Borderline personality disorder? Whatever. Darth Vader had it? Tell us more!

Emotional instability. Mood swings. Relationship troubles.... Those are just a few of the hallmarks of borderline personality disorder, a difficult-to-treat and under-recognized condition that can destroy the lives of people with it and, not that they may notice, but the lives of those around them as well. So thank goodness for Darth Vader. We'd have hated for it not to be taken seriously.

L.A. Times staff writer Shari Roan wrote last year  of people with borderline personality disorder:

"They have the thinnest skin, the shortest fuses and take the hardest knocks. In psychiatrists' offices, they have long been viewed as among the most challenging patients to treat.

"They are the kind of people who drive a friend away for interfering and subsequently berate that friend for abandonment.

"But almost 20 years after the designation of borderline personality disorder as a recognized mental health condition, some understanding and hope have surfaced for people with the condition and their families." Read full story here.

She was referring to increasing awareness of the disorder and of discussions about it at the American Psychiatric Assn. meeting. Time magazine took a similar approach in this article: The Mystery of Borderline Personality Disorder.

But French psychiatrist Eric Bui has done them one better  in the "raise awareness" arena -- at least we hope that's what his contention amounts to. He and his colleagues at Toulouse University Hospital contend that Anakin Skywalker -- Darth Vader of "Star Wars" fame -- probably had the condition. They'll be making their case in an upcoming issue of the journal Psychiatry Research.

Here's a LiveScience article that lays out their Anakin-Skywalker-had-borderline-personality-disorder talking points. (We note that it lacks any explainer of the potential effect of midi-chlorians.)

If you're one to bemoan the fact that a life-destroying condition might not be taken seriously as a result of this pop culture tangent, keep in mind that -- as my in-box attests -- any publicity is generally taken as good publicity. 

Besides, the Paging Dr. Gupta blog post over at CNN, What is Darth Vader's diagnosis? doesn't seem to buy the possible borderline-personality-disorder diagnosis. 

There's that whole evil-emperor thing, it points out.

Here's an overview of borderline personality disorder from the National Institute of Mental Health.  

-- Tami Dennis

Photo: Borderline personality disorder? Or played far too easily by an evil emperor? In any case, here's Hayden Christensen as Anakin Skywalker.

Credit: Lucasfilm Ltd.

Antidepressants during pregnancy increase risk of sponaneous abortion, study finds

Taking antidepressants during pregnancy increases the risk of spontaneous abortions by about two-thirds, Canadian researchers reported Monday. The increased risk was greatest with the family of drugs known as selective serotonin reuptake inhibitors (SSRIs), especially paroxetine and venlafaxine, and when more than one family of drugs were used.

Depression in women is most common during the child-bearing years, and estimates suggest that as many as 15% of pregnant women suffer from it. Because of fears about the effects of drugs, particularly psychiatric drugs, during pregnancy, only about 3.7% of women use them during the first trimester. Most studies looking at the use of antidepressants during pregnancy have focused on their effects on the fetus. Small studies of their effects on abortion have produced inconsistent results. Expecting mothers cannot routinely stop using the drugs, however, because that also presents risks to both the mother and the fetus.

Producing a controlled clinical trial examining the effects of the drugs is virtually impossible because few women would be willing to participate, experts said. The only way to get at the data is to examine it retrospectively.

In the new study, Dr. Anick Berard, director of the University of Montreal's Research Unit on Medications and Pregnancy at University Hospital Center Sainte-Justine used information from the Quebec Pregnancy Registry to identify 5,124 women who had a spontaneous abortions between 1998 and 2003 -- before warnings about the risks of the drugs became more common -- and compared them with about 10 times that many carefully matched women who did not have abortions. A separate database provided information about prescriptions the women had filled.

The researchers reported in the Canadian Medical Assn. Journal that 5.5% of the women who had spontaneous abortions had taken antidepressants, compared with 2.7% of those who did not have a spontaneous abortion. Controlling for other factors, that amounted to a 68% increase in risk. The biggest effects were found with paroxetine (brand names Paxil and Seroxat) and venlafaxine (Effexor) or when combinations of drugs from different families were used.

In a commentary in the same journal, Adrienne Einarson, a registered nurse who is assistant director of the Motherisk Program at the Hospital for Sick Children in Toronto, noted that the study had many deficiencies: many spontaneous abortions are not reported to doctors, the researchers did not know if the women actually took the drugs and they did not monitor the extent of the depression. Nonetheless, the increased risk in the study was about the same as that found by Motherisk (a teratology information service) in an earlier study, she said.

