Category Archives: Bpd

Childhood trauma and BPD.

Childhood Trauma, The Hippocampus, Depression And Neurogenesis.

Childhood Trauma Can Harm Brain And Increase Risk Of Depression. However, The Good News Is The Brain Can Recover. This Article Explains How.

When we are at our most depressed, we may look at (as others perceive it) a beautiful sunset and derive no more pleasure from it than we would from looking at a rubbish dump or ugly building site. In short, nothing can lift our spirits and we feel unvaryingly, utterly desolate. It is as if the part of our brain that once experienced pleasure is now dead and unresponsive, never to be revived.

In fact, the latest research suggests that, indeed, a part of the brain, known as the hippocampus (a structure involved with long-term memory, the formation of new memories, and associating emotions with such memories), is impaired in function and reduced in volume in those suffering from severe, recurrent depression.

The good news, however, is that research also suggests that this brain region’s functioning is NOT irrevecocably impaired due to a specific type of brain neuroplasticity (the ability the brain has to repair and rewire itself) known as NEUROGENESIS (the brain’s ability to generate new neurons).

THE RESEARCH :

The research to which I refer has discovered that, in individuals who are severely depressed and suffer recurrent depressive episodes, the hippocampus has become significantly reduced in size. (We know, too, from numerous other articles that I have published on this site, that those who have suffered severe and chronic childhood trauma and, as a result, have gone on to develop conditions such as borderline personality disorder or complex posttraumatic stress disorder are also liable to have incurred developmental damage to this particular brain region ; and, indeed, sufferers of these conditions frequently also receive a co-morbid diagnosis of clinical depression).

The study involved 8,927 participants of whom 1,728 had received a diagnosis of major depression. This allowed the researchers to compare the brains of the depressed individuals with the brains of the healthy individuals using data that had been obtained using a brain scanning technique technique known as magnetic resonance imaging (MRI).

Of the depressed individuals, 65 per cent had recurrent depression and it was this subset of the depressed individuals who were found to have shrunken hippocampi (those participants who were experiencing their FIRST depressive episode had hippocampi which were of normal size).

IMPLICATIONS OF THE ABOVE FINDINGS :

As the researchers pointed out, these findings suggest that it is the depression which causes the damage to the hippocampus, rather than the other way around and this discovery helps to emphasize how important it is to commence treatment for depression at the earliest possible opportunity, especially in teenagers and young adults whose brains may be more susceptible to physical damage due to their greater plasticity when compared to the brains of adults, in order to prevent such organic damage to the brain from occurring.

Indeed, the researchers. underlining this point, drew attention to the fact that the longer depression goes on, and the more depressive episodes an individual suffers, the greater the reduction in size of that individual’s hippocampus is likely to be.

EFFECT OF DAMAGE DONE TO THE HIPPOCAMPUS :

There now exists an increasing body of evidence that one of the functions of the brain’s HIPPOCAMPUS may be the recognition of novelty and it has been theorized that, because, as we saw above, it may be damaged in depressed individuals, particularly those individuals who have suffered long-standing, recurrent depressive episodes, these people may lose the ability to respond to novelty and this loss then contributes significantly to their depressive state. For instance, it helps explain why they may not respond with pleasure to a beautiful sunset (see opening paragraph) and why they are prone to seeing whatever they do as ‘being the same’, by which is meant everything produces the same feelings of flatness, emptiness, meaninglessness ; in short, a state of anhedonia.

THE GOOD NEWS : EVIDENCE THAT THE DAMAGE INCURRED BY THE HIPPOCAMPUS IS REVERSIBLE :

The good news, however, as has already been alluded to above, is that numerous studies have demonstrated that such damage to the brain is, in fact, reversible ; this is due to a quality that the brain possesses known as neuroplasticity (which I have written extensively about in many other articles that I have already published on this site – e.g. see my article about three ways in which the brain is able to repair itself in relation to the damage it has sustained as a result of childhood trauma).

Indeed, one of the leading researchers involved in the study, Hickie, described how the hippocampus was one of the brain regions within which it is known that cells can rapidly generate new connections between themselves (this process is known as neurogenesis, see above) to replace the connections that were lost during the periods of untreated depression.

