If you recall from Love and Opium, I discussed how borderline personality disorder possibly stems from attachment problems combined with temperamental sensitivity plus opiate receptor issues. And in other posts, I've discussed the basic idea that excess glutamate is Evil in our poor brains.
Well, a new article in the Archives of General Psychiatry brings it all together! Amazing what happens when you pay attention.
Let's review. Borderline Personality Disorder is a disruption of healthful coping skills, leading to impulsive behavior, inability to contain emotion properly, and difficulty controlling anger. This disorder affects 2% of the population and 20% of psychiatric inpatients, so chances are you know someone who suffers from it.
So is this all psychological, or are there actual neurological correlates in the brain? Yes, that is a silly question because OF COURSE there are neurological correlates in the brain. It comes down to dysregulation in the fronto-limbic network. The limbic region of the brain controls emotion, the frontal region is rather like the policeman in your head that tells you that your hysterical internal observations about your Aunt Gertie's Awful Hat are NOT appropriate to share at the present time and place. So if your fronto-limbinc network is out of whack, you can be impulsive, easily angered, and too sensitive.
So the Archives, in true form, goes into excruciating detail about all the fMRI and other imaging studies that have failed to show any conclusive correlations to borderline personality disorder. Don't worry! I want to keep my few dozen fans! So let's skip to the good stuff. Fronto-limbic function in borderline personality disorder was found to be especially dysregulated with respect to remembering "unresolved negative life events."
I've no doubt Kurt Harris, M.D. knows more about these types of imaging studies, but the next thing our intrepid borderline personality disorder researchers did was get a Proton Magnetic Resonance Spectroscopy (MRS) scan of their borderline patients. MRS apparently allows one to follow the metabolism of all sorts of interesting neurotransmitter characters, including glutamate, while the scanned subject is still alive and thinking.
Thirty female patients diagnosed with borderline personality disorder were scanned and tested alongside thirty female matched controls. And, not surprisingly, differences were found. Patients were higher with respect to anxiety, depression, impulsivity, and dissociation ("out of body" sorts of feelings, or numbness of response to intense emotions). And on the brain imaging studies, borderline patients had significantly higher amounts of glutamate (the excitatory, and, in excess, neurotoxic neurotransmitter) in the anterior cingulate cortex (ACC) than the controls. Since the ACC is the heart of our ability to contain our impulses, having too much glutamate on board could presumably short circuit our ability to restrain ourselves.
Abnormal levels of frontal glutamate have also been found in studies of depression, schizophrenia, and ADHD. And glutamate dysregulation has also been found to be a problem with dissociation symptoms in general. The difference is, insurance companies will pay when I record a diagnosis as major depression, schizophrenia, or ADHD (all considered "organic" disorders), whereas they might not if I made the mistake of coding a patients' primary problem as borderline personality disorder (considered "psychological" and not organic).
And men, if you are looking for male data here, you are a bit out of luck. Turns out all relevant MRS studies of borderline personality disorder have included only women.
Insurance companies - it is ALL organic. Psychology is expressed within the confines of the neurochemistry of the organism. And, eventually, all of it will have to be paid for, one way or another.