What Causes Borderline Personality Disorder?

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In the world of mental health, understanding is the first step toward healing. Today, we delve into the complex, multifaceted world of borderline personality disorder (BPD). First and foremost, we want to cover what causes borderline personality disorder. But we also want to get into its everyday reality, and the path toward managing it.

What Causes Borderline Personality Disorder?

If BPD were a landscape, it would be both stormy and beautiful, a place where emotions run deep and the quest for stability is ongoing.

Our psychological makeup is not simply black and white. It comes from multiple threads—genetic material, life experiences, and our interactions with the world. Borderline Personality Disorder, emerges when the tapestry is woven under particular conditions—sometimes involving genetic predispositions, sometimes through environmental factors like trauma or unstable relationships during formative years, and often, a combination of both.

Root of BPD

So what causes borderline personality disorder? Scientifically speaking, there isn’t a single cause for BPD. It’s like a stew with several key ingredients. Here is a collection of factors that could cause borderline personality disorder.

  • Genetic Predisposition: Family history of BPD or other mental health disorders increases risk.
  • Brain Structure and Function: Changes in areas of the brain that control emotions and decision-making might contribute to BPD symptoms.
  • Neurotransmitter Issues: Imbalances in neurotransmitters, including serotonin, could play a role.
  • Environmental Factors:
    • Traumatic Life Events: Experiences of abuse, neglect, or abandonment during childhood.
    • Unstable Family Relationships: Growing up in a family environment marked by conflict, instability, or invalidation.
  • Early Attachment Issues: Problems with bonding and attachment in early development can impact emotional regulation and interpersonal relationships later in life.
  • Cognitive Factors: Ways of thinking that might make a person more prone to experiencing intense emotions or fears of abandonment.
  • Social Factors: Bullying, social isolation, or societal discrimination can exacerbate vulnerabilities to developing BPD.
  • Stressful Life Events: Significant life changes or stressful events can trigger the onset in susceptible individuals.Top of Form

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What Does Borderline Personality Disorder Feel Like?

To understand what BPD feels like, imagine living in a world where your emotional thermostat is turned up to the highest setting. Emotional sensitivity is a trait many with BPD share; they feel emotions more intensely and for longer periods. It’s as if their emotional skin is thinner than most, exposing them to the harsh elements of the world in ways others might not understand.

Joy, pain, love, fear—every emotion is felt with overwhelming intensity. Relationships are the roller coasters in this world, marked by a profound fear of abandonment that can lead to intense, unstable connections with others. It’s a challenging way to navigate life, often misunderstood by those on the outside.

When Does BPD Develop?

BPD typically makes its presence known in adolescence or early adulthood, a time when life is already a whirlwind of change. It’s a crucial period for identity formation, and for those with BPD, the quest for self can be particularly tough.

This doesn’t mean that symptoms suddenly appear out of nowhere; they might have been simmering beneath the surface, becoming more noticeable as one navigates the complex social landscapes of young adulthood.

What Are the symptoms to look for?

BPD manifests in diverse ways, but common threads include a pattern of unstable relationships, a wavering sense of self, impulsive actions, and a roller coaster of emotional states.

It’s important to remember, though, that BPD looks different in everyone. The disorder wears many masks, and understanding the person beneath is key to providing support.

Is There a Test for BPD?

Diagnosing BPD isn’t as straightforward as a blood test or a simple questionnaire. It involves a comprehensive evaluation by a mental health professional, who looks at the pattern of thoughts, feelings, and behaviors over time. It’s a process of understanding the whole person, not just ticking boxes on a checklist.

Can BPD Be Cured?

“Cure” is a loaded word. When it comes to BPD, the journey is more about management and recovery than a definitive end point. Therapies like Dialectical Behavior Therapy (DBT) teach skills to manage emotions, navigate relationships, and find stability in the self. With the right combination of therapy, possibly medication, and support, individuals with BPD can lead fulfilling lives. Life with borderline personality disorder can be joyful again, filled with normal life events and relationships.

The reality of what causes borderline personality disorder is complex. However, learing about it creates a rich opportunity with the potential for growth. There will certainly be storms, but also moments of profound beauty and understanding.