The bottom line, it appears, is that the drugs do slightly increase the risk of a spontaneous abortion, but there are so many other factors leading to abortions that the overall risk is probably relatively small.

-- Thomas H. Maugh II

People who are certain they stink, and the psychiatrists who sense this may be a disorder [Updated]

Psychiatrists meeting this week in New Orleans at their annual confab got a first look at a largely unresearched patient population beset with a deeply distressing delusion: that they smell bad -- really bad.

Patients with the proposed diagnosis of "olfactory reference disorder" (sometimes referred to as a "syndrome") are certain beyond doubt that they stink, when in fact they smell no worse than is average for a 21st century American. According to Dr. Katharine Phillips, director of Rhode Island Hospital's Body Image Program, four in 10 people who likely have the disorder have sought out medical treatments for what they believe to be bad breath, foul body odor, stinky feet or residual fecal or urine smell. Their worry preoccupies them for between three and eight hours a day, on average, and impels patients to shower for hours, consume bars of soap or gallons of mouthwash in a single day -- even to drink perfume in an effort to eradicate the imagined smell.

A slight majority -- 60% -- of sufferers appear to be women, Phillips told her colleagues, and most began to suspect that they emitted foul odors at around 15 to 16 years of age. 

For people afflicted with this delusion, social situations can be a gantlet of shame and self-consciousness, said Phillips: When people with whom they come into contact innocently scratch their noses or a stray allergen causes someone to sniff, people with this unique bodily delusion report they feel certain it is in response to their own foul body odor. Another person's move to open a window or door in a stuffy room will fill such a patient with fear that he or she has stunk up the place. When they confide their fears to others and are assured they smell perfectly fine, these patients do not believe it: They suspect a friend is just being nice or has a poor sense of smell, Phillips said.

Not surprisingly, 40% report they have remained housebound for at least a week out of fear of offending others. Two-thirds have contemplated suicide, and a third have attempted it, Phillips reported. The vast majority suffer from depression or some other mental disorder, and substance abuse -- possibly an effort to "self-medicate," according to Phillips -- is common.

"I'm just so struck by the incredible distress they're feeling, the incredible sense of social ostracism," Phillips said. 

Is it real -- not the body odor, but the psychiatric disorder? That is something psychiatrists will likely begin to explore over the next decade: The American Psychiatric Assn. has proposed adding "olfactory reference disorder" to the appendix of the Diagnostic and Statistic Manual (DSM) V as an entity worthy of further research and consideration. Among the many questions that must be explored before the nation's psychiatrists would consider conferring on "olfactory reference disorder" the full status of a diagnosable disease: How widespread are these symptoms in the general population? How impairing is it? How does it start and manifest itself over a patient's life? Are these symptoms more closely related to compulsive behavior, depression, body dysmorphia? And what therapies does it respond to?

On this last point, Phillips said there is early evidence that cognitive behavioral therapy -- a form of "talk therapy" that is narrowly focused on problematic behavior and the thought processes that contribute to it -- can be helpful to some sufferers. She said antidepressants that are in wide use -- known as SSRIs -- may help some as well.

An article in the Journal of Family Pracitice is a good overview of the condition. If you think you may suffer from this, you could take this test. For a Los Angeles-based treatment program, see here.

-- Melissa Healy

[Updated at 12:15 p.m.: An earlier version of this post incorrectly stated the number of people who have sought out medical treatments for "olfactory reference disorder."]

Book Review: 'Difficult Personalities' by Helen McGrath and Hazel Edwards

Most people have at least one person in their lives they consider "difficult." This is the co-worker, in-law, neighbor or friend who's bullying, controlling, hypercritical or so anxious they can't make a decision.

Interactions with them can be challenging, frustrating, even perilous, depending on the role they play in your life. A new book, "Difficult Personalities," by Helen McGrath, a clinical psychologist and adjunct university professor in Melbourne, Australia, and writer Hazel Edwards, offers advice on managing this kind of behavior in other people -- and in yourself.

The authors share insights into what's behind various personality traits, typical behavior, positive aspects of the types and practical strategies you can use to deal with them or cope with your own tendencies.

