1. Research into BPD SPDN Jeremy Hall

3. Borderline Personality Disorder First defined by Gunderson Core features –Affective instability –Interpersonal difficulties –Impulsivity Heritability about 40% Strongly associated with early life stress

4. The Scale of the Problem BPD affects 1-2% of the population BPD accounts for 10% OPD contacts BPD main diagnosis in 6% admissions Frequent cause of attendance at A&E Associated with a 10% risk of suicide

5. Current Treatments 1. Pharmacological Treatments –Antidepressants only if concurrent depression –Antipsychotics for perceptual disturbances –Some evidence for mood stabilisers –All trials very small –NICE unable to recommend any treatment

6. Current Treatments 2. Psychological Treatments –Best evidence is for DBT –Some evidence also for CBT –HOWEVER Trials generally small Limited availability Not suitable for all

7. How can Research help? Psychological Research –Larger studies –“Real-life” settings Biological Research –Develop measures of deficits in BPD –Relate these to changes in the brain –Develop new treatments

8. Our Research Developing measures of BPD symptoms –Affective responses –Interpersonal interactions –Impulsivity Determining their specificity to BPD Developing translational assessments

9. Emotion and Impulse Study 1. Background information 2. Symptom severity 3. Computer tests of: –A. Emotion processing –B. Social responses –C. Impulsivity

10. Who did we study? 20 people with symptoms 20 people without symptoms Age range 20-55 75% female

11. What did we find out?

12. Background and Symptoms

13. Some things weren’t different… AGEIQ

14. … and some things were: CHILD STRESSDEPRESSION

15. Computer tests 1 Emotion Processing

16. Expression in faces

17. Facial Emotion Recognition Anger Happiness Fear Sadness Surprise Disgust

18. Results: Emotions **

19. Emotion Recognition and Trauma

20. Computer tests 2 Social Responses

21. Social decisions Trustworthy?

22. Social Judgement APPROACHABLENOT APPROACHABLE

23. Results: Social *** **

24. Social Judgement Bias BPD

25. Social Judgement and Trauma

26. Computer tests 3 Impulsivity

27. Motor Impulsivity

28. Delayed Reward £10 Straight away £20 In two weeks Which would you prefer?:

29. Delayed Reward

30. Conclusions

31. We could measure difficulties in core areas: –Emotion processing –Social responses –Impulsivity What does this mean in the brain?

32. Basis in the brain? PFC AMY

33. The future!

34. Acknowledgements CSO / SFC Merrick Pope Katie Nicol All the participants

35. Contacts Jeremy Hall –Email: jeremy.hall@ed.ac.ukjeremy.hall@ed.ac.uk –Tel: 0131 537 6313 Merrick Pope –Email: Merrick.Pope@nhslothian.scot.nhs.ukMerrick.Pope@nhslothian.scot.nhs.uk –Tel: 0131 537 6390