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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.

Make a difference.

VOTE!

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.

Let them be heard.

VOTE!

Wisdom from fellow writer, social activist and friend, Jane Devin:

“Racism, sexism, and all the other “isms” that would exclude people from opportunity on the basis of their biology are born of ignorance, and have no merit, socially or intellectually. It’s the job of an advanced society to make this clear to those who yearn for the days when they were specially privileged, and viewed as superior due to their race, sex, age, class, physical ability, religion, or sexual preference.”

(Click here to read Jane’s entire post and previous articles on poverty.)

We can do better. We must. For the sake of our children and their children. Let us be that advanced society; let us become the American dream.

The National Institute of Mental Health, funded by our tax dollars, has developed an excellent informational pamphlet about bipolar disorder. Useful for new patients, families, friends and support personnel, the easy-to-read publication, excerpted below, answers frequently asked questions about the illness.

What is bipolar disorder?

Bipolar disorder is a serious brain illness. It is also called manic-depressive illness. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and “up,” and are much more active than usual. This is called mania. And sometimes people with bipolar disorder feel very sad and “down,” and are much less active. This is called depression. Bipolar disorder can also cause changes in energy and behavior.

Bipolar disorder is not the same as the normal ups and downs everyone goes through. Bipolar symptoms are more powerful than that. They can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.

People with bipolar disorder can get treatment. With help, they can get better and lead successful lives.

Who develops bipolar disorder?

Anyone can develop bipolar disorder. It often starts in a person’s late teen or early adult years. But children and adults can have bipolar disorder too. The illness usually lasts a lifetime.

What causes bipolar disorder?

Several factors may contribute to bipolar disorder, including:

Genes, because the illness runs in families.
Abnormal brain structure and brain function.

The causes of bipolar disorder aren’t always clear. Scientists are finding out more about the disorder by studying it. This research may help doctors predict whether a person will get bipolar disorder. One day, it may also help doctors prevent the illness in some people.
Is bipolar disorder easy to diagnose?

No. Some people have bipolar disorder for years before anyone knows. This is because bipolar symptoms may seem like several different problems. Family and friends may not see that a person’s symptoms are part of a bigger problem. A doctor may think the person has a different illness, like schizophrenia or depression.

Also, people with bipolar disorder often have other health problems. This may make it hard for doctors to see the bipolar disorder. Examples of other illnesses include substance abuse, anxiety disorders, thyroid disease, heart disease, and obesity.

How is bipolar disorder treated?

Right now, there is no cure for bipolar disorder. But treatment can help control symptoms. Most people can get help for mood changes and behavior problems. Treatment works best when it is ongoing, instead of on and off.

1. Medication. Different types of medication can help. People respond to medications in different ways, so the type of medication depends on the patient. Sometimes a person needs to try different medications to see which are best.

Medications can cause side effects. Patients should always tell their doctor about these problems. Also, patients should not stop taking a medication without a doctor’s help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse.

2. Therapy. Different kinds of psychotherapy, or “talk” therapy, can help people with bipolar disorder. Therapy can help them change their behavior and manage their lives. It can also help patients get along better with family and friends. Sometimes therapy includes family members.

3. Other Treatments. Some people do not get better with medication and therapy. These people may try “electroconvulsive therapy,” or ECT. This is sometimes called “shock” therapy. ECT provides a quick “shock” that can sometimes correct problems in the brain.

Sometimes people take herbal and natural supplements, such as St. John’s wort or omega-3 fatty acids. Talk to your doctor before taking any supplement. Scientists aren’t sure how these products affect people with bipolar disorder.

Some people may also need sleep medications during treatment.

To obtain a copy of the new informational pamphlet from which this brief excerpt was taken, contact the National Institute of Mental Health.

National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
Toll-free: 1-866-615-NIMH (6464)
TTY Toll-free: 1-866-415-8051
Fax: 301-443-4279
E-mail: nimhinfo@nih.gov
Web site: www.nimh.nih.gov

SSRIs MAOIs

How do they actually work?

I recently heard from a reader who’s lived with depression for most of his life. After hearing much about how treatment works, he sought medical advice; and his doctor did, in fact, diagnose clinical depression and wrote a prescription for an antidepressant.

Unfortunately, the doctor did not satisfy the patient’s need to understand the science behind the prescription. Feeling ill-informed and uneasy about filling and taking the scrip, he asked me to explain how antidepressants literally worked.

Here’s a brief run-down of what I told him:

To understand how antidepressants work, you have  to how the brain works. The brain is made up of millions of cells called neurons.

Messages pass from one neuron to another using chemical messengers called neurotransmitters. The messages include information about emotions, behavior, body temperature, appetite… essentially all body functions. Different neurons are responsible for different functions.

When a message passes from a one neuron to another, the neurotransmitters leave a neuron and enter the space in between, which is called a synapse. The neurotransmitters then connect to a receptor on the receiving neuron to deliver the message.

Once neurotransmitters have sent their message, they return to the original neuron to be reabsorbed. This is called reuptake. Reuptake allows the messengers to be reused. Two of the neurotransmitters we know about are serotonin and norepinephrine. Low levels of serotonin and norepinephrine are associated with depression. Some medications used to treat depression work by increasing them.

