Η βιολογία της Μεθοριακής Διαταραχής Προσωπικότητας
Την τελευταία δεκαετία, στις έρευνες για την ΜΔΠ, το ενδιαφέρον έχει στραφεί στην νευρο-απεικόνιση (neuroimaging). Πολλά από τα ευρήματα αναφέρονται σε περιοχές που σχετίζονται με την επεξεργασία των συναισθημάτων όπως η αμυγδαλή, η νήσος του εγκεφάλου, στον οπίσθιο φλοιό της έλικας του προσαγωγίου (posterior cingulate cortex) και προμετωπιαίες περιοχές όπως ο κογχομετωπιαίος φλοιός (orbital frontal cortex), ο έξω ραχιαίος προμετωπιαίος φλοιός (DLPFC) και ο έξω κοιλιακός προμετωπιαίος φλοιός (ventral lateral prefrontal cortex).
Δομικές αλλαγέςΣε μέτα-ανάλυση που έγινε όπου συγκρίθηκαν περίπου 300 που εμφάνιζαν ΜΔΠ και ισάριθμούς υγιείς εθελοντές διαπιστώθηκε μείωση της φαιάς ουσίας στον δεξιό ιππόκαμπο και την αριστερή αμυγδαλή στα άτομα με Μεθοριακή Διαταραχή Προσωπικότητας.1 Λειτουργικές μεταβολέςΣε άλλη μετα-ανάλυση με εικόνες λειτουργικής Μαγνητικής Τομογραφίας (λΜΤ -fMRI) διαπιστώθηκε μεγαλύτερος βαθμός ενεργοποίησης στην αριστερή αμυγδαλή κατά την επεξεργασία αρνητικά φορτισμένων ερεθισμάτων. Το ίδιο και στον αριστερό ιππόκαμπο και στον οπίσθιο φλοιό της έλικας του προσαγωγίου. Παράλληλα (με τα ίδια ερεθίσματα) διαπιστώθηκε μειωμένη ενεργοποίηση στις προμετωπιαίες περιοχές (που είναι περιοχές κυρίως του ελέγχου της συμπεριφοράς).2
Η συσχέτιση αυτών των περιοχών με την Μεθοριακή Διαταραχή Προσωπικότητας υπογραμμίζεται και από ένα άλλο δεδομένο: Εχει βρεθεί ότι η Διαλεκτική Θεραπεία Συμπεριφοράς (που αποτελεί μέχρι σήμερα την ψυχοθεραπεία πρώτης επιλογής για την ΜΔΠ) επαναφέρει την υπερ-ενεργοποίηση αυτών των περιοχών στα φυσιολογικά επίπεδα. 3
Νευρωνικά κυκλώματαΤελευταία, με τη βοήθεια κυρίως της λΜΤ (λειτουργικής Μαγντητικής Τομογραφίας) έχουν αναπτυχθεί πολύπλοκες μέθοδοι μελέτης ανατομικών και λειτουργικών διασυνδέσεων (connectivity) ανάμεσα στις εμπλεκόμενες περιοχές του εγκεφάλου. Παρότι λοιπόν η έρευνα στο πεδίο αυτό είναι ακόμη στο “βρεφικό” της στάδιο, τα πρώτα δεδομένα φαίνεται να δείχνουν ότι μια δυσλειτουργία στις μετωπο-μεσομεταιχμιακές συνδέσεις μπορεί να σχετίζεται με τη βαρύτητα των συμπτωμάτων της Μεθοριακής Διαταραχής Προσωπικότητας όπως το ασταθές συναίσθημα, ο θυμός κλπ.4
Η ανάλυση των λειτουργικών διασυνδέσεων ανάφέρεται στο: ποιά άλλα κυκλώματα του εγκεφάλου ενεργοποιούνται ταυτόχρονα και μπορούν να μελετηθούν αναλυτικά ανεξάρτητα. Τα 3 κύρια κυκλώματα στην Μεθοριακή Διαταραχή Προσωπικότητας είναι:
- Το κύκλωμα καταστασης ηρεμίας (default mode). Είναι το κύκλωμα που λειτουργεί όταν ο εγκέφαλος είναι σε ηρεμία και δεν υπάρχει δραστηριότητα στοχο-προσήλωσης (δεν προσέχει κάτι συγκεκριμένο). Επηρεάζεται από τον έσω προμετωπιαίο φλοιό και τον οπίσθιο φλοιό του προσαγωγίου και είναι υπεύθυνο για τον αυτο-στοχασμό (self-referenial thinking).
- Το κύκλωμα ανάδειξης-προβολής (salience). Περιλαμβάνει την κογχομετωπιαία νήσο (orbital frontal insula) και το ραχιαίο πρόσθιο φλοιό του προσαγωγίου (dorsal anterior cingulate cortex)
- Το κύκλωμα του έσω κροταφικού λοβού. Είναι υπεύθυνο για την επεξεργασία αρνητικών συναισθημάτων.
Στη Μεθοριακή Διαταραχή Προσωπικότητας παρατηρούνται μεταβολές στην διασύνδεση αυτών των 3 νευρωνικών δικτύων και κυρίως προβληματική διασύνδεση μεταξύ του κυκλώματος ανάδειξης-προβολής και του κυκλώματος αυτο-αναφοράς. Αυτή η δυσλειτουργία έχει σαν αποτέλεσμα τη λανθασμένη ταυτοποίηση ουδέτερων ερεθισμάτων και αδυναμία απαρτίωσης των πληροφοριών που προσλαμβάνονται με τις εσωτερικές εκπροσωπήσεις. (Και επειδή η τελευταία παράγραφος φαίνεται αρκετά δυσνόητη, να με συγχωρήσετε να σας την αποδώσω με μία απλή φράση: Αποτέλεσμα αυτής της δυσλειτουργίας είναι “να κάνει ο άνθρωπος, την τρίχα, τριχιά” – doctorbabis)
1. Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73:153-160.
2. Schulze L, Schmahl C, Niedtfeld I. Neural correlates of disturbed emotion processing in borderline personality disorder: a multimodal meta-analysis. Biol Psychiatry. 2016;79:97-106.
3. Goodman M, Carpenter D, Tang CY, et al. Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. J Psychiatr Res. 2014;57:108-116.
4. Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2014;16:438.
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