Are there any structures or biological abnormalities that make one more likely to have a borderline personality disorder?
Prediction: I can imagine that an amygdala abnormality or perhaps dopamine receptor deficiency similar to those with addiction. I hesitate to rely on a biological explanation due to the social developmental issues those with borderline personality disorder commonly have such as a non-cogent family structure.
Article 1:
Borwin Bandelow, Christian Schmahl, Peter Falkai, Dirk Wedekind, Borderline Personality Disorder: A Dysregulation of the Endogenous Opioid System?, Psychological Review, Volume 117, Issue 2, April 2010, Pages 623-636, ISSN 0033-295X, 10.1037/a0018095.
(http://www.sciencedirect.com/science/article/pii/S0033295X10600527)
Validity: This journal is a registered trademark of the APA. APA has very high standards of validity. The association states “[it] is a violation of APA Ethical Principles to publish ‘as original data, data that have been previously published’ (Standard 8.13).
In addition, APA Ethical Principles specify that ‘after research results are published, psychologists do not withhold the data on which their conclusions are based from other competent professionals who seek to verify the substantive claims through reanalysis and who intend to use such data only for that purpose, provided that the confidentiality of the participants can be protected and unless legal rights concerning proprietary data preclude their release’ (Standard 8.14).
APA expects authors to adhere to these standards. Specifically, APA expects authors to have their data available throughout the editorial review process and for at least 5 years after the date of publication.
Authors are required to state in writing that they have complied with APA ethical standards in the treatment of their sample, human or animal, or to describe the details of treatment.” No further information was available at this level of access.
Summary:
This study studied several possible neurobiological dysfunctions such as serotoninergic, dopaminergic, and other neurotransmitter systems. The most promising was the opiod receptors. They questioned the sensitivity of the receptors and availability of the endogenuous opiods. The unhealthy behaviors that are symptomatic to BPD possibly occur stimulate the opiod system and dopaminergic reward system. The study explains clearly: “Frantic efforts to avoid abandonment, frequent and risky sexual contacts, and attention-seeking behavior may be explained by attempts to make use of the rewarding effects of human attachment mediated by the EOS.” The reduced activity of the same are may be causative of anhedonia (the inability to feel pleasure) and the feelings of emptiness. The substance abuse also damages those receptors. Other control oriented behaviors like food behaviors like restriction, self-mutilation, and aggressive behavior is to set the body in survival mode which depletes the last reserves of the EOS. Opiod receptor antagonists can control many of these behaviors.
Reflections and thoughts: I was pleased that the answer was relatively clear that by addressing the endogenous opiod system that borderline personality disorder could be that closer to a cure pharmacologically. It is interesting that these behaviors actually are falsely placing the body in a state of “fight or flight” and that feels like relief to those with BPD. It also explains the popularity of heroin use I have personally seen in those with BPD
Article 2:
Joel Paris, Hallie Zweig-Frank, N.M.K Ng Ying Kin, George Schwartz, Howard Steiger, N.P.V Nair, Neurobiological correlates of diagnosis and underlying traits in patients with borderline personality disorder compared with normal controls, Psychiatry Research, Volume 121, Issue 3, 1 January 2004, Pages 239-252, ISSN 0165-1781, 10.1016/S0165-1781(03)00237-3.
(http://www.sciencedirect.com/science/article/pii/S0165178103002373)
Validity: Although the article is seven years old, I am comfortable with the validity. The journal has high standards of validity stating that “[submitted] manuscripts will be reviewed anonymously by at least two referees. Should a revised manuscript be required by the editors, the authors are requested to resubmit their revised manuscript to the journal within 6 months time. Studies on humans submitted to the journal must comply with the principles laid down in the Declaration of Helsinki (Br Med J 1964; 2: 177-178). The editors retain the right to reject papers on the grounds that, in their opinion, the ethical justification is questionable.”
The small sample size is arguably less valid. The large number of controls is creates more validity as well as the barrage of tests. More results in general gives a more complete picture. No further information was available at this level of access.
