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monicaroni

Interesting article

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This is a really interesting article. I wonder if they're missing something though...which came first, the personality type or the cortisol?

 

http://qjmed.oxfordjournals.org/cgi/content/full/98/5/323

 

 

Type D personality: the heart, stress, and cortisol

L. Sher

 

From the Division of Neuroscience, Department of Psychiatry, Columbia University, New York, USA

 

Address correspondence to Dr L. Sher, Division of Neuroscience, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Suite 2917, Box 42, New York, NY 10032, USA.

 

Many studies have demonstrated the role of psychosocial and behavioural risk factors in the aetiology and pathogenesis of cardiovascular disorders. Recently, a new personality construct, the type D or ?distressed? personality, has been proposed. Type D behaviour is characterized by the joint tendency to experience negative emotions and to inhibit these emotions while avoiding social contacts with others. The observation that cardiac patients with type D personality are at increased risk for cardiovascular morbidity and mortality underlines the importance of examining both acute (e.g. major depression) and chronic (e.g. certain personality features) factors in patients at risk for coronary events. Both type D dimensions (negative affectivity and social inhibition) are associated with greater cortisol reactivity to stress. Elevated cortisol may be a mediating factor in the association between type D personality and the increased risk for coronary heart disease and, possibly, other medical disorders. Studies of the effect of age on hypothalamic-pituitary-adrenal (HPA) function in healthy humans have produced inconsistent results. This may relate to a different prevalence of type D individuals in study samples (i.e. some type D individuals may have alterations within the HPA axis that are similar to HPA axis changes in depressed patients). Further studies of the psychological and biological features of type D individuals may help develop treatment approaches to improve the psychological and physical health of individuals with type D personality.

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They didn't mention that these folks tended to be fat. Oh, I forgot. That's 'cause we're lazy and we eat too much.

 

I don't know if it's the cortisol talking, but I find this all offensive. Personality??? Oh wait, now I remember---'cause I've seen the notes talk about suspected borderline personality disorder. What kind of borderline and non-border line personality disorder do doctors, lawyers, politicians, etc., have when they make misdx's, when they drink too much, lie, cheat and steal??? Oh, yeah, they have a DISEASE---not a personality disorder.

 

I don't think it's the cortisol talking, I think that I'm just disgusted by the whole load of crap.

 

BIG PS: Monica---this is in no way aimed at you---but at the friggin' idiots who come up with this crap. If you ask me, all diseases are physical.

http://www.palace.net/~llama/psych/bpd.html

 

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one of the most controversial diagnoses in psychology today. Since it was first introduced in the DSM, psychologists and psychiatrists have been trying to give the somewhat amorphous concepts behind BPD a concrete form. Kernberg's explication of what he calls Borderline Personality Organization is the most general, while Gunderson, though a psychoanalyst, is considered by many to have taken the most scientific approach to defining BPD. The Diagnostic Interview for Borderlines and the DIB-Revised were developed from research done by Gunderson, Kolb, and Zanarini. Finally, there is the "official" DSM-IV definition.

 

Some researchers, like Judith Herman, believe that BPD is a name given to a particular manifestation of post-traumatic stress disorder: in Trauma and Recovery, she theorizes that when PTSD takes a form that emphasizes heavily its elements of identity and relationship disturbance, it gets called BPD; when the somatic (body) elements are emphasized, it gets called hysteria, and when the dissociative/deformation of consciousness elements are the focus, it gets called DID/MPD. Others believe that the term "borderline personality" has been so misunderstood and misused that trying to refine it is pointless and suggest instead simply scrapping the term.

 

 

What causes Borderline Personality Disorder?

It would be remiss to discuss BPD without including a comment about Linehan's work. In contrast to the symptom list approaches detailed below, Linehan has developed a comprehensive sociobiological theory which appears to be borne out by the successes found in controlled studies of her Dialectical Behavioral Therapy.

 

Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of):

 

* vulnerability vs invalidation

* active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)

* unremitting crises vs inhibited grief.

 

DBT tries to teach clients to balance these by giving them training in skills of mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.

 

Kernberg's Borderline Personality Organization

Diagnoses of BPO are based on three categories of criteria. The first, and most important, category, comprises two signs:

 

* the absence of psychosis (i.e., the ability to perceive reality accurately)

* impaired ego integration - a diffuse and internally contradictory concept of self. Kernberg is quoted as saying, "Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like."

 

The second category is termed "nonspecific signs" and includes such things as low anxiety tolerance, poor impulse control, and an undeveloped or poor ability to enjoy work or hobbies in a meaningful way.

