HPD double standard / empathy deficit

Orion..........

She sounds like an ASPD/HPD combo to me..........

Of course, lest I get jumped again..........I am not a mental health professional, I just notice traits here and there,
and wonder.........and question..........and wonder some more..........

wisdom wrote:In my mind the “addiction” model provides some possible early clues. Many guys have felt the addictive draw of card or video games. There are some interesting parallels.

Lack of Empathy is a prefrontal cortex (PFC) problem, as is ADD. Low dopamine levels are associated with a number of PFC problems, such as lack of impulse control, short attention scans, negativity, and conflict seeking. Addictions are associated with dysfunction in the brain's "reward system circuit", which encompasses PFC and subcortical regions where dopamine, a neurotransmitter critically implicated in drug self-reinforcement, is manufactured, and the nucleus accumbens, where dopamine is released. Dopamine release is also associated with sex, both the actual act and (according to some research) possibly even the anticipation thereof.

Dr. Daniel Amen wrote:Many people with ADD unconsciously seek conflict as a way to stimulate their own PFC. They do not know they do it. They do not plan to do it. They deny that they do it. And yet, they do it just the same. The relative lack of activity and stimulation to the PFC calls out or craves for more activity. Hyperactivity, restlessness and humming are common forms of self-stimulation. Another way I have seen people with ADD “turn on their brains” by causing turmoil. If they can get their parents or their spouses to be emotionally intense or yell at them that might increase activity in their frontal lobes and help them to feel more tuned in. Again, this is not a conscious phenomenon. They do not know that they do this to get turned on. But, it seems many ADD people become addicted to the turmoil. They repeatedly get others upset with them even though there is no conscious benefit to their behavior. This is “Pavlovian,” or conditioned behavior.

So, creating "drama" could be a HPD person's unconscious means of obtaining a biochemical balance that makes them feel better. I believe noradrenaline (aka norepinephrine, "fight or flight" chemical) is also involved, and further it is an immediate successor chemical after dopamine production*. These imbalances can be due to heredity, experiential synaptic "miswiring" growing up (bad childhood), and even brain injury.

See, really it's mainly about chemistry. HPDers are "addicted" to drama and often don't have the empathy to recognize the impact on others who provide the "fix". The erroneous causal misassignments we non-PDers make are our uninformed reconciliations of our human feelings on perceived emotional manipulations without fully understanding the underlying neurotransmitter mechanisms. IMHO.

* http://en.wikipedia.org/wiki/File:Catecholamines_biosynthesis.svg

realitycheque wrote:See, really it's mainly about chemistry.

Realitycheque, I admit my neurochemistry background is nill. I'm not in love with the area ever since I studied a neuron in depth decades ago, and it was so miserably complex I probably have PTSD over it, lol. I wanted to see it as a wire with an electrical signal, and it turned out to be this complex semi permeable membrane that carried a rippling charge down it, stuff flowed in, stuff was pumped out, it seemed to "anticipate" the next firing and behaved as if it was clairvoyant. I quickly retreated figuring I'd need a degrees in chemistry, biology and physics just to get to the foothills where I could return and master that thing.

However I rapidly concluded there were a bunch of very bright individuals on the case and surely with all their brainpower they were going to have that thing all mapped out and understood (especially by now, decades later.)

Hauling things back to the "functional" level thread focus -- inside the head of a HPD you must admit lots of stuff works exceedingly well! See a list I found over at Re: Had my first therapy session today!

If a HPD can feel pain inside themselves, then all the underlying biochemical circuits for that "awareness" are 100% intact. They get injured (a super sexy girl swoops in and poaches her current best BF when she has him in the "on the pedestal / perfect for me" phase ) and she feels intense loss and pain.

Also their side of the "intersubjectivity" channel works flawlessly - their antenna goes right out and sucks in all the verbal and non verbal emotional content from the Non, it comes right in that channel with "crystal clear" accuracy and with almost super human sensitivity . All that stuff flows right in and lights up on the control board. They function flawlessly there. All the biochemical circuits work terrific, right down to the neurons, neurotransmitters emitted out of one side, flowing with zeal across the synaptic clefs, join on the receptors, and the signal gets pass down the side, everthing pumps out correctly and is all set to go again with a very low recycle time. All perfect.

With all that intact how do you get to the double standard on empathy/ethics? It's OK for me to cheat, but it's not OK for you to cheat. How can you take someone who is so darn inter-personally sensitive and have them end up with blinders on to the damage they do to the other?

I speculate every bit of the underlying circuitry is working perfectly, its a active blockage that comes from elsewhere that is interfering with the normal operation of the circuits.

Were this an easy pharmaceutical problem you can bet tons of R&D money would be thrown at it in a heartbeat. Roughly 15% of adults 18+ have a PD. If 50% of those could be placed on $100/mo pharmaceuticals to alleviate most of the troublesome symptoms that would amount to over $20 billion per year in revenue. With an average of 18% of revenue spent on R&D that would be about $4b (yes billions) in R&D funding for solutions every year. And that's just the USA. So, if we could just raise or lower neurotransmitter chemicals or play with their precursors my bet would be that big Pharma would have already delivered us good solutions.

I start from the other end of the spectrum. Assume that the (really crappy) early childhood environment worked on a perfectly functioning system to cause, yes, neruochemical changes. So, yes, later in life we want to induce neurochemical changes induced to "correct" the original "warped" situation. However, instead of trying to use varying levels of neurochemicals directly (a pharmaceutical solution) we use corrective emotional experiences (i.e. intense psychotherapy and intense cognitive thought) to allow the internal chemistry be altered such that the active (but clearly no longer necessary) blockage on the empathy circuits is dissolved/removed, and the underlying normal human functioning returns. This assumes what caused the problem was emotional trauma and that same machine that installed the blocks (as a useful adaptation at the time) can in turn be asked (nicely, and in the right way) to remove them. Not easy, not quick, but can be done and is much more "site specific" and "surgical" than a general pharma "sledgehammer".

