BPD is predisposed early in life in a period where the Right Brain undergoes a growth spurt. Due to circumstances (epigenetically/environmental), there are certain prefrontal/orbitofrontal deficits that later on develop into emotion dysregulation or "emotional hijacking" with a range of severity in co-morbid Complex PTSD.
These prefrontal area's are highly interconnected with emotional systems like the amygdala, specifically the prefrontal/orbitofrontal brain area is known to inhibit emotional responses, which explains why a weakened state causes emotional hyperreacticity. In contrast, the most developed and integrated prefrontal and emotional systems are seen in loving-kindness meditation practitioners.
The "hijacking" by emotion can be seen as a more primitive defense that gets stored implicitly (unconscious) and that causes fragmentation of memory and of the Self. This fragmentation affects perception, representations, attention, cognitions, memory and reflection. This means, becoming aware and integrating these fragmented self-states is also the way to stabilize the system.
"In areas of the personality where trauma has left its mark, many self-states define not simply points of view of their own, but narrative truths of their own, which, as I’ve described earlier, are non-negotiable and protected by a dissociative mental structure…"
—at times our sole focus during the initial part of treatment—is participating in the restoration of fluidity between the dissociated self-state gaps—what I call the capacity for “standing in the spaces...." (Bromberg, 1998)
This prefrontal brain dissociative splitting of self-states (or repression) causes a build-up of unprocessed traumatic energy (avoidance/phobia's of emotions) that involve brain systems like the amygdala (fear center) and hippocampus (memory system), similar abnormalities are also found in non-BPD people diagnosed with PTSD (van der Kolk, Meares).
Because of dissociative defenses these traumatic states become overwhelming and causes people to re-live the past in the present (regressions). Because in that case we fail to differentiate between past traumatic emotions and sensations and the present the trauma is experienced as "now" and never properly worked through and timestamped (keeping the hippocampus online through Mindful Witnessing of "emotional younger parts" and activating an inhibiting Primary positive emotion (Safe, Care, Connection, Play, Pleasure, Importance, Value, Assertiveness) and/or EMDR is known to "timestamp" traumatic energy in the past and release it from the present (IFS unburdening)).
Activating opposing positive emotions and training different Primary emotional systems like 'muscle memory' is hypothesized to override traumatic states and promote Fail-Safe Brain Networks through promoting optimal self-organization of multiple brain systems (Albert, Beatriz Sheldon, 2021). Self-Organization causes a spontaneous order when under the right contitions where systems operate harmonious, flexible, adaptive, coherent, energized and stable (Daniel J. Siegel 2021).
When affect is regulated, the organism is integrated and able to respond flexibly to the internal and external environments. We experience a sense of self-mastery, and indeed, when regulated we are optimally functional. When affect is dysregulated, we become dissociated (disintegrated) and reduced to automated processes and isolated portions of our memory. In other words, the organization of the self is affect state dependent. We organize and disorganize depending on whether or not we are regulated.
Scientific Refereces (26-03-2022):
1. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation,
Volume 54, Issue 11,
2003, Nelson H Donegan, Charles A Sanislow, Hilary P Blumberg, Robert K Fulbright, Cheryl Lacadie, Pawel Skudlarski, John C Gore, Ingrid R Olson, Thomas H McGlashan, Bruce E Wexler
2. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study,
Biological Psychiatry, Sabine C Herpertz, Thomas M Dietrich, Britta Wenning, Timo Krings, Stephan G Erberich, Klaus Willmes, Armin Thron, Henning Sass,
Volume 50, Issue 4,
3. Failure of Frontolimbic Inhibitory Function in the Context of Negative Emotion in Borderline Personality Disorder
David Silbersweig, M.D., John F Clarkin, Ph.D., Martin Goldstein, M.D., Otto F. Kernberg, M.D., Oliver Tuescher, M.D., Ph.D., Kenneth N. Levy, Ph.D., Gary Brendel, M.D., Hong Pan, Ph.D., Manfred Beutel, M.D., Michelle T. Pavony, B.A., Jane Epstein, M.D., Mark F. Lenzenweger, Ph.D., Kathleen M. Thomas, Ph.D., Michael I. Posner, Ph.D., and Emily Stern, M.D.
American Journal of Psychiatry 2007 164:12, 1832-1841
4. Emotion dysregulation in borderline personality disorder: A fronto-limbic imbalance?,
Current Opinion in Psychology,
2021, Maurizio Sicorello, Christian Schmahl,
5. Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder,
David L. Perez MD, David R. Vago PhD, Hong Pan PhD, James Root PhD, Oliver Tuescher MD PhD, Benjamin H. Fuchs BA, Lorene Leung BA, Jane Epstein MD, Nicole M. Cain PhD, John F. Clarkin PhD, Mark F. Lenzenweger PhD, Otto F. Kernberg MD, Kenneth N. Levy PhD, David A. Silbersweig MD, Emily Stern MD, (2016), Neural mechanisms of psychotherapy. Psychiatry Clin Neurosci, 70: 51-61. https://doi.org/10.1111/pcn.12357