WHAT KINDS OF TREATMENT DO THE RESEARCHERS INVOLVED IN THE STUDY SUGGEST?

Hickie further states that there is some evidence that medication (antidepressants) protect, to some degree, the hippocampus from shrinking but also stressed the importance of meaningful social interventions as a form of treatment, pointing out that if, when depressed, we simply sit alone in a room and isolate ourselves, failing to interact socially with others, then this lack of social interaction, in itself, is likely to reduce the size of the hippocampus – a good social support system, then, is an extremely important factor to be considered when deciding how best to treat depression.

Furthermore, Hickie states that there is also evidence that treatment using fish oils can be ‘neuroprotective.’

In the case of young people, Hickie suggests that psychotherapy may often be the first-line treatment offered, rather than medication. (N.B. Always consult an appropriately qualified professional when considering medical treatments).

eBook :

Above eBook now available for immediate download from Amazon. Click HERE for further details.

Related Research : Hippocampal Volume Reduction In Major Depression.

RESOURCE :

Depression Self-Help | Self Hypnosis Downloads

David Hosier BSc Hons; MSc; PGDE(FAHE).

BPD And Resolving Conflict With Others

If we suffered severe and chronic childhood trauma, particularly if, as a result, we have gone on to develop borderline personality disorder, it is likely that, without appropriate therapy, we frequently find ourselves in heated conflict with others, especially those others to whom we are emotionally attached such as partners or family members.

Indeed, one of the hallmarks symptoms of BPD is the experiencing of difficulties with interpersonal relationships.

We may have relationship problems for a variety of reasons that include :

And, when a relationship ends, sufferers of BPD are liable to take it particularly hard, especially if rejected in such a way as to trigger reminders of childhood rejection (on either a conscious or unconscious level). Indeed, the emotional pain of such rejection can be as excruciating as severe physical pain.

Because of the frequent ‘love-hate’ relationships BPD sufferers are prone to creating, the nature of the conflict between the sufferer and his / her partner tends to be cyclical and the first step is to become aware of the cycle and recognize its futility and destructiveness.

We also need to recognize the damage it is doing to our relationship ; conflict leaves both us and the person with whom we are in conflict feeling bad. Indeed, following outbursts of anger and rage, BPD sufferers tend to experience overwhelming feelings of profound shame. So, in essence, everyone loses and the relationship is undermined (and is likely to collapse altogether in the absence of effective, remedial action being taken).

Once we have become aware of this destructive cycle, we next need to make a definite commitment to trying our best to break it.

Obviously, though, if one has had a long history of getting into high conflict situations with others, the process of change is likely to take time and cannot, of course, be expected to work instantaneously ; one needs to learn and practice new social skills until they, in an ideal situation, become ‘second-nature’ and there will inevitably be setbacks along the way, paricularly when one is under intense stress, is deliberately provoked or is facing rejection.

Of course, each individual will have their own set of personal triggers which put them at high risk of entering into conflict with another so the next step is to try to IDENTIFY SUCH TRIGGERS.

Not letting potential triggers set off undesirable behaviors also entails controlling impulsivity ; you can read my previously published article entitled : Control Impulsive Behavior by clicking here. Also, you may wish to read my articles : Impulse Control : Study Showing Its Vital Importance and Childhood Trauma And The Development Of Impulse Control Disorders.

Once triggers have been identified, the next step is to rehearse in the mind how one will respond in such a way as not to create conflict or in a way that de-escalates any conflict that already exists. Using visualization techniques to aid mental rehearsal of one’s new, positive ways of dealing with situations that would have previously led to conflict can be particularly effective.

In his excellent book : The High Conflict Couple : A Dialectical Behavior Therapy Guide To Finding Peace, Intimacy And Validation (see image below to view on Amazon), Fruzzetti PhD endorses the above techniques and suggests using the acronym SET to help us to remember more constructive ways of dealing with conflict than we may used in the past ; SET stands for utilizing sympathy, empathy and truthfulness.

Assertiveness training can also help to ensure that a gentler approach to dealing with potential conflict does not lead to being taken advantage of.

RESOURCE :

Fruzzetti PhD’s Book :

David Hosier BSc Hons; MSc; PGDE(FAHE).

