Thursday, October 6, 2011

Autoimmune Disease and Borderline Personality Link

After the post about Overreactions to Illness and Hysteria with Borderline Personality, I have received many emails and comments about how their Borderline Personality Disorder (BPD) mothers have auto-immune diseases. Specifically, one reader wrote,  "I find it interesting that your mother was diagnosed with an autoimmune disorder, as my mother is also (she is diagnosed with rheumatoid arthritis and psoriasis). Although I know there is nothing that can be done to prevent an autoimmune disorder, I can't help but wonder why so many BPD individuals are diagnosed with them. A friend's BPD sister was recently diagnosed with an autoimmune disorder as well. Now, this could be pure coincidence, but I was wondering if you had any thoughts on this topic or knew of any related research."

After this email, I thought researching this correlation further (BPD correlating with autoimmune diseases) would be interesting and revealing. And it sure was!
  1. Individuals who have BPD or any of the other Axis II Cluster B's (BPD, NPD, ASPD, HPD) often suffer from autoimmune illness due to the stress and elevated cortisol levels which  induce a cascade of autoimmune issues. 
  2. Autoimmune-related inflammation may exacerbate BPD symptoms or vice versa.
  3. Present data demonstrate a clinically significant, longitudinal correlation between fluctuating antithyroid antibody titers and symptoms of BPD psychopathology.
Further, keep in mind that BPD is also associated with less healthy lifestyle choices (e.g., smoking, alcohol use, lack of regular exercise) which can cause a myriad of health challenges, problems, and diseases.  With this article, however, we are focused on the connection between BPD and autoimmune disease specifically.

First off,  BPD can have a major impact on physical health. BPD individuals often endure chronic medical conditions and pain disorders such as fibromyalgia, chronic fatigue syndrome, obesity, diabetes, hypertension, arthritis, and back pain (Psyche Solve). Additionally, individuals who have BPD or any of the other Axis II Cluster B's (BPD, NPD, ASPD, HPD) often suffer from autoimmune illness due to the stress and elevated cortisol levels which  induce a cascade of autoimmune issues. In normal circumstances, cortisol keeps the immune system in homeostasis, preventing inflammation from going out of control. In many patients with autoimmune diseases, this cortisol response and the cascade of brain hormones that stimulates its release are impaired, so there is no shutoff valve to end inflammation when it is no longer needed. In other patients, the cortisol response may be intact but immune cells are resistant to the anti-inflammatory effects of cortisol due to abnormalities in the cortisol receptor. In both circumstances, inflammation goes on unchecked without the dampening effect of the body own cortisol (American Autoimmune).

Next, in the book, "Sometimes I Act Crazy: Living with Borderline Personality Disorder" by Jerold J. Kreisman M.D. and Hal Stras, the authors draw a connection between autoimmune disorders and BPD. The following is an excerpt: Some researchers have investigated the connection of BPD to autoimmune disorders, in which the body has a kind of allergic reaction to itself and produces antibodies to its own organs. One example, rheumatoid arthritis, is associated with an unusually high prevalence of BPD. One study followed a woman with fluctuating BPD symptoms over a period of nine months while measuring her antithyroid antibodies. These investigators discovered significantly lower levels of the antibodies during periods when her depression and psychosis ratings were low, and higher levels when her symptoms increased. This finding suggests that autoimmune-related inflammation may exacerbate BPD symptoms or vice versa.

The following abstract is focused on the same issue, that BPD and autoimmune disease are correlated. And the conclusion is that a relationship between thyroid hormones / autoimmunity and BPD exists. Before reading, understand that antithyroid antibodies are antibodies directed against the thyroid gland (a gland which produces thyroid hormones). Antithyroid antibodies can be associated with inflammation of the thyroid gland and affect its function. Testing for antithyroid antibodies in the blood is useful in the diagnosis of some thyroid and other disorders including: Hashimoto thyroiditis (an autoimmune thyroid disease), Graves disease (overactivity of the thyroid), hypothyroidism (underactivity of the thyroid), thyroid cancer, Lupus, rheumatoid arthritis, autoimmune hemolytic anemia and Sjogren syndrome. Now to that abstract... deep breath and read on:

Circulating thyroid autoantibodies are more prevalent in patients with mood disorders than in the general population, but longitudinal clinical data that establish a relationship between thyroid antibody status and the course of any psychiatric syndrome have been lacking. In addition, scant attention has been paid to thyroid hormones and autoimmunity in borderline personality disorder (BPD). We report a case of a patient with classic BPD whose fluctuating mood and, especially, psychotic symptoms-rated using a double-blind method-were directly linked to antithyroglobulin antibody titers serially determined over an inpatient period of 275 d. Significantly lower psychosis and depression ratings were seen during a 4-wk period of relatively low antithyroid antibody titers, during blinded treatment with carbamazepine, than were observed during two high autoantibody epochs. The significant positive correlations between nurse- and patient-rated depression and thyroid autoantibodies over the entire period of inpatient study were similar to those also observed between urinary free cortisol levels and depression; the positive correlation between antithyroglubulin antibody titers and psychotic symptoms was stronger (r = +0.544; p < 0.002). Although this patient had biochemical indices of primary hypothyroidism, she showed only marginal improvement to triiodothyronine (T3) and no apparent clinical response to sustained levorotatory thyroxine (T4) administration; neither were antithyroid antibody titers significantly associated with changes in T3, free T4, or thyroid-stimulating hormone concentrations. She clinically deteriorated during a 50-d fluoxetine trial. The present data demonstrate a clinically significant, longitudinal correlation between fluctuating antithyroid antibody titers and symptoms of borderline psychopathology in our patient. It will be of interest to determine the prevalence, pathophysiologic mechanisms, and treatment implications of this putative autoimmune- BPD link.

Another interesting observation is that medical conditions which cause organic behavioral function may result in a clinical picture that mimics to some degree BPD. Hormonal dysfunction over a long period, or brain dysfunction (e.g. the encephalopathy caused by lyme disease) can result in identity disturbance and mood lability, as can many other chronic medical conditions such as Lupus. These conditions may isolate the patient socially and emotionally, and/or cause limbic damage to the brain. However, this is not BPD which results, but rather a reaction to the isolating circumstances caused by a medical condition and the possibly coincident struggles of the patient to control his or her mood given damage to the brain's limbic system (Wikipedia).

So, with the reports coming from Kreisman and Stras as well as scientific exploration into the correlation between autoimmune diseases and BPD, we may be closer to finding out if indeed a direct link exists. At this point, the assumption seems pretty strong that a link does exist-- and solid research has already been conducted and concluded in regard to bipolar and autoimmune diseases. With BPD gaining more attention, more studies will be conducted. I will be very interested to see the results. A link exists as high levels of stress have been proven to trigger autoimmune diseases; however, does the reverse apply? Does an autoimmune disease bring about BPD?

Tuesday, October 4, 2011

How to Forgive an Abusive Parent

How do you forgive your abusive parent / parents? Well first off, what exactly is forgiveness? I have always pondered the definition as well as if I have actually forgiven my parents. "To forgive" seems like it's as difficult to define as "to love." 

I am not angry with my parents. I don't want any ill-will or negativity between them and me. I don't want revenge or wish them any harm. In fact, I simply want peace for me and my family. I am not a fighter, and I stray away from conflict. I dislike tit-for-tat and will not engage in that type of behavior. 

All along, I have never blamed my parents for anything that I am responsible for-- which includes my life and who I am. I am the master of my own destiny, and although my upbringing was tough, I believe my experiences made me who I am today. I learned as a young girl that I am the only one who is responsible for me. I learned that I am the only one with whom I can depend. I learned very young that I have to be strong and take care of myself. Thus, I grew into a strong and independent person. 