Now that you know how I'm biased, I can show you some cites from a well respected guy - Allan N. Schore Phd. I have not read this guy's work but would like to find the time to.

Affect Regulation and the Repair of the Self
http://www.amazon.com/Affect-Regulation ... 0393704076
Be sure to also see Douglas Robinson review the book on the same Amazon page..."In the first chapter I was overwhelmingly impressed with Schore's brilliance; in the second, the Seventh Annual John Bowlby Memorial Lecture, I was still onboard but got a little impatient with all the repetition from the first; by the third, on Melanie Klein's projective identification...[I found a ton of repetition.] "
***
Schore is also sloppy. I'm not sure whether this is a result of his productivity--...or his not-entirely-regulated personality

Comment - Melanien Klein and other concepts of projective identification is fairly complex (and has radical implications for HPD, intersubjectivity, empathy ...) so hearing it said a few times would not be horrible.

Schore wrote about Freud -- A Century after Feud's Project: Is a Rapprochement between Psychoanalysis and neurobiology at Hand? see: http://www.allanschore.com/pdf/SchoreJAPA97.pdf
The paper starts out "On April 27, 1895, Sigmund Freud wrote his friend Wilhelm Fliess that he was preoccupied, indeed obsessed, with a problem that had seized his mind. In what would turn out to be a creative spell, he was attempting to integrate his extensive knowledge of brain anatomy and physiology with his current experiences in psychology and psychopathology in order to construct a systematic model of the functioning of the human mind in terms of its underlying neurobiological mechanisms."

It goes on to say "If it is true that Freud disavowed the Project, why are we so familiar with the concepts it introduced? Ernest Jones points us to the answer—it is contained in the seventh chapter of Freud’s masterwork, The Interpretation of Dreams." More on that in another post. In that chapter 7 he really gets into the "mechanism" of dream analysis which is totally relevant to all psychoanalytic psychoanalysis.

I'll note that Schore was accused of having a not-entirely-regulated personality in this area, and Freud himself was said to have a total obsession over it, followed by a total disavowal! LOL!

If you have the stomach for it I think Schore might have some cool stuff that relates to brain chemistry and is directly relevant to HPD. (Advances in Neuropsychoanalysis, Attachment Theory, and Trauma Research: Implications for
Self Psychology looks on initial pass to be cool. Available on his web site. I have yet to allocate enough time to him. The other cool researcher in Affective Neuroscience in my book is Jaak Pankseepp. I especially like his taxonomy of affects which is well informed by current research in neuroscience. I think I posted that. Whenever I have an emo time I'm trying to sort through I try to use any lists/taxonomies to try to elicit and clarify my emotions. Pankseepps taxonomy has probably been the best organized.

wisdom, in another thread, wrote:I want to take a minute to talk about empathy, then come back to look in detail at your post, one step beyond the “self control” aspects. I want to cover two areas. 1. What I envision is a “blockage” that prevents otherwise perfectly functioning empathy circuits to fail to work for HPDs, and 2. a temporary “work around” – i.e. a way to “dart around” that blockage

wisdom wrote:If a HPD can feel pain inside themselves, then all the underlying biochemical circuits for that "awareness" are 100% intact. They get injured (a super sexy girl swoops in and poaches her current best BF when she has him in the "on the pedestal / perfect for me" phase ) and she feels intense loss and pain.

Also their side of the "intersubjectivity" channel works flawlessly - their antenna goes right out and sucks in all the verbal and non verbal emotional content from the Non, it comes right in that channel with "crystal clear" accuracy and with almost super human sensitivity . All that stuff flows right in and lights up on the control board. They function flawlessly there. All the biochemical circuits work terrific, right down to the neurons, neurotransmitters emitted out of one side, flowing with zeal across the synaptic clefs, join on the receptors, and the signal gets pass down the side, everything pumps out correctly and is all set to go again with a very low recycle time. All perfect.

I speculate every bit of the underlying circuitry is working perfectly, its a active blockage that comes from elsewhere that is interfering with the normal operation of the circuits.......Assume that the (really crappy) early childhood environment worked on a perfectly functioning system

I haven't responded sooner because I've been trying to understand where you're coming from on the Empathy topic. I think I've found it. Your usage of "100%" and "perfect" and "all" gives me the impression that you're envisioning the brain hardware / wiring as being either fine or faulty. There are different areas of the brain, and they can independently be fine or faulty or somewhere in between. Brain scans show these degrees of "normalcy", and we know that abnormalities can be present at birth. Areas that take some inputs and process them may be physically separate from one another, and may damaged due to heredity, experiences, and/or injury.

There is a correlation between lack of empathy and malfunctioning parts of the PFC and frontal lobes. It is possible that the empathy "circuits" are not inherently fine, so assumptions that they are, with explanations of why they are being hindered, can lead to difficulties in your hypothesis. That said, I am intrigued by possible re-routing of processing through properly working parts of the brain that train/simulate empathy. The brain can be remarkably adaptable to having damaged areas.

wisdom wrote:Were this an easy pharmaceutical problem you can bet tons of R&D money would be thrown at it in a heartbeat. Roughly 15% of adults 18+ have a PD. If 50% of those could be placed on $100/mo pharmaceuticals to alleviate most of the troublesome symptoms that would amount to over $20 billion per year in revenue. With an average of 18% of revenue spent on R&D that would be about $4b (yes billions) in R&D funding for solutions every year. And that's just the USA. So, if we could just raise or lower neurotransmitter chemicals or play with their precursors my bet would be that big Pharma would have already delivered us good solutions.

