Wednesday, 26 November 2014

Magnesium and the Brain: The Original Chill Pill | Psychology Today

Magnesium and the Brain: The Original Chill Pill | Psychology Today





Magnesium
is a vital nutrient that is often deficient in modern diets. Our
ancient ancestors would have had a ready supply from organ meats,
seafood, mineral water, and even swimming in the ocean, but modern soils can be depleted of minerals and magnesium is removed from water during routine municipal treatment. The current RDA for adults is between 320 and 420mg daily, and the average US intake is around 250mg daily.Does
it matter if we are a little bit deficient? Well, magnesium plays an
important role in biochemical reactions all over your body.  It is
involved in a lot of cell transport activities, in addition to helping
cells make energy aerobically or anaerobically. Your bones are a major
reservoir for magnesium, and magnesium is the counter-ion for calcium
and potassium in muscle cells, including the heart. If your magnesium is
too low, you can experience muscle cramps, arrythmias, and even sudden death. Ion regulation is everything with respect to how muscles contract and nerves send signals. In the brain, potassium and sodium balance each other. In the heart and other muscles, magnesium pulls some of the load.

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That doesn't mean that magnesium is unimportant in the brain. Au contraire! In fact, there is an intriguing article entitled Rapid recovery from major depression using magnesium treatment, published in Medical Hypothesis in 2006. Medical Hypothesis seems like a great way to get rampant (but referenced) speculation into the PubMed database. Fortunately, I don't need to publish in Medical Hypothesis, as I can engage in such speculation in my blog, readily accessible to Google. Anyway, this article was written by George and Karen Eby, who seem to run a nutrition
research facility out of an office warehouse in Austin, Texas - and it
has a lot of interesting information about our essential mineral
magnesium.

Magnesium is an old home remedy for all that ails you, including "anxiety, apathy, depression, headaches, insecurity, irritability, restlessness, talkativeness, and sulkiness." In 1968, Wacker and Parisi
reported that magnesium deficiency could cause depression, behavioral
disturbances, headaches, muscle cramps, seizures, ataxia, psychosis, and
irritability - all reversible with magnesium repletion.

Stress is the bad guy here, in addition to our woeful magnesium deficient diets. As is the case with other minerals such as zinc, stress causes us to waste our magnesium like crazy - I'll explain a bit more about why we do that in a minute.

Let's look at Eby's case studies from his paper:

A 59 y/o "hypomanic-depressive male", with a long history of treatable mild depression, developed anxiety, suicidal thoughts, and insomnia
after a year of extreme personal stress and bad diet ("fast food").
Lithium and a number of antidepressants did nothing for him. 300mg
magnesium glycinate (and later taurinate) was given with every meal. His
sleep
was immediately restored, and his anxiety and depression were greatly
reduced, though he sometimes needed to wake up in the middle of the
night to take a magnesium pill to keep his "feeling of wellness." A
500mg calcium pill would cause depression within one hour, extinguished
by the ingestion of 400mg magnesium.

A 23 year-old woman with a previous traumatic
brain injury became depressed after extreme stress with work, a diet of
fast food, "constant noise," and poor academic performance. After one
week of magnesium treatment, she became free of depression, and her
short term memory and IQ returned.

A 35 year-old woman with a history of post-partum
depression was pregnant with her fourth child. She took 200mg magnesium
glycinate with each meal. She did not develop any complications of pregnancy and did not have depression with her fourth child, who was "healthy, full weight, and quiet."

A 40 year-old "irritable, anxious, extremely talkative, moderately depressed" smoking, alchohol-drinking, cocaine
using male took 125mg magnesium taurinate at each meal and bedtime, and
found his symptoms were gone within a week, and his cravings for
tobacco, cocaine, and alcohol disappeared. His "ravenous appetite was supressed, and ... beneficial weight loss ensued."

Eby
has the same question about the history of depression that I do - why
is depression increasing? His answer is magnesium deficiency. Prior to
the development of widespread grain refining capability, whole grains
were a decent source of magnesium (though phytic acid in grains will
bind minerals such as magnesium, so the amount you eat in whole grains
will generally be more than the amount you absorb). Average American
intake in 1905 was 400mg daily, and only 1% of Americans had depression
prior to the age of 75. In 1955, white bread (nearly devoid of
magnesium) was the norm, and 6% of Americans had depression before the
age of 24. In addition, eating too much calcium interferes with the
absorption of magnesium, setting the stage for magnesium deficiency.

Beyond Eby's interesting set of case studies are a number of other studies linking the effects of this mineral to mental health
and the stress response system. When you start to untangle the effects
of magnesium in the nervous system, you touch upon nearly every single
biological mechanism for depression. The epidemiological studies (1) and some controlled trials (2)(3) seem to confirm that most of us are at least moderately deficient in magnesium. The animal models are promising (4). If you have healthy kidneys, magnesium supplementation is safe and generally well-tolerated (up to a point)(5),
and many of the formulations are quite inexpensive. Yet there is a
woeful lack of well-designed, decent-sized randomized controlled trials
for using magnesium supplementation as a treatment or even adjunctive
treatment for various psychiatric disorders.

Let's
look at the mechanisms first. Magnesium hangs out in the synapse
between two neurons along with calcium and glutamate. If you recall, calcium and glutamate are excitatory, and in excess, toxic.
They activate the NMDA receptor. Magnesium can sit on the NMDA receptor
without activating it, like a guard at the gate. Therefore, if we are
deficient in magnesium, there's no guard. Calcium and glutamate can
activate the receptor like there is no tomorrow. In the long term, this
damages the neurons, eventually leading to cell death. In the brain,
that is not an easy situation to reverse or remedy.

And then there
is the stress-diathesis model of depression, which is the generally
accepted theory that chronic stress leads to excess cortisol, which
eventually damages the hippocampus of the brain, leading to impaired
negative feedback and thus ongoing stress and depression and neurotoxicity badness. Murck tells
us that magnesium seems to act on many levels in the hormonal axis and
regulation of the stress response. Magnesium can suppress the ability of
the hippocampus to stimulate the ultimate release of stress hormone, it
can reduce the release of ACTH (the hormone that tells your adrenal
glands to get in gear and pump out that cortisol and adrenaline), and it
can reduce the responsiveness of the adrenal glands to ACTH. In
addition, magnesium can act at the blood brain barrier to prevent the
entrance of stress hormones into the brain. All these reasons are why I call magnesium "the original chill pill."

If
the above links aren't enough to pique your interest, depression is
associated with systemic inflammation and a cell-mediated immune
response. Turns out, so is magnesium deficiency.
In addition, animal models show that sufficient magnesium seems to
protect the brain from depression and anxiety after traumatic brain
injury (6), and that the antidepressants desipramine and St. John's Wort (hypericum perforatum)
seem to protect the mice from the toxic effects of magnesium deficiency
and its relationship to anxious and depressed behaviors (4).