Let’s Talk About Help for BPD

Navigating the turbulent waters of Borderline Personality Disorder can feel overwhelming, but at Lido Wellness Center in Newport Beach, we believe in a journey of healing anchored in understanding, compassion, and the latest in therapeutic advancements. If you or a loved one are wrestling with the complexities of BPD, let’s explore this landscape together. Our dedicated team offers personalized care that addresses the unique tapestry of your life, integrating therapies like Dialectical Behavior Therapy to help manage emotions, build relationships, and find your balance. Don’t walk this path alone; Lido Wellness is here to guide you toward a horizon of hope and healing. Reach out today, and let’s embark on this journey together.

Understanding Bipolar II Disorder

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In a world overflowing with life and variety of experience, many walk a tightrope between two opposite feelings. It’s reminds us of the full spectrum of human experience—from the profound depths of despair to the exuberant peaks of elation. However, for some, this swing of emotions isn’t just a mundane part of life but a relentless reality. The name for this condition is “Bipolar II Disorder.”

The Nature of Bipolar II

Bipolar II, a subset of bipolar disorder, is often misunderstood. It’s not merely the occasional shift between happiness and sadness that everyone experiences; it’s a serious mental health condition displaying episodes of depression and hypomania (a milder form of mania). These aren’t fleeting moments—they are intense, persistent, and capable of affecting everything from brushing your teeth to the way you interact with your closest loved ones.

According to the National Institute of Mental Health, nearly 2.8% of U.S. adults had bipolar disorder in the past year. Of this percentage, a significant number were diagnosed with Bipolar II. It’s not a rare butterfly fluttering in isolation but one that’s been seen by many, felt by a considerable number, and understood by just a few.

Types of Bipolar

Bipolar disorder emerges as a significant, multifaceted phenomenon. Delving into its depths, we discover that bipolar disorder is less like a single mental illness and more like a constellation of related conditions.

Bipolar I Disorder

Individuals diagnosed with Bipolar I experience full-blown manic episodes, which can include irritable moods, grandiosity, decreased need for sleep, and often impulsive behaviors. These manic episodes can last for a week or longer. With this diagnosis depression is also common, which mirrors the melancholic depths of the valley, where feelings of sadness, hopelessness, and a loss of interest or pleasure in most activities reign.

Bipolar II Disorder

If Bipolar I is the vast mountain range with its towering peaks and deep valleys, Bipolar II is its slightly gentler cousin, though no less complex. Here, the mania’s intensity is dialed down to what’s termed as hypomania. Hypomanic episodes share many symptoms with mania but are shorter in duration and less intense. They don’t typically require hospitalization and might even go unnoticed. But the valleys of depression in Bipolar II can be as profound and debilitating as those in Bipolar I.

Cyclothymic Disorder

Cyclothymia paints a picture reminiscent of the gentle undulations of rolling meadows rather than the stark contrasts of mountains and valleys. Those with this condition experience milder mood fluctuations, with hypomanic symptoms and periods of depressive symptoms lasting for at least two years. These mood swings, though milder than those of Bipolar I and II, are persistent and can affect one’s daily life, much like how a brook consistently winds its way through a meadow.

Rapid Cycling

Within this landscape we may find the phenomenon of rapid cycling. In this, people experience four or more episodes of mania, hypomania, or depression within a year. It’s as though the seasons change unpredictably, without notice, each one coming with its temperament and challenges.

Mental Health IOP for Bipolar

Treatment for Bipolar II isn’t a straight path. However, in recent years, there has been a surge in successful treatments, one of which is the mental health IOP (Intensive Outpatient Program) for bipolar.

The mental health IOP for bipolar offers structured therapy without the need for hospitalization. This means patients can remain in their homes, surrounded by familiarity and comfort, and yet receive rigorous therapeutic support. It’s similar to learning how to navigate a river with a seasoned guide, ensuring safety while also embracing the unpredictability of the journey.

Such programs typically involve group therapies, individual counseling, and education about the disorder. The beauty of the mental health IOP for bipolar is its blend of structure and flexibility, allowing patients to integrate treatment into their daily lives.

The Road Ahead

Understanding conditions like Bipolar II is a significant step forward in mental health. For those diagnosed, the statistics may seem daunting. However, the increase in specialized treatments such as the mental health IOP for bipolar is encouraging.

