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The Biology of Borderline Personality Disorder and Antisocial Personality Disorder: Making Inroads to Alleviate Suffering

Author:  Michelle Rosen

As a Forensic Psychiatrist and recent IMS graduate, Nathan Kolla has a lot to be proud of.  Recipient of the IMS Siminovitch-Salter Award for outstanding scholarly contributions Kolla hopes that his research on Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD) will help pave the way to new treatments for patients.   Concerned that not enough research has focused on the biology of the disorders, Kolla spent his time as a PhD student looking at biological influences.  Specifically, he uses brain imaging tools (PET, fMRI) to investigate biomarkers of impulsivity, aggression and low mood.

Nathan tells me that he has always been interested in this area of research.  As a medical resident he spent time in the prison system and forensic psychiatric hospitals where he encountered many individuals with diagnoses of BPD or ASPD.  “They had real problems functioning on a day-to-day basis because of their impulsivity, poor decision making, and inability to regulate emotions. There were not good biological treatments then and unfortunately we still don’t have interventions that effectively treat these symptoms. I saw a real need to investigate for possible interventions.”

In his last year of medical residency Nathan began the PhD program.   Under the supervision of Dr. Jeff Meyer Nathan was able to access state of the art PET imaging equipment to explore the research questions he was asking.  Through neuroimaging experiments, Kolla was able to ascertain that in BPD the level of the brain protein Monoamine Oxidase-A was very high, even higher than in people who were depressed without BPD. This was a breakthrough for Kolla and suggested that interventions that work to inhibit or stop this enzyme could be especially beneficial to people with severe forms of BPD.

Kolla thinks a biological approach to understanding and treating BPD provides a promising alternative to Dialectical Behavioral Therapy (DBT), a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with BPD. “While DBT undoubtedly helps many people with BPD, it is very resource intensive and often not available to people outside of tertiary health care centres. There’s potential to create knowledge or information that could be used to develop biological-based treatments as an alternative or complementary to DBT.”

Nathan also participated in the Clinician Investigator Program at the University of Toronto and found a great synergy between the two.   “I felt very fortunate to be able to carry out clinical work alongside my research activities. I think wearing both hats made me more attuned to pursuing research questions that would have an important impact clinically. For me, my clinical work energized my research activities and vice versa.”

An accomplished musician, Nathan has been playing piano since he was a child.  A great stress relief, the discipline and focus required of music has also affected his research. “As a musician you can spend so much time perfecting a phrase or line of music and I think some of that is applicable to research [when you are writing a grant for example], for me it’s  just very relaxing and an opportunity to use a different part of my brain.”

For Nathan, the greatest impact his research could have would be to increase the understanding of the biological basis of violence and aggression whether that’s toward the self or others and the creation of new treatments or interventions that can offset or mitigate this violence.

As a student Nathan was successful at staying focused on his research questions and achieved some great outcomes.  “I think completing a PhD poses unique challenges for everyone. For me, beyond the research, an important component was learning how to effectively navigate relationships with the people you work with, including supervisors and PAC members, in order to accomplish both individual and complementary goals. These are just great life skills that I’ll be able to apply to my working relationships going forward.”

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