 

Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Chief among these is splitting, in which a person or thing is seen as all good or all bad. Note that something which is all good one day can be all bad the next, which is related to another symptom: borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they lasted interacted with the borderline.

 

Other primitive defenses cited include magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others and projective identification, a process where the borderline tries to elicit in others the feelings s/he is having. Kernberg also includes as signs of BPO chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; transient psychotic episodes; denial; and emotional amnesia. About the last, Linehan says, "Borderline individuals are so completely in each mood, they have great difficulty conceptualizing, remembering what it's like to be in another mood."

Gunderson's conception of BPD

Gunderson, a psychoanalyst, is respected by researchers in many diverse areas of psychology and psychiatry. His focus tends to be on the differential diagnosis of Borderline Personality Disorder, and Cauwels gives Gunderson's criteria in order of their importance:

 

* Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.

* Repetitive self-destructive behavior, often designed to prompt rescue.

* Chronic fear of abandonment and panic when forced to be alone.

* Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.

* Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman's statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).

* Impulsive behaviors that often embarrass the borderline later.

* Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

 

The Diagnostic Interview for Borderlines, Revised

Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:

 

1. Affect

* chronic/major depression

* helplessness

* hopelessness

* worthlessness

* guilt

* anger (including frequent expressions of anger)

* anxiety

* loneliness

* boredom

* emptiness

2. Cognition

* odd thinking

* unusual perceptions

* nondelusional paranoia

* quasipsychosis

3. Impulse action patterns

* substance abuse/dependence

* sexual deviance

* manipulative suicide gestures

* other impulsive behaviors

4. Interpersonal relationships

* intolerance of aloneness

* abandonment, engulfment, annihilation fears

* counterdependency

* stormy relationships

* manipulativeness

* dependency

* devaluation

* masochism/sadism

* demandingness

* entitlement

 

 

The DIB-R is the most influential and best-known "test" for diagnosing BPD. Use of it has led researchers to identify four behavior patterns they consider peculiar to BPD: abandonment, engulfment, annihilation fears; demandingness and entitlement; treatment regressions; and ability to arouse inappropriately close or hostile treatment relationships.

 

DSM-IV criteria

The DSM-IV gives these nine criteria; a diagnosis requires that the subject present with at least five of these. In I Hate You -- Don't Leave Me! Jerold Kriesman and Hal Straus refer to BPD as "emotional hemophilia; [a borderline] lacks the clotting mechanism needed to moderate his spurts of feeling. Stimulate a passion, and the borderline emotionally bleeds to death."

 

Traits involving emotions:

Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them. One researcher (Marsha Linehan) said, "People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement."

 

1. Shifts in mood lasting only a few hours.

 

2. Anger that is inappropriate, intense or uncontrollable.

 

Traits involving behavior:

3. Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once

 

4. Two potentially self-damaging impulsive behaviors. These could include alcohol and other drug abuse, compulsive spending, gambling, eating disorders, shoplifting, reckless driving, compulsive sexual behavior.

 

Traits involving identity

5. Marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, sexual orientation, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what their opinions are, or what religion they should be. Instead, they may try to be what they think other people want them to be. Someone with BPD said, "I have a hard time figuring out my personality. I tend to be whomever I'm with."

 

6. Chronic feelings of emptiness or boredom. Someone with BPD said, "I remember describing the feeling of having a deep hole in my stomach. An emptiness that I didn't know how to fill. My therapist told me that was from almost a "lack of a life". The more things you get into your life, the more relationships you get involved in, all of that fills that hole. As a borderline, I had no life. There were times when I couldn't stay in the same room with other people. It almost felt like what I think a panic attack would feel like."

 

Traits involving relationships

7. Unstable, chaotic intense relationships characterized by splitting (see below).

 

8. Frantic efforts to avoid real or imagined abandonment

 

* Splitting: the self and others are viewed as "all good" or "all bad." Someone with BPD said, "One day I would think my doctor was the best and I loved her, but if she challenged me in any way I hated her. There was no middle ground as in like. In my world, people were either the best or the worst. I couldn't understand the concept of middle ground."

* Alternating clinging and distancing behaviors (I Hate You, Don't Leave Me). Sometimes you want to be close to someone. But when you get close it feels TOO close and you feel like you have to get some space. This happens often.

* Great difficulty trusting people and themselves. Early trust may have been shattered by people who were close to you.

* Sensitivity to criticism or rejection.

