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Ep. 005 - What is borderline personality disorder?
- 2021/08/31
- 再生時間： 36 分
- ポッドキャスト
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あらすじ・解説
This week’s podcast episode focuses on borderline personality disorder. Borderline personality disorder is a common condition Borderline personality disorder is relatively common. It’s a condition that currently affects about 1 out of every 60 people (Lenzenweger, 2007). Up to 1 of every 20 people may be diagnosed with borderline personality disorder at some point in their lives (Grant, 2008). “Borderline personality disorder” is a terrible name Dr. Messamore starts off by pointing out that the name of this condition – “borderline personality disorder” – is long overdue for change. It is based on 1930s-era psychological concepts. The psychological concepts have been updated over the past 90 years. Tragically, the name of this condition has not. Modern neuroscience has revealed a lot about the underlying causes of borderline syndrome. Biochemical studies, genetic studies, and brain imaging studies point to biological and neurological factors as the primary cause of “borderline” symptoms. Considering all that we’ve learned about this condition, it would be easier to understand – and scientifically more accurate – if we retired the term “borderline personality disorder” and replaced it with “emotion regulation disorder.” What causes borderline personality disorder? You can think of the brain as having an emotion-generating part and an emotion-checking part. The “borderline” syndrome happens because the engine and the brake are out of balance. The engine Emotions are your brain’s way of influencing your behavior or decisions in ways that the brain thinks will benefit your survival. The job of the limbic system is to generate emotional reactions to events (or ideas). The limbic system is just the generator. It does not have the ability to decide if its reactions are useful or not. That’s the job of the prefrontal cortex. The brake The part of your brain that does the things you recognize as thinking… that region is called the pre-frontal cortex – the PFC. One of the many important functions of the PFC is to analyze whatever situation you find yourself in. (For us human beings, creating an explanation is as fundamentally important as food or water). Whenever the limbic system generates an emotion, the PFC is supposed to check it out. (Remember the limbic part is just the generator – not the evaluator). The PFC is supposed to determine of the emotional response is appropriate for the event. If the emotional response is out-of-proportion to the event (or if the emotional response is interfering with other important decisions), then the PFC can talk back to the limbic system. Overactive engine, inefficient brake Numerous studies have shown overactivity in parts of the emotion-generating limbic system among people with borderline personality syndrome. Meanwhile, studies have also shown that the activity in the PFC braking region is under-active, or that its connections with the limbic system are inefficient. The result: the brain generates emotion signals that are either not needed in response to some events, or that are unnecessarily strong. That’s why I think that “emotion regulation disorder” would be a better term for this condition. How overcharged emotions are at the heart of many “borderline” symptoms So now consider what happens when you, or someone you know, is feeling extremely uncomfortable. The strong emotion constrains your options. You can’t think about things that are not in line with what your emotion makes you think is true. You’ll do almost anything to feel better. Maybe even things that others would call “reckless” or “impulsive.” In fact, most of the symptoms of borderline personality can be easily understood as attempts to change emotions that feel too strong. What are the symptoms of borderline personality disorder? The diagnostic criteria for psychiatric conditions are listed in the DSM-5, which is published by the American Psychiatric Association. The DSM-5 describes borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and emotions, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:” Frantic efforts to avoid real or imagined abandonment.A pattern of unstable and intense interpersonal relationshipsIdentity disturbance: markedly and persistently unstable self-image or sense of self.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).Chronic feelings of emptiness.Inappropriate, intense anger or difficulty controlling anger (e.g....