BPD: not a personality disorder?

There's been already a lot of debate on the name of BPD, the disorder. While doing some research for my blog and a presentation about epigenetics and the role of transposons in mental disorders (I'm a Biotechnology junior student), I found about an interesting perspective of a doctor who saw BPD as a neurological disorder, he decided to give the name of "Dyslimbia". While I didn't fully agree with his thoughts, there are studies that back up some of his statements:

- Dr.Heller claims BPDs suffer from a faulty (or neurologically atypical) amygdala, which it's backed up by several studies found at NCBI

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702446/
https://www.ncbi.nlm.nih.gov/pubmed/20933369

- Polymorphisms extremely related to the lymbic system such as DAT1 9-allele repetition
- Oxytocin has also been related to anxiety disorders, contributing to avoidant behaviour and fear of abandonment, which symptoms appear in BPD. The methylation of oxytocin found in BPDs and the malfunctioning of amygdala may cause problems in social relationships, as noted in article (3)
https://www.ncbi.nlm.nih.gov/pubmed/28812274 (1)
https://www.ncbi.nlm.nih.gov/pubmed/26616386 (2)
http://readingroom.mindspec.org/?news-i ... al-stimuli (3)
https://www.ncbi.nlm.nih.gov/pubmed/26616386
- In a research study done in 2005, 222 genes were shown to be related to the formation of fear memory, very much related to BPD users, especially those who suffered from childhood abuse or co-morbid disorders such as PTSD

My point is, is the study of BPD and its pathogenesis insufficient and the label stigmatizing? Other groups of people with neurodivergences have been fighting for their rights to get proper treatments while we are often misdiagnosed, feel we have no explanation for our behaviour and get judged easily on our approach of life, as we tend to be seen as "manipulative crybabies", when the truth is, BPD, in general, may not be a problem that affects the entirety of someone's personality nor completely fits the criteria to be included in one of the clusters, especially Cluster B, which its the most stigmatizing of them all. As a person who suffers from BPD who isn't an expert (yet) in neurological development and genetics, I would say BPD is a combination of a neurological disorder and an emotional disorder, rather than a faulty personality.

Whether if it's a personality disorder or not, more studies on its pathogenesis are absolutely needed, as proper medical treatment has yet to be found (SSRIs don't seem to work well, nor antipsychotics or most mood regulators; and benzos only work for sleeping / calming anxiety momentarily) and DBT psychotherapy is (slightly) difficult to get by those with low-income.




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"Personality Disorder" is an easier way to describe a mental condition which has an unknown cause, has an unknown mechanism, has no cure, and pervades the whole person. You could also expand the scope of PD to include other illnesses, if more were known about them through discovery.

It's an "open another box" syndrome and you could have called some forms of dysthymia a "personality disorder" if SSRIs were never discovered.

I think it's obvious that all PDs are neurological disorders when you look at them from all the angles.

If it were learned behavior through plasticity then it could be unlearned, in which case it never is. Even brainwashed individuals or feral children can recover because there is something physically for the new information to move into. Dumping information into a hole means nothing.

Also, there is enough imaging done on some of them to show structural alterations in those brains.

It's beyond the scope of pharmacology for recovery.

Nice analysis, and you're on to something, Loonsong. The idea, for instance, that Toxic Parents is the cause of BPD is quite old school by now. For the last fifty years, BPD has been attributed to anatomic differences and therefore the impaired ability to process emotion. Not in such a rush to blame parents.

More and more is coming out, but it is embattled by this lingering attribution to Toxic Parents that it's becoming conspicuous. Who has a stake in blaming parents? Some seem to over-emphasize it and even coach kids to blame parents with their own terminology, such as Gaslighting.

The differential diagnosis is usually made by a more thorough history and physical [many medical problems mimic psychiatric ones], family counseling and a medical clearance on the patient before they even get to know each other. These are ignored largely because of poor access, keeping costs down, and arguments over their value. [Argument over tests is another point to stall facing the likelihood that the condition is endogenous.]

But dispute doesn't validate anything; it only causes a waste of time to my way of thinking when the proven more concrete methodology is medical clearance, H and P, and other tests to follow through on an index of suspicion. [You have to be looking for it.] It is wrong to dx the patient with toxic parents in every case when it may not be the case at all.

As far as 'dispute' goes, then, I am locating more and more toward the brain's lurking as predisposed to BPD while waiting for a trigger to launch it. That trigger could be branded at 'trauma' I suppose, but that would be dishonest. The trigger many families describe as the cause of their child's emotional misery is usually a universal one which is unavoidable. How the child reacts to such fact-of-life ups and downs tells the story the therapist is looking for.

