Third in a series related to Borderline Personality Disorder (BPD) based on the impairments and personality traits listed in the DSM5.

Description

Do you blame yourself for every little thing that goes wrong? Are you always the first to apologize? Do you hear a voice inside your head reminding you of all the things that have gone wrong in the past? Join the club. We have the second impairment – excessive self-criticism. I think the description is in the description. The title speaks for itself.

Looks like we are on our own again. The only piece of research I could find on this topic was by Ouimette et al. (1994). Two measures of personality styles and a structured diagnostic interview for personality disorders were administered to 138 outpatients. Looking at the broad range of personality disorders and personality traits, they discovered that autonomy/self-criticism was correlated with a broader range of personality disorder traits and diagnoses than anticipated. That’s it. Not sure what they were expecting, but we borderliners certainly would include this impairment near the top of our list

So what is happening in the brain? Longe et al. (2010) presented two scenarios, one positive and one negative, to project participants and watched the brain activity through fMRI scans. Participants were instructed to either imagine being self-critical or self-reassuring in each situation. Self-criticism activated the prefrontal cortex *(side: probably our old friend the OFC which is part of the PFC). It also activated the dorsal anterior cingulate (dAC). Since this is the first time we have encountered this villain, let me explain. The dAC* (aside: try to keep up with these abbreviations, there will be a quiz on Friday. Just trying to have fun, not easy for us borderliners) is involved in error processing and resolution and behavioural inhibition. Since they were also looking at what happens on the positive side, they found that self-reassurance was associated with the left temporal pole and the insula  which is involved in expressing compassion and empathy towards others. They also discovered activation in the dorsal/ventral PFC which attempts to find balance between self-critical or self-reassuring thought patterns.

So what does this mean in layman’s terms? First of all let’s look at the limitations of these studies. Neither of these studies were looking at a defined target of borderliners, so we do not get a clear description of how self-criticism works for us specifically. We can conclude however, that excessive self-criticism is common in all people with personality disorders. From the neurology study I think it is safe to say that borderliners would have more activity in the areas associated with self-criticism, namely indicating problems with error processing and controlling behavior, and a lack of self-assurance, namely problems in expressing compassion and empathy towards others. And since all problems start at home, I think it is safe to say that we have problems feeling empathy and compassion for ourselves. Therefore we blame ourselves for making mistakes. And since we have trouble processing information and making positive decisions, we find fault in everything we do right down to attention to the smallest details.

Our brain is simply not capable of doing its job. There is no self-assurance and no self-confidence because our mind cannot see solutions to problems. Because we are damaged by painful past experiences, we have put blocks to past pain in place, which interrupts the flow of thought. We tend to blame ourselves for not finding solutions to the problems that we are not even able to define. Keeping in mind that the root of these problems probably took place in early childhood and are therefore buried in implicit memories, the mind has a difficult time resolving past and present problems by employing rational processes. Also keeping in mind these past early childhood negative experiences are loaded with powerful negative emotions*(aside: ever see and hear a toddler having a tantrum?), we can see why the mind cannot unravel the problems and provide solutions. Therefore, the self-criticism is filled with frustration and anger directed at the one who is ultimately to blame. The buck stops here. We blame ourselves.