The
overall levels of magnesium in the body are hard to measure. Most of
our body's magnesium is stored in the bones, the rest in the cells, and a
very small amount is roaming free in the blood. One would speculate
that various mechanisms would allow us to recover some needed magnesium
from the intracellular space or the bones if we had plenty on hand,
which most of us probably don't. Serum levels may be nearly useless in
telling us about our full-body magnesium availability, and studies of
levels and depression, schizophrenia, PMS, and anxiety have been all over the place (7).
There is some observational evidence that the Mg to Ca ratio may be a
better clue. Secondly, the best sources of magnesium in the normal
Western diet are whole grains (though again, phytates in grains will
interfere with absorption), beans, leafy green veggies, and nuts. These
happen to be some of the same sources as folate, and folate depletion is
linked with depression, so it may be a confounding factor in the
epidemiological studies.

Finally, magnesium is sequestered and
wasted via the urine in times of stress. I'm speculating here, but in a
hunter-gatherer immediate stress sort of situation, maybe we needed our
neurons to fire on all cylinders and our stress hormones to rock and
roll through the body in order for us to survive. Presumably we survived
or didn't, and then the stressor was removed, and our paleolithic diets
had plenty of magnesium to replace that which went missing. However, it
may not be overall magnesium deficiency causing depression and
exaggerated stress response - it may just be all that chronic stress,
and magnesium deficiency is a biomarker for chronic stress. But it
doesn't hurt to replete one's magnesium to face the modern world, and at
least the relationships should be studied thoroughly. Depression is hugely expensive and debilitating.
If we could alleviate some of that burden with enough mineral water...
we should know whether that is a reasonable proposition.

As I
mentioned before, there are only a few controlled trials of magnesium
supplementation and psychiatric disorders. A couple covered premenstrual
dysphoria, cravings, and other symptoms (8)(9). Another small study showed some improvement with magnesium supplementation in chronic fatigue syndrome (10). Two open-label studies showed some benefit in mania (11)(12). There is another paper
that postulates that magnesium deficiency could exacerbate the symptoms
of schizophrenia. However, there is nothing definitive. Which is, of
course, quite troubling. How many billions of dollars have we spent on
drug research for depression, bipolar disorder, and schizophrenia, when here is a cheap and plausibly helpful natural remedy that hasn't been properly studied?

So
everyone get out there and take some magnesium already!  Whew.  Well,
just a few more things to keep in mind before you jump in.

There
are some safety considerations with respect to magnesium
supplementation. If you have normal kidney function, you do not have
myasthenia gravis, bowel obstruction, or bradycardia, you should be able
to supplement without too many worries. In addition, magnesium
interferes with the absorption of certain pharmaceuticals, including
dixogin, nitrofurantoin, bisphosphanates, and some antimalaria drugs.
Magnesium can reduce the efficacy of chloropromazine, oral
anticoagnulants, and the quinolone and tetracycline classes of
antibiotics.

Magnesium oxide is the cheapest readily available
formulation, as well as magnesium citrate, which is more likely to cause
diarrhea in excess. (In fact, magnesium is a great remedy for
constipation). The oxide is not particularly bioavailable, but the
studies I've referenced above suggest that you can top yourself off
after about a month of daily supplementation. Those with short bowels
(typically due to surgery that removes a large section of bowel) may
want to supplement instead with magnesium oil. You can also put some Epsom salts
in your bath. In addition to diarrhea, magnesium can cause sedation,
and symptoms of magnesium toxicity (again, quite unlikely if your
kidneys are in good shape) are low blood pressure, confusion, arrythmia,
muscle weakness, and fatigue. Magnesium is taken up by the same
transporter as calcium and zinc, so they can fight with each other for
absorption. Jaminet and Jaminet
recommend total daily levels (between food and supplements) of
400-800mg. Most people can safely supplement with 200-350mg daily
without any problems (again, don't proceed without a doctor's
supervision if you have known kidney disease or if you are elderly).

People looking for good (but not all paleo) food sources can go here (also a good link for more information on the other formulations of magnesium - there are many!), here, and here.

Image credit (magnesium is used to make sparklers)

More articles like this one at Evolutionary Psychiatry

Copyright Emily Deans, M.D.

Magnesium and the Ketamine Connection | Psychology Today

Magnesium and the Ketamine Connection | Psychology Today



A natural mineral mimics the intercellular effects of the anesthetic ketamine





Ketamine,
an anesthetic and street drug known as “Special K” has garnered a lot
of attention for it’s ability, in some, to relieve the symptoms of very
severe depression in a matter of minutes. A recent study has demonstrated how it might work, but before you go signing up for a clinical trial (and there are currently many going on in the US),
it’s important to understand the downsides to the drug. One major
problem is that the effects wear off, usually within 10 days, leaving
you just as depressed as before. It can cause urinary incontinence,
bladder problems, addiction, and, with chronic use, it can worsen mental health problems, causing more depression, anxiety, and panic attacks.

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Ketamine seems to have a remarkable, short term ability to heal the synapses injured by chronic stress. However, anything that acts that quickly and successfully usually has a long-term cost. All powerfully addictive drugs work on our own natural receptors and neurons. Cocaine, for example, causes immediate racing euphoria by inhibiting the natural neurotransmitter dopamine
from being recycled, leaving bunches of dopamine in the synaptic cleft.
In the very short term, you feel great. In the long term, you tax the
system by driving the neurotransmitter system far out of balance in an
aggressive way.

Nicotine has a similar effect on
the alpha-7 nicotinic receptor. It activates it in a pleasing way, but
unfortunately desensitizes the receptor so much that only nicotine will
keep it firing. A nutrient found in foods such as egg yolks called
choline activates the same receptor, but without desensitizing it.  Long
term, regular ingestion of choline keeps the receptor functional and
happy, helping with certain brain
tasks. Long term, regular use of nicotine activates the receptor but
forces you to take more nicotine to keep the receptor working, leaving
you foggy-headed and less sharp if you go without cigarettes.

So
is there a less dramatic, “natural” version of ketamine, something we
can safely ingest every day, but might be a little depleted in our
modern diets? Nothing taken in physiologic amounts would reverse a
depression in half an hour like ketamine, but could another chemical we
find in food and mineral water help with resilience
to stress, synaptic repair, and make us more resistant to depression
and anxiety symptoms? Sure—that chemical is the mineral magnesium.
Magnesium, like ketamine, acts as an antagonist to the NMDA receptor,
which means it is a counter to glutamate, the major excitatory
neurotransmitter in the brain. The exact mechanisms are complex, but
both ketamine and magnesium seem to help glutamate do its job,
activating the receptor, without damaging the receptor with too much
activation, which, chronically, leads to excitotoxicity, synaptic
degradation, inflammation, and even cell death.