BPD, The Love-Hate Relationship And Neuroscience

love=hate

We have seen from several other articles that I have published on this site that one of the hallmarks of borderline personality disorder is the tendency of sufferers of this devastating psychiatric condition to flip suddenly from idealizing / feeling love towards individuals and demonizing / feeling hate towards them (which, of course, is a major reason why BPD sufferers also tend to have severe difficulties with their interpersonal relationships). This tendency is sometimes referred to as ‘SPLITTING.’

Intriguingly, a study (Zeki et al.) carried out at University College, London, may help to elucidate this tendency to suddenly ‘switch’ betwen loving and hating the same person from a neurological perspective (i.e. in terms of brain’s physical organization and biological functioning).

THE STUDY :

The study invoved 17 individuals who had their brain scanned under two conditions :

CONDITION 1 : Brain scans were taken whilst the individuals were looking at photos of people they loved.

CONDITION 2 : Brain scans were taken of the same individuals in Condition 1 whilst they were looking at photos of people the claimed to hate.

NERVOUS CIRCUITS IN THE BRAIN :

Researchers found that some of the brain’s nervous / neural circuits involved in generating feelings of hate are ALSO INVOLVED IN GENERATING FEELINGS OF LOVE.

More specifically :

The region of the brain known as the putaman seems to be activated both when an individual is experiencing feelings of love and when s/he is experiencing feelings of hate including disgust, contempt and aggression.

The region of the brain known as the insula also seems to be activated both when an individual is experiencing feelings of love and when s/he is experiencing feelings of hate,

THE CEREBRAL CORTEX :

Furthermore, research findings suggest that regions of the cerebral cortex are deactivated both when an individual is experiencing feelings of love (the regions deactivated when we are experiencing feelings of love are involved in reasoning and judgment) and also when s/he is experiencing feelings of hate.

However, it should also be noted that fewer regions in this part of the brain are deactivated when the person is experiencing feelings of hate.

This finding may help to explain the neurological underpinnings of the origin of the expression that ‘love is blind’ (i.e. when feeling intense love, all reasoning and judgment tends to go out of the window and we are, to put it colloquially, liable to be led irrationally by the heart rather than rationally by the mind).

Furthermore, the fact that fewer regions of this brain region seem to be deactivated when people experience feeling of hate may be a kind of safely mechanism to prevent them from, for example, resorting to excessive, unnecessary and perhaps, ultimately, self-defeating violence in response to these feelings.

Indeed, the author of the study suggests that the cerebral cortex is less deacivated when people feel hate than it is when people feel love because when they feel hate they need to be able to reason effectively so that they can be sufficiently calculating when it comes to exacting revenge! Such calculation, more relevant to our ancient ancestors, may involve judging if a physical fight could potentially be won and what it would be necessary to do in any such fight to win it – alternatively, it might be necessary to judge whether a violent attack on an opponent will backfire as said opponent is of vastly superior physical strength.

One can, perhaps, tentatively infer from this that evolutionary processes have determined that we are less rational in response to feelings of love than we are in response to feelings of hate.

In any event, it seems the fine line between love and hate, and the propensity, especially in the case of BPD sufferers, to flip suddenly between the two has a neurological basis.

RESOURCE :

Increase Your Emotional Intelligence | Self Hypnosis Downloads.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Attitudes Of Medical Professionals Towards BPD Sufferers

childhood-trauma

We have seen from other articles I have published on this site that if we suffered significant and protracted childhood trauma we are, as adults, at increased risk of developing borderline personality disorder (BPD).

Many specialists in the field are of the view that of all psychiatric conditions, BPD causes its sufferers the greatest amount of mental pain and anguish – indeed, this is borne out by the generally accepted statistic that approximately 1 in 10 BPD sufferers will eventually kill themselves.

It is particularly tragic, therefore, that it seems that there still exists a great deal of prejudice towards BPD sufferers. And I don’t just mean amongst lay-people who lack understanding of, and education about, the condition, but also amongst those who should know better : namely those who work within the medical profession itself and are responsible for their care and safety.