Pharma is already providing drugs that treat the symptoms of PDs, i.e., depression. It is making billions on it. The problem with many PDs is that people can function in society with untreated PDs, just not happily. And insurance companies won't endlessly pay for those drugs (and PDers won't pay out-of-pocket for those drugs) unless the PDer is disabled by the PD. Further, getting most types of PDers to help himself/herself (if they will even acknowledge they have a problem) is like herding cats with a sheepdog. I didn't say biochemicals were the solution, but they are key to the problem. I do believe natural and synthetic sources that help regulate these biochemicals are underutilized in correcting underlying imbalances from PDs, and should be evaluated for reducing at least the HPD and NPD extremes.

Wisdom said:

Still, at the end of the day, I can’t get a grip on why HPD doesn’t crash/hit bottom/snap out of it, particularly as one matures and gains irrefutable life experiences? Why doesn’t the HPD double standard, over time, just self-correct, and with the dissolution of that take out the entire disorder altogether, all pretty much automatically?

I reached rock bottom when I was 19 and had to go to inpatient rehab for my multiple eating disorders. That was three years ago. I believe that I successfully charmed my therapists who were, understandably, primarily focused not on diagnosing me with a PD but treating my ED symptoms through Cognitive Behavioral Therapy. Like Masquerade, though, I really hit a rough time a few months ago and decided I needed to confront my issues with recovery in the forefront of my mind. So I'd guess that many people who become aware of HPD and choose to seek recovery have done so because of a rock bottom type experience.

RealityCheque, I have pretty bad ADD, along with poor impulse control, short attention span, and CONFLICT SEEKING. Ohhh boy. This one has gotten me into trouble ALREADY in my first adult job. (I've only been out of college since this past May.) I'm a lowly breakfast hostess at a hotel who essentially "started $#%^" with a manager so that I could avoid responsibility for something I'd accidentally done wrong. I absolutely have displayed a pattern of seeking conflict in order to achieve a sort of high that "feels" emotional but must surely be physical as well. My consistent lack of empathy has enabled me to progress (or de-gress!?) this far without considering the impact of my behavior on other people.

StrugglingHPD,

Thanks for sharing your experiences. It helps to hear a first-hand account of what I've been gleaning from Dr. Amen's book. He doesn't specifically address HPD, so I've been trying to put pieces together from shared NPD and OCPD characteristics (i.e., lack of empathy) to account for HPD traits.

Sorry I don't know your full story (I'm a casual observer here). A few Qs:
What kind of eating disorder did you have, and did certain types of foods trigger it?
Do you feel better (less prone to "bad" HPD feelings/behaviors) after exercising rigorously or eating high protein diets?
Have you been prescribed or taken any dopamine-enhancing meds or supplements?

Realitycheque,

Thanks very much for your reply. I’m open to your suggestion that parts of the head (really any specific part, any region, any mood altering hormone gland, etc.) can be physically malfunctioning. Not only that, but the pure physical malfunctioning can occur:

• randomly
• periodically
• only in conjunction with another single event or unique state
• only in conjunction with multiple other events/states (including odd or rare and miserably complex combinations.) What’s more all these co-required events / states might be occurring at difficult to track frequencies)
• or, perhaps just be 100% dead at all times

If there is a physical malfunction there are also likely identifiable reasons that lead to either

1. the breakdown of what was at one time 100% functional or
2. some type of external disruptive force that operated during the development period that interfered in a physical way, effectively prevented the malfunction object from maturing 100%. (Note: this would have to occur long enough such that, if it resolved in the present, and once again became operational, the opportunity for “downstream” normal maturation would have permanently lapsed. Otherwise, after this part became functional in the present, the maturation dependent on it would restart right from where it left off.

As you point out there can be all sorts of physical reasons that a part might be malfunctioning

• heredity – something in the genes that cause some part, region, gland, etc to be malformed
• environmental physical factors such as malnutrition, harsh living conditions, insufficient water, dietary deficits, etc.
• external physical damage such as laceration, puncture, crushing, burning, shock, irradiation, etc.
• internal disease, illness, and internal physical trouble (like a tumor, aneurysm, cancer, blood flow blockage, etc.)
• such intense experiences that the electrochemical reaction that goes off actually does irreversible physical damage, and that damage can’t be regenerated.

realitycheque wrote:There is a correlation between lack of empathy and malfunctioning parts of the PFC and frontal lobes. It is possible that the empathy "circuits" are not inherently fine, so assumptions that they are, with explanations of why they are being hindered, can lead to difficulties in your hypothesis.

One thing is certain in my book about neuroanatomy - there is a wealth of knowledge of how traumatic brain injury (TBI) affects functioning and behavior. It seems through the years every part of the physical brain has been seriously injured in battle, fighting, via accidental wounds, all types of highly specific gunshot wounds, piercing of all types, disease, routine and experimental neurosurgeries, etc. The subsequent effects on behavior and experience of these intrusions have been painstakingly detailed, recorded, extensively corroborated and have evolved to an exceptionally refined knowledge state.

I’ll further admit that much of these information rich findings (many enabled by the phenomenal rise in the ability to do relatively cheap, incredibly accurate, non-invasive, three-dimensional imaging) have yet to be exploited by the psychological community for the benefit of treating PDs.