In one’s journey with Bipolar II, it’s essential to remember that, just like the seasons that shift from winter to spring, from fall to summer, the seasons of the mind too can change. With understanding, treatment, and support, individuals with Bipolar II can lead fulfilling lives, ones where they navigate their emotions and not the other way around.

What Now?

The journey towards balance, understanding, and wellness is within your grasp. Embrace the opportunity to navigate the intricate terrains of your mind with skilled guides beside you.

Call Lido Wellness Center, your mental health IOP, at 949-541-8466. Let today be the day you choose to begin the path towards serenity and understanding. Remember, in the vast tapestry of human emotions, there’s a thread of hope, strength, and healing waiting for you.

Bipolar Treatment Newport Beach

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LIDO Wellness Center offers the best treatment for bipolar disorder in Newport Beach with a dedicated team of therapists at affordable prices. We help individuals overcome trauma and PTSD using proven and science-based therapies like CBT, DBT, EMDR, somatic experiencing, etc.

Do I Have Bipolar Disorder?

Bipolar disorder causes extreme mood swings. Patients may experience emotional highs called mania or hypomania. Alternatively, you may feel emotionally low, which can develop into depression. Bipolar disorder can be of many types, and the symptoms can vary depending upon the changes in your mood and behavior.

You should seek treatment for bipolar from one of the trauma treatment facilities if you have one or more of these types of bipolar:

  1. Bipolar I disorder – You have had at least one manic episode before or after a hypomanic or major depressive episode. A manic episode may trigger a break from reality and cause psychosis.
  2. Bipolar II disorder – You have had at least one major depressive episode and one hypomanic episode but never a manic episode.
  3. Cyclothymic disorder – You have had at least two years of hypomania or depressive symptoms. The duration of the symptoms can also be in your childhood or teenage years. Cyclothymic disorder symptoms include intermittent psychological highs and lows that become more pronounced over time.

If you are unsure if you have bipolar disorder, consult a psychiatrist at one of the top trauma and PTSD treatment centers for an accurate diagnosis. Make sure to seek PTSD and trauma treatment in the early stages of your mental health condition to prevent it from worsening and leading to adverse health implications.

Importance Of Receiving Treatment For Bipolar Disorder in Newport Beach

Bipolar disorder is serious mental health that you should not take lightly. Leaving the condition untreated can result in drug and alcohol abuse disorder, experiencing suicidal thoughts and tendencies, legal or financial problems, and damaged relationships.

Besides, you could end up losing your job and ruining your reputation. Sign up for a top-rated PTSD treatment program as soon as possible to prevent your bipolar disorder from worsening.

Can I Prevent Bipolar Disorder?

Unfortunately, there is no sure way to foresee a hypomanic or depressive episode and prevent bipolar disorder. However, getting PTSD treatment in Orange County soon after you spot the sign of a mental health disorder can help you prevent bipolar disorder. There are ways to try to identify the triggers of bipolar disorder, which can help manage the symptoms. If you have a diagnosis of bipolar disorder, here are a few strategies that can help prevent your symptoms from transforming into full-blown mania or depression:

  1. If you have identified a pattern to your bipolar episodes, you can note down your triggers. Contact your doctor immediately if you’re experiencing manic or depressive episodes.
  2. Involve your family members or friends in watching for warning signs.
  3. Avoid drugs and alcohol as these can worsen your symptoms.

The sooner you receive treatment for bipolar disorder in Newport Beach, the higher the chances of getting well. Call 949-541-8466 to verify your insurance with us.

LIDO Wellness Center offers the best PHP, IOP, and outpatient programs to those suffering from depression, anxiety, schizophrenia, PTSD, and other mental disorders. Entrust your recovery to us, and we will help you begin a liberating wellness journey.

 

Sources for Bipolar Treatment Help:

  1. National Institute of Mental Health: This is a government agency that provides information and resources related to mental health conditions. You can visit their website at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  2. American Psychiatric Association: The APA is a professional organization for psychiatrists in the United States. Their website has a section on bipolar disorder, which you can access at https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
  3. National Alliance on Mental Illness (NAMI): NAMI is a non-profit organization that offers education, support, and advocacy for individuals and families affected by mental illness. You can visit their website at https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder

The Types of Bipolar Disorder

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What Is Bipolar Disorder?

