Personality Disorders: Causal Factors of BPD

The cause of Borderline Personality Disorder (BPD) is not clear; but according to research, genetics, brain structure and function; as well as environmental, cultural, and social factors; play a role or may increase the risk of developing the disorder. People with BPD tend to have chaotic personal histories marked by interpersonal strife, abuse, and inconsistent parenting. This history, at times, may reflect their earliest memories (childhood memories).

In a study conducted with those with BPD and healthy participants, the two parties were asked to describe their earliest life memories. When the contents of the research were analyzed, researchers discovered that individuals suffering from Borderline Personality Disorder recalled times they had been treated in a malevolent manner six times more than the other party did. Furthermore, the individuals suffering from BPD had also viewed potential helpers as far less helpful to them.

Many BPD patients' parents are described as abusive, rejecting, and non-affirming; and some theorists suggest that an early lack of acceptance by their parents may cripple their self-esteem and lead to a clinging dependency as well as an inability to cope with separation. As they mature, the behaviours of these individuals tend to evoke negative reactions and rejections from others, which causes them to affirm a sense of worthlessness and a view of the world as being wicked towards them.

Not everyone suffering from Borderline Personality Disorder experiences all these symptoms; some may experience just a few of them, while others experience all of the symptoms. BPD patients may feel distressed by minor separations from the people whom they feel close to (even as simple as a business trip, or visiting a sick relative or friend). The severity and frequency of these symptoms depend on the individual, and his or her illness.

Psychological factors

Psychoanalysts Kernberg and Caligor's focus was on the dramatic changes exhibited by individuals with BPD, in their relationships with other people. Their sudden and vitriolic shifts from extreme love and clinging dependence to intense hate or feelings of abandonment, is a reflection of cognitive process called Splitting: the failure in interrogating negative and positive aspects of another's behaviour (for example, a parent who is mostly accepting but at times, voices disapproval) into a coherent whole.

This may result in BPD patients reacting as if the other person has two separate identities: one deserving of love; and the other, of hatred. Whichever of these seemingly independent images such an individual is reacting to at the moment determines how they relate or feel. Together with severe problems in emotional control, splitting makes for chaotic and unpredictable relationships in such individuals.

Biological factors

Biological factors also seem to play a part in this disorder (Depue & Lenzenweger). Close relatives of BPD individuals, such as siblings and parents, have five times more likelihood of having the disorder than those in the general population with the disorder (Torgerson). The impulsivity and emotional explosiveness of BPD individuals may also be a reflection of some biological abnormality in neurotransmitter systems, or areas of the brain that contribute to emotional self-regulation (Gurvitz).

It seems to be entirely possible that BPD reflects an interaction between biological factors and early history of trauma, rejection, as well as psychological and/or physical abandonment. Sociocultural factors also may contribute to the emergence of the disorder. Cases of Borderline Personality Disorder seem to be more prevalent in rapidly-changing, unstable societies, leaving some of its members with a sense of emptiness, problems with identity, and fear of abandonment.

Although individuals with BPD are said to have experienced traumatic events such as abuse, abandonment, or adversity during childhood, it doesn't necessarily mean that all such individuals would develop the disorder, although it is likely. And even though biological factors do contribute to the development of Borderline Personality Disorder, it doesn't necessarily mean such persons will get the disorder. Moreover, persons with no family history of the disorder could get the disorder nevertheless.

Diagnosis and Treatment

Borderline Personality Disorder was viewed as a difficult disorder to treat in the past, but with newer evidence-based treatment options, BPD patients are able to live better lives with fewer or milder symptoms, as well as improvements in the quality of life. It is important for patients of the disorder to receive specialized treatment from an appropriately-trained provider. Other types of treatment, or treatment provided by doctors or therapists who aren't properly trained, may not benefit these individuals.

It takes time for BPD symptoms to improve, once the treatment is begun; and it depends on many factors, so it is important for such individuals and their loved ones to be patient and to receive appropriate support during the treatment. A licensed mental health professional would be able to diagnose this disorder by; completing a thorough interview, which includes a discussion on symptoms; performing a thorough medical exam in order to rule out other possible causes of symptoms; as well as inquiring about family medical history, including any history of mental illness.

