Sebern’s Response to “Imaging Study Maps Brain Activity in Borderline Personality Disorder”

 

Imaging Study Maps Brain Activity in Borderline Personality Disorder

A colleague of mine asked for my take on the above article and I wanted to share it with anyone who might be curious:

I don’t think that Borderline personality disorder is a discreet disorder and I doubt highly that there is a genetic brain fault. I think of BPD as Complex Affect Regulation Disorder. The complexity comes from the fact that these are people whose early life experiences were terrible enough to leave them with developmental brain deficits -overstimulated fear circuitry in the limbic brain and sparse attachment experiences- that compromise prefrontal control of the sub cortical brain, just as this study suggests. This conspires to make it very difficult to shut down wild limbic firing leading to ambient and acute fear, rage and anger and shame ( self-hate) and all the cognitive and behavioral distortions that arise under these circumstances. They don’t just feel these things, which is bad enough. ¬†They are overcome by these emotions to such an extent that they become them. They are what they feel. They have no separate identity. If you look at the Lanius slide in my book (C.4) you will see another brain representation of this reality. She took fMRI scans of people with no history of developmental trauma and scans of those with serious early trauma and neglect. It will make you weep. There is robust blood flow in the self-system or the default mode network in those with no history. There is hardly any activation of this self network in those with severe developmental trauma.

I think this study is documenting the fact of brain disorganization in BPD nicely. But of course it would have to be there. Another study that I cited in the book found epileptiform activity in a high percentage of people stigmatized with this dubious but all too popular diagnosis.