Bipolar disorder is a mental health condition that is characterized by dramatic emotional swings. The swings can include—without warning—depression, anger, anxiety, paranoia, and bouts of mania that can last for weeks or months. This condition can interfere with interpersonal relationships and daily responsibilities.

An example of a bipolar experience could be when a person experiences a manic episode—they feel thrilled, energetic, and productive. They may have racing thoughts, might be easily distracted, and possibly engage in impulsive or risky behavior. They may also have difficulty sleeping and may chatter quickly.

This may be followed by a period of depression—very low, hopeless, and exhausted. They may have difficulty concentrating, changes in appetite and sleep patterns, and thoughts of death or suicide.

Types of Bipolar Disorder

Bipolar disorder is likely to last a lifetime. At worst, symptoms of bipolar disorder can bring on suicidal thoughts, self-harm, unwanted thoughts, and a loss of touch with reality that can lead to suicide. While the high-and-low episodes can cause havoc in a person’s life, there are often recognizable bipolar disorder triggers that can be managed.

However, bipolar disorder is a treatable condition. There are several effective options available. Treatment for bipolar disorder typically involves a combination of medication and therapy.

There are several types of bipolar disorder, but 4 main ones including bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

Bipolar I

Bipolar I is the most common and often surfaces in teens and young adults, with most developing the disorder before the age of 50. Those with bipolar one have experienced at least one emotionally elevated manic episode that can induce psychosis, followed by one low depressive episode.

Bipolar II

Bipolar II involves at least one depressive episode and one hypomanic episode, a milder version that lasts a few days instead of weeks. Those with bipolar II usually never experience a manic episode.

Cyclothymic Disorder

Cyclothymic disorder is rare and an outlier from Bipolar I and II. It is considered a category, as hypomanic and depressive episodes are less stringent than those of major depression and bipolar disorder. In adults, it involves at least two years of several hypomanic and less severe depressive symptoms and at least one year in teens. Symptoms can be chronic, vary throughout a person’s lifetime, and may increase aggression.

Unspecified Bipolar Disorder

Unspecified bipolar disorder is most akin to cyclothymic disorder but does not meet the criteria of the previous types enough to be official. Those who suspect it reports having experienced bipolar symptoms at some point in their lives. Yet, unspecified bipolar symptoms parallel the others and tend to follow less of a pattern.

Getting Help for All Types of Bipolar Disorder in Newport Beach

Outpatient treatment for bipolar disorder, available at Lido Wellness Center, typically involves attending therapy sessions and taking medication as prescribed by a healthcare provider. Outpatient treatment can provide support and structure for people with bipolar and can help them manage their symptoms and improve their overall mental health.

Outpatient mental health treatment can include a variety of therapies, such as cognitive behavioral therapy (CBT), which can help people with bipolar disorder to better understand and manage their symptoms. Therapy can also provide a supportive environment in which people with bipolar disorder can work through any challenges they may be facing and develop coping strategies.

In addition to therapy, medication can also be an important part of treatment for bipolar disorder. Mood stabilizers and antipsychotics are commonly prescribed to help control the extreme mood swings and other symptoms of bipolar disorder. These medications can help to prevent manic and depressive episodes and can make them less severe when they do occur.

Overall, outpatient mental health treatment can be an effective way to manage bipolar disorder. Call our experienced team at Lido Wellness Center in Newport Beach to determine the best treatment plan for your individual needs.

Living With Bipolar Disorder in Orange County

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Am I Bipolar?

Living with bipolar disorder can be a challenge. Here we explore some ways to stay healthy offer day-to-day solutions.

Most of us have heard about bipolar disorders. The various media and news outlets tend to cover it in a non-descript way. But that approach is not exactly helpful, and as a result very few of us really understand what bipolar disorder is. (The movie Silver Linings Playbook is an example of characters that may struggle with bipolar disorder.)

Even if you have been diagnosed with one of the types of bipolar disorder, you might not fully understand it and, more importantly, how to make sure you are living with bipolar disorder in a healthy way.

Bipolar Highs and Lows

Bipolar common knowledge is if you have bipolar disorder, you likely have times where you are very happy and times where you are very sad. That’s pretty much the extent of most people’s understanding.