One
of the exciting things about ketamine is that it works in some people
with severe treatment resistant depression who have failed the
traditional therapies. Treatment-resistant individuals tend to have
lower intracellular magnesium levels than normal (1).
Ketamine and magnesium may also work synergistically, complementing
each other. Ketamine leads to an increase of intracellular magnesium,
and ketamine will reverse the normally seen magnesium decreases after
brain trauma (2). There is some evidence also that more standard antidepressant
medications, such as imipramine, work in part by reversing the
magnesium-depleting effects of chronic stress, suggesting that adding
magnesium supplementation to standard antidepressant regimens might help
the medications work better (at least in rodents) (3).

It’s
great to see an interesting compound like ketamine be taken seriously
and thoroughly studied for its action in serious, resistant depression.
Ultimately its usefulness may be limited to hospitalized patients who
can be closely monitored for the side effects, and who also may benefit
the most from the quick mechanism of action, while the longer term risks
may be outweighed by the short term benefit in such a critical, serious
situation. I would love to see a much safer compound, the mineral
magnesium, be studied as an adjunct treatment.

In the mean time,
magnesium supplementation is generally safe for most folks with normal
kidney function. Many folks eating a normal Western Diet have a low intake of the mineral (4).
Those with bowel obstructions, very slow heart rate, or dangerously low
blood pressure should not take it. Magnesium can interfere with the
absorption of certain medicines (digoxin, nitrofurantoin,
bisphosphanates, and some anti malaria drugs). Here are some excellent food sources
of magnesium (though remember that both nuts and grains have phytates,
which bind minerals, so the magnesium you absorb may not be quite as
much as the magnesium you ingest.) Magnesium is also available in many
mineral waters.



For more information about magnesium and the brain, please read my article here: Magnesium the Original Chill Pill. A nice paper from last year details the ketamine-magnesium connection if you have journal access (thanks to Drew Ramsey for pointing the paper out to me). 

Sunday, 23 November 2014

Dyslimbia - A Possible New Name for BPD”

A Possible New Name for BPD”



The BPD is a medical problem, likely a form of epilepsy (brain cells
firing inappropriately and out of control). The characteristic symptoms
include inappropriate moodiness, chronic anger, emptiness, boredom,
dysphoria (anxiety, rage, depression and despair) and psychosis. The
other criteria are symptoms related to these medical problems.

ALL neurological disorders can have an effect on the personality,
such as Parkinson’s disease which isn’t called the ‘shaking personality
disorder.’ ”

What does this term “Dyslimbia” mean?

Dys’ means malfunction, and limbia meaning from the limbic system.

‘Dyslimbia’ is malfunction of the limbic system. While other
neuropsychiatric disorders involve malfunction of the limbic system, the
limbic system dysfunction is profound in the BPD. I chose Dyslimbia for
my patients to take the stigma away. The BPD needs a new name, one that
emphasizes healing not labeling.

I don’t care if it’s renamed ‘Dyslimbia’ or not, but a more honest,
humane, and hopeful name needs to be made for this illness. Patients
deserve to get medical attention for ‘Dyslimbia’ (or an equivalent
name), rather than have doctors and therapists shun them because they
are ‘borderlines.’”

Borderline Personality Disorder (BPD) – Biological Unhappiness (Dr. Leland M. Heller)

Dr. Leland M. Heller discusses the Borderline Personality Disorder (BPD) – Biological Unhappiness

By On October 18, 2011 · 1 Comment
“…Epilepsy was once thought to be a psychiatric problem, until the
underlying neurological abnormalities were understood.  Researchers
have uncovered medical and neurological abnormalities in borderlines. 
Many symptoms are likely due to malfunction in the brain’s limbic
system.  In my opinion, the borderline personality disorder is primarily
a medical problem.  It can now be treated."

The Borderline Experience

Imagine you are faced with a minor stress – a flat tire, a
clogged-up sink, or a trivial disagreement with your spouse, friend,
lover, child, etc.  Instead of finding an acceptable solution, your mind
seems to panic.  A sense of unease develops, possibly causing
discomfort in the stomach or chest.  Feelings of anxiety complicate the
increasing sense of uneasiness and restlessness.  This is followed by
progressively worsening anger – eventually becoming a rage so strong it
overwhelms you – even though you realize it’s excessive.  Over the next
few minutes to hours, other negative sensations creep in – including
memories of past hurts – until you are experiencing virtually every bad
emotion a human can feel.


You feel trapped and vulnerable.  Your psychological defenses are
overwhelmed by unbearable emotional pain.  You feel depressed.  You find
yourself unable to cope as your mind and body are now in a full scale
panic.  You lose proper perception of reality – jumping to erroneous
conclusions in a futile effort to make sense of what’s happening.  As
the pain continues to intensify the nervous system creates bizarre
sensations such as emptiness, numbness, and unreality.  You become
incapable of rational thinking as the panic continues to worsen.


Your mind now desperately tries to find a way out of the pain and
searches for solutions.  It recalls past activities that have made you
feel better.  Once a method is found, your mind frantically forces you
to pursue that activity to a self-destructive excess – finally resulting
in a biochemical rescue.  Brain chemicals are released that stop the
pain and let you feel ‘normal’ again.


But how can you ever feel normal again knowing that such a
horrible experience will return?  How can you feel normal again when
your self-destructive and inappropriate behaviors are witnessed by
family, friends, employers and/or co-workers?  How can you feel normal
again when those behaviors result in financial, interpersonal, physical,
or legal trouble?


For those not afflicted with the Borderline Disorder this is a
nightmare we hope never happens to us.  Borderlines experience it over
and over – especially when confronted with stress.  While individual
borderlines may feel some symptoms differently, the horrible feelings
described in the first paragraph (called ‘dysphoria’) intrude frequently
into a borderline’s life.


Borderlines will do almost anything to make dysphoria go away. 
Most impulsiveness and self-destructiveness is an effort to relieve
dysphoria.  Some borderlines, especially those suffering very severely,
will literally cut their bodies during dysphoria.  The self-mutilation
is itself painless (the cuts don’t hurt), yet it relieves the dysphoria.


Borderlines also suffer from intense, frequent and unpredictable
mood swings that can cause ‘dysphoria’ even without stress.  The mood
swings cripple a borderline’s efforts to live a happy, successful life.
Borderlines are victims of an incredibly painful illness…


Like victims of epilepsy, muscular dystrophy, and
neurofibromatosis (the ‘Elephant Man’s’ disease), victims of borderline
neither asked for, deserved or caused their affliction.  The symptoms
can be so unpleasant to those interacting with borderlines that feelings
of compassion and understanding may be difficult or impossible to
feel.  Borderlines desperately want to be loved, but their illness makes
them at times seem unlovable.  They are terrified of being abandoned,
yet are powerless to keep the illness from destroying relationships.