Summary:
This study was also focused on neurotransmitter systems. Thirty women with the disorder plus twenty two controls went through the following tests: Diagnostic Interview for Borderlines, revised, the Hamilton Depression Scale (HAM-A) and the Hamilton Anxiety Scale (HAM-A), the Diagnostic Assessment of Personality Pathology, the Buss–Durkee Guilt-Hostility Inventory, the Barratt Impulsivity Scale (BIS), and other tests to measure serotonergic, cholinergic and noradrenergic activity. Results point to issues with sertogenic systems, that are related to serotonin, as most pertinent to the disorder.
Reflections: Most of those with BPD that I know have been in dual diagnosis wards. They are heavily medicated with SSRIs. This closely relates to this study. It also made me realize that as far as validity the large amount of tests made me feel more confident in the study. Interesting that an increase in data can be more convincing. My ignorance of the actual test methods lead me to believe that this may not make the study more valid.
Article 3:
Tsutomu Takahashi, Andrew M. Chanen, Stephen J. Wood, Mark Walterfang, Ian H. Harding, Murat Yücel, Kazue Nakamura, Patrick D. McGorry, Michio Suzuki, Dennis Velakoulis, Christos Pantelis, Midline brain structures in teenagers with first-presentation borderline personality disorder, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 33, Issue 5, 1 August 2009, Pages 842-846, ISSN 0278-5846, 10.1016/j.pnpbp.2009.03.035.
(http://www.sciencedirect.com/science/article/pii/S0278584609001080)
Validity: This journal again had high standards for validity. It only accepts original research or mini reviews of work done in the last two years. The work must current and relevant. Similar statements on disclosure of conflicts of interests and ethics are enforced. All work must not have been previously published and be original. Ethics must be practiced: “The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans; EU Directive 2010/63/EU for animal experiments; Uniform Requirements for manuscripts submitted to Biomedical journals. This must be stated at an appropriate point in the article.” No further information was available at this level of access.
Summary:
This studied differed from the previous studies in that it focused on potential midline brain abnormalities that may be found in those with BPD. The study included 20 in the sample and 20 controls. They used an MRI to study the length of two structures adhesio interthalamica (AI) and cavum septum pellucidum (CSP) and the volume of the third ventricle. as well as third ventricular volume in 20 teenagers with first-presentation BPD and 20 healthy controls. The findings were that “the AI was significantly shorter in BPD patients than in controls. Furthermore, the BPD patients had a significantly larger third ventricle than controls.” The conclusion of the researchers was that further neuroimaging can help.
Reflections: Strangely what strikes me most about this study is the frustration with the conclusion. All that they were comfortable with saying was that?! It was such a let down. It also reminded me of the brain size studies that compared the sexes. How unfulfilling!
Article 4:
Katja Wingenfeld, Carsten Spitzer, Nina Rullkötter, Bernd Löwe, Borderline personality disorder: Hypothalamus pituitary adrenal axis and findings from neuroimaging studies, Psychoneuroendocrinology, Volume 35, Issue 1, January 2010, Pages 154-170, ISSN 0306-4530, 10.1016/j.psyneuen.2009.09.014.
(http://www.sciencedirect.com/science/article/pii/S0306453009002911)
Validity: The recent date of the publication was a promising sign of validity. The journal also has an international reputation. Articles are mostly acquired by invitation only. When submitted, policies for submission are strict requiring 4-5 additional reviewers with submission, full disclosure of potential or actual conflicts of interest, and a description of general details of support from sources for the study. The journal warns “Failure to comply with conflict of interest requirements may result in rejection of the manuscript and/or retraction of the published article. Disclosure of the conflict of interest will be made in the published article. There is no disclosure form as such, you only need to mention any conflict of interest by mentioning its nature, but only when there is one.” No further information was available at this level of access.
Summary:
The focus of this study on was the hypothalamic-pituitary-adrenal (HPA) axis in BPD, compared to others such as bipolar and PTSD. They used neuroimaging to assess the stress that may damage possibly the hippocampus. Results pointed to incressed suppression in the HPA Axis.
Reflections: I did like that this study compared other disorders neurobiology. The symptoms of bipolar and PTSD are very similar to BPD. Thusly I was surprised that BPD individuals had increased suppression. In a lot of ways BPD seems safer. Maybe increases options/solutions for those with BPD made me on some level think that it would not show a difference. I would be interested in seeing how MRI’s might detect improvement in those with BPD who had used DBT.
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