtr. I wonder if this was the cause of the BPD, or just a coincidence.

It is possible to develop BPD after a brain injury.  I couldn't say whether or not that is how your daughter developed it, but it is possible to develop it from a brain injury.

I would not doubt that for one moment, and I do believe there is some research underway involving sports-related head injuries and the development of mental health issues (major depression, Parkinsons, etc.)

My uBPDbf had his first major head injury from a car accident in his early 20s (face meets car windshield), I can't help but wonder if his troubled childhood combined with this serious accident helped to contribute to his current struggles.

[Shells]

Without a doubt, head and brain injuries can cause personality changes. Psychologists have known about that since the mid 1800s when Phineas Gage had a railroad spike go through the frontal lobes of his brain. He survived just fine, but his personality changed dramatically.

I suspect that the genetic component of BPD represents a biological predisposition which may (or may not) become manifest depending on the stresses (both physical and biological) that the individual experiences. There are likely multiple possible causal pathways that alter brain structure and function in BPD, but the article certainly implicates brain structure as a proximal cause.

It's consistent with what we know -- unmedicated and without therapy, BPD cannot exert control the way the rest of us can. It can also potentially point researchers toward more effective treatments. Good stuff.