This is the borderline experience.


The Facts

Genetic factors are important – borderline tends to run in
families.  The risk of developing borderline is 6 times higher when a
close relative has the disorder.  In studies of identical twins,
researchers have discovered that many personality traits are genetically
determined.  There is an association between some personality
characteristics and blood type (called ‘blood group antigens’).
Borderlines commonly suffer from other disorders as well.  PMS,
depression, hypothyroidism, vitamin B 12 deficiency, other personality
disorders, anxiety, eating disorders, and substance abuse problems are
the most common.  Intelligence is not affected by the disorder, but the
ability to organize and structure time can be severely impaired.  There
is no association with Schizophrenia.


…While many borderlines suffered from abuse or neglect in
childhood, some developed the disorder from head injuries, epilepsy, or
brain infections.  Early parental loss and incest are commonly
associated with borderline.


The facts indicating a medical origin are impressive: Brain wave
studies are frequently abnormal.  Neurological physical examinations are
abnormal.  Sound interpretation is impaired.  Memory and vision are
impaired.  Glandular function may be abnormal.  Sleep is abnormal.  The
response to some medications is bizarre.  When injected intravenously,
the medication procaine normally causes drowsiness, but a borderline
will feel the ‘dysphoria’ described in the first paragraph.  If
borderline was exclusively an emotional illness, why would all these
medical neurological abnormalities be present?


Borderlines likely have abnormalities with the neurotransmitter
‘serotonin’ – an incredibly important brain chemical.  Serotonin
problems can cause anxiety, depression, mood disorders, improper pain
perception, aggressiveness, alcoholism, eating disorders and
impulsivity.  Excess serotonin can depress behavior.


Serotonin deficiencies can cause many problems, especially
suicidal behavior.  Low levels of serotonin increase the risk of
self-destructive or impulsive actions during a crisis.  The most violent
suicides (hanging, drowning, etc.)  are usually committed in patients
with low serotonin metabolite (waste product) levels in the spinal
fluid.  In those who attempted suicide unsuccessfully, 2% will likely be
dead within one year.  If the serotonin metabolite level is low, that
risk increases to 20%.


Treatment

Due to new developments in medicine, borderlines can now be
treated and often cured.  The medication fluoxetine (Prozac) usually
stops most of the mood swings in a few days.  It is, in my opinion, as
big a breakthrough for borderlines as insulin was for diabetics. 
Borderlines generally see themselves very profanely.  I frequently tell
my borderline patients ‘you’re not an *#%@*, your brain is broken.’ Once
this concept is understood, the borderline patient usually feels an
enormous sense of relief.  They need to know they have value as a human
being.  Feelings of desperation and hopelessness are often replaced by
optimism and motivation once Prozac stops the mood swings and the
patient begins to realize that a happier, more successful life is
possible.


All borderlines need psychological counseling.  It’s almost
impossible to live for years as a borderline and not need psychological
help.  While the underlying problems are probably structural within the
brain, the borderline is left with a lifetime of bad experiences and
inadequate skills for recovery.


No medication should be given without proper medical supervision.
This is particularly true for the drugs used to treat the borderline
disorder.  Some medicines make the symptoms of borderline worse,
especially amitryptilline (Elavil) and alprazolam (Xanax).  Possibly a
third of borderlines may suffer from low thyroid (hypothyroidism) –
despite a normal ‘TSH’ blood test.  They may need to take thyroid
medication.


The antidepressant fluoxetine (Prozac), a serotonin increaser,
virtually eliminates the mood swings.  Feelings of anger, emptiness and
boredom are often eliminated or reduced as well.  Most borderlines I’ve
treated consider Prozac to be a miracle.  While some need the medication
indefinitely, many have been able to stop it after a year without the
mood swings returning.  Side effects are rarely a significant problem.


Neuroleptics…have been proven effective.  They are remarkably
helpful for treating dysphoria and psychosis, and can be preventive when
the borderline is undergoing stress.  They seem to ‘put on the brakes’
when the thoughts are racing.  They should only be used as needed, like
using an antacid for heartburn.  These medications can be effective at
low doses, and must be taken with great caution.


While medications can help with some symptoms, the brain is
clearly broken.  After a stroke, the brain needs therapy to let the
healthy areas take over for the broken ones.  The same is true for
recovering borderlines.  I feel strongly that the brain must be
retrained.  Affirmations…will work, as the human brain can believe
almost anything if told it enough times…


The psychology of positive thinking is very helpful.  I strongly
recommend massive brain re-education.  Devote as much time as possible
for 3-6 months reading positive self-help books and listening to
motivational tapes – especially those by the motivational speaker Zig
Ziglar…


Sometimes symptoms of ‘temporal lobe’ involvement (similar to
epilepsy) complicate the disorder.  Common symptoms include unawareness
spells, feeling like things are unreal, and numbness of body parts. 
These symptoms are more common under stress, depression, severer
dysphoria, and incest crisis.  They can be treated with the epilepsy
medication carbamazepine (Tegretol)…


Borderlines are VICTIMS – they did not cause their illness.  They
do not want their illness.  They want to be treated and possibly cured.
They deserve that opportunity.


The National Institute of Mental Health (NIMH) has been the single
most influential source of unbiased study and information regarding the
true biology behind the borderline personality disorder.


Landmark studies, such as those produced by Drs. Cowdry and
Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and
neuroleptics, and the dangers of Xanax (alprazolam).  This article was
published in the Archives of General Psychiatry Feb 1988.  A subsequent
article showed that conclusions of low brain serotonin in the BPD were
erroneous, low levels were associated with suicide, not the BPD.


Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research.”


Permission by Leland M. Heller, M.D.

The BPD New Management Concepts

The BPD New Management Concepts



By On November 2, 1991 · Leave a Comment

For Primary Care Physicians

by Leland M. Heller, M.D.

November 2, 1991

SUMMARY OF TREATMENT


1. Prozac 20 mg daily (clomipramine) Anafranil and other SSRI’s may prove to be just as effective

2. Haldol 0.5 mg q 4-6h prn (thioridazine, 10 mg and thiothixene 1 mg can be equally effective)


3. check for hypothyroidism, treat if suspicious


4. check for vitamin B12 deficiency


5. psychological counseling


6. stress reduction


7. help with spiritual issues


8. develop self-esteem


9. retrain the brain with books, tapes and affirmation



INTRODUCTION

The Borderline
Personality Disorder (BPD), a psychoneurological disorder affecting tens
of millions [1,2] is now treatable with a combination of medication and
other therapies. Fortunately fluoxetine (Prozac) [3] and low dose
intermittent neuroleptics [4] can stop most of the mood swings, and many
of the irrational behaviors. Untreated, these patients suffer from very
painful, difficult lives – and a caring health care professional can
make a profound difference.


