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Borderline Personality Disorder, Mood Disorders & Anxiety Linked through Structure and Function

Borderline Personality Disorder , as explained in Wikipedia, “is a psychiatric diagnosis describing a prolonged disturbance of personality function characterized by depth and variability of moods. BPD typically involves unusual levels of instability in mood; “black and white” thinking; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy. Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time, with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms.”

Michael Minzenberg, M.D., of the University of California, Davis, and NIMH grantees Antonia S. New, M.D., and Larry J. Siever, M.D., of Mount Sinai School of Medicine reviewed MRI images of patients diagnosed with Borderline Personality Disorder, and found that they experience differences in the working tissue of the brain, called grey matter.

According to the groups research, people with BPD had more than the average amount of gray matter in a fear hub found deep in the human brain. On images, this area over-activated when the patients viewed scary faces.

Interestingly, these same patients had less gray matter and less activity in the hub’s regulator near the front of the brain. These deficiencies effectively removed the normally built-in controls for a runaway fear response, leading to overreaction.

These imaging studies conducted by Minzenberg, New, and Siever are the first to link structural brain differences with functional impairment in the same sample of BPD patients; and their findings impart significance to millions of other patients since similar changes in the same areas of the brain have been documented in mood and anxiety disorders. As the research evolves, it seems clear that there are numerous shared and common mechanisms with mental illnesses that have traditionally been viewed from a biological perspective.

Click here to view “The Neurobiology and Genetics of Borderline Personality Disorder” written by Antonia S. New, MD & Larry J. Siever MD.

The Department of Health and Human Services is the umbrella organization for the Substance Abuse & Mental Health Services Administration Center for Mental Health Services, or SAMHSA.

SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center) aims to engender social acceptance and inclusion by helping people with mental health problems live full, productive lives without fear of prejudice and discrimination. They offer information and assistance to help individuals, families and communities fight prejudice and discrimination and promote social inclusion.

Formerly known as, SAMHSA’s Resource Center to Address Discrimination and Stigma, the Center was re-named in 2008 to SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center).

The name change represents a reinvigorated purpose: “To promote a strengths-based vision, recognizing the importance of a caring, welcoming, and supportive community in helping to promote recovery and wellness for people with mental health problems.” Of course, reducing stigma and combating discrimination continue to be part of the center’s work.

The SAMHSA ADS Center offers:

• Information about what works to promote acceptance and social inclusion of people with mental illnesses.
• Training and technical assistance to help create initiatives to promote social inclusion.
• Information about how to connect with more than 50 existing international, national and local campaigns and programs.
• Information about available publications, events, research, and issues of relevance regarding prejudice and discrimination associated with mental illnesses.
• A comprehensive online library of more than 2,000 items that addresses prejudice and discrimination.
• Resources and information promoting social inclusion related to special populations such as: children, older adults, and racial and gender minorities as well as information for employers, realtors/landlords, medical providers, educators, faith groups, policy makers, and the media.

Links for consumers, families, medical practitioners and older adults lead users to the most appropriate pages on the site, where brochures, information sheets, articles and services abound.

If you’re interested in spreading accurate information about mental illness and reducing stigma, check out the ADS Center site.

If you’d like to communicate with staff on a specific topic, contact information is below:

By Phone:
1-800-540-0320. Monday-Friday (9:00 a.m. to 5:00 p.m. Eastern Time) with bilingual (English/Spanish) staff.

By Post:
ADS Center
11420 Rockville Pike
Rockville, MD 20852

By e-mail:
promoteacceptance@samhsa.hhs.gov

Five years ago, 26-year old Karla Smith died from a self-inflicted gunshot wound. She was, by all accounts,  a talented young woman, a brilliant writer, much loved by her twin brother Kevin and parents, Tom and Fran…and bipolar.

The Smith’s chronicled their experiences in book and web forms, and created The Karla Smith Foundation to provide “hope for a balanced life to family and friends or anyone with a mental illness or who lost a loved one to suicide.”

Over the next few weeks I will mention the Smith’s, their advocacy efforts, and the resources they’ve created. For today, I share a glimpse of Karla from Kevin’s perspective. You can read this eloquent tribute in it’s entirety at the website “In Memory of Karla Smith”.

In Kevin’s words…

…Karla was officially diagnosed with bipolar disorder, also known as manic-depression…The symptoms fit Karla’s behavior to a T. The mania stage includes excessive energy, delusional thinking, paranoia, often accompanied by financial struggles and a desire for constant movement. The depths of the depression stage lead to suicide for one in five individuals with bipolar disorder. There was disbelief, a fear, and countless questions that struck each one of us in our family. A lot of what we discovered was scary - 2.3 million Americans are diagnosed as bipolar, the cause is unknown and generally manifests itself during the late teenage years, and there is no cure. We had to accept that we would never be able to answer the ‘how’ and the ‘why’ questions. We all became experts on this new thing called bipolar disorder and sadly realized it is a lifelong battle that does not go away. As a family member watching this, the word ‘forever’ was a difficult one for me to grasp.

Throughout the years, Karla explained to me eloquently how her illness felt inside and I’m going to share an example in her words from both the manic side and the depression side. During the mania phase, she explained it like this:

“Imagine your mind as a switchboard and you are looking right at it. And on this switchboard is everything that has ever happened in your life - every past thought, every past event, every past emotion. And one flash appears on the switchboard so you focus on it, but 10 seconds later, another flash appears, and you have to look at it, but then there’s another flash over there, and another one here, and another - and your mind pushes you to see all of them because you have to see them all and experience them all. It’s constant. And I try to explain my thoughts, and what is going on, but it’s so hard to speak that fast because everything is just so confusing.”

And on the reverse-side, an example of her depression came to me in the form of a letter:

“It’s hard for me to talk out loud. There’s a rock that lives in my throat. My mind thinks only of death and escape and I cannot keep up with it. I am afraid of everything, I can’t do things I used to do with ease, and I’m afraid of even people that I’m closest to. I often don’t answer the phone or call anyone back. I’m not afraid of one specific thing, but instead a big general fear - that’s how it’s been inside.”

The extremes of this illness are unbelievable. It is mind-boggling to me how a person can change so drastically in the span of just a few weeks. We did discover one very positive thing about bipolar: even though it did not have a cure; taking daily medication could control it. Bipolar individuals can live long normal lives and most people would not even know the individual has been diagnosed…

Learn more about The Karla Smith Foundation and its work to help those whose lives are affected by mental illness or suicide.

Watch the video.

Hear the voices of our children.

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Special thanks to fellow writer, speaker and mental health advocate, Andy Behrman, for spreading the word about this video.

And remember…your choices only count if you vote. If you can, VOTE early. If not, VOTE on November 4.

Huge election.

Significant outcomes.

Your opinions matter.

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