Their approach changes depending on the behavior. With worriers and perfectionists, they suggest offering understanding, empathy and a reality check. With inflexible and over-controlling people they suggest an assertive, rational and sometimes reassuring manner. They describe pragmatic ways to confront and defuse (or avoid) negative, bossy or "superior" people. And for dealing with bullies, con artists and sociopaths, they focus on concrete steps to identify the behaviors and protect yourself.

But for the most part, McGrath and Edwards advise an approach toward other people -- and ourselves -- that is respectful and compassionate, recognizing that we all have flaws and annoying traits. To that end, they include chapters on getting on top of anxiety, practicing rational thinking, managing anger, negotiating conflict and maintaining strong romantic partnerships.

They base much of their material, they say, on the "Diagnostic and Statistical Manual of Mental Disorders," the widely used American Psychiatric Assn. reference book. They also draw on the Myers-Briggs Type Indicator psychological test to discuss ways to manage differences between introverts and extroverts, thinkers and feelers, and planners and "optionizers." 

-- Anne Colby

Photo: "Difficult Personalities," Helen McGrath and Hazel Edwards, the Experiment, $14.95

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Binge eaters can gain control relatively cheaply, studies find

Binge eating frequently confounds sufferers and therapists alike -- but that doesn't have to be the case.

A self-help program using cognitive behavioral techniques (change your thinking, change your behavior) has shown promise in significantly reducing episodes of binge eating. In a new study, participants who went through a 12-week, eight-session program based on these principles were much more likely to gain control of their eating than those participants who simply received the various types of treatment they'd normally get in a managed-care setting.

The researchers reported that after 12 weeks, 28.3% of the treatment-as-usual group and 63.5% of the cognitive-behavioral-therapy group had managed to stop binging. After a year, those numbers were 44.6% and 64.2%, respectively.

The study was published Thursday in the Journal of Consulting and Clinical Psychology, by researchers at Wesleyan, Rutgers and Stanford universities, and Kaiser Permanente's Center for Health Research.

A related and extremely relevant study, published in the same issue, found that the therapy was cost-effective and maybe, just maybe, should eventually be adopted on a wider basis.

Want a glimpse of the therapy? That's easy enough. It was based on the  book "Overcoming Binge Eating" by Dr. Christopher Fairburn. The book offers not just a basic primer on binge eating -- what it is, what causes it, who does it, the physical problems associated with it -- but a detailed self-help program. In short, the latter teaches bingers how to develop their own moderate eating pattern and how to stick with it.

Here's a recent package of stories from the L.A. Times exploring the psychiatric gray area of binge eating.

The main story, Is binge eating a psychiatric disorder?, begins:

"Rina Silverman's refrigerator is almost always empty. She keeps it that way to avert episodes of frantic food consumption, often at night after a full meal, in which she tastes nothing and feels nothing but can polish off a party-sized bag of chips or a container of ice cream, maybe a whole box of cereal. The food she's eating at these moments hardly matters.

In short order, the nothing that Silverman feels and tastes will give way to nauseating fullness, and a bitter backwash of guilt, shame and self-reproach.

The fullness, in time, passes. But the corrosive shame and self-reproach are always there.

Silverman, a 43-year-old executive assistant from Sherman Oaks, is one of the 145 million Americans who are overweight or obese. But the frenzies of consumption put her in a far smaller category of Americans, not all of whom are even overweight."

Related stories:

Trying to define binge eating disorder

Binge eating: Is it a form of addiction?

Holidays feed binge eaters' problems

If you see yourself in these stories... well, a quick perusal of the book couldn't hurt.

-- Tami Dennis

Photo: Some people, perhaps more than you think, would have trouble stopping with a serving or four.

Credit: Richard Derk / Los Angeles Times

Child bipolar diagnosis is a poor fit for many

Over the last decade, more children with behavior and emotional troubles have received a diagnosis of bipolar disorder. This is a condition in which moods swing dramatically between depression and mania. Traditionally, bipolar was diagnosed only in adults.

A fierce debate has raged in recent years over diagnosing children with bipolar illness because the symptoms vary so much in children compared with adults, and because the medications used to treat the disorder carry some serious side effects. The American Psychiatric Assn. has proposed changes to how the diagnosis is made in children for the next edition of its diagnosing guide, the Diagnostic and Statistical Manual, or DSM-5. An expert panel has suggested two new diagnoses to account for the symptoms seen in children: "severe mood dysregulation" and "temper dysregulation disorder with dysphoria."

