The Brain in Love: 12 Lessons to Enhance Your Love Life (28 page)

Many people do not recognize the seriousness of this disorder and just pass off these kids and adults as lazy, defiant, or willful. Yet, ADD is a serious disorder. Left untreated, it affects a person’s self-esteem, social relationships, and ability to learn and work. Several studies have shown that ADD children use twice as many medical services as non-ADD kids, up to 35 percent of untreated ADD teens never finish high school, 52 percent of untreated adults abuse substances, teens and adults with ADD have more traffic accidents, and adults with ADD move four times more than others.

Many adults tell me that when they were children, they were in trouble all the time and had a real sense that there was something very different about them. Even though many of the adults I treat with ADD are very bright, they are frequently frustrated by not living up to their potential.

From our research with SPECT scans, it is clear that ADD is a brain disorder, but not one simple disorder. I have described six different types of ADD. The most common feature of ADD is decreased activity in the prefrontal cortex with a concentration task. This means that the harder a person tries, the less brain activity they have to work with. Many people with ADD self-medicate with stimulants, such as caffeine, nicotine, cocaine, or methamphetamine, to increase activity in the PFC. They also tend to self-medicate with conflict-seeking behavior. If they can get someone upset, it helps to stimulate their brain. Of course, they have no idea they do this behavior. I call it unconscious, brain-driven behavior. But, if you are around ADD people long enough, you will see and feel the conflict-seeking behavior.

The best treatment for ADD depends on the type of ADD a person has. See my book
Healing ADD
for a complete description of types and treatments. In general, intense exercise helps, as does a higher protein, lower carbohydrate diet. Sometimes medications or supplements are helpful, but sometimes they can make things worse if they are not right. When correctly targeted, ADD is a highly treatable disorder.

Being a Jerk or a Bitch

I know “being a jerk” or “being a bitch” are not medical diagnostic terms. They are negative, name-calling phrases about someone’s behavior. Yet, in my experience, it is possible that these behaviors are the result of poor brain function and not completely under conscious will. Sometimes, a head injury, toxic exposure, sleep deprivation, and personality disorders (see below) can interfere with someone’s effectiveness in social and sexual situations.

Our character can be defined in part by the way we interact with others. When the way in which we interact with others doesn’t work, when we notice a pattern of multiple relationships and multiple disconnections, it may be that a personality disorder is at the root of the problem. The term
personality disorder
implies
inflexible and long-standing patterns of experience and behavior (Diagnostic and Statistical Manual of Mental Disorders IV, or DSM-IV) that impair healthy functioning. They can be the source of great personal pain for the person suffering and those he or she loves. A personality disorder can sabotage relationships, prevent the realization of desired goals, and impede our moral development and our spiritual and sexual health. When we are preoccupied, for example, with intrusive thoughts, deep fears of abandonment, or feelings of paranoia or superiority, it’s hard to reach beyond the self to the expansive concerns of spirit and morality. It’s hard to be our best selves. A person with a personality disorder may feel inexplicably apart from a sense of well-being, of closeness to others, and to God. It may be hard for someone with a personality disorder to feel empathy and thus to feel part of a reciprocally loving community. Feelings of isolation and disconnectedness can lead to the sense of life being meaningless and to devaluing one’s own individual contributions. This sense of aloneness and lack of purpose can place people with personality disorders at higher risk for suicide. Personality is what we present to the outside world. It is not the true self, which is broader and deeper than the outward-appearance self. When we think of working on aspects of the personality, we think not of correcting flaws but of opening doors to greater joy and connectedness.

Personality disorders have been traditionally resistant to psychotherapy. Traditional psychiatric thought has focused on developmental causes of these disorders rather than brain abnormalities. It has been my experience that many people labeled as personality disordered are really brain disordered. The implications for treatment are immense—do we talk someone through their difficult behaviors or try to change their brain? Probably we need both.

Antisocial Personality Disorder

Antisocial personality disorder is characterized by a long-standing pattern of disregard for the rights of others and may be an extension
of conduct disorder seen in adolescence. The likelihood of developing antisocial personality disorder seems increased in young children with conduct disorder and ADD. People with antisocial personality disorder frequently break rules, inhabit prisons, and have constant relationship and work problems. They often get into fights. With little or no empathy, they may steal, destroy property, manipulate or deceive others for their ends. They tend to be impulsive and lacking in forethought. Traditionally, these people are thought of as evil, bad, and sinful. The work of psychologist Adrienne Raine of the University of Southern California has seriously challenged this notion. Dr. Raine found that compared to a group of healthy men, the MRI scans of the men with antisocial personality disorder showed decreased PFC volume. They are likely dealing with less access to the brain part that controls conscience, free will, right and wrong, and good and evil. A fascinating additional finding of Dr. Raine’s work was that people with antisocial personality disorder also had slower heart rates than the control group and decreased sweat gland activity. Lower heart rates and sweat gland activity are often associated with low anxiety states (your hands sweat and your heart races when you are anxious). Could this mean that people with this type of difficult temperament do not have enough internal anxiety? Could the PFC be involved with appropriate anxiety? Intriguing questions. For example, most people feel anxious before they do something bad or risky. If I needed money, and got the thought in my head to rob the local grocery store, my next thoughts would be filled with anxiety:

“I don’t want to get caught.”

“I don’t like institutional food.”

“I don’t want to be thought of as a criminal.”

“I could lose my medical license.”

