Borderline personality disorder I hate you, please don

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Borderline personality disorderI hate you,
please dont leave me

• Tori Collins

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BPD

• Borderline personality disorder (BPD) is a
  condition in which a person makes impulsive
  actions, has an unstable mood and chaotic
  relationships.
• BPD affects 1-2 of the general population
• Most common in young women
• Borderline between neurosis and psychosis

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DSM-IV

• Affective Criteria
• Periods of intense anger and difficulty
  controlling anger
• Chronic feelings of emptiness
• Affective instability episodes of dysphoria,
  irritability, or anxiety lasting from a few hours
  to a few days
• Cognitive Criteria
• Transient paranoia/dissociation due to stress
• Unstable self image or sense of identity

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DSM-IV

• Behavioral Criteria
• Recurrent suicidal behavior, gestures, threats,
  or self-mutilation
• Impulsivity in at least two areas that are
  self-damaging that do not include the above (i.e.
  substance abuse)
• Interpersonal Criteria
• Frantic efforts to avoid real or imagined
  abandonment
• Unstable and intense relationships alternating
  between extremes of idealization/devaluation

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BPD

• Causal factors
• Childhood abuse is reported by many patients
• Genetic sparse data
• 37 concordance rate for monozygotic twins (7
  dizygotic)
• multivariate analysis reveals 47 heritability
  in emotional dysregulation

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Lieb, 2004
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BPD

• Treatments
• Group and individual psychotherapy
• Antidepressants, mood stabilizers, antipsychotics
• Regulate 5HT/NE/GABA
• Dialectical behavior therapy developed
  specifically for treatment of BPD
• Teaches emotional regulation
• Tolerate distress
• Be more effective in interpersonal conflict
• Control attention to be in the moment

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BPD

• BPD is often comorbid with other psychiatric
  illnesses
• Major depression
• Eating disorders
• Anxiety disorders
• Other personality disorders
• Post-traumatic stress disorder 46-56 of BPD
  patients are diagnosed with PTSD

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BPD

• BPD and PTSD can both be caused by the experience
  of traumatic events
• BPD is considered by some to be a form of complex
  chronic PTSD
• BPD is often associated with childhood trauma
• Neglect, abuse
• Most frequently associated with sexual abuse
• Impulsive behavior puts those with BPD at greater
  risk for experiencing traumatic events such as
  driving accidents and physical or sexual assault

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Reduced amygdala and hippocampus size
intrauma-exposed women with borderline
personalitydisorder and without posttraumatic
stress disorder

• Godehard Weniger, MD Claudia Lange, PhD Ulrich
  Sachsse, MD Eva Irle, PhD

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Background

• PTSD associated with reduced volume of the
  hippocampus and left amygdala and with reduced
  cognitive functions
• Small hippocampus and amygdala size are also seen
  in patients with PTSD and BPD
• Current study are reduced amygdala and
  hippocampus volume and cognitive deficits present
  in patients with BPD and without PTSD?

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Methods

• 24 female in-patients exposed to severe physical
  and sexual childhood abuse
• 25 matched healthy controls
• Assessed for history of neurologic disease, MRI
  abnormalities, psychotic disorders, bipolar
  disorders, substance abuse, and dissociative
  disorders
• Diagnoses of BPD without PSTD based on DSM-IV
  criteria and SCID interviews

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Methods

• Comorbid disorders in subjects included major
  depression, alchohol-related disorders and eating
  disorders
• Patients had been medicated for at least 3 weeks
  prior to the study
• Some were given antidepressants and/or sedatives

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Methods

• Measured intracranial and total brain volume by
  MRI, separating the amygdala and hippocampus
• Measured intellectual, mnemonic and attentional
  function using the WAIS-R, WMS-R, Trail Making
  Test (TMT), and the subtest TAP.

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Results

• Groups
• 10 patients met criteria for PTSD
• 14 met only 1 DSM-IV criterion for PTSD (5 are
  required)

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Results

• No difference between groups in neglect, physical
  abuse, disorder duration, depression severity,
  global psychological distress and alcohol
  consumption
• Patients without PTSD reported more sexual abuse
  and intrusion of traumatic material

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Results

• Patients with PTSD had significantly smaller
  total brain volumes and increased global atrophy
  (brainskull ratio) when compared with controls
• 3 2 (group hemisphere) ANCOVA comparing the
  amygdala volumes of patients with and without
  PTSD and controls indicated smaller amygdala
  volumes of trauma exposed patients
• Patients with and without PTSD did not differ
  significantly

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Results

• The overall 3 2 (group hemisphere) ANCOVA
  comparing the hippocampus volumes of patients
  with and without PTSD indicated smaller
  hippocampus volumes of trauma-exposed patients
• post-hoc 2 2 (group hemisphere) ANCOVA for
  each trauma-exposed group and the control group
  confirmed the results in both regions

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Results

• During ANCOVA testing of amygdala and hippocampus
  volumes while introducing IQ as a covariate, the
  results of all analyses remained the same
• except comparison of hippocampus volumes across
  the group with PTSD and controls, which did not
  yield a significant effect of group

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Results

• Neuropsychological
• patients with PTSD were significantly impaired on
  all intellectual and mnemonic measures except
  verbal memory and delayed recall
• patients without PTSD were unimpaired
• patients with PTSD had lower test scores

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Results

• Stats
• Performance IQ (R2 0.261, p 0.011),
  attention/concentration (WMS-R R2 0.319, p
  0.004) and part B of the TMT (R2 0.217, p
  0.022) were significantly predicted by right
  hippocampus volume
• Larger hippocamus volume better test performance

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Discussion

• Overall
• 12 hippocampus size reduction in patients with
  BPD and PTSD
• 11 reduction in those without PTSD
• 34 amygdala size reduction in patients with BPD
  and PTSD
• 22 reduction in those without PTSD

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Discussion

• BPD, irrespective of traumatic exposure
  orsubsequent development of PTSD, has a negative
  impact on amygdala and hippocampus size.
• Studies of BPD without trauma exposure are needed

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Discussion

• Cognitive deficits have been repeatedly reported
  for patients with PTSD
• better cognitive performance in patients without
  PTSD statistical significance?
• Total brain volumes of patients with PTSD were
  decreased, global atrophy increased
• Head trauma?

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