This unfortunate state of affairs is exacerbated further when one considers that many BPD sufferers have been demonized throughout their lives (including, often, by one or both of their parents) and have come to internalize such demonization, seeing themselves as intrinsically and irredeemably ‘bad’ ; so to meet with similar disparaging attitudes amongst those to whom one turns, often in absolute desperation, for support can be devastating and can potentially tip BPD sufferers over the precipice (most BPD sufferers are perpetually living their lives on the edge of said precipice most, or all, of the time).

RESEARCH PROVIDING EVIDENCE OF STIGMATIZATION OF BPD SUFFERERS WITHIN THE MEDICAL PROFESSION :

STUDY 1 :

Reseachers (Black et al.) surveyed 706 clinicians who were responsible for treating BPD patients and found that a large minority expressed a preference not to work with such patients.

STUDY 2 :

An Italian study (Lanfredi et al.) investigated caring attitudes towards BPD sufferers amongst 860 mental health professionals (these included social workers, educators working in social health, nurses, psychiatrists and psychologists). It was found that :

  • nurses and social workers scored significantly lower on caring attitudes towards BPD sufferers than psychologists, psychiatrists and social health educators.
  • those mental health professionals who had more years experience in mental health and those who had had training in working with BPD patients, overall, scored higher in terms of their caring attitudes towards BPD sufferers compared to those with fewer years of experience / no training in working with BPD sufferers.

The researchers who conducted the above study concluded that training in working with BPD sufferers should be targeted at those clinicians who are less experienced and professional groups for whom such training is less accessible.

STUDY 3 :

A study carried out by Imbeau et al., looked at the attitude of General Physicians and Family Medicine Residents towards patients with a BPD diagnosis.

In total, the study involved 35 General Physicians and 40 Family Medicine Residents. Their attitudes towards their BPD patients was measured using the ATTITUDES TOWARD PEOPLE WITH BPD SCALE (ABPDS; Bouchard, 2001).

This scale is divided into 2 subcales :

SUBSCALE ONE : COMFORT WHEN INTERACTING WITH SOMEONE WHO HAS BPD.

SUBSCALE TWO : POSITIVE PERCEPTIONS ABOUT BPD.

It was found that the attitudes of General Physicians towards people with BPD was similar to the attitudes of mental health professionals towards people with BPD.

However, it was also found that Family Medicine Residents’ attitudes towards people with BPD were less positive than the attitudes displayed by General Physicians and mental health professionals.

Furthermore, and reinforcing the findings of Lanfredi et al’s study, it was found that less experienced clinicians had less positive attitudes towards BPD sufferers than their more experienced colleagues.

This also serves to emphasize the conclusion drawn from Lanfredi et al’s study, namely that training of clinicians dealing with people with BPD needs to be a key focus to help ensure these highly vulnerable and anguished patients receive the treatment they deserve.

STUDY 4 :

A Spanish study (Castell) also found negative attitudes within the medical profession and, like the studies cited above, also stressed the importance of training such mental health professionals so that the gain a better understanding of the causes of, nature of, and treatment for borderline personality disorder.

OTHER USEFUL ARTICLES :

You may also wish to read my previously published articles about dialectical behavior therapy, other treatment options for BPD , BPD and psychodynamic therapy and BPD and remission.

eBook :

bpd ebook

Above eBook now available on Amazon for instant download : CLICK HERE.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Maternal Reinforcement Of Passive Dependency In Future BPD Sufferers

When I was young, my mother seemed to derive an odd sense of satisfaction (one hesitates to use the word ‘pleasure’) from my emotional distress. At such times, I see now, her fundamental motivation to comfort me (by talking to me, never in a tactile way by hugging etc.) was to make herself feel needed, of value, powerful, in control and superior to my own ‘inadequacy’.

Indeed, I can now see that she would deliberately induce states of distress in me so that she could then play the role of a nurturing mother ; she seemed to enjoy, and derive satisfaction from, toying with my emotions – repeatedly ‘breaking’ me in order to afford herself the opportunity of ‘fixing’ me – rather as a cat might enjoy and derive satisfaction from toying with a mouse by repeatedly catching it and letting it go only so it could catch it again…and so on…and so on…

This gave her complete control and absolute power over me ; once she had reduced me to a desperate and pleading display of tears by subjecting me to her unbounded rage and name-calling, and then left me to suffer for a while (often by giving me the silent treatment ),

I would be pathetically grateful, submissive and pliable when, at a time of her choosing, she deigned to ‘forgive’ me and play (for short while until the cycle repeated itself) the ‘magnanimous’ mother (on more than one occasion, it comes back to me now while writing this) by administering to me whisky in warm milk and half of one of her valium).