The anxiety would prevent me from acting out on the bad thoughts. But, what if, as Dr. Raine’s study suggests, I do not have
enough anxiety and I get an evil thought in my head like, “Go rob the store”? With poor PFC activity (a lousy internal supervisor with little to no anxiety), I am likely to rob the store without considering all of the consequences to my behavior. There is an interesting treatment implication from this work. Typically, psychiatrists try to help lessen a person’s anxiety. Maybe we have it backward for people with antisocial personality disorder; for them we should try to increase their anxiety.

Narcissistic Personality Disorder

People with narcissistic personality disorder believe that they are special and more unique or gifted than other people. They require constant admiration and recognition for their achievements. A sense of entitlement derived from a bolstered sense of superiority may lead people with narcissistic personality disorder to place great demands on others, expecting their needs to be met immediately, regardless of the inconvenience. Although they may appear confident, they may in fact have very low self-esteem, which they attempt to boost by association with others they imagine being as gifted as they. They may seek connections exclusively with those whom they perceive to be as special and form alliances solely to advance their careers or other endeavors. While lacking empathy and ability to listen patiently to others’ concerns, a person with narcissistic personality disorder may spend an inordinate amount of time thinking about what others think of her or him. People with narcissistic personality disorder may belittle or be envious of others’ achievements and be unwilling to acknowledge contributions others make to their own successes. A person with narcissistic personality disorder may appear to be rude, condescending, and arrogant, criticizing others while being unable to tolerate criticism him- or herself. A person with NPD often seesaws between a depressed mood because of feelings of shame or humiliation and grandiosity. As with other personality disorders, a person with narcissistic personality disorder may suffer from additional problems
such as anorexia, substance abuse, anxiety, and depression. People with narcissistic personality disorders may have overactive cingulate systems, disallowing them to see outside themselves and to take a broader perspective. Poor prefrontal lobe activity may cause the lack of empathy so pronounced in this disorder.

A feeling of social connectedness is the basis of a healthy soul and character. Clinging to the notion that you might be better than others, somehow more privileged or entitled, erects barriers between you and the people to whom you want to get close and makes it impossible to empathize with others’ needs. Protecting yourself with distancing tactics such as criticism, disinterest in others’ problems, belittling others, or refusing to acknowledge their accomplishments makes it tough to develop a sense of security and companionship, of being loved. It’s very hard to make moral decisions from this place, from the position of “What I need is most important.” Persistent focus on yourself, your appearance, how others see you, and the neediness that accompanies these anxiety-provoking concerns takes you away from your true self, the self that can focus on what you really care about and what you want your life to be about. Because people with narcissistic personalities disorder may sometimes accomplish external goals, it can be hard to discern the reasons for a lack of connectedness and a hollow spiritual life. Identifying with others; being able to be humble, grateful, and kind; to listen; and to truly appreciate others’ caring and contributions to your life readies you to receive spiritual learning.

Borderline Personality Disorder

Instability in relationships, impulsivity, and low self-esteem characterize borderline personality disorder. People with borderline personality disorder may quickly switch attitudes toward others, identifications, values, and goals. For example, someone with borderline personality disorder may worship a new friend or lover and then drop him or her quickly, complaining that their new friend
wasn’t caring enough. Professional goals and interests may change suddenly, as may moods. Highly reactive and impulsive, they may experience periods of extreme irritability, anger, or anxiety. They may engage in self-destructive behaviors such as drinking heavily, driving fast, overspending, bingeing on food, or having unsafe sex. People with borderline personality disorder may feel periods of great emptiness and engage in suicidal or self-mutilating behaviors. Boredom may be intolerable to someone with this disorder, and consequently, he or she may perpetually seek stimulation. Childhood abuse or neglect or the early loss of a parent may be found in family histories of people with this disorder.

The biological underpinnings of borderline personality disorder are complex. People with borderline personalities may have a combination of prefrontal lobe problems, which accounts for impulsivity, conflict, and stimulation-seeking behaviors, and the tendency to intensely value or devalue individuals. Anterior cingulate problems may also exist, evidenced by the obsessive thinking, cognitive inflexibility, and a very strong tendency to hold onto grudges and past hurts. As well, there may be temporal lobe abnormalities. The left temporal lobe is involved with aggressive behaviors toward the self and others.

Consistency and control over impulsivity are necessary to developing and sticking to character goals. When you are controlled by your emotions, constantly reacting to outside events in the heat of the moment, you cannot develop an overall sense of who you are, what you want, and how you will get it. Contemplation is important to developing a sense of right and wrong, what is good and bad for you and for others. Likewise, being enslaved by impulses and reactions denies you the opportunity to build a strong sense of self-esteem. When you can control what you do, you can feel greater certainty about your identity. It’s rewarding to be able to clarify your personal values and to stick to them, to know that you and you alone are in charge of your life.

It’s hard to build a sense of security and of being loved when you find yourself attaching unrealistic expectations to people to
whom you’re attracted and then ending friendships before they’ve had a chance to develop. Social connectedness takes work: It implies forgiving and flexibility. It’s important for all of us to try to develop greater empathy for others by asking ourselves about another’s point of view and not to automatically assume we know what others feel and think.

When Is It Time to See a Professional About My Brain?

This question is relatively easy to answer. People should seek professional help for themselves or a family member when their behaviors, feelings, thoughts, or memory (all brain functions) interfere with their ability to reach their potential in their relationships or work. If you are experiencing persistent relationship struggles (parent-child, sibling, friend, partner), it’s time to get help. If you have ongoing work problems related to your memory, moods, actions, or thoughts, it is time to get professional help. If your impulsive behavior, poor choices, or anxiety are causing consistent monetary problems, it’s time to get help. Many people think they cannot afford to get professional help. I think it is usually much more costly to live with brain problems than it is to get appropriate help.