I’m moved by seeing post after post in this form that so much is known about HPD and BPD yet so many people suffer from it directly and indirectly without benefit whatsoever of that huge pile of collected wisdom. Too much “good stuff” is locked up in esoteric professional journals, hard to obtain and understand clinical textbooks, notes on effective treatments, etc. Even in this supposed “information age” the system seems painfully slow to apply what we already very much know. This is another great example that illustrates this - no doubt there is much more “fruit” just hanging in the imaging studies and wealth of info on TBI waiting to be picked.

Back to part of the above quote “there is a correlation between lack of empathy and malfunctioning parts of the PFC and frontal lobes”. Warming myself up to think of that with some “self questions” I’ll share my stream of consciousness …

• Probably an imaging study with CAT scanners and MRI – newish stuff. Some scanner to psych research has had some harsh critical reviews. On the other hand there is no question that imaging technology is indeed a wow. Wonder where on the “lasting quality” spectrum this particular research fall? In 10 years will it be considered “landmark” or will it just pass as another several pages, forgotten, left behind in a dusty, esoteric library journal that never again comes productively off the shelf.
• Gee, nuroanatomy. Isn’t that the most complex subject in the entire world to actually understand? How many times have I heard “you don’t have to be a brain surgeon to figure out…”. When I went to the Dictionary of Occupational Titles in high school and couldn’t resist looking up the top-paying job in the U.S. what was it? Yes, neurosurgeon. Boy they must be smart! So… big fear I just don’t have the intellectual horsepower to “get my head” around the totality of this neuroanatomy with psychology stuff. Can one human in one lifetime comprehend, integrate and apply this stuff?
• Humm, all these super bright neurologists / neurosurgeons had put down their scalpels to study behavior? Humm, indeed - that doesn’t really fit with the typical lack of “bedside manor” I seem to envision a top-drawer academic surgeon having. Most seem to live in their own world, not really interested in anything human, outside of their specialty (performing very difficult surgery).
• Come to think of it how did they measure empathy? It’s been an area that seems to have eluded the best psychiatrist/psychologist and criminal justice specialists, for centuries. Do they have a reliable, large sample, painstakingly normalized empathy inventory? How come I’ve not heard about this before? Do they established a norm based bright line between normal empathy and deficit? This I have got to see…
• Gee if they have a solid empathy inventory why not just give that to the entire population and isolate out all those that fall below that bright line? [I’d never actually consider that, however in my mind, during this “pondering” phase I unleash my self to wander everywhere uninhibited for a while, then “put the blocks to it” and reality test a bit later.]
• Humm, imaging you say. Back in the 70’s as I studied the biochemistry of a single neuron (err…well.. struggled hard with that study of a single neuron) At that time I noted odd parallels of the discharge fields around the neuron (as imaged at that time) with what seemed to be capturing with Kirlian photography http://en.wikipedia.org/wiki/Kirlian_photography. However that entire effort was sort of a “black hole” for me personally – lots of time and effort going in, nothing tangible of practical benefit coming out. So, perhaps I’ve been “burned” by psychological “imaging” personally. Note to self, times may have changed….

realitycheque wrote:That said, I am intrigued by possible re-routing of processing through properly working parts of the brain that train/simulate empathy. The brain can be remarkably adaptable to having damaged areas.

Re-routing is a huge part of TBI rehab treatment. In TBI they often know for certain some part of the head is 100% gone. And they have all types of rehab “bypass” workarounds. There is also some evidence that the workarounds eventually become permanent new neural connections, so the “factory original” specifications are sometimes partly or even fully restored!

At risk of being over reliant on a computer / logic model of the human head I’ll again try to illustrate conceptually why I think “underlying circuits” in HPD are likely not physically impaired. Imagine a neuron as a CPU chip all in itself. Individually and collectively it takes inputs, computes, and produces outputs. In a conventional CPU chip you have a set of operations that can be called, one at a time. A specific operation does something useful, a unit of work. A CPU might have a few hundred instructions that can be executed. You send the CPU a specific instruction; it performs exactly in the same way, every time.

Now imagine out of the several hundred instructions a CPU was designed to handle, due to a manufacturing error, three instructions don’t perform as designed. Any of the hundreds of other instructions compute perfectly, and each of the three doesn’t, but they fail in exactly the same way.

The problem is easily resolved in the (very close to the chip) software – just don’t use those three instructions. Or, use those three instructions but later, in the software, go back to the CPU, have more instructions run, and then you have the desired output. OK you lost a bit of speed (lets say each instruction can be executed in one tick of the clock) and these three problem instructions need to be excluded, worked around, and that detour may cost 5-6 operations to be used where ideally, by design, only one should have been needed. Does this result in any functional impairment? No, not really. With the small in-software correction the CPU performs exactly as originally designed, and since those three workaround instructions are used only once in a while (out of several hundred operations) the degradation is miniscule.

Is the CPU defective as produced? It works well. You can make a lot of them, put them in lots of computers, ship them out with the correction in the small “patch” and they work fine. Never make a “hardware” error over their entire useful life, etc.

In the lifetime of all those computers how many will have a higher-level software problem? Something due to error in programming the application software? Bugs at that level? Unusual conditions that cause a need for a full reboot? Software changes in one area that were unaware of dependencies and “broke something” that with prior versions worked fine? In my model / hypothesis much more widespread “trouble” comes from faulty programming vs. underlying hardware (physical) issues.

