Notes from Professionals – Antonia S. New, MD

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.

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.

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.