Although my parents engaged in all types of manipulative, guilt-trip, emotionally abusive, and confusing behaviors with my brother and me, I always knew that they were in the wrong-- that we were just children and not responsible for our parents' reckless and careless actions. After being caught in the middle of my parents destructive divorce (my childhood), they each remarried into ready-made families before my brother and I were able to adjust from the split of our own family unit. Parental Alienation continued, battles in court ensued, and the emotional fall-out continued. Throughout my childhood and teen years, I accepted how my parents were, clearly cognizant that neither was **right** And into my adulthood, my parents were flippant with their relationships with my brother and me. So my brother and I went in and out of estrangements with our parents. 

I always searched for my part in the relationship's challenges-- as every relationship takes two. I would analyze and dig deeply to assess my accountability in the estrangements. And time and time again, I was never angry or resentful or even bitter-- always sad that broken relationships surrounded my family. I also wished that our family could be a happy family that shared in successes and supported during failures. But most importantly, I always accepted that these were the cards that I was dealt, and I would manage them to the best of my abilities. When I was a single woman, I could handle the dysfunction and toxicity to a degree and then I would have to back away. But with the entry of a husband and then a daughter, the tolerance for the disruptive, harmful, hurtful, and terribly confusing behavior had to stop. No more cycles in and out ... no more endless nights analyzing why this and that happened... no more walking on egg-shells. 

So, have I forgiven?

From a dictionary stand point, forgiveness is:
  • letting go of the need for revenge and releasing negative thoughts of bitterness and resentments
  • excusing for a fault or offense-- to pardon.
  • renouncing anger against. 
I never felt the need for revenge nor have I been angry. I have felt hurt and astonished by they behaviors. I never felt the need to disparage my mother the way she's done to me since my childhood. I have not been bitter or held resentments to my mother or Dad. I also realize that they are who they are-- that they act the way they do, not because of me, but because of who they are. They treat others the way they treat me-- so I do pardon them for how they act. I don't like how I was treated nor accepted being treated poorly but I understand that they are both personality disordered. I definately will not accept my husband or child being treated poorly like how I was treated; therefore, I protect both from the 'known dangers.'

From a psychological perspective, forgiveness involves the affective, behavioral and cognitive systems of the forgiver, how one feels about the offender, behaves toward her and thinks about her. Forgiveness is letting go of the negative feelings and the emotional consequences of the hurt, namely the bitterness and resentment. The negative behavior toward the perpetrator is replaced with positive behavior. The choice is not to retaliate but to respond in a loving way and giving up the right to hurt back. The  negative thoughts regarding the offender are changed as the intellectual decision to forgive is made and the good and bad aspects of the perpetrator are integrated. The Forgiveness Web

How do I feel about my mother and Dad? Again, I am not bitter or resentful. I am not hurt by them at this point. By removing myself from the Dr. Jekyll / Mr. Hyde cycles of my mother as well as the narcissistic behaviors of my Dad, I have removed myself and my husband from repeatedly getting hurt, insulted, manipulated, and involved in the dysfunction & toxicity. I have never felt the need to hurt back which is evidenced by my walking away rather than fighting time-and-time again.

I love this definition of forgiveness: to forgive is to give up all hope for a better past: 
  1. If you are locked in regret over the past, you have less available to your life now.
  2. If you don't forgive, you are prejudging your future because you are on-guard, defended and, helpless from residual bitterness which influences your capacity for happiness because you haven't resolved something from your past.
I love that definition and it's counterparts. I have always had a rich and abundant life-- from as far back as I can remember, I have had a positive and cheery outlook on life and what is ahead. I have not had regrets, especially with my parents. I tried to manage, understand, tolerate, and move forward. And I have not been on-guard, defended, or helpless because of my past-- in fact, my experiences have been the opposite as I became empowered due to what I experienced in the past. I knew I had to be able to be self sufficient, and I shot out into the world at 18-years old and never looked back. I went to college, excelled in academics, went out into the corporate world, and succeeded as a single woman, living independently. I didn't look back until I was almost 30 years old, which is when I started to think about what brought me to where I was at that point.