In short, playing the nurturing’ mother wasn’t about making me feel good – it was about making herself feel good about herself.

However, I have never mentioned this particular aspect of my mother’s behavior to anyone for fear of sounding ungrateful and cynical. After all, as many who have suffered childhood trauma will know all too well, even our most patently reasonable and self-evidently justifiable objections to our upbringing can be, and frequently are, invalidated by others (for myriad reasons – e,g. see my articles How Narcissistic Mothers Can Invalidate Us ; my article, BPD, Effects Of Biparental Dysfunction And Invalidation and also my article about gaslighting) compunding the effects of our trauma and intensifying our irrational feelings of shame.

I was heartened, therefore, to come across the work of Masterson and Rinsley (1975). They theorize that mothers can cause psychopathology in their children, later leading to the development of borderline personality disorder (BPD), by preventing them from undergoing the separation-individuation process (see also my article on ‘enmeshment’).

They prevent their children going through this process, according to Masterson and Riley, by encouraging them to be dependent. They encourage this dependency, according to the theory, as it gives them (i.e. the mothers) a sense of pride, satisfaction , gratification and self-esteem. It is further theorized that they achieve this by positively reinforcing the child’s ‘needy’ and ‘clingy‘ behavior whilst discouraging any signs of the child creating an independent, autonomous life for him/self. This then has the effect of preventing him/her from breaking away from her and forming his/her own idenity

passive-dependence

Indeed, tangetially related to the idea of certain types of mothers (especially narcissistic mothers) not wanting their child to form his/her own sense of identity, I recall that my own mother would frequently take it as almost a personal affront if ever I tried to change the subject from talking about her life (normally her ‘boyfriend troubles’) to talk, even for a short while, about any of my own intersests (at the time these were meteorology and magic tricks ; I often think now that it is no co-incidence that the former involved trying to understand a chaotic and difficult to predict system, whilst the latter involved developing ‘special powers’ to make the ‘impossible’ happen, like making things ‘disappear’ – no prizes for guessing what these things almost certainly symbolized in my unconscious).

But back to Masterson and Risley. The researchers state that such maternal behavior (i.e. rewarding the child’s dependence whilst punishing him/her – or, at least, withdrawing approval – when s/he attempts to gain mastery, independence and self-sufficiency) is frequently most prevalent during the developmental stage of the child when psychological and social influences are at their most potent in relation to instilling in him/her a need to become independent, thus creating maximum conflict in the child’s mind.

David Hosier BSc Hons; MSc; PGDE(FAHE).

BPD, Feeling Painfully Empty, The ‘Leaky Cup’ Metaphor And Thrill Seeking

When a child is born into the world, s/he is utterly helpless and dependent upon his / her mother, and, in the early days of life, as long as his / her mother is present and sufficiently responsive to his / her needs, the baby is able to feel relatively safe, content and secure.

However, when the mother is absent, the baby quickly becomes panicked and distressed (as s/he has no way of knowing for certain that the mother will return.

As the baby develops, though, and continues to receive at least adequate nurturing from the mother, s/he becomes more able to tolerate periods of time when the mother is not present, especially if s/he is able to derive some compensatory comfort during such periods from objects such as soft toys and dummies. This is possible because s/he has managed to internalize the emotional nourishment s/he has previously received from the mother in such a way as to protect him/herself from developing overwhelming feelings of insecurity during temporary, maternal absences.

A metaphor that helps to elucidate this process is that of the ‘leaky cup,’ If an infant has received adequate ’emotional nourishment’ from the mother during the very early part of his/her life, s/he will have a good store of this nourishment in his/her (metaphorical) cup, and, during separations from the mother, the nourishment will only slowly ‘leak out of the cup.’ In other words, the infant is able to draw on this ‘nourishment’ during ephemeral periods of maternal absence as the store is reasonably voluminous and enduring.