The more complex term for this is episodes of mania or hypomania contrasted with depressive episodes. This is where the term manic depression comes from, the term that once referred to bipolar.

Though it is common to call them mood swings, they are fairly intense. And to qualify for a bipolar diagnosis, they have to have a significant negative impact on your life.

Bipolar Mood Swings

Bipolar Highs: During manic episodes, a person with bipolar disorder is gleeful, energetic, or unusually irritable.

Bipolar Lows: Depressive episodes have you feeling hopeless, sad, and without interest in pleasurable activities. Often, the mood shift is accompanied by emotional symptoms as they affect your sleep, thoughts, energy, and judgment.

Seeking treatment helps you live a good life despite the condition. However, there are simple, everyday habits you can adopt to get better control over your symptoms.

Living With Bipolar Disorder in Orange County

The worst thing you can do with a bipolar diagnosis is pretend it doesn’t exist. Bipolar Disorder Treatment comes with a certain degree of acceptance so you can move forward towards healthy change and wellness.

When you fully engage and participate in your treatment, you become an expert in your own individual journey living with bipolar disorder.

This may look like this:

  • You understand the symptoms and can recognize them before they become debilitating.
  • You actively research and explore available treatment options to ensure you lead a healthy life.
  • You work with your treatment professional to draw up a list of achievable goals to work on.
  • You develop trust and patience in the process.
  • You also learn to communicate your thoughts and feelings with your therapist.

Know Your Triggers

The symptoms of bipolar disorder are often a result of specific life experiences. Knowing your bipolar triggers helps you recognize an oncoming episode and take measures to protect yourself. The most common triggers of bipolar disorder include:

  • Stress
  • Irregular sleep schedule
  • Strained relationships with close friends and loved ones
  • Financial strain
  • Inability to adapt well to a new environment

*We go further into 10 bipolar triggers and how to manage them in this article.

Monitor Your Symptoms and Moods

If you have bipolar disorder, staying attuned to your thoughts, feelings, and environment helps you intercept mood swings. You are aware of subtle changes in your thoughts, moods, energy levels, and sleep patterns. When you monitor your symptoms and temper, you can prevent a minor change from turning into a full-blown bipolar episode.

Develop an Active Daily Routine

Your lifestyle choices affect your mood, energy, sleep patterns, and eating habits. Developing an active daily routine is a great way to get your symptoms in check and keep bipolar episodes at bay. One way to build an active lifestyle is to structure your life, so you know what to do and when to do it. Other positive ways to improve your life are:

  • Having a strict diet – Your body is what you eat. Watching what you eat and having healthy meals ensures you have enough nourishment and energy to keep you going.
  • Having a regular sleep schedule – the ups and downs of life can overwhelm you and affect your sleep schedule. Having a regular schedule ensures you get enough rest and are focused on what you need to do to survive every day.

Living With Bipolar Disorder by Getting Treatment

If you are currently living with a bipolar disorder and want help, Lido Wellness Center in Newport Beach offers a full PHP, IOP, or outpatient mental health program that is designed for whole life healing. Our team is available now to answer any questions about our unique program and specifically how we can help you manage a bipolar disorder. Call us today: 949-503-9655.

10 Bipolar Disorder Triggers And How To Manage Them

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Bipolar disorder is a mood disorder where people experience mania (extreme highs) and depression (extreme lows). These episodes are often random or may be triggered by specific events. However, understanding your bipolar disorder triggers can help manage or prevent an episode. 

What Triggers A Bipolar Episode?

Bipolar disorder generally develops due to a combination of genetic and environmental factors. Although the genetic aspect of bipolar disorder is not fully understood, having a parent with this disorder increases the likelihood of also struggling with bipolar disorder. 

If you are struggling with bipolar disorder, it is vital to understand the personal factors that can trigger an episode. Though triggers vary from person to person, we will explore the most common triggers of bipolar disorder. This is important when learning how to live with a bipolar disorder.

1. Sleep Issues

Sleep issues are not only a symptom of bipolar disorder but also a trigger. If you work long hours or you’re a student functioning on little sleep, you risk triggering a bipolar episode. Sleep disturbances such as traveling between time zones may contribute to these sleep issues as well.

2. Positive Events

While most bipolar disorder triggers revolve around a negative event, meeting goals and positive events can also be triggers of bipolar disorder. Winning an event, getting a promotion, or starting a new relationship can all trigger a manic episode. 

