The association between borderline personality disorder, FM and CFS: systematic review

[Large Donner]

a mood is just a mood unless it becomes part of a disorder or disease ......

And exactly when does it "become part of a disorder or disease" who decides this, how do they define it to "be part of the disease". Surely this would mean that buying more tissues during the flu is "part of the disease"?

As far as defining a disorder goes, its back to circular logic because if its as simple as a disorder is a "change in behaviour" at onset of physical illness all you are doing is describing situational changes/symptoms of a disease and then calling them a disorder.

 

[osisposis]

SO ANYWAYS THEY ARE FINDING A FEW DIFFERENCES, I've BEEN TRYING TO TELL PEOPLE FOR YEARS THAT THIS SEVERITY OF BRAN INJURY IN ME/CFS IS TBI!, this is why I've followed GWI and THIS IS HOW I KNEW WHY GWI was being looked at, along with knowing that Claudia Miller was involved in MCS research long ago and GWI . so heres what I'm trying to say to you, you have to look at the bigger picture here to understand that not all Psychiatrist's are against us. it well benefit them as well as us to determine the level of environmental exposure involvement in Brain disorders, whats the result from severe abuse for example vs. chemical exposures. it's important for everyone to know if chemicals we are exposed to everyday in our world are affecting our brain. Canary in the Coal Mine.

Different Neural Mechanisms Underlie Deficits in Mental Flexibility in Post-Traumatic Stress Disorder Compared to Mild Traumatic Brain Injury

The neural model of frontal lobe executive functions (10) would predict that, given the different mechanisms of injury involved in PTSD and mTBI, these conditions would perform differently on tasks of mental flexibility. In our studies, while the behavioral and neuropsychological assessments of mental flexibility looked very similar between these groups, our MEG data showed stark differences that clearly differentiate the two groups. The PTSD group showed abnormal activations in paralimbic systems that acted as an obstruction to normal cognitive processing, while the mTBI group showed reduced cognitive processing ability as evidenced by disorganized and delayed brain activations. These findings not only fit known neuroanatomical models of frontal lobe cognitive functions but also indicate that approaches to rehabilitation and therapy need to consider that different neural mechanisms are at play in these disorders. This would suggest that interventions tailored toward addressing the specific dysfunctional mechanism would offer a more effective treatment and long-term outcome. The impact of these studies and their implications for addressing these disorders underline the value of the high temporal and spatial resolution of MEG and its potential utility to change the way we diagnose and treat PTSD and mTBI.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668286/

 

[osisposis]

And exactly when does it "become part of a disorder or disease" who decides this, how do they define it to "be part of the disease". Surely this would mean that buying more tissues during the flu is "part of the disease"?

As far as defining a disorder goes, its back to circular logic because if its as simple as a disorder is a "change in behaviour" at onset of physical illness all you are doing is describing situational changes/symptoms of a disease and then calling them a disorder.

when two illnesses have overlapping symptoms maybe

 

[Hip]

No one can even define personality, how can there be a disorder of it.

My view is that unless you have a high degree of empathy, you are not going to be able to observe personality and personality traits in others; just like those without higher mathematical abilities are not going to be able to do work in theoretical physics.

So my guess is that good psychologists are likely very skilled empathetically, which allows them to probe, like an X-ray, into others minds. At the other end of the spectrum, many people are just blind to others' minds.



I think psychology should become more like physics: in physics, there is a division of labor between the theoretical physicists and the experimental physicists. The experimentalists probe and observe physical phenomena; that's their job and skill set, and in a way, they are like the empathetic psychologists, who probe and observe mind.

But the experimental physicists leave it up to the theoretical physicists to try to construct theories that can explain the phenomena these experimentalists observe. That's because doing theoretical physics involves different skills and abilities, compared to the skills required for experimental physics.

I think there should be the same division of labor in psychology. Because the empathetic skills and abilities needed to probe and observe mind are different to the skills you need to construct a biological (eg neurological and immunological) theory that can explain those observations of mind, at least in the area of mental health.