However, in the case of an infant who has received inadequate nurturing from his mother during his/her early life, his/her ‘cup of emotional nourishment’ will be far less full than the relatively secure infant’s cup, and, what’s more, far ‘leakier’. Such a poorly cared for infant, then, will have an insufficient supply of previously stored emotional nourishment upon which to draw and is liable to become highly distressed as a result of even very brief periods of maternal absence (in terms of Bowlby’s theory, the infant is ‘insecurely attached’ to the mother).

Putting it simply, then, the nurtured infant can be viewed as adequately ‘full’ in terms of ’emotional nourishment’, whereas the neglected infant can be viewed as nearly ’empty’ in terms of such maternal nourishment.

As the neglected / empty child grows (assuming this lack of emotional nourishment is not somehow corrected, s/he will then, of course, eventually become an adult who also feels a pervasive sense of emptiness, especially if the extent of his/her childhood neglect has led him/her to develop borderline personality disorder (BPD) or complex posttraumatic stress disorder (complex PTSD).

In such cases, this feeling of ’emptiness’ can lead to severe and chronic psychological suffering and anguish.

It has been hypothesized, therefore, that these feelings of emptiness (one hallmarks of BPD, as alluded to above) are intimately connected to another frequent symptom of the disorder, namely that of impulsive thrill-seeking and risk-taking.

In short, in a desperate (and, ultimately, of course, futile) attempt to rid him/herself of intolerably painful feelings of emptiness,the BPD is exquisitely vulnerable to developing an array of risky, self-destructive addictions, including drug-taking, alcoholism, chain-smoking, gambling and self-harm.

Currently, one of the most effective treatments for BPD available is dialectical behavior therapy.

David Hosier BSc Hons; MSc; PGDE(FAHE).

BPD And Genetic Heritability

GENES, ENVIRONMENT AND BORDERLINE PERSONALITY DISORDER (BPD) :

Studies have been conducted that suggest that parents suffering from borderline personality disorder (BPD) may pass on certain genes to their children that predispose them to impulsive behavior and emotional volatility.

For example, a study conducted by Distel et al. (2007) suggested that the genetic component (heritability) of BPD is about 42%, whilst a study conducted by Torgersen (2000) put them figure even higher, at 69%.

Of course, this does not mean there is a ‘gene for BPD’, but, rather, the findings suggest that certain temperamental features of an individual that are passed on genetically may increase a person’s RISK of developing BPD in later life. However, whether or not this person does develop it will depend upon the QUALITY OF THE ENVIRONMENT, WITH PARTICULAR REFERENCE TO TREATMENT BY PRIMARY CARERS, IN WHICH S/HE GROWS UP and how this INTERACTS with any genetic vulnerability to the disorder s/he has inherited.

Clearly, too, it should be noted that, as the disparity between the two percentages shows (42% and 69%), trying to quantify the heritability of disorders like BPD is a far cry from being an exact science.

MOTHERS WITH BPD :

Of course, if the mother of a child has been diagnosed with BPD, not only may her child have inherited certain temperamental characteristics (see above) that predispose him/her to developing the same disorder in later life, but, additionally, the mother may also create an environment for the developing child that compounds any genetically inherited propensity s/he may be harbouring for later being diagnosed with BPD him/herself.

genes

Dysfunctional maternal behaviors towards the child that may increase his/her risk of developing psychopathology in later life include rejection, inconsistency (e.g oscillating between idealizing and demonizing the child) , hostility, invalidation, ’emotional incest’ and other forms of emotional abuse.

And, if the child is, by temperament, emotionally labile, his/her responses to the BPD mother’s unstable and unpredictable behavior may serve to create a vicious-cycle of mother-child interaction.

As a result of this, the child may start displaying severe problems relating to mood (e.g. depression and anxiety) and behavior (e.g. aggression, self-harm and hypervigilance).

PROTECTIVE FACTORS :

Children who may have inherited personality traits which increase their risk of developing BPD in later life may be protected from this most undesirable fate by consistently receiving affectionate, loving and accepting nurturing. If this is not forthcoming, therapeutic intervention (e.g. family therapy or dialectical behavior therapy) can be of substantial benefit.

David Hosier BSc Hons; MSc; PGDE(FAHE).