GENERAL DESCRIPTION

According to Dr. Rex
Cowdry of the NIMH the “BPD is characterized by tumultuous interpersonal
relationships, labile mood states, and behavioral dyscontrol set
against the background of a relatively stale character structure. While
the syndrome can be identified with reasonable reliability, the
fundamental nature of the disorder remains unclear…” [ 5] See Table 1
for the DSM-III-R criteria. It is a worldwide phenomenon, being
described in the U. S., England, Scotland, Switzerland, Germany, France,
Norway, and Japan. [6] It likely affects approximately 2-3% of men and
5-10% of women. [1]


Prior to effective
medical therapy, managing borderlines was a difficult struggle. Articles
in Family Physician [7] and Nursing [8] journals describe them as
demanding, manipulative, disruptive, frustrating, non-compliant, and
hostile – especially when not medicated properly.


WHAT BORDERLINES EXPERIENCE

Untreated, a borderline
lives an emotional vertigo – experiencing totally unstable moods. These
mood swings and most any stress cause a horribly progressive dysphoria.
They intensely feel almost every painful emotion at once.


Borderlines desperately
search for relief, usually by endorphin releasing behaviors that are
ultimately self-destructive – such as binge eating, binge spending,
aberrant sexual behavior, substance abuse, and reckless driving. When a
severe borderline is extremely dysphoric, cutting the skin causes no
physical pain and actually relieves the dysphoria.


Because untreated
borderlines live with constant mood swings and frequent dysphoria,
normal psychological functioning is crippled. Understanding this enables
the Family Physician to help. Borderlines need to understand their
illness, and to be treated properly.


MAJOR SYMPTOMS

Mood Swings:
Mood swings are a fundamental devastating symptom of borderline. Moods
can shift inappropriately from hour to hour, even minute to minute.
Without appropriate environmental of though-provoked justification. [9]


Dysphoria:
A combination of depression, rage, anxiety, and despair – often
complicated by shame, humiliation, embarrassment, excitement, terror,
jealousy, and self-hate. It can be triggered by mood swings, stress, and
emotional pain. Once dysphoria begins, it tens to steadily intensify –
possibly due to limbic system malfunction. [5] The sensation is so
painful that borderlines will desperately search for a way out – often
relying on drugs, alcohol, self-destructive and impulsive behaviors,
self-mutilation, and suicide. [9.10]


Psychosis:
Psychotic thinking often develops when the dysphoria becomes severe.
Because of the psychotic episodes, borderlines are said to live at the
“border” between reality and psychosis. The main psychotic symptoms are
moods, physical sensations and perceptual distortions.


The dominant psychotic
moods center around worthlessness, badness, rage, and self-destruction.
The physical sensations are remarkably similar to temporal lobe epilepsy
and include unreality, derealization (familiar things become unreal).
Deja-vu, out-of-body experiences, depersonalization (as though no longer
yourself), unawareness spells, and feeling like body parts are numb and
no longer part of oneself. [9]


Psychotic perceptual
distortions primarily include transference (incorrectly perceiving a
present day person to be like someone hurtful from the past),
inappropriate interpretation of motives, and hallucinations. Psychosis
can also be brought on by drugs, especially alcohol and marijuana. [1]


Splitting:
Small children see everything in life as being all good or all bad.
This immature psychological defense persists in borderlines, resulting
in “black and white thinking.” When life events are perceived as bad,
dysphoria usually results. When things are good, the borderline
frequently feels vulnerable, and fears the black returning – often
leading again to dysphoria.


Other symptoms:
A borderline’s life is defined by inconsistency – mood, identity,
trust, behavior, attitudes, values and thoughts. While intelligence is
not impaired, [11] organization and structure are [12] – borderlines
have trouble following through and completing tasks. Access to memory is
frequently impaired. Chronic anger, fear of abandonment (often
resulting in manipulative behavior), lack of trust, impulsivity,
feelings of emptiness and/or boredom, jumping to incorrect conclusions,
and severe PMS are commonly experienced.


Comorbidity:
Borderlines frequently suffer from other psychiatric illnesses. The
most common include depression, [1] anxiety, [13] substance abuse,
alcohol abuse, [14] other personality disorders, and eating disorder
(approximately 40% of eating disorder inpatients suffer from the
borderline). [15] There is no association with schizophrenia. [16]


ETIOLOGY

Psychological theories
alone cannot explain the BPD. Borderlines have significant biological
abnormalities – see Table 2. CNS serotonin malfunction is likely
involved. Temporal lobe dysfunction is often associated with stress. The
BPD is probably a medical predisposition combined with environment
insult.


There are many
psychological theories and concepts, with considerable disagreement
among experts in the field. Both overprotective and underprotective
parents have been “blamed” as the cause. [16] Most theories center
around traumatic childhood experiences, arrested psychological
development (especially at the separation/individuation phase), and
reliance on maladaptive coping and survival mechanisms. [23,28]


Adoption, early parental
loss, and incest are often associated with the BPD. [14] The most
severe borderline patients suffered from both sexual and physical abuse,
usually while very young [6] – chronic dysphoria and derealization are
the best predictors. [29] In one study, 81% reported major childhood
trauma, 71% physical abuse, 68% sexual abuse, and 62% witnessed serious
domestic violence. [30]


Genetics:
The BPD tends to run in families, six times more likely in first degree
relatives. There is an increased family history of alcoholism,
substance abuse, other personality disorders, and depression, but not
schizophrenia. [16]


DIAGNOSIS

Psychological tests,
such as the MMPI and NIMH Diagnostic Interview Schedule, are only
accurate between 85 and 89%. [31,32] Most knowledgeable psychologists
can easily arrange for an MMPI. The NIMH test may be more difficult to
obtain.


If I encounter a patient
who has multiple complaints, especially fatigue, headaches, stress,
depression, etc. I will often review and discuss the DSM-III-R
Borderline criteria to determine if he/she feels 5 or more symptoms are
present. If yes, I will usually initiate treatment with fluoxetine
(Prozac), evaluating the patient and diagnosis 1 week later.


TREATMENT

Medications:

Prozac (fluoxetine):
Prozac appears to increase serotonin. It is a breakthrough medication
for borderlines – eliminating most mood swings, chronic anger, chronic
emotional pain, emptiness and boredom within 3 days. A daily a.m. 20 mg.
dose is usually effective. For most side effects (nausea, jitteriness,
agitation), reduce the frequency to every 2 or 3 days. If fatigue
develops, switch to an evening dose. While for a few patients the
serotonin deficiency symptoms resolve permanently in 6-12 months, most
need to take the medication long term. In my experience, clomipramine
(Anafranil) and sertraline (Zoloft) have shown similar efficacy.