So if psychologists restricted themselves to observing mental phenomena, and then handed over their findings to biologists, who would then look at the body and brain to try to find the physical causes of those mental phenomena, I think the whole field of mental health would become much more successful. It's this division of labor that is much needed in psychology.

 

[osisposis]

well, heres something I do know and have known for a long time, FM and CFS are not the same thing and can be had separately, and I'm glad someone is finally looking at the separation ! and folks because for some of us this isn't just about the stomach!, Fibromyalgia does involve mood disorders even if they are overlapping because they go together TBI , it may not be reconized with lesser severities but it is with the more severe groups. if I had to pinpoint reasons why I might point to prefrontal areas of the brain that are known to be involved in mood regulation!

 

[Large Donner]

Osisposis said:

when two illnesses have overlapping symptoms maybe

You dont see the paradox of claiming there's two "overlapping" illnesses whilst claiming that a disorder is one illness simply because the "symptoms" of a disorder as a stand alone illness are purely the observations of the physical illness?

 

[Tom Kindlon]

https://twitter.com/i/web/status/772555510415552512

 

[osisposis]

Osisposis said:


You dont see the paradox of claiming there's two "overlapping" illnesses whilst claiming that a disorder is one illness simply because the "symptoms" of a disorder as a stand alone illness are purely the observations of the physical illness?

am I talking to a bunch of men here , lols JK, can you tell if someone is depressed? can you tell when someone is crying, angry, sad, hurt ? , you say yes, ok, can you tell if someone is doing any if these actions because they are mentally ill or because they just had a hit from a trigger? I doubt it, therefore it is what it is until it isn't anymore and ignoring something just because you don't see it or understand it completely, hum, I'd think that would be the last thing ME/CFS'ers would do! and because stressful events like abuse can affect the same pathway, aka, when your sick with this illness you cant tolerate stress anymore because it too now can make you very ill, visa versa, the parasympathic pathway.

 

[Tom Kindlon]

At present, there does not appear to be firm and consistent evidence to support the hypothesis that the prevalence of BPD would be higher in individuals with fibromyalgia compared with the general population.

 

[osisposis]

I dare any of you to stick a close pin somewhere on your body in a chronic way for 2 or 3 days and tell me you haven't had any emotional response to that chronic pain . now while your at it consider someone that may have been abused or fought in action and consider what kinds of stress might play a role in ME/CFS. AKA FM,CFS,ME/CFS.

 

[actup]

Maybe it boils down to many research psychologists seeing what they believe rather than believing what they see. Okay for love and religion but not so much for good science.

 

[Dolphin]

Prevalence of CFS in primary care setting ranges from 3 to 20%.18,19

18.Lee S, Yu H, Wing Y, Chan C, Lee AM, Lee DTS, et al. Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong. Am J Psychiatry 2000; 157: 380–4.

19. Davis MP, Khoshknabi D, Yue GH. Management of fatigue in cancer patients. Curr Pain Headache Rep2006; 10: 260–9.

That's a ridiculous claim. It makes me wonder how much they know about ME/CFS.

 

[Dolphin]

The 1996 study by Johnson et al investigated the relative rates of personality disorders in patients with CFS, compared with patients with multiple sclerosis, control patients with depression and healthy controls.24 The prevalence of BPD was found to be 17% in those with CFS, 25% in patients with multiple sclerosis, 29% in control patients with depression and 0% in healthy controls.24

This makes one wonder whether any increased prevalence is specific to CFS or instead is common in many chronic debilitating illnesses.

 

[osisposis]

not everything that's a affect has to be a cause! sometimes it's just a affect, doesn't mean it aint there tho!

 

[Denise]

We get so little research funding for this disease and yet money can be found over and over again (sometimes in great quantities) for things other than biological research.

 

[Denise]

That's a ridiculous claim. It makes me wonder how much they know about ME/CFS.

