Le Trouble de la Personnalité Limite

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One
of the problems with the href="http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders">Diagnostic
and Statistical Manual of Mental Disorders is that there is
no clear rationale for the division of problems into Axis I vs. Axis II
disorders.  It is assumed, sometimes, that Axis I disorders
are "biological" and Axis II disorders are "psychological."  



Legend has it that the division arose directly from the conflict
between psychodynamically-oriented
psychiatrists, and those with a more biological orientation, at the
time that DSM-III was written.  The division was deep and
acrimonious.  No one could figure out how to reconcile the two
approaches, so each side got to write a different section of the book.



Anyway, DSM-III was published in 1980.  Nowadays, the
divisions are not so acrimonious, and it is increasingly recognized
that there is no clean distinction between psychology and biology.
 



This is illustrated nicely in this paper:



href="http://www.cma.ca/index.cfm/ci_id/52420/la_id/1.htm">Neuroimaging
and genetics of borderline personality disorder: a review


E. Lis, B.
Greenfield, M. Henry, J. M. Guilé, G. Dougherty


J Psychiatry
Neurosci 2007;32(3):162-73.


Le
trouble de la personnalité limite (TPL) est une affection
psychiatrique très répandue qui comporte un
facteur de risque grave de suicide chez les adolescents et les jeunes
adultes. Il s’est fait relativement peu de recherche sur son
étiologie biologique. On a observé des
différences entre les sujets aux prises avec le TPL et ceux
qui n'en sont pas atteints au niveau du volume et de
l’activité de structures du cerveau
reliées à l’émotion et
à l’impulsivité. La présente
étude vise à évaluer la recherche
courante sur les différences neuro-anatomiques
observées entre des sujets avec et sans TPL, ainsi que sur
les gènes qui peuvent intervenir dans le
développement de ce trouble.



French is such a poetic language.  The term Le
trouble de la personnalité limite
sounds so much
less stigmatizing than Borderline Personality Disorder.
 



Here is the English version:



Borderline
personality disorder (BPD) is a highly prevalent psychiatric disorder
that carries a severe risk factor for adolescent and young adult
suicide. Relatively little research has examined its biological
etiology. Differences in the volume and activity in brain structures
related to emotion and impulsivity have been observed between
individuals who have BPD and those who do not. The present study seeks
to assess current research on the neuroanatomical differences observed
between individuals with and without BPD and the genes that may play a
role in the development of this disorder.



The crux of the article is this:



Overall,
use of neuroimaging in the study of BPD dates back only a few years.
BPD has been linked to the amygdala and limbic systems of the brain,
the centres that control emotion and, particularly, rage, fear and
impulsive automatic reactions. Studies have shown that the hippocampus
and amygdala may be as much as 16% smaller in people with BPD and have
suggested that experiences of trauma may lead to these neuroanatomical
changes. Positron emission tomography (PET) scans have generally shown
that people with BPD show hypometabolism of glucose in their prefrontal
cortex and limbic system relative to people who don’t have
BPD, suggesting that the disorder may result from a failure of the
“rational” prefrontal cortex to regulate the
“impulsive” limbic system.



No doubt this is an oversimplification.  But the link between
psychological trauma, brain changes, and psychopathology is an
important one.  



Maybe
, if we can figure out the mechanism by which
emotional/physical/sexual abuse, and neglect, all damage the brain, we
can figure out better ways to intervene.



Maybe we can find it in our hearts to be more
accepting and less judgmental about these problems.  



Maybe people will realize that domestic
violence/abuse and acquaintance violence/abuse (bullying) are not
normal, are not helpful, are not
"part of growing up," do not make people tougher or
more mature, and are not excusable in any way.



In fact, these various forms of abuse lead to substantial problems and
have a terrible economic impact on our society.  In other
words, violence and abuse cost money.  Those who abuse and
neglect children, and those who permit bullying to occur, are not only
evil; they are lowering our GDP.  



More like this

I agree so much ! French is much more poetic. Psychology is just between science and art, french is just perfect for this discipline !

I look at much of this as being chicken-and-egg questions, so therefore do not expect the "final" answers that some do. Everything we experience changes the physical structure of the brain.
While it's good to begin to be able to see these structural brain changes, what caused what remains an unanswered question.

I agree completely. In fact, I sometimes find myself thinking that I don't much care what caused what. Perhaps that is because I don't think we'll ever know, but in part it is because what I really care about is whether it should be treated, and if so, how it should be treated. Knowing what caused the problem is a secondary issue, in practical terms.