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Notes from
Professionals
Antonia S. New, MD
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| Antonia S. New, MD is the
Associate Director of the Special
Evaluation service and an Assistant
Professor of Psychiatry at The Mount
Sinai School of Medicine. She is
involved in research, clinical work
and teaching at the medical school.
She specializes in borderline
personality disorder, exploring the
neurobiological underpinnings of
this disorder as well as the
implications of these findings on
treatment. Her research focus is on
impulsive aggression and she uses
neuroimaging techniques, genetic
studies, and laboratory assessment
of behavior and treatment studies.
She also studies the effect of sex
hormones on impulsive aggressive
behavior. |
Recent publications:
New AS, , Buchsbaum
MS, Goodman M, Reynolds D,
Mitropoulou V, Sprung L, Shaw RB Jr,
Koenigsberg H, Platholi J, Silverman
J, Siever LJ. Blunted prefrontal
cortical 18fluorodeoxyglucose
positron emission tomography
response to meta-chlorophenylpiperazine
in impulsive aggression. Arch
Gen Psychiatry. 2002
Jul;59(7):621-9.
New AS, Gelernter J, Goodman M,
Mitropoulou V, Koenigsberg H,
Silverman J, Siever LJ. Suicide,
impulsive aggression, and HTR1B
genotype. Biol Psychiatry.
2001 Jul 1;50(1):62-5. |
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| Recently, I received a call
asking me if I wanted to moderate a
session on borderline personality
disorder for a conference for
National Education Alliance for
Borderline Personality Disorder for
patients, families and health
professionals working with these
patients. As an academic
psychiatrist, I had been working on
neurobiological models for this
disorder for years, and yet I
hesitated, wondering if I had
anything to offer. My work life is
spent mostly planning studies,
applying for grants, analyzing data,
and writing papers etc. But the
reason I had chosen to study this
disorder was because of an encounter
I had had many years ago as a
resident. |
At that time, I took care of a
15-year-old girl who had a long
history of cutting herself. This
behavior puzzled me and I asked her
why she did this. She told me that
she often felt that life was
unbearable, and that cutting herself
was the only thing that made her
feel better. I asked how she had
first started, how she had thought
of this. She replied that she had
never known anyone who had cut
themselves nor had she heard of
anyone who did it. The first time
she cut herself it was with the
thought of suicide, but then she
discovered that cutting herself
lightened her dark, hopeless mood.
She was the first of many borderline
patients I met with similar stories.
I met a patient who struggled
mightily to control outbursts of
rage that filled her body from head
to toe tingling through her whole
being. Her mother told me that she
knew from an early age that
something was wrong. Her little
18-month-old daughter would have
such fits of temper that she
actually broke her crib.
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| I was eager to get back in touch
with the people who had inspired me
to try to understand this illness in
the first place, although I wondered
what I really knew about the disease
that might be helpful to others.
|
I accepted the invitation to the
conference and arrived at a morning
panel to hear moving stories and
pleas for more research and
treatment for this disorder by
family members of patients with BPD.
They described what it was like to
have a mother, a sister, a daughter,
a niece with this disorder. They
described the anguish, the
frustration, and also the anxiety
felt on their behalf. The morning
session ended and I went to “run”
the Breakout Session.
At first we all sat together and ate
our lunch. Everyone needed a break
after the emotionally raw morning.
As I stood up to try to get the
group to engage in a discussion
together, I asked people to
introduce themselves and to explain
how they happened to be at this
meeting. Present were professionals
treating people with BPD, parents of
patients with BPD, patients
themselves, sisters of BPD patients.
All were there to try to understand
this enigmatic disease, hungry for
understanding. One mother said that
her 17-year-old daughter had just
been diagnosed and she wanted so
much to have a clearer picture of
the disorder than she had received
from her daughter’s psychiatrist.
Another woman wanted to know what
kind of colleges might provide the
best environment for a borderline
person to succeed. |
| What followed was wonderful. One
of the young women in the session
acknowledged her own diagnosis of
borderline personality disorder, and
offered that she had just started
college. She was able to share
information about how she had gone
about choosing her school. I was
able to provide information from my
work in neuroimaging to give a
backdrop on which some of the
symptoms of BPD are played out and
provide a glimpse into the
underlying neurobiology of this
disorder. There was openness and
willingness to share experiences and
to value information that might be
helpful, from whatever quarter or
voice experience could provide. What
I had to offer from a
neurobiological vantage point seemed
helpful, but I left feeling as if I
had received more than I had given. |
| I left feeling reinvigorated
from the openness of people about
the suffering and the strengths of
people living daily with the
disorder. I was renewed in my
commitment to understand and help to
find better treatments; I felt I had
gained an even clearer focus for my
work. I had always known that it was
a political risk in my career to try
to tackle this disorder, but this
conference renewed in my commitment
to stand up and confront the
terrible stigma of this disease
(which is even above and beyond
other mental illnesses). The
diagnosis of borderline personality
disorder is all too frequently used
as a fancy way of insulting people
and calling them a bad person. |
| My commitment remains to work
toward setting up a larger treatment
center and getting even more
research funds to understand what
causes borderline personality
disorder, and even more importantly,
what treatment makes it better. |
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