The references for this are from articles on

"chronic fatigue" and "fatigue in cancer patients".

edit to add:
And these are the abstracts for the articles


Am J Psychiatry. 2000 Mar;157(3):380-4.

Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong.
Lee S1, Yu H, Wing Y, Chan C, Lee AM, Lee DT, Chen C, Lin K, Weiss MG.

Author information
Abstract
OBJECTIVE:
The authors' goal was to examine the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong.

METHOD:
One hundred adult patients with medically unexplained fatigue for 6 or more months were assessed with the Explanatory Model Interview Catalogue, psychopathological rating scales, and an enhanced version of the Structured Clinical Interview for DSM-III-R.

RESULTS:
The lifetime prevalence of DSM-III-R depressive and anxiety disorders was 54%. Current depressive and anxiety disorders were identified in 28 patients, who exhibited more psychopathology and functional impairment than other patients. Thirty-three patients had somatoform pain disorder, and 30 had undifferentiated somatoform disorder, but most of them could also be diagnosed as having shenjing shuairuo (weakness of nerves) and, to a lesser extent, ICD-10 neurasthenia. Chronic fatigue syndrome diagnosed according to the 1988 Centers for Disease Control criteria was rare (3%) and atypical. [<---emphasis mine] Generally, patients mentioned fatigue if asked, but pains (36%), insomnia (20%), and worries (13%) were the most troublesome symptoms. Most patients attributed illness onset to psychosocial sources.

CONCLUSIONS:
Psychiatric morbidity was common among primary care patients with chronic fatigue. Subthreshold psychiatric morbidity was very common and was more validly represented by the disease construct of shenjing shuairuo or neurasthenia than somatoform disorder.

PMID:
10698813
DOI:
10.1176/appi.ajp.157.3.380
[PubMed - indexed for MEDLINE]
http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.157.3.380





Curr Pain Headache Rep. 2006 Aug;10(4):260-9.

Management of fatigue in cancer patients.
Davis MP1, Khoshknabi D, Yue GH.

Author information
Abstract
Cancer-related fatigue (CRF) is either a symptom or a syndrome depending on criteria for diagnosis. CRF is present in 20% to 30% of long-term cancer survivors and 80% to 90% during treatment and at the end of life. Assessment requires determining the presence, severity, and interference with daily activities. Different descriptors for fatigue (eg, tiredness, lack of vigor) measure different patient experiences. Associated factors such as depression, pain, insomnia, dyspnea, anemia, and deconditioning worsen CRF and should be treated if present. Associated factors that contribute to the severity of fatigue differ depending on the stage of cancer. Pharmacologic interventions include recombinant erythropoietin, psychostimulants, corticosteroid, anti-inflammatory drugs other than steroids, and L-carnitine. Advances in the management of CRF will require an understanding of the underlying mechanism before target-specific therapies can be developed.

PMID:
16834940
[PubMed - indexed for MEDLINE]
http://link.springer.com/article/10.1007/s11916-006-0030-2

 

[valentinelynx]

Borderline personality patients are the the most dreaded of psych patients. CFS/FMS patients are the most dreaded of medical patients. Thus you see the obvious connection.

 

[Snowdrop]

Personally, I think they should call it Borderline Personality Syndrome
For me, there's the obvious connection.

 

[osisposis]

for me mood chances in response to re-accuring exposures/triggers has been hell and pretty embarrassing sometimes for whoever is with me when it happens cause you cant control it at all, because it is about affects to the brain . and what kind of mood changes happens seems very much to depend on what the exposure is to, I have had mood changes just by walking into a store,mixes of perfumes and colones can make my cry and cry and cry if I get in a position where theres a bunch of smelly people in a inclosed area and I cant leave, I've had exposures that even caused laughing fits when nothing is funny, and on a brain scan my amygdala's show a big black spot in the middle, one worse than other , I wondered if this was showing inflammation or permanent damage. I have decreased left frontal lobes size, and obvious over all brain shrinkage, my CNS fibromyalgia is severe, once I desided to try a steroid nasal spray prescribed to me and one shot up the nose set my face on fire that quickly spread to my brain and every nerve in my body felt on fire, the fibro pain was very severe for about a week this is when I first started realizeing just how severe the TBI was and I use that term TBI because this is what it is TBI/PTSD

