Borderline Personality Disorder Why They Dont “Get Used to It ”

At the annual meeting of the American Psychiatric Association in New York this year, I learned about a new finding from one study with patients who exhibit borderline personality disorder (BPD). The same finding also applied, although to a lesser degree, to those with avoidant personality disorder (AVD), which is pretty much identical to the diagnosis of Social Phobia.  I suspect that the reasons for the similar findings may be different for the two disorders.

The finding involved a part of the brain called the Amygdala. This little doohickey is central to a lot of brain functions, but in particular, it is the center for the body’s “fight or flight” response. I always though it fascinating  that the amygdala also has specific cells which respond only to one’s own mother (or other primary female attachment figure) and nothing and nobody else, and other specific cells which respond onlyto one’s father (or other primary male attachment figure). 

Although one cannot prove such things, this fact suggests to me that primary attachment figures may be the most potent of all of the environmental triggers to fear-based flight or fight reactions. They are certainly more powerful that a therapist can ever be for doing so, for instance.

The finding may relate to one of the primary symptoms of BPD, which goes by a variety of names. In the actual DSM criteria, it is described as “affective instability, or marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.)” It is also called high reactivity, and lay people often label it hypersensistivity. In psychological tests, it is called neuroticism. Clearly, amygdala activation is intrinsic to this phenomenon.

Therapists have a tendency to think that patients with BPD over-react because they misperceive the behavior of others as being emotional slights, when the behavior is not at all meant as such. In fact, these therapists do not even know to what exactly the patient may be reacting to, or alternatively, that sometimes patients with BPD feign such reactions in order to provoke a specific response in others in order to recruit them to be enablers of the patients’ spoilerrole.

For example, one patient would go ballistic if anyone ever even implied that her mother might have been a loving parent. Of course, if one knew all the horrible things her mother had done to her, one could easily see why she would find such a comment annoying - to say the least!

The study I am discussing here is by Harold Koenigsberg and others (Journal of the American Psychiatric Association 171:82-90, January 2014). Study participants were asked to look at a series of pictures with either highly negative or neutral content, and the activation of the amygdala and another region of the brain called the dorsal anterior cingulate was measured using a specific type of brain scan. The subjects also subjectively rated their emotional responses to the pictures. 

Exposure to these pictures and these measurements were then repeated. Repeated only once, I’m afraid. The study would have been a lot more powerful if they had repeated the exposure several times.

The changes in emotional arousal and brain activation after a repeat viewing of the negative images was small but signficantly different between patients with BPD or AVD and the "normal" control subjects.  

The brains of the controls seemed to habituate, while those of the patients with BPD did not.  Habituation means that the controls got used to or became accustomed to the awful pictures, and their arousal levels decreased from what it had been after the initial viewing.

If anything, the emotional arousal of patients with BPD actually increased with the repeat viewing.

This finding, if it can be replicated, might seem to indicate that the brains of those with BPD are abnormal in this regard. However, as I have ranted in the past, a difference is not automatically indicative of an abnormality. In fact, it may be a conditioned response that is highly adaptive in particular environments.

In the case of patients with BPD in particular, they invariable grow up in chaotic family environments in which “getting used” to the chaos and not reacting to it when one needs to could be hazaradous to their and their family’s health, as described in my post on Error Management Theory.  If the chaos continues, such individuals need to pay even more attention to it, not less. 

This new research finding fits my ideas about that to a tee.

They Could Have Been the Worst Four Years of My Life

The years of 2003 to 2006 could have been the worst four years of my life. My health was literally disintegrating before my eyes.

Although I had been gradually going deaf since my late teens, in 2004, my thirty-eighth year, I lost all hearing in my left ear. This crippled me. I had to leave the church band, could not engage in social dialogue, stopped listening to music (one of my greatest pastimes), could not hear the television, and almost drove my family crazy asking them to constantly repeat themselves. Otosclerosis, an inherited disease that causes the calcification of the bones of the middle ear, was the cause of this ailment. Yet of equal concern to me was the accompanying tinnitus. Although both ears suffered from it, my deaf ear produced a cacophony of continuous, ‘deafening’ sounds, including roaring, thundering, grating, and an extremely deep humming that was extremely unsettling.

