A Silver Lining in Borderline Personality Disorder Bret Stetka, MD; Christopher J. Hopwood, PhD

Medscape
Editor's Note:
At the 2012 annual meeting of the American Psychiatry Association, held in Philadelphia, Pennsylvania, Medscape spoke with Christopher J. Hopwood, PhD, Assistant Professor in the Department of Psychology at Michigan State University, on new research that suggests a silver lining for patients with borderline personality disorder (BPD).
Medscape: Can you give us a brief summary of the work on BPD that you presented today?
Dr. Hopwood: A interesting finding that has emerged recently is the idea that personality disorders are less stable than previously thought; people's symptoms actually decline eventually, and they get better, which is really good news.
I presented on the stability of underlying personality traits among people with BPD compared with people with other personality disorders. It's interesting from a scientific perspective, because the issue of normal trait stability has been a long-standing debate. One of the findings has been that personality traits are generally stable, meaning they're relatively consistent over time in adulthood. But new findings show that people with clinical conditions tend to have less stable personality traits than people without such conditions.
Because BPD is defined in part by such traits as instability of emotions, interpersonal behavior, and self-esteem, a hypothesis is that instability in the underlying personality system might be implicated as an etiologic factor in BPD. And in fact, we know that normal trait instability over time has heritable components. So it might be that some people have a propensity to have less stable personalities and that people who are extreme in this propensity maybe end up demonstrating symptoms that we describe as BPD. That is, the characteristic instability we see in BPD may be a consequence of instability in the underlying normative trait system.
Medscape: Meaning that everyone has personality trait variability, but that in some people this variability is more extreme, pushing them over the edge into a pathology? But also that this instability isn't consistent, or stable, throughout one's life?
Dr. Hopwood: Yes. What we know from cross-sectional research is that people with BPD are more neurotic, but our research shows that these people also change more in neuroticism over time. Neuroticism is a trait involving negative emotions, such as anger, sadness, and anxiety. So those with BPD were more neurotic at baseline than the other sample, but their neuroticism also declined much more rapidly. This suggests that the average level of neuroticism might be an important factor when considering whether a person has BPD pathology, but also that variability in this trait over time might be a relevant and independent factor.
Medscape: What other traits are important, particularly in terms of stability, when assessing BPD?
Dr. Hopwood: It's interesting, because there are different kinds of stability. We looked at average changes over time, or absolute stability, but there is also differential stability -- the rank ordering of people over time. For example, when considering 2 people, person A may be more neurotic than person B at baseline, but at follow-up person B may be more neurotic than person A. Whereas absolute stability is evaluated by comparing group means over time, differential stability is assessed by computing retest correlations on a trait over time.
There is also individual-level stability, which refers to variability around a mean change. So our study showed that individuals with BPD change, on average, more than others, but different people within those groups may change more rapidly than others. The amount of variability within a group in change over time on a trait is referred to as individual level-stability.
Each of these kinds of stability are independent of one another and may indicate different psychological processes. It turns out that different traits have different stability effects when patients with BPD are compared with other groups, depending on which kind of stability you're looking at. For example, across 2 longitudinal samples, conscientiousness changes more in terms of rank order and individual stability for patients with BPD than for those with other personality disorders. But it's not all clear yet, and we're still working on this.
Medscape: You looked at stability in BPD over 16 years. What does the typical disease course look like in BPD? What are the chances of remission?
Dr. Hopwood: Mary Zanarini^[1] just published on this in The American Journal of Psychiatry. In this paper she builds on previous findings from her McLean Study of Adult Development, as well as other studies, such as the Collaborative Longitudinal Personality Disorders Study, showing that BPD symptoms decline more rapidly than was once thought. She also showed, however, that some patients have recurrences despite an initial remission, and that functioning does not always improve despite symptom remission.
So this is a mixed picture. On the one hand, when you identify individuals with BPD at their worst, I think we can be optimistic that they will improve, particularly with treatment. On the other hand, it is a pernicious disease that is highly disruptive to individuals' lives, and we still have a lot to learn about how to best help individuals with BPD.
In terms of clinical course, generally speaking BPD symptoms are most severe during adolescence, and they tend to decline over time. This tracks very nicely with the course of normal personality traits: Adolescence is typically a time of high neuroticism, low agreeableness, and low conscientiousness, but this tends to change and improve over time.
BPD remains one of the most severe conditions in psychiatric classification. However, many psychosocial treatments for BPD have proven effective in randomized controlled trials in the past couple of decades, including dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, and cognitive therapy. Although we still have a long way to go to better understand how to benefit individuals with BPD, recent findings on course and remission from longitudinal research, coupled with the development of effective treatments, permits more optimism than ever about the ability of clinicians to treat individuals with this difficult condition.