Neuroleptics:
Can be effectively used on a prn basis during stress or dysphoria, or
prophylactically for stressful situations. I prefer Haldol 0.5 – 1 mg
every 4-6 hours as needed (side effects are rarely a problem at this low
dose). Navane (thiothixene) [3] and Mellaril (thioridazine) [4] have
been proven effective. High doses, especially in hospitalized patients,
are also effective. [4]


Tegretol (carbamazepine):
Can markedly reduce episodes of behavioral dyscontrol. [5] Extremely
effective for unreality, chronic dysphoria, incest crisis, relationship
dissolution, extreme anger, dissociative symptoms, and when neuroleptics
are ineffective. Dosing and blood levels are comparable to treating
temporal lobe epilepsy.


Thyroid:
Many borderlines have symptoms of hypothyroidism, with “low normal”
thyroid blood tests. Approximately 1/3 of borderlines have an impaired
TSH response to TRH. [33,34]


Vitamin B12 deficiency: Approximately 20% of borderlines have low vitamin B12 levels, with symptoms of fatigue, leg stiffness, and dysesthesias.

Medications to Avoid:
Xanax (alprazolam) can markedly worsen behavioral dyscontrol. [5]
Elavil (amitriptyline) increases suicide threats, demanding and
assaultive behavior, and paranoid ideation. [35] MAO inhibitors have
helped borderline symptoms, but may be dangerous due to the impulsivity
and behavioral dyscontrol borderlines can experience.


Psychological Counseling:
Borderlines need a multidisciplinary approach. A good therapist is
necessary, and borderlines should be strongly encouraged to get into
counseling. For some, a psychologist/family physician team is very
effective. Referral to a psychiatrist may be necessary. Psychiatric
hospitalization is occasionally required, especially for strong suicidal
ideation.


Stress Reduction:
Borderlines need to keep their stress level down, and to use
neuroleptics when under stress. Physical exercise, relaxation
techniques, and TM (Transcendental Meditation) can be very helpful.


Spiritual Healing:
Making peace with God and one’s spiritual self is very important. The
AA (Alcoholics Anonymous) approach can help, especially with destructive
behavior patterns. Borderlines generally hate themselves. I try to get
them to understand that they have a “good” soul that has been “stuck” in
a broken biological computer.


Self-esteem: Since most borderlines experience self-hate, strong efforts must be made to build a strong and secure self-esteem.

Retraining the Brain:
Borderlines must learn to think differently. Cassette tapes, books, and
affirmations can teach them how. I strongly encourage borderlines to
purchase and listen to the “How to Stay Motivated” tape series (or at
least “Success and the Self-Image”) by Zig Ziglar. (1-800-527-0306).


Borderlines need to
listen to positive/motivational tapes frequently and persistently. Brian
Tracy’s “The Psychology of Achievement,” and others (Earl Nightingale,
Denis Waitley, Robert Schuller) from Nightingale /Conant
(1-800-323-5552) are excellent subsequent tapes.


Borderlines must be convinced to read positive/inspirational books. I recommend How to Win Friends and Influence People by Dale Carnegie, The Power of Positive Thinking by Norman Vincent Peale, Seeds of Greatness by Denis Waitley, Unlimited Power by Anthony Robbins, Your Erroneous Zones by Wayne Dyer, and books by Leo Buscalia and Norman Cousins.

Affirmations: Saying a
meaningful phrase in a repetitive, broken record like manner – are very
effective. The borderline needs to say these affirmations dozens of
times daily, and within a few weeks they will subconsciously accept new
and much needed positive concepts. I recommend phrases like “I like
myself and feel terrific,” “I am lovable,” and “I’m a success.” This
technique is very powerful.


FINAL COMMENTS

The borderline
personality disorder is common and now treatable with a combination of
medications, psychological counseling, and self-help approaches.
Untreated borderlines suffer painful, destructive lives. They are
victims of an illness they don’t want and didn’t cause. They deserve to
be helped, and the primary care physician is in the best position to
initiate treatment.


TABLE 1 – DSM – III-R CRITERIA

“A pervasive pattern of
instability of mood, interpersonal relationships, and self-image,
beginning by early adulthood and present in a variety of contexts, as
indicated by at least five of the following:


1) a pattern of unstable
and intense interpersonal relationships characterized by alternating
between extremes of overidealization and devaluation.


2) impulsiveness in at
least two areas that are potentially self-damaging, for example,
spending, sex, substance abuse, shoplifting, reckless driving, binge
eating, (do not include suicidal or self-mutilating behavior covered in
No. 5)


3) affective
instability: marked shifts from baseline mood to depression,
irritability, or anxiety, usually lasting a few hours and only rarely
more than a few days


4) inappropriate,
intense anger or lack of control of anger, for example, frequent
displays of temper, constant anger, recurrent physical fights


5) recurrent suicidal threats, gestures, or behavior, or self-mutilating behavior

6) marked and persistent
identity disturbance manifested by uncertainty about at least two of
the following: self-image, sexual orientation, long-term goals or career
choice, type of friends desired, preferred values


7) chronic feelings of emptiness or boredom

8) frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behavior covered in No. 5)”

Those who suffer from the Borderline Personality Disorder have at least 5 of the 8 criteria.

TABLE 2 – BIOLOGICAL ABNORMALITIES

1) Abnormal neurological
soft signs (such as awkward gait, left-right confusion, and difficulty
with pronation/supination and finger-thumb opposition). [17]


2) Abnormal REM sleep. [18,19]

3) IV procaine, normally sedating, causes dysphoria in BPD. [20]

4) Abnormal auditory P300 on EEG – sharing a dysfunction of auditory neurointegration with schizophrenia. [21]

5) EEG abnormalities in 1/3 – ½, not usually correlating with symptoms. [22,23]

6) Altered platelet alpha 2-adrenergic receptor bind sites. [24]

7) Low platelet monoamine oxidase activity. [25]

8) Low circadian melatonin profile. [18]

9) Abnormal lithium transport. [26]

10) Normal head CT’s. [22,27]

11) Cases of BPD have been described from CNS trauma and infection. [27]