There appears to be growing support for backing away from the child bipolar diagnosis. In a paper published this week in the journal Child and Adolescent Psychiatry and Mental Health, experts from the Hastings Center summarized findings from a series of workshops on the issue and concluded that it may be better to avoid giving a child a diagnosis of bipolar disorder. The authors say the label simply does not fit many children who have been given it over the last decade. Moreover, there is still too much debate and confusion over what the children's symptoms represent. For example, it's unclear what mania really looks like in children compared with a much more precise concept of mania in adults.

"Using new labels such as SMD or TDD reflects that physicians do not yet know exactly what is wrong with these children or how to treat it," Josephine Johnston, a co-author of the study, said in a news release. "Facing up to this uncertainty could lead to better treatment recommendations and more accurate long-term prognosis."

This is not to say that these children and their families don't need help, the authors state. The concept of treating troubled children and their families without pinning a firm label on the behavior is a good idea. Unfortunately, health insurers often demand such labels in order to provide coverage for care. I wonder if insurers will cover care for "severe mood dysregulation" in the same way they would for "child bipolar disorder."

-- Shari Roan

Photo credit: Susan Tibbles  /  For The Times

What's in your head? Study suggests a psychiatric self-test can tell you

Depression, bipolar disorder, anxiety disorder, post-traumatic stress disorder .... Maybe you could, or should, just screen yourself for these conditions.

A study published online Monday in the Annals of Family Medicine found that a simple 27-item questionnaire shows promise in effectively screening potential patients for a variety of psychiatric disorders. That's the conclusion of researchers at the University of North Carolina who asked 647 adults at a family medicine clinic to test themselves while in the waiting room. The whole thing took less than five minutes. 

In fact, write the researchers, the one-stop-shopping diagnostic tool called the M-3 (explained later) was as effective as screening tools for individual disorders. They're optimistic about its potential, especially in the primary-care setting, noting that many folks are inclined to simply consider depression or anxiety, not a profusion of possible diagnoses.

That's not to say a doctor would glance at a checklist and write a prescription based on the answers, but those answers could help shape effective followup inquiry. As the authors write in their conclusion:  

"As with all screening instruments, the M-3 seeks to efficiently identify patients at high risk for one or
more specific psychiatric conditions. However, while the M-3 increases the likelihood of identifying a patient experiencing a psychiatric illness, the M-3 by itself is not a definitive diagnostic instrument. Indeed, as a screening tool, the M-3 screen was more likely to identify a risk of psychiatric illness than was confirmed by diagnostic interview."

Here's the full study. And here's the test, as published in the journal, and as offered by My Mood Monitor (hence the M-3 reference above). M-3 Information paid for the study.

Go ahead. Test yourself. (It's almost as much fun as the Patient Safety IQ Quiz.)

-- Tami Dennis

Photo credit: Custom Medical Stock

Doctors cautioned on Zyprexa for adolescents

The Federal Drug Administration on Friday issued a warning to doctors that adolescents taking the drug olanzapine have an "increased potential" -- in comparison with adults taking the new-generation antipsychotic drug -- for weight gain and metabolic disturbances that could result in diabetes or elevated blood cholesterol levels.

"Clinicians should consider the potential long-term risks when prescribing to adolescents," the FDA said in a statement released Friday night. "In many cases, this may lead to prescribe other drugs first," the statement went on.

The agency has not approved the marketing of olanzapine -- sold under the commercial name Zyprexa by the drug maker Eli Lilly -- for use in children under 13 who are diagnosed with schizophrenia or bipolar disorder. But the medication, one of a class of psychiatric medications called the "atypical antipsychotics," is widely prescribed for young patients, despite growing evidence that call its safety profile into question for this population.

The warning comes in the wake of the October publication in the Journal of the American Medical Assn., in which a study showed that children and adolescents taking their first-ever course of Zyprexa gained, on average, more than 17 pounds over a 12-week period, as well as dramatic increases in triglycerides and cholesterol levels -- all factors that put them at higher risk of developing cardiovascular disease. While two other antipsychotic drugs -- Seroquel and Risperdal -- were implicated in significant weight gain and metabolic changes, Zyprexa was found to carry the highest risks of all three.  

The FDA said that in cases where physicians opt to prescribe olanzapine, the drug should be part of a "comprehensive treatment program," which could include psychological, educational and social counseling as well as medication therapy.