 

[Snow Leopard]

Table 2 lists the characteristics of studies assessing the prevalence of BPD in patients with CFS. Five studies were identified. All of the studies used the Centers for Disease Control (CDC) criteria for CFS and relied on self-report questionnaires such as the Personality Diagnostic Questionnaire–Revised or 4th edition (PDQ-R, PDQ-IV) or the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for diagnosis of personality disorders.

The 1996 study by Johnson et al investigated the relative rates of personality disorders in patients with CFS, compared with patients with multiple sclerosis, control patients with depression and healthy controls.24 The prevalence of BPD was found to be 17% in those with CFS, 25% in patients with multiple sclerosis, 29% in control patients with depression and 0% in healthy controls.24

The 2009 study by Courjaret et al assessed the prevalence of personality disorders in a sample of female CFS patients compared with two control groups (psychiatric and general population controls).25 The study found that the prevalence of BPD was 2, 42 and 6% in the CFS, psychiatric and general population groups, respectively.25

The 2010 population-based study by Nater et al compared the prevalence of personality disorders and traits of survey respondents meeting criteria for CFS versus respondents with ‘insufficient fatigue’ and ‘well’ respondents. The authors found that the prevalence of BPD was 1.8% among those with CFS, 0.4% among those with fatigue who did not meet criteria for CFS and 0% among those identified as well.26

The Kempke et al study published in 2012 assessed the prevalence of DSM-IV personality disorders among female patients with CFS, compared with ‘normal community individuals’ and ‘psychiatric patient’ controls.27 The prevalence of BPD was found to be 6.5% in patients with CFS, 6.5% in the community control group and 39.1% in the psychiatric patient control group.27

The 2015 study by Carvo et al assessed the prevalence of personality disorders among patients with CFS and found that 3.03% of the participants had a comorbid BPD diagnosis.28

For an association to be considered to have causality, there needs to be both sensitivity and specificity of the finding.

The NIH reports a 1.6% yearly prevlaence of BPD in the general (US) population. http://www.nimh.nih.gov/health/statistics/prevalence/borderline-personality-disorder.shtml

Only one study found "statistically significant" higher rates in CFS patients than controls: The Johnson study reporting 25% in Multiple Sclerosis and 17% in CFS suggests methodological issues with this study, since such numbers are not replicated elsewhere.

The rest of the findings, 1.8%-Nater, 2%-Courjaret, 3.03%-Calvo (and 6.5% in both CFS patients and controls - Kempke) suggest that there is no association - since these figures overlap with population norms.

Major methodological issues of the above studies is that they all relied on questionnaire results to determine an association, rather than a formal diagnosis.

One of the studies (Kempke et al.) explicitly mentioned that the Personality Diagnostic Questionnaire has consistently shown to overestimate the prevalence. personality disorder. This questionnaire was used in the Johnson study mentioned above, along with the Calvo study - note "Carvo" in the article above was a typo!

All but the Nater study relied on biased case-control patient selection methodology (or cross-sectional study in tertiary care without a control), rather than relatively unbiased population based studies. Unfortunately, the Nater study used the relatively nonspecific 2005 CDC "empirical" criteria - the quoted article did not mention there are two different CDC criteria used.

The authors state:

There does not appear to be firm and consistent evidence to support the hypothesis that the prevalence of BPD is higher in individuals with CFS than in the general population.

Indeed. The lack of association, let alone a lack of specificity/sensitivity suggests no association. It is therefore a non-sequitur when they finally conclude:

Until more evidence is presented to either support or refute possible associations between the disorders of interest, the authors will continue to maintain an index of clinical suspicion for conditions such as fibromyalgia and CFS in patients with BPD as part of a thorough psychiatric assessment.

Sounds like the same "suspicion" of climate change denialists etc.