Sinopsis
Borderline personality disorder is a scientific enigma that
pathbreaking neuroscientists are trying to decipher. Thus far, research on BPD
has revealed problems or irregularities in several important areas of
functioning, such as impulse control and mood regulation. However, understanding
the cause or etiology of BPD at the present time is like working on a complex
jigsaw puzzle that has pieces missing when you have never seen a picture of the
completed puzzle. Various scientific communities are engaged in research on
different areas of the brain, on chemicals in the brain called neurotransmitters, on the anatomical architecture of the
brain, and on how specific parts of the brain function and interact with each
other. Current research is exploring specific behaviors as well as the functions
and reactions of distinct areas of the brain. Researchers are piecing together
what seem to be snippets of data, finding some answers in research from other
disciplines such as neurology and addiction. As of now, we do not know precisely
how all these new findings fit together to explain this disorder, nor do we know
what destabilizes the person, what actually triggers the emotional dysregulation
that characterizes or actually drives BPD symptoms, what starts the cascade that
leads to the emotional outbursts or suicide attempts. What we are missing is a
clear overview, a theory to integrate all these diverse observations. How does
information about specific structures of the brain, functional abnormalities, or
neurotransmitter increases or decreases add up to explanations that can account
for BPD behaviors? How do we connect the dots to see how research in one area of
neuroscience fits into research in other areas? The scientific findings brought
together here will help you reframe BPD as a mental disorder with real, tangible
biological underpinnings rather than a “character flaw” or a matter of “bad”
personality.
Imagine a doctor who is trying to treat a person with a
“fever” in the year 1200. He would see a patient who was hot to the touch,
shaking with chills, possibly red in the face, sweating profusely, or very pale
with parched lips, perhaps afflicted with hives, spots, or pustules. The doctor
would diagnose the person as having a fever. Today we would describe the person
with much more refined terminology, as having an infection caused by strep,
staph, or other bacteria or viral in origin. The patient would then receive a
specific treatment.
BPD research is still in the Middle Ages, so to speak. If a
group of blindfolded scientists were on various ladders around an elephant and
were asked to describe only what they feel and smell directly in front of them,
each one would be sure that the part he is describing is the whole. Research on
BPD is in a similar place. It has been looking at facets of the disorder—such as
mood dysregulation, impulsivity, or addictive behaviors—rather than the disorder
as a whole. As a result, BPD is generally described by its symptoms in a
dimensional way. We do not know for sure how to effectively decrease or prevent
the situations that trigger the behaviors nor do we have a panacea drug to cure
BPD, as penicillin cures infection or chicken soup “cures” the common cold. What
we do have is burgeoning neurobiological research that is giving us new areas to
study, vital clues about the disorder, and new directions as to how to treat
it.
Changing the Brain Changes Behavior
Phineas Gage was a railroad worker who lived from 1823 to
1860. Gage was a responsible, reliable, well-liked, nondrinking, and considerate
family man. He was not aggressive, nor did he get into arguments or barroom
brawls. He was in charge of a work crew that blasted rocks to clear a path for
railroad tracks. They drilled holes in the rocks, pushed gunpowder and a fuse
into the hole, added sand, then pushed it all down with an iron tamping rod. One
day, Gage was somehow distracted and a terrible accident occurred. The fuse was
ignited while the tamping rod was still in place. The resulting explosion blew
the tamping rod out of the hole and into Gage’s skull, entering under his eye
socket and coming out through the area at the top of his skull above his eye—the
region called the prefrontal cortex (PFC).
Miraculously, Gage survived his injury. The hole in his head
managed to heal, yet he seemed to turn into a completely different person. His
personality changed so drastically that he became irresponsible, made very bad
decisions, could not get along with his crew or his family, was aggressive and
careless, fought with everyone, drank heavily, and eventually abandoned his
family. He died destitute and homeless.