* Feeling of "needing" someone else to survive

* Heavy need for affection and reassurance

* Some people with BPD may have an unusually high degree of interpersonal sensitivity, insight and empathy

 

9. Transient, stress-related paranoid ideation or severe dissociative symptoms

 

This means feeling "out of it," or not being able to remember what you said or did. This mostly happens in times of severe stress.

 

Miscellaneous attributes of people with BPD:

 

* People with BPD are often bright, witty, funny, life of the party.

* They may have problems with object constancy. When a person leaves (even temporarily), they may have a problem recreating or remembering feelings of love that were present between themselves and the other. Often, BPD patients want to keep something belonging to the loved one around during separations.

* They frequently have difficulty tolerating aloneness, even for short periods of time.

* Their lives may be a chaotic landscape of job losses, interrupted educational pursuits, broken engagements, hospitalizations.

* Many have a background of childhood physical, sexual, or emotional abuse or physical/emotional neglect.

 

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))))))))))))))))))))))))))))))))))))))))))))

 

I think I hear someone barking up the wrong tree.

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Shell, that's exactly what I meant--they looked at the personality and that the cortisol was raised, but they didn't look at the possibility that maybe the cortisol was causing the "personality" symptoms...and the heart symptoms.

 

Maybe we should write to them.

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Thanks for setting me straight Monica. I have been looking at some other stuff about BPD---and I swear, I must be oozing cortisol right now---I'm so frigging mad!!!

 

I was just complaining to our bishop from church who came by earlier this evening. His son just completed his first year of medical school, and we were talking about how he wished his son was here so he could look at the labs and reports that I have that cover the last 10 years. I've got what looks like hypokalemia, low DHEA-S's, polyuria, nocturia, polydipsia, etc., and more and more and more!!! It matches almost perfectly with Conn's syndrome or disease---where your adrenal glands are up to no good. The only thing I don't have is a headache---I don't get headaches very often.

 

If they'd just open their eyes and think about it, they'd help people! What is their pathological personality disorder? Honestly, I've demonstrated over and over that I'm not helpless---but they seem to be stuck on some island of denial and delusion.

 

 

 

Thanks for setting me straight Monica. I have been looking at some other stuff about BPD---and I swear, I must be oozing cortisol right now---I'm so frigging mad!!!

 

I was just complaining to our bishop from church who came by earlier this evening. His son just completed his first year of medical school, and we were talking about how he wished his son was here so he could look at the labs and reports that I have that cover the last 10 years. I've got what looks like hypokalemia, low DHEA-S's, polyuria, nocturia, polydipsia, etc., and more and more and more!!! It matches almost perfectly with Conn's syndrome or disease---where your adrenal glands are up to no good. The only thing I don't have is a headache---I don't get headaches very often.

OUr bishop, who has known me for more than 18 years, said that he doesn't know anyone who has had more physical problems and illnesses. Yeah, I know. I've been dealing with them for more than 50 years---but I keep getting blamed for them. I'm tired of it. Why would I want to do this to myself?

 

If they'd just open their eyes and think about it, they'd help people! What is their pathological personality disorder? Honestly, I've demonstrated over and over that I'm not helpless---but they seem to be stuck on some island of denial and delusion.

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they looked at the personality and that the cortisol was raised, but they didn't look at the possibility that maybe the cortisol was causing the "personality" symptoms...and the heart symptoms.

Having lived with three people with high cortisol, I'd definitely say the elevated cortisol came first. I wonder at what point someone will figure out that they have some of these things backwards.

Judy

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I think my husband can vouch for me that cortisol can make a person freak out...(for example...oh...throwing all the shampoo and soap over the shower door because you can't get the shampoo open...I wouldn't know anything about that....) :spudnikwaving:

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Yep, if something isn't working right and it makes you mad, just hit it and break the whole thing. :spudnikwaving:

Judy

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That why my refrigerator door is broken now too...and my poor husband (who was a very good sport about it all) got a pee jug thrown at him and a cup of soda dumped on his head...(those were times when my test results were the highest too. :Jumpy::hippi:

 

Luckily those days are over now...proof that the high cortisol was the cause of my...um...erratic behavior.

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I never had issues before high cortisol. Then came the really high levels and the "mental stuff". No one fixed it, no one fixed me and now I think it is to late to fix. 4 months should have been long enough if it was going away after the bla. They want to give me drugs to hide it, but no one wants to fix it. Same crap different day.

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Steve, 4 months is not a very long time for a post-BLAer! Are you down to your physiological dose yet? How often do you have to stress dose? I really think it takes a while for the cortisol to get out of your system.

