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Borderline Personality Disorder
Tomorrow is Tuesday, so I already know you’ll be feeling extra down
because it’s the anniversary of your goldfish Barry’s death
and although even your little sister has moved on,
you still insist on holding a memorial service in his fishtank every year.
I know that tomorrow you won’t get out of bed all day,
and you’ll be in one of those blue moods that lasts for hours
when the rest of your family will only be mildly sad, but only
for around five minutes or so, then they’ll forget all about Barry.
Last night you came home from the bar and sat on my bed, hungover,
wasted after having unprotected sex with three women
in one evening, but then one of them mentioned
that you looked too angry when you were inside her
so you immediately pulled out and spent the rest of the night
moping alone at the counter with a Bloody Mary,
but I forgive you like I always do
for fucking other women on impulse, since you’ve done it so many times
and I know it’s just a part of your diagnosis.
Sometimes you feel things so acutely
that I’m afraid of even touching you on the shoulder
for fear you might lash out; you’ve told me you feel
like a failure countless times, a reject, worthless.
When I kiss you on the rainy nights
you always kiss me back harder, so hard our teeth clash,
bite my lip til you draw blood.
Sometimes you adore me and bring home a dozen white roses
or text me e.e. cummings poems at work,
take me out to dinner at fancy restaurants and repeat I love you,
I do, twenty times over in one day; other times
you can hardly even stand to look me in the eye,
won’t even sleep in the same bed.
And I know you don’t mean to act like this, but sometimes
I just wish that I knew the person I’m hoping to spend
the rest of my life with as well as I know myself,
instead of just wondering who you’ll be tomorrow
and if it’s anything like who you were today.
The subtle hallmarks of psychiatric illness can reveal themselves even remotely
Most people are so attuned to the nuances of social interaction that they can detect clues to mental illness while playing a strategy game with someone they have never met.
That was the finding of a team of scientists led by Read Montague, director of the Human Neuroimaging Laboratory at the Virginia Tech Carilion Research Institute. The researchers discovered that healthy people and those with borderline personality disorder displayed different patterns of behavior while playing an online strategy game, so much so that when healthy players played people with borderline personality disorder, they gave up on trying to predict what their partners would do next.
For their large neuroimaging study, the scientists used a multiround social interaction game, the investor-trustee game, to study the level of strategic thinking in 195 pairs of subjects. In each pair, one player played the investor and the other the trustee. The investor chose how much money to send the trustee, and the trustee in turn decided how much to return to the investor. Profit required the cooperation of both players.
“This classic tit-for-tat game allows us to probe people’s responses to the social gestures of others,” said Montague, who also directs the Computational Psychiatry Unit, an academic center that uses computational models to understand mental disease. “It further allows us to see how people form models of one another. These insights are important for understanding a range of mental illnesses, as the ability to infer other people’s intentions is an essential component of healthy cognition.”
The scientists classified the investors according to varying levels of strategic depth of thought. The healthy subjects fell into three categories: about half simply responded to the amount the other player sent; about one-quarter built a model of their partner’s behavior; and the remaining quarter considered not just their model of their partner, but also their partner’s models of them.
Not surprisingly, the depth-of-thought style of play correlated with success, with the players who looked deeper into interactions making considerably more money than those who played at a shallow level.
When healthy subjects played people with borderline personality disorder, though, they were far less likely to exhibit depth of thought.
“People with borderline personality disorder are characterized by their unstable relationships, and when they play this game, they tend to break cooperation,” said Montague. “The healthy subjects picked up on the erratic behavior, likely without even realizing it, and far fewer played strategically.”
Notably, the functional magnetic resonance imaging of the subjects’ brains revealed that each category of player showed distinct neural correlates of learning signals associated with differing depths of thought. The scientists used hyperscanning, a technique Montague invented that enables subjects in different brain scanners to interact in real time, regardless of geography. Hyperscanning allows scientists to eavesdrop on brain activity during social exchanges in scanners, whether across the hallway or across the world.
“We’re always modeling other people, and our brains have a substantial amount of neural tissue devoted to pondering our interactions with other people,” Montague said. “This study is a start to turning neural signals into numbers – not just theory-of-mind arguments, but actual numbers. And when we can do that across thousands of people, we should start to gain insights into psychopathologies – what circuits are involved, what brain regions are engaged, and how injuries, congenital disorders, and genetic defects might play into psychiatric illness.”
Montague believes the study represents a significant contribution to the field of computational psychiatry, which seeks to bring computational clout to efforts to understand mental dysfunction. “Traditional psychiatric categories are useful yet incomplete,” said Montague, who delivered a TEDGlobal talk on the growing field of computational psychiatry last year. “Computational psychiatry enables us to redefine with a new lexicon – a mathematical one – the standard ways we think about mental illness.”
Computationally based insights may one day help psychiatry achieve better precision in diagnosis and treatment, Montague said. But until scientists have the right instruments, they cannot even begin to make those connections.
“The exquisite sensitivity that most people have to social gestures gives us a valuable opening,” Montague said. “We’re hoping to invent a tool – almost a human inkblot test – for identifying and characterizing mental disorders in which social interactions go awry.”
Some good sites I've found about Borderline Personality Disorder
Here are some helpful links for people with BPD or who think they may be Borderline.
Early Sea Changes in Borderline Personality Disorder (research about BPD and new treatment options)
BPD Central (self-coping, resources for family and friends as well as Borderlines themselves)
PsychCentral Borderline Personality Disorder Treatment (they also have a forum specifically for Borderline Personality Disorder - click the ‘Community’ section and BPD is under ‘Personality Place’ - as well as forums for other mental illnesses)
Clearview Treatment Program on Borderline Personality Disorder (also has free workshops and seminars if you’re in the area)
- Family: We love you, and we always will no matter what!
- Friends: Oh my god, we love you so much! You're awesome!
- BPD: Your family only loves you because they have to, they're sick of you and they're sick of the bullshit you pull. Your friends are too. They only like you when you're happy, they wish you were more fun. They're probably talking to each other behind your back about how pathetic you are, and how they wish you would just get better already. No one loves you, they just put up with you and you don't even know why.