I believe that forgiveness is a fresh start and clears a new view. The view is that an 'awful thing' happened and hurt; however,  that incident(s) will not take over life. I have the ability to love my mother when she was around (not bringing up previous estrangements or conflicts with her) but then handle the estrangement knowing that she went into another Mr. Hyde cycle. Don't get me wrong-- going into another estrangement wasn't a **happy** occurrence. Going into an estrangement was the feeling of sadness and loss again-- but also the feeling of a huge weight off my shoulders as the walking on eggshells can be very stifling. As far as my Dad, I tried to comprehend and understand his selfishness and the behaviors surrounding it; however, the weight that was lifted when I didn't have to endure being invisible or his condescending comments was freeing. The choice of a fresh start with clear new view is always available rather than bitterness and revenge. People who have forgiven have visible power, strength, and courage. Rather than eye-for-an-eye, they heal.

Part of forgiveness is not blaming for suffering. The 'awful thing' happened and the response is to move forward.  Move forward with openness and trust without blaming for suffering. Give very little power to people who are cruel. Forgiving means power is taken back and declaring your own life. 

Sure I wish things were better-- and sure I wish that I had happy, peaceful, and mutually beneficial relationships with my parents; however, I don't have the ability to have a happy, peaceful, or mutually beneficial relationship with them. The specific BPD woman marries a specific BPD man: hermit with a huntsman (protector), queen seeks a king (attracts attention and is a narcissist), witch seeks a fisherman (is dominated and controlled), and the waif marries a frog-prince (rescuer). The common denominator in the various types of men who marry BPD's is their tendency to reinforce the pathological dynamics between the mother and child (Lawson pp 178 -179). Therefore, understanding my Dad's relationship with my BPD mother (and even my step-father's relationship with my BPD mother) was essential to understanding my own experience-- and also essential in my understanding why I can't have a mutually beneficial relationship with them.

There's clear evidence that if people apologize, it's easier to forgive. Forgiveness, though, is not limited by that-- and I have gotten apologies from my mother at various times during my life; however, she overwhelmingly points the finger at my brother and me. She either doesn't comprehend or realize the repercussions from her actions-- or she has rationalized and justified her actions-- or she has convinced herself by telling the same lie over and over. Even if the person utters no conciliatory words and suffers no consequence, forgiveness can still occur because forgiveness is always for you. 

I don't need my mother or Dad to apologize-- I would like them to recognize and acknowledge their actions but apologizing for them would actually seem insincere since their narcissism is so encompassing that the apology would most likely be self-serving. You forgive by remembering what happened and you commit yourself to it never happening again-- thus the reason why I have walked away after 4 decades of trying to have relationships with them. 

Forgiveness does not mean condoning the action or that you have to reconcile with or like the person who did it. Declaring, "This was such a heinous act, I sever my relationship with them" which doesn't mean seeking justice. Forgiveness means that you don't take what happened as just personal, that you see it as a part of the bigger, ongoing human experience of hurt, resolution, conflict and negotiation. I realize that I happened to be born to this mother, a mother whom I don't like her actions or like her. I don't seek justice but I don't condone her behaviors. I also was born to a man who left when I was months old. I forgive him for letting me be adopted by another man, but I am not reconciled with him. And the man who adopted me is highly narcissistic with behaviors that are very self-serving; however, I don't condone the behaviors and don't want to subject myself or husband or child to his hurtful and bewildering actions.

Parents are the people we look to nurture us and keep us safe. When a parent abuses a child,  the  impact is life-long. Adult victims of abuse may have trouble trusting or suffer post-traumatic stress. For some, forgiving abusive parents may be a needed step to recovery. Be patient as forgiveness may take time until you are ready to forgive abusive parents. Take the time you need to work through your issues and don't revisit old arguments as going over the same issues may not help the situation.

Forgiveness the key to living "better, not bitter." While you are weak or while you are still suffering from the effect of the 'awful thing' done to you, forgiveness is challenging. Even if forgiveness is possible, it's still challenging. Take the time to heal wounds, eliminate of the negative consequences, and become more powerful-- then forgiveness will become much easier.