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my therapist who is a mental health psychiatric nurse practioner has told me many times that excess cortisol is like washing the brain in battery acid. this is why just plain old stress let alone cushings causes all kinds of emotional problems. it has taken me 3 years and anti depressants to restore some chemical balance in my brain and i will never know what is permanent. in kids who are absused and have had prolonged excess stress reations in addition to elevated cortisol they have found certain parts of the brain that help moderate emotions are smaller than in other brains. i will never doubt that emotions are very much the biochemical state of the brain.

 

kathyz

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There's actually a study being done at Cedars about whether PTSD causes pit tumors. I know there are many of us here who have some form of PTSD. I'm glad someone is finally making the connection.

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Steve,

 

Don't be so hard on yourself. Four months is **nothing** compared to the years your body has been dealing with this trauma. I do think it will get better. OTOH, if you are not taking an anti-depressant you might consider it. Your body might need the extra *oomph* from the meds to help build up your reserve -- it doesn't have to be a long-term solution.

 

:)

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I keep refusing the drugs to "hide" things. I want to figure out what the heck is going on!

 

Taking anti-depressants is like lying to my brain and my body.

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That's why we don't have the glass door on our shower now! Ooops, I'm going to tell on myself! Well, obviously this was before I was cured . . . . I got mad one day and put my foot through it and instead of fixing it we just put a bar and shower curtain on it.

 

Well, hubs said I might do it again. Roid rage can make a person do some bad things . . . . . :wub:

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Oh my gosh!!!

 

I'm so glad I came to these boards...before being diagnosed last year, I always wondered why my moods and behaviour were so erratic...screaming and shouting one minuite then calm as pie half an hour later...but...I've had 2 pit. surgeries this year, most of the tumor has gone...why am I still an emotional wreck...you say it takes a while for the cortisol to leave the body...HOW LONG...you guys seem to know so much.

 

Angela, x

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I'm so glad we're having "confession" time, makes my family fit right in! :wub:

Probably what I considered one of the worst was one morning a couple of years ago when I was trying to wake Justin, he drew his fist back and I know he was thinking of decking me. The emotions on his face when he really thought about what he was thinking of doing almost made me cry. That really isn't his personality.

Judy

eta - Angela, if there is still part of the tumor left, isn't there a good chance you still have Cushing's?

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My roid rages come and go---and they are nearly impossible for me to control---it's not a matter of choice---it's more like I'm in the fight of my life.

 

I'm the same way---I'm usually very calm and don't get rattled---but talking to my pcp today, I told him that when I get bad, I'm a total, 100%, certified jerk. And I hate it.

 

Check out your bp and your blood sugar when it happens---my bp and my blood sugar seem to be high when I'm raging.

 

BP at doctor's office was high---they didn't say how high, but the machine took about four minutes to get a reading---and the cuff got so tight, I was about ready to cry.

When I got home, my bp was 187/109 but my blood sugar (after eating) was just 72. I wasn't going into a rage today---although I was upset. Still trying to figure things out---but this seems to back up my theory that when my blood sugar is high, and my bp is high---I'm roid-raging.

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I get the real rages occassionally, but a lot of the time I'm just more irritable than I used to be. I've managed to keep from breaking things in the rages so far, but give me time! A couple of years ago, my mom had sent me cookies in a package that was in the mailroom of my dorm. When the person in charge of the mailroom said that she wasn't opening it that night, I had to walk away quickly, because I really badly wanted to punch her. A few minutes later, I couldn't even figure out why it upset me so much. I hate this.

 

~LauraP

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Steve, 4 months is not a very long time for a post-BLAer! Are you down to your physiological dose yet? How often do you have to stress dose? I really think it takes a while for the cortisol to get out of your system.

 

I was down to 25 for a month and half. Was in AI the whole time I think my doctor is telling me. She made me go back up to 30. I stress dose not to often. Something isn't right with my meds and whatever happened in my head isn't fixed either.

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I tried coming off of my anti-depressants a few weeks back, thinking that maybe my GH was helping in that area, and I found out quickly as did everyone else in my family that it was a BAD idea!! I got really angry and emotional. I had to quickly get back on them!

 

I had weaned off just as you are suppose to do. Didn't just come straight off of them incorrectly. That was the first thing the doctor asked me. But NO I did it the right way. I also went back on them the right way.

 

Cushings just does something to us . . . . and I will be the first to admit the Lexapro really helps me a LOT!! It makes me calmer and more relaxed. Wish that I didn't need but . . . . .

 

Hugs

Amy

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