Mind you, since you are a student, BPD does not come from abuse, tho there are abuse etiologies of other illnesses.

Something - something - impelled researchers to look into non-abuse etiologies for BPD, and they seem to be intrigued that there is a lot of support for the endogenous arousal of it in the absence of what might pass for trauma. For instance, why do kids get BPD with no hx or abuse in the family?

A therapist is not looking for facts if they don't do the medical clearance and family counseling at the very least.

Best.

For a few years now I have not believed in personality disorders but do believe in neurological disorders.

As the OP has said there is a lot of evidence pointing to a neurological problem with regards to BPD as opposed to a psychological one.

While I agree that nurture can have an impact I feel that in the majority of cases it only has an impact to those who are pre-disposed to the disorder.

Take for instance PTSD. There was a study by the Swedish army which showed that the troops who suffered a trauma and developed PTSD had lower than normal cortisol levels before deployment. One thing cortisol does is blur the memory when fight or flight mode kicks in so an incident when played back is blurred rather than in HD. Another study by an ambulance service in America administered cortisol injections to victims of trauma immediately after an incident. None of the patients developed PTSD during the study. This to me shows a genetic predisposition.

Other disorders such as APD have shown a particular gene being present. Then there are disorders such as autism where a distinct difference in the brain is seen.

It may only take a small difference in a part of the brain to be the cause of these disorders. If things such as eye colour or male pattern baldness can be passed down genetically then why not differences in the brains structure?

My main point wasn't to argue that BPD may not sincerely come from abuse, as it's already proven it's a factor. But the debate you've opened is quite interesting. I didn't suffer from family abuse (though I suffered from heavy bullying since I was a kid) and I'm a BPD. Since I was a child I already had "signs" of neurodivergence: extreme shyness, social anxiety, habit disorders. In fact, I was believed to have symptoms of Asperger (now labelled as a type of Autism), hyperactivity and ADHD before puberty. I wonder if other BPDs were like that when they were kids: nervous kids misdiagnosed with ADHD, highly intelligent, extravagant and shy kids. Sometimes I do wonder if what my inherited neurodivergences (my family has a story of mental disorders) were in the beginning turned into this disorder due to a lack of comprehension, adaptation and understanding of the symptoms in the early stages of my life.

Could things such as being taken to kindergarten even if I puked there daily (because of nerves), having no friends until I was 15 and my general experience with bullying could have tweaked my inherited neurodivergence? It's a weird conversation topic because when I first was analyzed by a group of therapists when I was eleven, none of the symptoms for BPD showed up, but others did. I actually have a neurological disorder diagnosed, that doesn't seem to affect my daily life as of nowadays.

My personal experience makes me reflect on the power of epigenetics and how fluid the brain is. I'd really really really like to take part in a research study, don't care if it's as a patient, as a doctor/master graduate or both. The thing is, the more I read about BPD genetics, I keep gathering more evidence about the important role of inherited genes in this illness and how it connects with others such as schizophrenia, autism, bipolarity...

Αs far as I know BPD hippocampus and amygdala are smaller than non BPD

I mean, I wouldn’t say it’s strictly a ‘personality’ vs ‘neurological’ disorder. But I feel like the argument is over semantics at that point. Various PDs, to my knowledge, are neurologically atypical. It’s the whole nature vs nurture argument, when in reality I personally believe both are a factor.

I’ve never been clinically tested or anything, but I can relate to a lot of the inventory of a HSP. I was also incredibly sensitive as a child, had social anxiety and even paranoia at a very young age, was seen as incredibly gifted, and autism is in my family.

What I think is, had I been neurotypical and suffered the same trauma, I might not have developed my particular set of mechanisms that I use to function and for self preservation. On the other hand, if I had the same biological setup, but I did not suffer trauma, had a secure attachment with caregivers, and more in tune parents who were sensitive to my needs, then I probably could’ve developed healthier ways of coping, even with my poorer emotional regulation etc. This is why there is “no definitive cause” because I think there are several factors, that later develop into what is known as BPD.

There’s no clear test for it, diagnosis is based off of observation by a doctor, along with loved ones, and the disordered person’s personal take on things (which can be skewed). So instead we make our best educated guess. BPD is definitely stigmatized, as there is very little understanding of PDs in general among the general population. A lot seem to think we are just #######5 people, with little desire to understand more. If the neurological aspect were more focused on, I think there may be more understanding, but it would also take an entire campaign to educate people on it lol

I might have more to add later. I’m actually in a hurry and didn’t plan on posting, but found this interesting and wanted to give my two cents.