--Melissa Healy

This new year, resolve to be happy

Instead of planning to lose weight, find a better job, be a better person (typical New Year’s resolutions, according to a recent Marist poll) why not use 2010 to focus on what’s really important – your own happiness?

Dropping a few pounds and getting a raise might seem like means to that end. And happiness itself might sound like a nebulous, unachievable goal. But happiness might be worth pursuing in its own right – and, according to recent research, could be a much more measurable and tangible goal than previously thought.

Want a primer on that special feeling? A three-part PBS series, "This Emotional Life," tonight will look at why we feel what we feel, through a scientific lens and through the wisdom of such celebrities as Larry David, "Seinfeld" co-creator: "I don't think it's that much of a mystery. If you don't have a job that you like, and you're not having sex, you're just not gonna be happy."

Show host Daniel Gilbert, who sat down with NPR today for an interview, said the larger point on relationships and happiness rings true. "If you're not involved in a relationship," the Harvard psychologist said, "then indeed we see that people who aren't in romantic relationships are less happy than those who are."

Perhaps happiness is contagious, too. In an article published in the Journal of Personality and Social Psychology, researchers found that the feeling created by absence of relationships -- loneliness -- spreads like a disease:

Results indicated that loneliness occurs in clusters, extends up to three degrees of separation, is disproportionately represented at the periphery of social networks, and spreads through a contagious process.  

Another reason to pursue happiness and avoid loneliness this year – scientists say it’s just as important on the New Year’s resolution list as quitting smoking or losing weight. As Health reporter Melissa Healy blogged last month, loneliness can be as bad for your health as smoking and obesity. 

One double-take worthy theory presented in the PBS show: That, controlling for health problems, older people are generally happier than younger people. Counterintuitive as that notion might seem, it’s been gaining strength in recent years. Health reporter Shari Roan found some logical explanations for the theory in a 2007 story:

[M]ost scientists now think that experience and the mere passage of time gradually motivate people to approach life differently. The blazing-to-freezing range of emotions experienced by the young blends into something more lukewarm by later life, numerous studies show. Older people are less likely to be caught up in their emotions and more likely to focus on the positive, ignoring the negative.

In a special to The Times, Marnell Jameson explores how scientists are starting to quantify and measure happiness -- and what their conclusions are. She starts with a quick quiz: 

True or false:

___ I would be happier if I made more money, found the perfect mate, lost 10 pounds or moved to a new house.
___ Happiness is genetic. You can't change how happy you are any more than you can change how tall you are.
___ Success brings happiness.
Answers: False, false and false. 

Want to find out why? Read Jameson's story, and check out the first part of “This Emotional Life” tonight, airing at 9 p.m. on KCET.   

-- Amina Khan

SARS survivors continue to suffer mental health problems, study finds

Before swine flu and bird flu, there was SARS.

As you may recall, severe acute respiratory syndrome was the scary virus of 2003. It caused fever, headaches, body aches, pneumonia and diarrhea, among other symptoms. SARS originated in Asia and spread to more than two dozen countries on four continents before it was contained. Nearly 8,100 people got SARS during the outbreak, and 774 people died, according to the World Health Organization.

Whatever happened to the survivors?

After one year, patients’ physical symptoms had improved greatly, but their mental health had deteriorated. A group of researchers from the Chinese University of Hong Kong checked back with all the SARS survivors they could find in one district of the city and found that psychiatric problems persisted even four years later.

The researchers assessed 233 former patients through interviews and questionnaires. They determined that 42.5% had “active psychiatric illnesses,” including post traumatic stress disorder, depression, somatoform pain disorder, panic disorder and obsessive compulsive disorder.

In addition, 40.3% had chronic fatigue syndrome. These former SARS patients were more likely than others to have ongoing psychiatric problems, the researchers reported in Tuesday’s edition of Archives of Internal Medicine.

Among the SARS survivors, many who were working in hospitals at the time of the outbreak have abandoned their careers in medical care.

“The persistence of psychiatric morbidities among the SARS survivors who participated in our study was alarming,” they wrote. “Because new infectious diseases are emerging at an unprecedented rate and pose a global threat for pandemics, there should be better preparation in public health strategies for dealing with … the long-term potential mental health complications.”

-- Karen Kaplan

Photo: These ballerinas-in-training in Hong Kong wore masks to protect themselves from a SARS outbreak in 2003. Credit: Vincent Yu / Associated Press