Borderline Personality Disorder may often occur with other mental disorders and hence, co-occurring disorders may make it difficult to diagnose and treat BPD, especially when symptoms of other disorders tend to overlap with it. For example, individuals with BPD may be more likely to experience symptoms of depression, anxiety disorders, Bipolar Disorder, eating disorders, and substance abuse disorders as well. According to studies, individuals who do not receive adequate treatment have a likelihood of developing other chronic mental or physical illnesses, and are more likely to fail in healthy lifestyle choices. They are also at high risk of self-harm and suicide.

Medication is not typically used for BPD patients as the benefits are unclear, but medications may be provided to treat other conditions associated with the disorder, such as mood swings, depression, and other co-occurring disorders. Treatment may be needed from more than one medical professional and medication could cause different side-effects, which need to be discussed with the medical practitioner. Some patients may be severely affected by the disorder and need intensive care, while others may be able to do with just outpatient treatment with no need for hospitalization.

Personality Disorders: Causal Factors of ASPD

Biological Factors

Research on the biological factors of Antisocial Personality Disorder (ASPD) has focused on both genetic and psychological factors. The concordance rate of genetic predisposition shows a higher evident rate among identical twins than in fraternal twins for ASPD. Adoption study conclusions are similar, too. When researchers compared criminal records of men who were adopted, the rate of criminality was almost twice as high when the biological father had a criminal record and the adoptive father did not—a clear sign of genetic predisposition.

The clue to genetic predisposition factors of antisocial behaviour in individuals could be the relative absence of anxiety and guilt, which seems to characterize Antisocial Personality Disorder. According to many researchers' beliefs, the psychological basis for the disorder may be a dysfunction in the brain structures governing emotional arousal and behavioral self-control. This can result in impulsive behaviour and a clinically under-aroused state; impairing avoidance learning, causing boredom, and encouraging a search for excitement. According to psychological basis, children and adults alike with antisocial behaviour patterns tend to have lower heart rates, particularly under stress.

MRIs of antisocial individuals have shown subtle neurological deficits in their prefrontal lobes—the seat of executive function; which are planning, reasoning, and behavioral inhibition; such neurological deficits are associated with a reduction of autonomic activity. This supports a long-suspected idea of severely antisocial individuals being wired differently at a neurological level, causing them to respond with less arousal and a greater sense of impulsiveness to pleasurable and unpleasurable stimuli alike.

Psychological & Environmental Factors

According to psychodynamic theorists, antisocial personalities are individuals with no conscience. Psychoanalytic theorists believe that such individuals lack anxiety and guilt because they did not develop an adequate superego. The absence of a well-developed superego causes reduction of the restraints on the identity, resulting in impulsive behaviour. Inadequate identification with appropriate adult figures is thought to cause these individuals' failure to develop a strong superego because these figures weren’t either physically or psychologically available to the child. Supporting this position, the absence of the father from home has a higher related incidence of antisocial symptoms in children, even with socioeconomic status equated.

Cognitive theorists believe that an important feature of antisocial individuals is their consistent failure in thinking about—or to anticipate the long-term negative consequences—of their acts. This results in impulsive behaviour, with thought only of their wants of the moment. From this perspective, the key to preventing these individuals from getting themselves into trouble is to help them develop cognitive control (executive function) necessary to think before acting. Learning through modelling can play an important role too.

Many antisocial personalities come from homes of aggressive and inattentive parents. Such parents become role models for aggressive behaviour and disregard for others' needs. Another important environmental factor is exposure to deviant peers. Antisocial children often learn some of their deviant behaviour from peer groups that help model antisocial behaviour and reinforce it with social approval. When environmental factors are combined with a possible genetic predisposition for antisocial behaviour, it clearly encourages a pattern of deviant behaviour.

According to the learning explanations of some biological theorists, it suggests that individuals with antisocial behaviour lack impulse control. Learning theorists believe that the reason for poor impulse control in these individuals occur due to impaired ability to develop conditioned fear responses when they are punished. This results in a deficit of avoidance learning. Hans Eysenck said a person's ability to develop a conscience depended on that person’s ability to learn fear and inhibitory avoidance responses. Individuals who fail in these aspects will have less ability to inhibit their behaviour.

Clinical studies

In accordance with this hypothesis, Adrian Raine and his co-workers did a 14-year follow-up on males who had been subjected to classical conditioning at the age of 15, in which a soft tone had been used as the conditioned stimulus (CS) and a loud averse tone as the unconditioned stimulus (UCS). Conditioned fear was measured by the participant’s skin conductance response when the CS occurred after a number of pairings with the loud UCS. According to the research findings, the men who accumulated a criminal record by the age of 29 had shown poorer conditioning at the age of 15 than those with no criminal record.