If you accept my analogy above (“It’s almost never the hardware” and when it is, the problem is incredibly obvious, it can’t be fixed without component replacement) it follows that the application “software” layer is the most likely area to contain the bugs (i.e. the problematic emotional upbringing and learning patterns that occurred, has resulted in maladaptive behavior in the present.)

You can argue that the (early childhood) application software (learning, experiences) actually harden up to physically become hard wired, (i.e. start out as “programmable” but then rapidly solidify into hardware), once some level of maturation is reached.

Or you can argue that most of that is still software, and through metallization, “controlled” emotional experiences, etc. all that is highly reprogrammable, and from then on (unless it’s deeply disturbed yet again) it works pretty much flawlessly, just as originally designed.

That’s not saying there is no room for high quality pharmaceuticals (and potentially in the future other electrochemical interventions).

Imagine if empathy was just a hormone, just like estrogen. Using the crack shot empathy inventory discussed above all the primary care physicians could double check that level as part of a routine annual physical. Having noted anyone falling below the bright line minimum they could just order a pharmaceutical replacement. Having “topped off” the deficient naturally produced empathy hormone to a normal level those patients would be effortlessly cured. When the replacement drug went off patent the generic version would finally be affordable to virtually everyone. We could close up this forum, problem solved.

Jails, correctional facilities, juvenile detention centers, police, governments, (and even Non’s collectively) etc could afford to pay tons for an empathy replacement pharmaceutical. Just think of the “future costs” that could effortlessly avoided.

Long term, perhaps its a viable option, but so is “dart around” / “bypass” / “reprogram”. As you say the human head was very well designed, highly intelligent and exceptionally adaptable (highly reprogrammable.)

I still contend that where we are right today the therapy route is most cost effective path towards HPD symptom reduction (better adaptation, greater happiness, etc). Yes there are great drugs that can relieve depression and anxiety, smooth out bipolar swings, help with intermittent psychotic episodes, put you to sleep at night, anesthetize and sedate you. Judicious use of those as an adjunct to therapy, where clearly beneficial, does nothing but accelerate the process. For some, permanently being on such drugs is extremely beneficial.

However, in the end I’m struck by all the HPDers here who have sought therapy. Almost to a person they seem to have “hit a bottom”, gone through a rather crushing, mind bending depression, followed by a change in the way they think and feel about things. They report changed behavior going forward (and some even seem to climb right out and be 100% HPD symptom free). I’m not sure just pumping them up with antidepressants so they could totally avoid that emotionally unpleasant introspection period, that admittedly has some very dark moments, would prove long-term beneficial.

I can’t tell you how very much I enjoy and appreciate your insights here. In my hypothesis much is pure speculation, just trying to integrate what I’ve found out about the HPD/BPD disorders. After doing readings I generally don’t really think much about it; stuff sort of just spews from my mind after a while. So, I’m positive I frequently have misperceptions. I assure you, in light of such mental spewing, I find a good “biblical” level rebuke very bracing! It stimulates my mind intensely in new directions. I like to think I’m pretty fluid here and only party self-directed. Bushwacking for me is often times just following feelings / vibes / intuition.

realitycheque Was wondering do you have a background in this stuff? What draws you to it and maintains your interest?

RealityCheque,

It started out as anorexia when I was about 16 years old. Starving, overexercising, the works. I accidentally discovered purging when I was 17, and my anorexia gradually became bulimia. After all, who wants to restrict yourself when you can go all out and avoid the weight consequences? Bulimia was a much easier route, it seemed. You asked about certain types of food. Really, I vomited just about everything. I majored in dietetics so I knew to try to keep down vegetables and at least some carbs (like fruit or whole grain) but I lost about 35 lbs in total off an already-thin frame. Things that I would ALWAYS make sure I threw up in their entirety would be items like ice cream, cake, cookies; namely anything high-calorie and sweet. As a side note, you’d probably be surprised at how many dietetics majors are there because they’re afraid of food. My obsession with it was why I decided to study it in college. I mistook obsession for passion. My best guess is about 10%-15% of majors or minors suffer from EDs. Just an interesting little nugget for you.

Hmm, I’m not sure I can accurately answer the question about a high protein diet. I don’t really switch up my diet; I try to always just eat with balance between all the groups. I do, however, feel great after exercising. Pretty natural. Honestly, I probably am less prone to exhibit HPD behaviors after vigorous exercise simply because I am worn out. I have less energy to focus on how I am coming across to others if I’m busy thinking, “Holy crap, my legs feel like jelly!” J

In rehab at Remuda Ranch, I was prescribed a daily 150 mg Zoloft, an SSRI (Selective Serotonin Reuptake Inhibitor). Zoloft blocks dopamine reuptake at high levels.

To throw things in a wilder direction, when I WAS OFF MY MEDS, I went through that

“rather crushing, mind bending depression, followed by a change in the way they think and feel about things. They report changed behavior going forward… emotionally unpleasant introspection period, that admittedly has some very dark moments, would prove long-term beneficial”

that Wisdom referred to. I had moved to a new city and failed to obtain a new Rx and went off my med cold turkey. Not a wise idea, I know. But it was during those dark several weeks that I began to realize just how screwed up of a person I was. I was genuinely suicidal for the first time in three years. It was then that I discovered HPD, and suddenly everything made sense. I got a new Rx, went back on 100 mg (instead of the prescribed 150 in order to save money and just because I wanted to lessen my doage). This time around, though, I had garnered the knowledge to better myself. I don’t know that I would have been desperate enough to seek it unless I had been unmedicated for those few weeks.

Hope this answered everything adequately.