TABLE 3 – SUMMARY OF TREATMENT

1. Prozac 20 mg daily (clomipramine) Anafranil and other SSRI’s may prove to be just as effective

2. Haldol 0.5 mg q 4-6h prn (thioridazine, 10 mg and thiothixene 1 mg can be equally effective)

3. check for hypothyroidism, treat if suspicious

4. check for vitamin B12 deficiency

5. psychological counseling

6. stress reduction

7. help with spiritual issues

8. develop self-esteem

9. retrain the brain with books, tapes and affirmations

BPD comes with Other Common Disorders

Other Common Disorders



By On April 7, 1998 
The borderline
disorder is usually associated with other neuropsychiatric problems.
Attention deficit disorder is probably the most common one. Most of
these “disorders” are really not illnesses at all, but traits that had
advantages in a different time and environment – but they are a serious
problem for patients in today’s society and it’s pressures. Successful
BPD treatment requires successful treatment of all neuropsych problems:
1) Generalized Anxiety Disorder (GAD):
the body’s “flight or fight” system seems to be on all the time,
causing fear related symptoms. One can experience mostly a “thinking”
anxiety problem, called the “cognitive component” of the GAD, where the
person is unable to sit peacefully with a quiet mind. This diagnoses is
almost always the case when medications like Paxil, Prozac and Ritalin
cause increased anxiety. Treating this disorder first is often necessary
before successfully treating the other diagnoses.


2) Obsessive Compulsive Personality Disorder (OCPD):


like the BPD, it’s a medical problem, not a “character disorder.” In
my opinion it is a condition people are born with. The body’s automatic
switch that takes over when facing a life and death situation stay’s on
all the time, constantly experiencing “life and death” sensations.
Symptoms include inappropriate perfectionism, difficulty making
decisions, inability to prioritize, and being a pack rat – all because
the person feels literally like he/she will die if an error is made.


3) Obsessive Compulsive Disorder (OCD):


an anxiety disorder (and/or symptom) characterized by excessive and
intrusive thoughts and ritual behaviors that help the person cope, such
as washing hands excessively, repeatedly checking the door, etc. The B
vitamin inositol in high doses can be as effective as standard
medications.


4) Attention Deficit (Hyperactive) Disorder:


a reduced flow of blood to the brain areas responsible for staying
focused on an activity or thought, and/or to think and consider before
acting or speaking. Some patients have hyperactivity as well. It appears
that the “disorder” does not go away at adulthood. I suspect a high
percentage, if not a majority, of untreated or undertreated ADD
individuals go on to get the BPD.


5) Rejection sensitivity:


along with dysthymia (rarely depressed, rarely happy – sort of in
between) and irritability they compromise a syndrome I call “fractured
enjoyment” (not a true medical diagnosis!). These symptoms collectively
so far are only treatable with Prozac, and are the main reason Prozac
has been so successful.


6) Panic Disorder:


results when the brain incorrectly assumes the individual is being
choked to death. This is a true medical problem with a high suicide
risk. Experiencing the body’s last ditch effort to avoid being “choked
to death” is a terrible sensation, and the victim may live in terror
that he/she will experience it again (preanticipatory anxiety).


7) Phobias:


irrational fears that limit the person’s ability to function, even
though he/she knows they’re irrational. They are usually treatable
medically, and include claustrophobia.


8) Cyclothymia:


is a relatively common mood swing disorder, similar to bipolar but with “mini highs” and “mini lows.”


(Dr. Heller’s book “Biological Unhappiness” explains the biology and treatment of these and other conditions).

BPD, Dysphoria and Treatment

Borderline Personality Disorder Dysphoria and Treatment



By On October 18, 2011 · Leave a Comment
Q. How do I tell when what I am going through is Dysphoria?

I have emotional storms that are extremely painful, and seem to be a
combinations of depression, some anger, fear and despair, all at once,
along with racing thoughts I can’t follow; I just feel like being
alive is a mistake when I get like that. I also feel a lot of stress, I feel like something inside of me
is about to snap… Is this *anything* like Dysphoria? Or is this just
“feeling bad”?

These “episodes” vary in strength and quality, the emotion that
dominate can change. There are times when I go into states that are
more slow, depressive but not exactly. It’s like things slow down
inside me; it takes me longer to respond to what happens around me, I
feel a little disconnected from the rest of the world (just a little).
this feeling is like floating around in a bubble, seeing everything but
through a thin layer. And if someone insists on talking to me and I
have to be responsive, I kind of “snap out of it” and after about a
minute, it can go away… I didn’t notice how much my behavior/perception
were affected by some of these episodes until one day, when I was
taking the subway to somewhere while feeling disconnected (after a bad
therapy session), someone tried to explain to me how to use the
turnstile — I guess I looked a little disoriented and like I didn’t
know what to do, because I was doing everything slower, and thinking
about what to do next took more time… and this is just one kind of
“episode.”

While there are those times when I slow down, other times I get
incredibly tense. I remember having “attacks” of terrible distress when
I was going through depression a few years ago, and they were so
unbearable that they drove me to self-mutilate to get rid of the pain.
They were different from the feeling of depression. The ones I have now
are not as bad; so I am not sure if this is even Dysphoria. I often
don’t even know what causes me to feel this way. It’s like a build-up of
despair that just erupts all of the sudden; other times, it happens
because I feel rejected, self-loathing, hated or guilty. Is this
treatable?

One thing I should probably mention is that, unlike most BPDs,
although I grew up in a very problematic family, I did not have a
traumatic childhood and I was not abused.

I guess the disconnecting thing is when my feelings reach a state of
overload. Another reaction I get when it’s too much is feeling nothing
— being numb, functioning well but being “dead” inside. I must admit
that there are times when I find it useful and count on it when I have
to go through something painful; I don’t know how to “turn it on”, but
somehow it happens. Sometimes the numbness turns into euphoria. I am
completely confused about this.

Sometimes I take mild sedatives when I can’t stand the tension, but
they rarely do anything. I just lay in a dark room or stare at the
wall. Sometimes these feelings–esp. the stress– are triggered by things
like someone saying they’ll come over and being late; not being able
to get someone on the phone; expecting something that I know should
happen — even if nothing goes wrong, the expectation alone makes me go
crazy. I try to remind myself of the reality, that I am not being
rejected, but it does not help at all. Once my mind starts this kind of
a cycle it’s like it doesn’t know how to stop.

I’m in therapy, and it’s helped me control my anger and violent
outbursts (for which I will feel guilty for the rest of my life, as I
should), but we have not found a solution for this emotional
vulnerability yet. Other than the “episodes” I was talking about, I
generally suffer from tension (to the degree that I get extremely
annoyed by sounds; I go ballistic when a neighbor plays his radio a
little too loud, or the TV in the other room is on, while other people
in the house get angry for a minute, then shrug it off), and, on the
other hand, a complete lack of energy, concentration and interest in
anything.

BPD BEHAVIORS: Dissociation and Dysphoria

BPD BEHAVIORS: Dissociation and Dysphoria




« on: March 08, 2007, 09:09:45 AM »


It strikes me that the borderliners in our lives have so much negative behaviour in common.