Selective serotonin reuptake inhibitors, or SSRIs, and tricyclic antidepressants, work by slowing or blocking the reuptake of serotonin. In that way, more of this chemical is available in the synapse. With more of this neurotransmitter available, depression is reduced.

MAO inhibitors, or MAOIs, work differently. Monoamine oxidase (MAO) is a natural enzyme that breaks down neurotransmitters. The MAOI disrupts the action of the enzyme MAO. In that way, there is an increase in the amount of neurotransmitters in the synapse, making more messengers available to the receiving neuron, thus reducing depression. (Some of this information was taken from an article by Bobbie Hasselbring at About.com:Mental Health, a source I recommend to anyone seeking additional information.)

Because he needed to understand the science of depression and its treatment, my reader now feels comfortable filling and taking the prescription. He will soon feel better.

If ever you have questions about your health or its treatment, seek information.

Learn all you can.

Be an informed consumer.

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Most people suffering from clinical depression find great relief and a return to health through antidepressant treatment. Unfortunately, a small percentage of patients do not experience a level of improvement that enables them to resume normal function. For those non-responsive cases, a new treatment option is finally available.

The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system, created by Neuronetics, is now approved as a treatment option for people with major depressive disorder who haven’t seen significant improvement from at least one prior antidepressant medication.

TMS is a non-invasive therapy during which the nerve cells in the brain that have been linked to depression are stimulated by delivering MRI-strength magnetic pulses. For a more detailed explanation, click here. TMS  is done on an outpatient basis, daily for four to six weeks, and requires no anesthesia or sedation.

In clinical studies involving 164 people with major depressive disorder, substantial improvement was recorded for symptoms of core depression, anxiety, and other forms of psychological distress.

The most common side effect is mild-to-moderate scalp pain or discomfort at the treatment area, which diminishes after the first week. Also encouraging is that fact that fewer than 5 percent of patients stopped treatment due to adverse effects.

Initially, NeuroStar TMS therapy will be available at a limited number of treatment centers across the United States. If you are interested in learning more about NeuroStar TMS and would like to see results from Neuronetics research, click here.

Click Here to watch a video about how NeuroStar TMS works.

Kat, from Blissfully Domestic, read my most recent book Mommy I’m Still in Here, interviewed me, attended a virtual book club meeting where I joined the discussion and answered questions, and then wrote the following review:

Kate McLaughlin, provides an open and honest insight into the challenges of raising children with Bipolar Disorder in her amazing book, “MOMMY I’M STILL IN HERE”.

McLaughlin began to use writing as a form of emotional release and healing, but eventually her writing turned into a motivating resource for parents trying to cope with their child’s disorder and its effects on their family.

I had the pleasure of talking and discussing the book with Kate. She is currently a mental health advocate, a member of the Depression and Bipolar Support Alliance, the National Alliance on Mental Illness and the Juvenile Bipolar Research Foundation. She also participates in NAMI’s Family-to-Family program.

What was it like for you, personally, to write this book?

Writing is cathartic for me.

It helped me process and purge a lot of self recrimination.

What was the biggest motivator to you to ‘keep it together’?

My biggest motivator to ‘keep it together’ was reflection on the times when I did not! I wanted to learn from my mistakes and avoid repeating them. As most mothers will vouch, my attitude often dictates the attitudes of those around me. My family needed to be uplifted and I was in the best position to do this, but don’t get me wrong, this experience has been a process of personal development. I got better at a lot of things…gentle assertiveness, patience, a calm demeanor, hopefulness, and a positive outlook…as time went on.

What has been you biggest “high point” in being a Mother?

My children’s abilities to live happily independent is the acme of my mothering experience. They developed the skills, confidence and levels of wellness to be who they are, doing what they choose. That’s successful parenting.

What was the hardest thing you had to come to grips with?

Within the perspective of MOMMY I’M STILL IN HERE and the time frame it covers, knowing that my kids’ illnesses were chronic, would never go away, was the hardest pill to swallow. I had to release lots of the unfulfilled expectations I’d created over my lifetime in order to accept the current, true, reality. But once that was done… happiness, hope and optimism returned.

More recently, I’ve worked hard to accept a truth that plagues a majority of those diagnosed with bipolar disorder. My son Michael is an addict. He cannot stay clean and sober despite numerous rehab, counseling, and detox programs. And the hard truth is, I cannot do this for him. He is solely in charge of this facet of his life. I‘m on a path to love him without condition, but sometimes I stray off that path and have to renegotiate the rough terrain.

What do you look forward to in the future?

I’m excited about advances in research and medical treatments that will provide the mentally ill with greater normalcy. I’m thrilled that the stigma surrounding serious mental illnesses is abating. People are finally learning that these illnesses are biologically driven, just like diabetes or cystic fibrosis or muscular dystrophy. And I look forward to the decades of experiences I will share with my husband and children and the people they love. We have a lot to look forward to and are greatly blessed.

This book covers the gauntlet of emotions. It has been a long time since I was so moved and touched by an author. It is definitely a book worth reading!!

Thank you Kat, for everything!