StrugglingHPD: Your experience seems to be supporting my budding hypothesis on some manifestations of HPD being a combination of ADD/ADHD (due to hypoactive prefrontal cortex / dopamine deficiency) and OCD/OCPD (due to hyperactive anterior cingulate gyrus / serotonin deficiency) with childhood experiences driving the BPD "flavor" to HPD or NPD or other/neither. DSM5 recommends folding HPD and NPD under BPD, and there is a study (A Philipsen) concluding an 80% co-morbidity of BPD with ADD in women. There is a significant (30%) co-morbidity of eating disorders with OCD.

StrugglingHPD wrote:It started out as anorexia .... Starving, overexercising, the works. I accidentally discovered purging when I was 17, and my anorexia gradually became bulimia.....My obsession with it was why I decided to study it in college.

StrugglingHPD wrote:Things that I would ALWAYS make sure I threw up in their entirety would be items like ice cream, cake, cookies; namely anything high-calorie and sweet.

StrugglingHPD wrote:In rehab at Remuda Ranch, I was prescribed a daily 150 mg Zoloft, an SSRI (Selective Serotonin Reuptake Inhibitor). Zoloft blocks dopamine reuptake at high levels.

Hard to say if there's a cause-and-effect relationship on what you chose to purge. See my information regarding diet for dopamine deficiencies (below). Decreasing/purging simple carbs as you did would tend to raise your brain's dopamine levels while reducing your serotonin levels. The sertraline (Zoloft) is primarily a serotonin enhancer (anxiety reducer) though it does appear to have some minor dopamine-enhancing capabilities. SSRIs also tend to lower interest/performance in sex.

StrugglingHPD wrote:I had moved to a new city and failed to obtain a new Rx and went off my med cold turkey. Not a wise idea, I know. But it was during those dark several weeks that I began to realize just how screwed up of a person I was. I was genuinely suicidal for the first time in three years.

Apparently, this is a common withdrawal side effect. The silver lining is that you sought out answers and now have a better understanding of how your brain and body are working (or not).

StrugglingHPD wrote:I do, however, feel great after exercising. Pretty natural. Honestly, I probably am less prone to exhibit HPD behaviors after vigorous exercise simply because I am worn out. I have less energy to focus on how I am coming across to others if I’m busy thinking, “Holy crap, my legs feel like jelly!” ..... This time around, though, I had garnered the knowledge to better myself. I don’t know that I would have been desperate enough to seek it unless I had been unmedicated for those few weeks.

You characterize this is pretty natural, but studies have indicated that serotonin, in smaller amounts of dopamine, are released as a "side effect" of vigorous exercise. Thus, it is the additional serotonin that is lessening your over-focus, rather than your gelatinous lower appendages, and the little boost of dopamine makes you feel happier.

But it doesn't seem like you're really having a dopamine-deficiency addressed. That could be where the need for drama and sex are continuing to be a problem. Maybe you would consider upping your protein intake and see what effects you have (recommendations are below in Dr. Amen's Prefrontal Cortex Issues literature).


Wisdom, thanks again for the in-depth response and interest. I do enjoy reading your posts.

wisdom wrote:Gee, neuroanatomy. Isn’t that the most complex subject in the entire world to actually understand? How many times have I heard “you don’t have to be a brain surgeon to figure out…”. When I went to the Dictionary of Occupational Titles in high school and couldn’t resist looking up the top-paying job in the U.S. what was it? Yes, neurosurgeon. Boy they must be smart! So… big fear I just don’t have the intellectual horsepower to “get my head” around the totality of this neuroanatomy with psychology stuff. Can one human in one lifetime comprehend, integrate and apply this stuff?

wisdom wrote:realitycheque Was wondering do you have a background in this stuff? What draws you to it and maintains your interest?

My grandfather and uncle were published neurosurgeons. My half-brother is a psychiatrist who has OCD. My wife has OCPD, and my mom and son appear to have dopamine-deficiency issues. I'm a biochemical engineer in the pharmaceutical industry with specialization in analytical spectroscopy technologies. I'm just trying to make sense of it all, and come up with solutions that seem to be so frustratingly evasive in the medical community by looking at application of new technologies and reading about the traits from those experiencing them, and then (hopefully) making those big-picture connections.

wisdom wrote:At risk of being over reliant on a computer / logic model of the human head

Funny, I also have used a computer analogy/model to help describe my theory on the mind of an OCPDer.

realitycheque, on another forum, wrote:I believe the main foundation of disorders is genetic. Brain functions (i.e., activity) control how a person processes information, whether it be sensory inputs or memories. Behavior is the result of that processing. Faulty neuro-activity in certain processing areas of the brain have been linked to specific "abnormal" types of behaviors. These types of abnormal behaviors are periodically grouped by the neurology/psychology medical profession into disorders. OCPD is one of those groupings, but it is not an absolute classification, nor is it independent from other disorders and their behavioral traits.

So, the brain may have faulty processors at birth; think of them as the computer hardware (chips). The memories that a person has do play a significant role in not only behaviors, but also in the development of the parts of the brain that process information. Continuing the computer analogy, the experiences a person has are raw data collected (on the hard drive), and affect the mind's programming. There are actual physical neurological connections that are being made until age 25 (firmware), and there are more pliable relational connections (models) that occur throughout life (software). Further, the raw data memories stored on hard drive for re-processing at any time, and can affect the output both as inputs to a particular situation and as the basis of the model/algorithm/program being run to react to the situation.

Food (the power supply) also affects the processing. Power conditioning (food selection) helps the brain run smoothly by evening out too much or too little activity in certain parts. Meditation/spirituality/music (cooling fans) also reduce the chance of the mind overheating, including rages. Exercise and sleep (utility programs) keep the whole brain (processors, storage, and power supply) healthy and properly maintained.