A
couple of weeks ago I came to a conclusion that most of that behaviour
is due to a single defense mechanism with lots of faces: Dissociation.  I
have been reading about dissociation ever since.

Common behaviour:
- Daydreaming, fasing out = dissociation
- depersonalised sex = dissociation
- "Black and White" thinking = dissociation
- Self mutilation, cutting = dissociation
- Remembering things differently than others do, lying = dissociation
- Raging = dissociation

We
all have our occasional dissociation in the form of daydreaming,
meditation, dancing on music until we get in a trance state... But I
believe BPD's do it quite often without having control over it as we do;
and their dissociation does not limit itself to occasional daydreaming;
it has a lot of different faces.

If the feelings of the BPD do
not match the situation or reality, the BPD will alter the
situation/reality to the point it does match.  They do this because they
do not want to be confronted with their out-of-place feelings.

PS: This is a personal conclusion.  Maybe I see a pattern that is incorrect. Please feel free to comment.


Wikipedia:
Dissociation
is a psychological state or condition in which certain thoughts,
emotions, sensations, or memories are separated from the rest of the
psyche. For this reason, it is sometimes referred to as "splitting."

French psychiatrist Pierre Janet:

The
French psychiatrist Pierre Janet (1859-1947) coined the term in his
book L'Automatisme psychologique; he emphasized its role as a defensive
maneuver in response to psychological trauma. While he considered
dissociation an initially effective defence mechanism that withdraws the
individual psychologically from the impact of overwhelming traumatic
events, a habitual tendency to dissociate would, however, promote
psychopathology.

The American Psychiatric Association:
The
American Psychiatric Association's Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition considers symptoms such as
depersonalization, derealization, and psychogenic amnesia to be core
features of dissociative disorders. However, in the normal population
mild dissociative experiences are highly prevalent, with 80% to 90% of
the respondents  indicating that they have had dissociative experiences
at least some of the time. [citation needed]

Dr. Richard Moskovitz
What is the difference between BPD and the spectrum of dissociative disorders?

In
normal consciousness, we experience an exquisite and seamless
integration of a variety of neurological functions. We are perceiving
input via all five of our senses and integrating these perceptions into a
meaningful picture of reality. Current experience is also influenced by
memory traces from the past that are automatically called into
awareness according to their relevance to the present. New memory traces
are constantly being created and stored. And we must remember that we
are not merely passive recorders of our environment but interact with it
via our various motor functions, altering both our surroundings and our
perceptions of them. Finally, to distinguish us from the computer on
which I record this message, we experience emotions, which further color
and individualize the content of consciousness.

Dissociation
describes any conditions in which one or more of these functions fail to
integrate and are split off or dissociated from the mainstream of
experience. The dissociated piece may be a small fragment of a function,
for example a specific memory of a single event in time, or it may be
of more sweeping consequence, such as amnesia for the essential elements
of one's identity.

Dissociation may affect memory creation or
retrieval, any aspect of sensory input and interpretation, the capacity
to execute motor functions such as movement or speech, and the emotional
coloring of experience. The cognitive and emotional aspects of
experience can be separated in more than one way. The perception of
one's surroundings may be robbed of all emotional tone as in
depersonalization. On the other hand, emotion can so dominate
consciousness that it blots out current reality as might occur in the
flashbacks that occur in Post-traumatic Stress Disorder.

Most of
the dissociative disorders that have been defined are well-circumscribed
in scope and may, in turn, originate with a single intense or traumatic
emotional experience. There may be amnesia covering a specific event or
period of time. There may be a discrete alteration of sensory input,
such as tunnel vision or even an episode of psychogenic blindness (often
interpreted as an unconscious unwillingness to view something painful).
Motor functions may be affected as in the paralysis of a limb or an
inability to speak (which may be understood as unconscious recognition
that something is unspeakable). Such alterations of sensory or motor
functions that are not based upon physical diseases characterize the
conversion disorders along with pseudo seizures and other non-organic
neurological dysfunctions. There may even be apparent alterations of the
individual's usual cognitive abilities.

Any of the dissociative
symptoms may occur in BPD. Dissociative experiences are a hallmark of
BPD. They are generally more varied, more complex, and often more
persistent than the single symptoms that characterize many dissociative
disorders. All people with BPD dissociate. Only some people who
dissociate have BPD.
At the other end of the complexity spectrum is
Dissociative Identity Disorder. In Chapter 4 of Lost in the Mirror, I
compared multiple personalities to the channels of a radio or
television. With this model, the tuner would be governed by current
circumstances and emotions, determining which personality would be tuned
in at any given time.

About BPD and depersonalisation and dissociation:
http://www.aapel.org/bdp/BLdissoUS.html

About BPD and lying, remembering facts different than others:
http://www.aapel.org/bdp/BLlieUS.html

About BPD and "black and white thinking"
http://www.aapel.org/bdp/BLsplittingUS.html

Friday, 21 November 2014

Born Without Social Genes | Nick Jr. Parents Blog

Born Without Social Genes | Nick Jr. Parents Blog



A young boy with Asperger’s interviews his mother and the result is a touching tribute to parenting.

Q&A from StoryCorps on Vimeo.

Joshua Littman was a twelve-year-old boy with Asperger’s Syndrome
when he and his Mum took part in an oral history project run by Story Corps.
In it Joshua, who is now twenty, interviews his Mum and the audio has
been beautifully animated to allow the viewer to ‘see’ the world from
Joshua’s eyes.

In the interview, Joshua asks his Mum some pretty candid questions.
The honest and touching answers that Sarah gives illustrates the
powerful bonds of parenthood and also show some of the challenges that
come with being a parent of a kid with Asperger’s.

Kids with Asperger’s Syndrome often miss social cues and can have
topics or interests that can be described as obsessive. Joshua’s
obsession is with animals. His Mum, Sarah, describes him as like “being
born without social genes”.

In the interview Joshua asks his Mum questions such as, “Do you have
any mortal enemies?” and the more tricky one, “Have you ever lied to
me?”. But the most touching moment has to be when Joshua asks his
mother, “Did I turn out to the son you wanted when I was born?” Sarah’s
beautifully articulated answer will bring a tear to your eye, and really
gives a glimpse into how much she herself would have grown and
developed over the course of Joshua’s life.

This interview was one of the most popular produced in the Story
Corps oral history initiative, and prompted a follow up five years
later, when eighteen-year-old Joshua re-interviewed his Mum following
his departure to college. In the updated interview, Joshua questions his
Mum about how she felt when he left for college and again her
sensitive answers to his questions show the depth of their relationship
and the special bonds that they have.

You can here the updated interview here.