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The Roots of Problem Personalities: Scientific American

April 1, 2009

This article is of particular interest to me because my sister-in-law is mentally ill and has been diagnosed with BPD.

The Roots of Problem Personalities: Scientific American.

By itself, this ailment accounts for up to 10 percent of patients under psychiatric care and 20 percent of those who have to be hospitalized.

They fail to mention the high percentage of the prison population, as well.

…have difficulty controlling their impulses and regulating their emotions…

That’s the understatement of the year. I think my toddler has better impulse control.

parts of the brain’s limbic system … govern[ing] negative moods… are abnormally small in patients with BPD…. [and] tend to be hyperactive…[possibly]…leading to impulsivity and overly negative reactions to events.

I think the hyperactivity makes them hyperactively focus on negative events. The impulsivity comes from the smallness. But that’s just my opinion.

…..aside from lacking emotional restraint, individuals with BPD have problems correctly perceiving social gestures from others…… indicating that people who have this disorder lack the social skills essential for establishing and maintaining cooperative relationships

I could have told them that. They also have trouble with reality. And if they don’t perceive social reality, they’d have a hard time with good social skills, wouldn’t they?

…In healthy subjects…the anterior insula seemed to neurally represent the investment level, so that small contributions from a partner corresponded to a large activation in the trustee’s brain, and vice versa. In the brains of BPD subjects, however, no such relation existed.

….a large amount of insula activation in the trustee’s brain predicted a small payment from the trustee. In this case, however, both players with BPD and healthy volunteers displayed the same neural pattern.

Thus, although in healthy subjects the insula encoded both “distrustful” offers from investors and “stingy” repayments, the insula activity in people with BPD reflected only their own actions. Their impairment seemed to selectively concern the portrayal of the other player.

I don’t follow the logic here. Is she saying that the insula was hyper-activated in BPD patients, no matter what?  What was the pattern in BPD subjects? How do they know the insula was “self-centered”?  Not that I’m necessarily arguing – my sister-in-law believes the world is an awful place, that people are out to get her, and she’s insanely selfish.

The anterior insula has long been associated with the representation of unpleasant bodily sensations such as pain. In addition, many studies have shown that this area strongly responds to uncomfortable social contact, including interactions that seem unfair, frustrating or risky.

Based on my experience, I think that BPDs interpret all social contact as painful, uncomfortable, and risky, and interpret everyone else’s behavior as unfair and frustrating.

This body of work suggests that the anterior insula tracks information about the intentions and behavior of others and colors them with a feeling of discomfort. If that interpretation is accurate, then one reason BPD subjects may be impaired in maintaining cooperation is that they do not have the “gut feeling” (resulting from the anterior insula signal) that there is a problem with the relationship. Unable to detect the breakdown of trust, BPD sufferers do not work to repair it and are less likely to trust others at all.

I think this is optimistic. I think  BPDs assume that there is always a problem with the relationship, and that it’s always the other person’s fault. Everyone else in the world is mean and selfish and out to get you.  And yes, they’re socially clueless.

many of the personality components of the ailment, including impulsiveness and aggression, are highly heritable. Moreover, researchers have linked genetic variants, such as those involved in the neurotransmission of serotonin, to the disorder. (Selective serotonin reuptake inhibitors such as Prozac, however, are not effective treatments for BPD, according to a recent study.) It would be of high interest to determine whether these genetic variants compromise the structure and function of the anterior insula. Because no brain region operates in isolation, neuroscientists should aim to fully characterize the brain network of which the insula is a part.

Sadly, my sister-in-law’s eldest is showing signs of BPD as well.

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