Antonio Damasio, in his book Descartes’
Error, described the actual area where Phineas Gage’s skull was injured;
his prefrontal cortex had suffered devastating damage. This is of particular
interest to neuroscientists today because it documents a radical change in a
person’s personality and behavior that corresponds with damage to a specific
part of the brain, the prefrontal cortex. Long before we had functional magnetic
resonance imaging (fMRI) machines with which to observe how the brain functions,
Gage’s injury demonstrated the interconnection between the architecture, or neuroanatomy, of the brain, and actual behavior. Dr. Damasio
studies people with brain injuries and tumors, relating how the exact location
of a brain injury, tumor, or lesion affects a person’s behavior. It seems that
Phineas Gage developed many symptoms of BPD after his prefrontal cortex was
damaged; certainly he became impulsive and exhibited poor judgment.
Behavioral Aspects of BPD
You have no doubt seen a juggler in a circus or magic act
tossing five or six colored balls into the air in different combinations and
rhythms
that constantly vary. Sometimes all the balls
are moving in a circle, sometimes two may be up in the air from the juggler’s
right hand while the others remain low in his left hand. Or, two are up and
three down, four up and one down. There does not seem to be a logical plan as to
how the juggler tosses these balls. You are always anticipating what he will do
next, ready for a surprise.
Now, imagine that each one of the colored balls the juggler
tosses into the air is a behavioral aspect of BPD caused by a neurobiological
system in dysregulation. Keep the image of the juggler in your mind as we
discuss how different neurobiological systems work, how they affect behavior,
and how they can help to explain BPD. This metaphor will help you understand the
mercurial behavior of people with BPD and how the nine symptoms of BPD in the
DSM-IV-TR can combine or morph into so many different variations, yet still meet
criteria for a single disorder.
Latest research findings on various neurobiological systems
explain some of the apparently irrational BPD behaviors from a neurobiological
and genetic point of view, minus guilt or blame. Have you ever noticed the
cacophony when an orchestra is tuning up before a performance? Like the
juggler’s balls, each section of the orchestra can be thought of as a
neurobiological system in dysregulation. When the orchestra is in tune you will
not hear an individual flute or an out-of-tune violin. When tuned up, each
section is in harmony with the others and you hear beautiful music. When the
brain is in tune, when moods are regulated, and sleep is not troubled, a person
will be in harmony and will function well in most situations. His behavior will
tend to be predictable and generally stable.
People with BPD have been found to have neurobiological
vulnerabilities that are likely genetic in origin yet are probably exasperated
or mitigated by environmental influences. Study your family members and try to
create your own family tree. You will probably find an impulsive uncle, an aunt
who suffered from depression, someone else who was painfully shy, a brother who
suffered with addictions, a distant cousin who was emotionally volatile and
another who was extremely sensitive. People who develop BPD seem to have lost at
the genetic lottery. They have inherited a combination of dysregulations that
have reached a critical mass of system dysregulations that seems to add up to
the disorder. If one were to inherit these traits separately, they could be
considered as assets—such as a very sensitive person who becomes an artist, an
impulsive person who is fun to be around,
or a highly
successful business person who enjoys taking risks. But the combination of these
elements, the pileup, so to speak, in one person, can result in BPD. Sometimes
BPD affects more than one child in a family or both a parent and child in
family. BPD can be found in both biological and adopted children. In one family,
a mother may have BPD, as well as four out of five of her daughters. Studies
with twins have shown that BPD runs in families, and that 69% of the variance in
the likelihood of someone having BPD can be explained by inherited genetic
factors.
Content
- Loving Someone with Borderline Personality
Disorder: The Family Experience
- The Science of Borderline Personality
Disorder
- The Principles of Behavior
Change
- Understanding Dialectical Behavior
Therapy
- Understanding and Applying
Validation
- Mindfulness
- Grieving and Radical
Acceptance
- Dialectical Behavior Therapy Skills for Behavior
Change: Interpersonal Relationships, Emotion Regulation, and Distress
Tolerance
- Mentalization: Understanding Misunderstanding
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