Is BPD a Chronic Stress Disorder? | Dr Lois Choi-Kain

you know the movement in the field of psychiatric research is really towards understanding what we call trans diagnostic processes because let's face it a lot of patients don't just have one problem because of multiple forces that increase the likelihood of people developing depression and anxiety and personality disorder and an eating disorder and a substance use disorder so it's not that useful to investigate all those things separately and treat them all separately if they're driven by the same problems so a lot of people in the field they're really trying to move the field forward and trying to integrate some of these ideas so that we can understand the forces that are common underlying these different disorders that co-occur in many people so as a researcher i've been thinking with a lot of my partners in research on trans diagnostic concepts something like rejection sensitivity is very common for people who have borderline and other personality disorders but also social anxiety and also a form of depression called atypical depression and so there are these factors that feed into risk for a number of different kinds of problems within psychiatry and we have to understand also how to intervene on those factors so i've been thinking lately about these trans diagnostic concepts when it comes to the development of bpd and its treatments and one of the things i've always been interested in is the idea that borderline personality disorder is a stress sensitivity disorder and this first came to light for me because one of my earliest papers was a review on studies to assess the hpa axis which is the neurohormonal axis that modulates the body's stress response and what we found was that the findings in those reports were really inconsistent because a lot of the people who met criteria for borderline personality disorder also had either depression or ptsd both of which are characterized by chronic stress and disturbed functioning of their hpa axis so there were no real answers from that but it really started to form this idea that stress is an important part of the development of personality disorders then i did a lot of attachment research and attachment has to do with distress the attachment system is activated in the face of stress and it's a process that motivates organisms to send signals to caregivers so that the caregiver provides attention in a certain way that calms and regulates that organism so that then they can explore the world again and that's a stress response you don't need your attachment figures as much as you grow up when you're not distressed so that was another angle into understanding bpd as a disorder of stress because we know that bpd has been associated with insecure disorganized attachment tendencies there's a huge debate about whether or not bpd is a motion regulation disorder or a interpersonal disturbance disorder but they're both likely right i think we need to think more broadly because we all know people who are emotionally dysregulated have problems in relationships and people who have a lot of problems in relationships have emotional dysregulation so these two things are probably entities that go hand in hand for people who develop personality disorders and other disorders i think it's either emotional stress or interpersonal stress but they're both forms of stress and furthermore what's really biologically interesting about this is that chronic stress in the physiology works differently than acute stress so acute stress is actually very pleasurable to all of us like you know when you have a deadline and you like mobilize and you make it happen that activates a reward process that stimulates more of that behavior because it's pleasurable and reinforcing if the stress is chronic however the same system that allows the organism to survive threats actually starts to really impair the organism so the effects of chronic stress on the brain actually both cause growth and higher levels of activity in the amygdala where fear originates and other emotions so that it actually develops more and potentiates more and also generalizes more so that more fear is felt about more situations but in the meantime the memory systems of the brain and the frontal executive function systems of the brain go in the opposite direction they have decreased neurogenesis and neuroplasticity so that your ability to think appraise strategize plan as well as remember things that you need to remember goes down so you potentiate your fear response but then your ability to learn and do things that are strategically helpful to yourself in the bigger picture are diminished and that's why i think bpd is a disorder of chronic stress is that some people are born very sensitive so they're more likely to find things stressful that other people don't that overwhelms their ability to gain skills that may help them master stressful situations so they become less stressful over time and then they on top of that do things because of the differences in their their underdeveloped frontal capacities and their over developed emotional tendencies cause them to do things that make things that are stressful even more stressful that is they make bad situations worse that process of being stress sensitive and then managing stress poorly so that more stress is generated is the engine i think of bpd and then the effects of chronic stress are the outcomes the symptoms the features the co-occurring disorders the functional problems i think those are an outcome of both the physiologic impact of chronic stress but also the psychological impact causes disorder which is impairing and also this inability to manage the world that seems totally fear generating for that person and that's what is very disabling about the disorder as a whole if we help patients in general to manage stress more effectively by taking care of outlets managing predictions and uncertainties and getting social support that's a universal generic recipe for increasing people's mental health and we also have to look at people who endure very significant stress and don't have psychiatric or psychological problems what are the ingredients of their reactions to stress that help them come out of it unscathed we have to also understand that so the more we as a field can kind of deal with the basics of what everybody needs to be well then layer on specifics for people in certain circumstances or people with certain disorder constellations and then with people who don't respond to that do something much more specific for them and the later you intervene in the process so if somebody's already far down the road of having missed out on life not having had the opportunity to develop coping functions in a social network to survive the chronic stressors then they need help rehabilitating to having a life for themselves that they can improve on so it feels worth living and that's a different intervention than psychotherapy it's like a life rehabilitation life resuscitation process that might actually make them more symptomatic in the short run so that they can re-travel the road that didn't go so well for them and the truth is the outcome may not be what they want it to be but it is more likely to be better than it is now

Channel: BorderlinerNotes

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Id: W8qaeNK2944

Length: 9min 34sec (574 seconds)

Published: Tue Aug 03 2021