So, a parent can impact the hardware (genetically) and the firmware/software (environmentally). You can have a little control the former through medication, but you can help significantly on the latter, and the earlier the better before the synapses (firmware) are too far burned. The software programming can take place at any time, and CBT is one effective way that you and a professional and the PDer can all help re-program the brain; it also can offset some of the firmware problems. Food, activities, and home atmosphere all contribute to a child's development, and we as SO parents must take initiative to offset OCPD influences in these areas.

Just my theory. It's taken over a year of reading and observations to assemble the puzzle, so there's a significant amount of research behind my brief synopsis.

wisdom wrote:Probably an imaging study with CAT scanners and MRI – newish stuff. Some scanner to psych research has had some harsh critical reviews. On the other hand there is no question that imaging technology is indeed a wow. Wonder where on the “lasting quality” spectrum this particular research fall? In 10 years will it be considered “landmark” or will it just pass as another several pages, forgotten, left behind in a dusty, esoteric library journal that never again comes productively off the shelf.

Here is some additional pertinent information from Dr. Daniel Amen in his book "Healing the Hardware of the Soul". He has come under some critical reviews for his research using single photon emission computed tomography (SPECT) brain scans on people with psychological problems, but there's lots of potential insight from his findings from thousands of scans.

WebMD wrote:SPECT uses a radioactive dye to create a three-dimensional image of the blood flow and activity in the brain. It is typically used to diagnose medical conditions such as Alzheimer's disease, Parkinson's disease, and head injury. Amen says this type of scan also can provide doctors with more thorough information about ADHD and other psychological conditions.
Based on these symptoms, and the use of SPECT brain scans to highlight activity in the parts of the brain related to attention, short-term memory, and forethought, Amen described these six types of ADHD:

* Type 1 -- Classic ADHD. All of the hallmark symptoms of ADHD, plus hyperactivity and impulsivity. Responds well to stimulant medications.
* Type 2 -- Inattentive ADHD. All of the hallmark features of ADHD, but instead of hyperactivity, there is low energy. Also responds well to stimulant medications.
* Type 3 -- Overfocused ADHD. All of the hallmark features of ADHD, in addition to negative thoughts and behaviors, such as opposition and arguing. Tends to respond better to an antidepressant (such as Prozac) combined with a stimulant.
* Type 4 -- Temporal Lobe ADHD. The hallmark features of ADHD, plus irritability, aggressiveness, and memory and learning problems. Responds better to antiseizure medications (like Neurontin) than to stimulants.
* Type 5 -- Limbic ADHD. Combines ADHD with depression and low energy and decreased motivation. Responds better to stimulating antidepressants than to stimulants.
* Type 6 -- The Ring of Fire. Cross between ADHD and bipolar disorder. Characterized by moodiness, aggressiveness, and anger. Anticonvulsants or newer antipsychotic medications tend to work better than stimulants.

Dr. Daniel Amen wrote:Borderline Personality Disorder

Instability in relationships, impulsivity, and low self-esteem characterizes borderline personality disorder. People with borderline personality disorder may switch attitudes towards others, identifications, values, and goals quickly. For example someone with borderline personality disorder may worship a new friend or lover and then drop him or her quickly, complaining that the new friend wasn't caring enough. Professional goals and interests, as well as mood, may change suddenly. Highly reactive and impulsive, such people may experience periods of extreme irritability, anger, or anxiety. They may engage in self-destructive behavior such as drinking heavily, driving fast, overspending, hinging on food, or having unsafe sex. People with borderline personality disorder may feel. The great emptiness and engage in suicidal or self-mutilating behaviors. Boredom may be intolerable to someone with this disorder, and consequently he or she may perpetually seek stimulation. Childhood abuse or neglect or the early loss of a parent may be found in family histories of people with this disorder.

The biological underpinnings of borderline personality disorder are complex. People with borderline personalities may have a combination of prefrontal lobe problems, which accounts for impulsivity, conflict-seeking and stimulation-seeking behaviors, and a tendency to intensely value or devalue individuals. Anterior cingulate problems may also exist, evidenced by obsessive thinking, cognitive inflexibility, and a very strong tendency to hold onto grudges and past hurts. There may also be temporal lobe abnormalities. The left temporal lobe is involved with aggressive behavior towards the self and others.

Consistency and control over impulsivity are necessary to developing and sticking to character goals. When you are controlled by your emotions, constantly reacting to outside events in the heat of the moment, you cannot develop an overall sense of who you are, what you want, and how you will get what you want. Contemplation is important to developing a sense of right and wrong, what is good and bad for you and for others. Likewise, being enslaved by impulses and reactions denies you the opportunity to build a strong sense of self-esteem. When you control what you do, you feel greater certainty about your identity. It's rewarding to be able to clarify your personal values and stick with them, to know that you and you alone are in charge of your life.

It's hard to build a sense of security and of being loved when you find yourself attaching unrealistic expectations to people to whom you're attracted and then ending friendships before they've had a chance to develop. Social connectedness takes work; it implies forgiving and flexibility. It's important for all of us to try to develop greater empathy for others by asking ourselves about another's point of view and not automatically assuming we know what others feel and think.

Dr. Daniel Amen wrote:Prefrontal Cortex Issues

If your [101-point questionnaire checklist] score in the PFC indicates problems, there are a number of things you can do to optimize this part of the brain. Problems in this part of the brain can be associated with a diagnosis of attention deficit disorder (ADD), brain trauma, or toxic exposure. ADD is commonly divided into two main categories: ADD with hyperactivity and impulsivity, and ADD without hyperactivity and impulsivity.