3. Substance Abuse

Using drugs and alcohol does not cause bipolar disorder. However, they are significant triggers of a bipolar episode. Drugs and alcohol can also “awaken ” bipolar disorder that beforehand was dormant. Even though both drugs and alcohol are bipolar disorder triggers, one in five people with bipolar disorder has a co-occurring substance use disorder. 

4. Life-Changing Event

One of the most significant life changes we will face is the death of a loved one. Although you may be able to manage your bipolar episodes while mourning, death can also be a trigger of bipolar disorder. 

If you are going through a life-changing event while also managing bipolar disorder, eliciting the help of friends and family may provide extra support and monitoring during difficult times.

5. Stress

Stress is perhaps the number one trigger of bipolar disorder. Not only can childhood stress lead to developing bipolar disorder, but stress can also trigger an episode. Managing stress is often easier said than done. It is crucial to work with a therapist to learn ways to cope with and manage your stress levels.

6. Trauma

Childhood trauma is a leading factor in the development of bipolar disorder. This trauma may include physical or sexual abuse, neglect, or the loss of a parent. While the trauma may have happened during childhood, symptoms of the trauma may not be apparent until another traumatic event occurs in adulthood.

7. Changes In Seasons

The changes in seasons are triggers for almost 20 percent of people with bipolar disorder. Seasonal changes are often experienced as mania during the spring and summer, and depressive episodes or seasonal depression in the winter and fall.

8. Changing Or Missing Medications

The majority of those who experience bipolar disorder rely on medication for symptom management and stabilization. This is important in keeping depressive and manic episodes under control and preventing a relapse. However, finding the proper medication can be tricky. 

For instance, antidepressants may actually trigger bipolar disorder. To mitigate this trigger, they must be taken with a mood stabilizer or avoided altogether. Always consult with your doctor before changing or stopping medications to avoid unwanted side effects or bipolar episodes.

9. Arguments With Friends, Family, Or Coworkers

When your bipolar disorder goes untreated, it often leads to broken relationships. The irritability you experience during manic and depressive episodes can increase arguments with friends, loved ones, and even co-workers. 

These arguments increase stress which is one of the triggers of bipolar disorder. In fact, A study in the Journal of Affective Disorders found that negative social experiences often trigger suicidal thoughts in those struggling with bipolar disorder triggers. 

10. Having A Baby

Bipolar disorder is strongly associated with postpartum psychosis. As a result, 67 percent of women with bipolar disorder will experience episodes weeks and months after birth. New moms commonly experience changes in their sleep, hormones, and medication each of which are common triggers of bipolar disorder. 

How Can You Manage These Bipolar Disorder Triggers?

It is impossible to avoid your bipolar disorder triggers. However, learning how to manage these triggers is key to controlling this disorder. Just like with triggers of bipolar disorder, managing personal triggers may be different from others. 

Minimizing your stress levels is the best way to prevent and manage bipolar episodes. Some ways to reduce stress include:

  • Avoid drugs and alcohol
  • Get more sleep
  • Create boundaries
  • Manage your time 
  • Eat a balanced diet
  • Exercise
  • Spend time with friends and family
  • Yoga
  • Mindfulness and meditation

Regularly attending therapy is very beneficial in helping you manage your bipolar disorder triggers. Some people also use medications along with therapy. However, you should never self-medicate as this can worsen your bipolar disorder.

Why Is A Stable Routine And Environment Important For Bipolar Disorder Triggers?

If you struggle with bipolar disorder, it is vital to have a stable environment and regular routine. People suffering from Bipolar Disorder are often sensitive to disruptions in routine.

The most important way to manage bipolar disorder triggers is having a set sleep schedule. This means going to bed at the same time each night and waking up at the same time each morning. A set sleep schedule helps keep the brain regulated and minimizes your reactions to bipolar disorder triggers.

Lido Wellness Center Can Help You Manage Triggers Of Bipolar Disorder

If you or a loved one is struggling with managing bipolar disorder or other mental health issues, we can help. With our integrative and comprehensive holistic care, you can live a happy and fulfilled life. Contact us today to find out how.

References:

https://pubmed.ncbi.nlm.nih.gov/25706607/