References

1. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476-483. Abstract

Overuse of antidepressants is not just a problem for us

Kate Ravilious

for National Geographic News

Published July 16, 2010

There's no happy ending for shrimp exposed to the mood-booster Prozac, according to a new study.
Remnants of antidepressant drugs flushed into waterways worldwide are altering shrimp behavior and making them easier prey, experts say.
(See "Cocaine, Spices, Hormones Found in Drinking Water.")
To mimic conditions in the wild, scientists exposed the estuary-dwelling shrimp Echinogammarus marinus to the antidepressant fluoxetine at levels detected in average sewage-treatment waste. Fluoxetine is the key ingredient in the drugs Prozac and Sarafem.
Shrimp normally gravitate toward safe, dark corners. But when exposed to fluoxetine, the animals were five times more likely to swim toward a bright region of water, the team discovered.
"This behavior makes them much more likely to be eaten by a predator, such as a fish or bird," said study co-author Alex Ford, a biologist at U.K.'s University of Portsmouth.
The fluoxetine likely makes shrimp's nerves more sensitive to serotonin, a brain chemical known to alter moods and sleep patterns, according to the study, recently published in the journal Aquatic Toxicology.
Prozac Rise May Harm Other Animals
Antidepressant use is rising rapidly—more than 10 percent of U.S. citizens, or about 27 million people, used the drugs in 2005, according to a 2009 paper in the journal Archives of General Psychiatry.
(Related: "Is Salt Nature's Antidepressant?")
It's so widespread that animals other than shrimp likely suffer from these high doses of fluoxetine, the authors noted. (Get the facts on freshwater threats.)
"We focused on shrimp because they are common and important in the food chain, but serotonin is also linked to behavioral changes in other species, including fish," Ford said.
(Read about chemicals changing male fish to female in a U.S. river.)
Ford believes that many other common prescription drugs—such as antiinflammatory drugs and painkillers—could also be causing problems for aquatic life.
But there are ways of protecting aquatic creatures from the drugs we take, Ford noted.
For instance, more public awareness about responsible drug disposal and better technology for breaking down pharmaceuticals at sewage works, among other solutions, could help to solve the problem, he said.

Slow Ride to Turin

Please take a look at this website of Maddy Corbin's - http://www.slowridetoturin.co.uk/index.html . Her daughter, Philippa, sadly took her own life at the age of 27 after becoming profoundly depressed.
Maddy's feeling is that Philippa might still be here if there was better treatment for the illness more widely available. The ride she and her team are doing is to raise money for two charities, the HGF being one, and the other is The Charlie Waller Memorial Trust ( http://www.cwmt.org.uk/ ) that is concerned with raising awareness about depression and provides training and information.

http://www.slowridetoturin.co.uk/index.html

http://www.cwmt.org.uk/

Rapport goes further than we think

Dogs copy their owners' yawns

Dogs are compelled to yawn if they hear their owners do the same, according to a new study.

Researchers claimed that dogs responded to an audio cue such as a yawn even if they didn't see the action taking place.
The study found this was particularly noticeable when the dogs were listening to the yawns of people they knew.
Scientists suggested the findings, presented at the National Ethology Congress in Lisbon, showed canines had empathy to human behaviours.
"These results suggest that dogs have the capacity to empathise with humans," said lead author Karine Silva, from the University of Porto, Portugal.
For their study, researchers selected 29 dogs that had lived with their owners for at least six months.
They recorded the owners yawning before playing it back to the pets, along with recordings of the yawn of a stranger.
The study said nearly half of all dogs yawned when they heard a recording of a human being making a yawning noise
But the results also found the dogs were five times more likely to yawn when they heard their owners' voices played back.
 

A nice first-person account about discovering the Observing Self from a forum

"I'm currently reading a book that I had read a little while back. I decided to read it again and go through the exercises since my anxiety levels have been high. I wanted to point out some things that were mentioned in the book concerning out "thinking self" verses our "observing self". I think it would be helpful to others here, and may even help with those who experience health anxiety as well.

To sum it up, your thinking self is the part of you that thinks, plans, compares, judges, daydreams, analyzes...etc. Your observing self however, does not think and is responsible for attention, awareness and focus. Your observing self can pay attention to your thoughts but it cannot produce them. Both, however, are two distinctive aspects of what we commonly refer to as "the mind".

The example given in the book to describe this, is to imagine you are playing tennis. If you are focused on the game, then your attention (observing self) is directed at the ball. Now imagine that while you are playing, you start having different thoughts...I better hit this...I hope I don't get hit in the face...etc. Those thoughts would be your thinking self. Now, if you were to start paying attention to your thinking self, then your observed self would be distracted from the game, as it would now be paying too much attention to your thinking self and your performance in the tennis match would now be affected. (I hope that makes sense!)

So, we really have two aspects of our minds at play, both of which interact and communicate with one another every day for all of us. Your observing self is aware of what you are thinking or feeling at any given moment and your thinking self (as described in the book) is....

"like a radio playing in the background. Most of the time, it is the doom and gloom show, broadcasting 24 hours a day...reminding us of bad things from the past...warning of future dangers...and giving updates of all that's wrong with us".

What we need to realize though is that the radio will never turn off and the more we try to tune out the "broadcast" or turn it off, the worse it gets. The thing is though, that it isn't only those of us with anxiety who have these crazy thoughts broadcasting 24/7 in our minds. We do, however, react to these thoughts in an unhealthy manner. And that is where your observing self comes into play.

One needs to practice techniques where the observing self will not show these unhelpful thoughts from our thinking selves much attention.  Actively trying to just ignore the thoughts doesn't work. Er...it may work actually, but only for a short while, until you succumb to the same thoughts later down the road. The point is to teach you how to gain the ability to let the thoughts from your thinking self come and go as they please, while acting on those thoughts, ideas, or what have you, that are helpful, and acknowledging the thoughts that are unhelpful then turning your focus/attention i.e...your observing self, elsewhere.

I was doing some of the breathing exercises recommended in the book. The suggestion is to take 10 deep breaths...you can start with a lower number...as slowly as you can. As your doing the breathing, focus on the movement of your body as you inhale and again when you exhale. (the rise and fall of the ribcage, expansion of your lungs, etc.) Try to focus completely on only these exercises. While you are doing this try to let any thoughts that pop into your mind (which they will) come and go as they please while continuing to keep your focus/observing self on the breathing exercises...which is much easier said than done!

When doing this exercise, it allows one to see how easily we can get roped into certain thoughts, while letting others just pass on by. I also found it to be very helpful in recognizing just how damn crazy my thinking self can be at times! Lol."

Robert Ornstein: The Evolution of Consciousness

Pat Williams on story and metaphor