Brain studies of the first subtype revealed decreased activity in the prefrontal cortex and premotor cortex in response to intellectual challenge, most likely due to low dopamine availability in the deeper structures of the brain. This subtype is usually very responsive to stimulant medications. These medications enhance PFC activity and prevent brain shut down, allowing a person to have more access to this part of their brain.

Girls with ADD are frequently missed because they are more likely to have the non-hyperactive form. The severity of both of these disorders is rated as mild, moderate, or severe. Additional symptoms for the non-hyperactive subtype include excessive daydreaming, frequent complaints of being bored, appearing apathetic or unmotivated, appearing frequently sluggish or slow-moving, or appearing spacey or internally preoccupied. Most people with this subtype of ADD are never diagnosed. They do not exhibit enough symptoms that grate on the environment to cause others to seek help for them. Yet they often experience severe disability from the disorder. Instead of help, they get labeled as willful, uninterested, or defiant. This subtype is also usually responsive to stimulant medications.

Nutritional intervention can be especially helpful in this part of the brain. For years I have recommended a high-protein, low-carbohydrate diet that is relatively low in fat to my patients with ADD. This diet has a stabilizing effect on blood sugar levels and helps both with energy level and concentration. Unfortunately, the great American diet is filled with refined carbohydrates, which has a negative impact on dopamine levels in the brain and concentration. With both parents working outside of the home, there is less time to prepare healthy meals. The breakfast of today typically involves foods that are high in simple carbohydrates. Sausage and eggs have gone by the wayside in many homes because of the lack of time and the perception of fat is bad for us. Even though it is important to be careful with fat intake, the breakfast of old is not such a bad idea, especially where ADD or other dopamine-deficient states exist.

The major sources of protein I recommend including include lean meats, eggs, low-fat cheeses, nuts, and certain beans. These are best mixed with a healthy portion of vegetables. The ideal breakfast is an omelette with low-fat cheese and lean meat, such as chicken. The ideal lunch is a tuna, chicken, or fresh fish salad with mixed vegetables. The ideal dinner contains more carbohydrates, such as bread or potatoes, with lean meat and vegetables. Eliminating simple sugars (such as cakes, candy, ice cream, and pastries) and reducing simple carbohydrates that are readily broken down into sugar (such as bread, pasta, rice, and potatoes) will have a positive impact on energy level and cognition. This diet is helpful in raising dopamine levels in the brain. It is important to note, however, that this diet is not the ideal diet when there are cingulate or overfocus issues, which usually stem from a relative deficiency of serotonin. Since tech serotonin and dopamine levels tend to counterbalance each other, whenever serotonin is raised, dopamine tends to be lowered, and when dopamine is raised, serotonin is lowered.

Nutritional supplements can also have a positive effect on brain dopamine levels and help with energy and focus I often have my patients try L-tyrosine. This supplement helps to increase dopamine and blood flow in the brain, and many of my patients report that it helps with energy, focus, and impulse control. In addition, exercise boosts blood flow in this part of the brain.

Plenty of food for thought.

StrugglingHPD, realitycheque

A couple of quick questions, off the mark, but have bugged me for a while, and my local nutritionist friends don't seem to have a clue. Its oddly related to how pharmaceuticals might be used to treat HPD/BPD but its perhaps "far upstream".

1. Exactly how is RDA (recommended daily allowance) determined?

You can't just have several large groups of humans to test on, each getting something like "Vitamin A" in various daily amounts then (controlling for all other nutritional, emotional, physical and environmental factors, etc.) measure the health outcome of none through massive overdosegroups? How then do you come up with the RDA number accurately? It seems like the number is just a loosely informed "rough guess" base on highly eclecitc research "around the edges". Also why on earth is it not MG per KG?

Is it just a WAG based on a odd combination of studies for each "essential thing you need to eat" to have a "balanced" diet. For example an odd combination of:

• laboratory studies - rats, etc. Rats getting x mg of Vitamin A seemed happier, better able to relax, think clearer? Can these be reliably be applied to humans?
• Dietary intake studies - two groups (rich in beta-carotene and vitamin A vs. Normal) - cancer rates? (but they only looked at one disease? No downsides?)
• chemo-prevention studies - give massive amounts see if they do/don't develop cancer? (again, only looked in one narrow spot)
• Toxic effects or bad outcomes - "study was stopped after researchers discovered that subjects receiving beta-carotene had a 46% higher risk of dying from lung cancer"-- glad they stopped that one!
• eclectic examinations using tiny samples - e.g. "found that a dietary retinol intake greater than 1,500 mcg/day (more than twice the recommended intake for women) was associated with reduced bone mineral density and increased risk of hip fracture as compared to women who consumed less than 500 mcg/day" Sample size was only 9!

2. How am I assured that RDA knows everything I should eat, not just a tiny sub-segment (where there are sufficient studies to support at least a WAG) made up of a select few vitamins and minerals. In reality is the list of "should eat" much, much larger?

3. RDA is never MG/KG and "is the same for everyone"

• all ages
• all seasons
• all physical conditions
• all moods / mental conditions / levels of stress
• doesn't vary with hereditary factors
• doesn't vary even if you are sick some times, well others...

4. If I have a "cocktail" of the very best currently known nutritional supplements, precursors, herbs, and "enhancements" (assume all OTC / unregulated) do you think I could increase mental performance by 10% or more with low risk? Would at least some experts agree on what should go into the "cocktail" and the amounts per day? Any risk of doing damage to my head or any other body parts?

Would love to know...