Yes, no, maybe, IDK


I have been feeling very scattered the last few days, very turbulent. My psychiatrist (pdoc) and I decided that with my focus issues it would be wise to start me back on Adderall again, which I took for a long time in college and found very helpful. I don’t have ADD per se, but my MI (borderline, bipolar, anxiety) can have symptoms that mimic ADD, effectively supplying me with the same problem. I am all over the place. I’ve been able to do my homework and some studying with the help of the meds, but as soon as it wears off I’m back to my normal scattered self and I can’t figure out what to do with my hands, my body, my mind. I’ve been skipping around between math problems, reading psychiatric journals, listening to TED talks as much as I can, playing video games with friends, and coloring, though the last is really hard on my back so I don’t do it as much as I used to.

If you asked me a question, I’d probably respond as above in the image: “Yes, no, maybe, I don’t know.” I hate this feeling. It has break through impulsivity, which makes me an impulse shopper and compulsive online “window” shopper. I think of something and I immediately have to see if someone has made it. I haven’t felt social, in fact I’m actively avoiding a few people just so I don’t have to be a social animal right now. I do have to go to class today, but luckily that is mostly absorption and not contribution. I still desperately want to share everything with everyone. It feels like mild hypomania. Last night I was so scattered, feeling empty and itchy and twisty and tight, that I had to resort to a Xanax just to bring me back down to the world. It helped a lot.  I need to use them more when I feel that way. I was able to chill out and watch some TED talks as I lay in bed. I really appreciate TED talks because they’re so informative and mind-broadening. I’ve learned so much already and I’ve only been obsessed with them for about a week.

Right now I’m reading an article on the structural properties of BPD. Through fMRI and other studies it appears that Borderline brains actually function differently than normal brains. We are more likely to recognize negative facial expressions (found in the fusiform facial region of the temporal lobe) than those without BPD. There are structural differences as well, including reduced gray matter in the amygdala on the left side of the brain and the hippocampus on the right side of the brain. We also have an increased volume of connection between the amygdala, the emotional center, and other parts of the brain, which could perhaps explain why we experience more emotions than people without the disorder. I am not a neuroscientist, as a means of disclaimer, so here is the actual information below.


Volume. A meta-analysis of brain volume—which comprised 281 persons with BPD and 293 healthy controls—and 19 imaging studies noted left amygdala and right hippocampus gray volume decreases in persons with BPD.1 Volume studies in adolescent-onset BPD populations also exist but are limited by small sample size, discrepant imaging techniques, and highly comorbid presentations. They do not reproduce the volume differences reported in studies of adult BPD.2

Function. A meta-analysis of functional MRI (fMRI) findings in persons with BPD revealed heightened activation during processing of negative emotional stimuli in the left amygdala, left hippocampus, and posterior cingulate cortex as well as diminished activation in prefrontal regions (including the dorsal lateral prefrontal cortex).3 Another meta-analysis showed heightened activity in the insula and less activation in the subgenual anterior cingulate cortex in persons with BPD but did not find amygdala hyperactivity.1

Conflicting amygdala results are believed to result from the medication status of research participants because psychoactive drugs attenuate limbic activity. Pharmacologic probes have also shown decreased metabolic activity in the anterior cingulate cortex and orbital frontal cortex in response to serotonergic challenge in impulsive-aggressive and affectively unstable BPD populations, and decreased coupling of resting metabolism between the orbital frontal cortex and the ventral anterior cingulate cortex has been reported.4

Dialectical behavioral therapy (DBT) was found to attenuate amygdala hyperactivity at baseline, which correlated with changes in a measure of emotion regulation and increased use of emotion regulation strategies.5 Taken together, these findings highlight that dysfunctional circuits involving hyperactive limbic regions and hypoactive prefrontal modulation—most pronounced in the dorsal lateral prefrontal cortex—represent the anatomical corollaries to BPD.

Connectivity. Connectivity studies developed over the past 2 years introduced novel research strategies that heavily rely on fMRI. Connectivity can be described in terms of anatomical and functional connectivity. Diffusion tensor variables of mean diffusivity and fractional anisotropy are measures of white matter integrity and anatomical connections. While such work in BPD is in its infancy, initial data suggest that deficits in frontolimbic connections relate to the severity of symptoms such as affective instability, avoidance of abandonment, and anger.6

Functional connectivity analyses provide information about which brain regions are co-activated and can be studied using seed-based correlations (most often with the amygdala and dorsal anterior cingulate cortex) and independent component analysis. The 3 networks most salient in BPD are:

• The default mode: a network activated when the brain is at rest in the absence of goal-directed activity; it is influenced by the medial prefrontal cortex and posterior cingulate cortex and is responsible for self-referential thinking

• The salience network, including the orbital frontal insula and the dorsal anterior cingulate cortex

• The medial temporal lobe network, which is responsible for processing negative emotions

In BPD, there are alterations in the connections between these 3 networks with particularly problematic connectivity between salience detection and self-referential encoding. This results in misidentification with neutral stimuli as well as a failure to integrate salience information with internal representations.

These networks can be mapped on fMRI, which shows dampening of the negative correlations between the dorsal anterior cingulate cortex and the posterior cingulate cortex as well as increased connectivity of the amygdala and rostral anterior cingulate cortex. Connectivity is also heightened between the amygdala and parahippocampus as well as the ventral anterior cingulate cortex and insula. In a study that examined neural correlates of emotional distraction, persons with BPD showed positive connectivity between the amygdala and prefrontal regions (right default mode prefrontal cortex and left dorsolateral prefrontal cortex).6


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