Not long before losing my hearing in one ear, I was diagnosed as suffering from complex partial epilepsy, confirmed by undergoing MRI and EEG scans. Prior to this, I had never heard of this condition, thinking the partial-seizures to be a symptom of depression. At this time I ceased taking anti-depressants and took anti-seizure medication, which had (and still has) quite horrid side effects. I lost interest in almost all of my hobbies, entered a continual state of exhaustion, and both short term and long term memory deteriorated significantly.

During these years a recurring injury received from my childhood worsened to the point that I was frequently afflicted by agonising, throbbing pain for ten hours a day, for up to three months at a time. (An operation in 2006 healed this injury.)

It was a Sunday morning in November 2004, when I had come down with the flu for the sixth time in a row, (which may have had something to do with burning the candle at both ends recently…) that I reached a crossroads. With the deafness, epilepsy, injury and apparent inability to return to any semblance of health, I felt the crushing weight of despair threatening to descend upon me. This was the last straw.

I had a choice. My life appeared to be in a state of utter disarray. I could succumb to despair and slip into the miry pit of depression, or I could turn to Jesus and rely upon His strength in my weakness, as He said to Paul in 2 Cor 12:9, "My grace is sufficient for you, for my power is made perfect in weakness."

I chose the second option. While I drove down Canterbury Road that November summer morning, I waited upon Jesus and recalled something I had heard in a sermon. My life was like riding in a bus, and the bus driver was Jesus. I was comforted by the fact that the bus driver always knew the destination and how to get there. This was my situation in a nutshell. Although my life appeared to be a complete mess and out of control, this was not the truth. The truth was that Jesus was in control of my life. I had nothing to fear. Jesus said in John 10:27-28, “My sheep listen to my voice; I know them, and they follow me. I give them eternal life, and they shall never perish; no one can snatch them out of my hand.”

So rather than let these burdensome troubles drive me to depression, I surrendered them to Jesus and placed my trust in Him. The pressures faded away and hope, joy, and peace prevailed.

May I ask you, the reader, a question here?

Considering the breadth of my troubles at this time, does it seem too easy?

I know the Bible says in James 1:2 to ‘Consider it pure joy, my brothers, whenever you face trials of many kinds,’ but trust me, although I reach this place eventually, this is not my initial reaction to trials!

Perhaps you are wondering why it did not take me days, weeks or months to learn to cope with these trials. How could I, after going through so much, ‘seem’ to shrug off their debilitating affects and yet live a normal life?

The only reason these afflictions did not drag me headlong into depression’s merciless grip was because I had already been down that road, back in 1990. It began with an eight-month period of living hell which included an endless cycle of debilitating anxiety attacks, chronic insomnia, crippling feelings of guilt, low self-esteem, utter despair at what was happening to me, and much more. As the days turned to weeks and then to months, I was crippled by the fear that this ‘thing’ that had overcome me would never lessen or end.

Here is an extract from my diary dated February 20th, 1990. (At this time, I had no idea what was wrong with me.)

Oh Lord, when will this end?
Day after day, I remain trapped
In this endless personal hell of pain and confusion.
I want to get out of myself!
To be someone else, anyone but me.
The me I know is gone, yet somehow I am still me.
I must escape from myself, but
I'm trapped in a suffocatingly small, dark room.
I know there is sunlight outside.
I run, push, and strive to reach that light,
But the room comes with me--I cannot get out!
Why? Because I am the room.
Jesus, for what reason have you allowed this?
Where are you? How long will you remain silent?
They say that others who have been down this route
Have left signposts along the way
To help those like me find the way out.
But where are these signposts?

By His grace and provision, Jesus helped me overcome depression and live a normal life again. And in learning how to cope with depression, Jesus set me free so that I need never again succumb to its depths. Galatians 5:1 ‘It is for freedom that Christ has set us free. Stand firm, then, and do not let yourselves be burdened again by a yoke of slavery.’ In conclusion, it was because of what I learnt during my trials of the early 1990s, that I was able to endure the trials of 2003 to 2006 and through Christ, overcome them.

The purpose of this blog is to encourage all (myself included!) undergoing trials and tribulations to establish Jesus Christ as the cornerstone, or foundation upon which to build our lives, and through His strength, endure and overcome those trials in order to live life to the full. John 10:10 Jesus says, “I have come that they may have life, and have it to the full.”

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(All verses from NIV)