According to further studies, major damage to the grey and white matter in the prefrontal cortex, as well as autonomic deficits, can result in pseudo-psychopathic personality in patients with neurological disorders, but it is not known whether individuals with antisocial personality disorder in the community, with no discernible brain trauma, also have subtle prefrontal deficits.

When prefrontal grey and white matter volumes were assessed using structural magnetic resonance imaging in 21 community volunteers with ASPD; as well as in two control groups which comprised of 34 healthy subjects, 26 subjects with substance dependence, and 21 psychiatric controls. The autonomic activity of (skin conductance and heart rate) was assessed during a social stressor in which the participants gave a videotaped speech of their faults.

The ASPD group showed an 11 percent reduction of prefrontal grey matter volume in the absence of ostensible brain lesions and reduced autonomic activity during the stressor. These deficits were a prediction of group membership independent of psychosocial risk factors. These findings are said to be the first evidence of structural brain deficits in ASPD. This prefrontal structural deficit may underlie the low arousal, poor fear conditioning, lack of conscience, and decision-making deficits known to characterize antisocial behaviour.

Causal Factors of Schizophrenia

Schizophrenia has long been a focus of research due to the seriousness of the disorder as well as the many years of anguish and incapacitation experienced by the patients. Predisposition to schizophrenia is high if an immediate family member has the disorder, but there are chances of developing Schizophrenia even without a family history of the disorder.

Biological factors

Genetic predisposition:

Strong evidence exists of genetic predisposition to schizophrenia, but some develop the disorder without family history. The more closely an individual is related to a person with the disorder, the higher the chances are of him developing it. According to studies, identical twins have a higher rate of developing the disorder than fraternal twins. Adoption studies show a higher concordance with biological parents than with adoptive parents.

But genetics is not the only cause; if it was, the concordance rate of schizophrenia in twins would be at 100 percent. Schizophrenia develops in adulthood. Men develop symptoms of schizophrenia in their late teens or early twenties, while women show symptoms of the disorder in their twenties or thirties. More subtle signs of the disorder maybe present earlier, such as poor performance in school, troubled relationships, and lack of motivation.

Brain abnormalities:

Brain scans of such individuals indicate a number of structural abnormalities. According to the Neurodegenerative Hypothesis, the destruction of neural tissue can cause schizophrenia. MRI studies have shown mild to moderate brain atrophy; a general loss or deterioration of neurons in the cerebral cortex and limbic system, together with enlarged ventricles (cavities containing cerebrospinal fluid).

The atrophy is centered in the brain region influencing cognitive process and emotion. This may explain the thought disorders and inappropriate emotions seen in such patients. Likewise, MRI images of the thalamus, which collects and routes sensory input to various parts of the brain, reveal abnormalities as well. This may help account for the disordered attention and perception reported by the patients whose cerebral cortex may be getting garbled with unfiltered information of the thalamus. These structural differences are more common in patients exhibiting negative symptoms.

Biochemical factors:

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the Dopamine Hypothesis, the symptoms of schizophrenia, specifically the positive symptoms, are produced by overactivity of the dopamine system in areas of the brain which regulate emotional expression, motivational behaviour, and cognitive function.

Individuals diagnosed with schizophrenia have more dopamine receptors on neuron membranes than non-schizophrenics. These receptors seem to be overactive to dopamine stimulation and additionally, the effectiveness of antipsychotic drugs used to treat this disorder are positively related to their ability to reduce dopamine-produced synaptic activity. Other neurotransmitter systems could be involved in this complex disorder, too. Considering the biochemical and brain findings concerning schizophrenia, it is not clear whether they cause the disorder or vice versa.

Psychological factors

Freud and other psychoanalytic thinkers' view of schizophrenia was that it is a retreat from unbeatable stress and conflict. To Freud, schizophrenia represented an example of an extreme defence mechanism of regression, in which such a person retreats to an earlier and more secure (even infantile stage) of psychological development, when faced with overwhelming anxiety. Other psychodynamic thinkers, focusing on the interpersonal withdrawal, which is an important feature of schizophrenia, tend to view the disorder as a retreat from an interpersonal world that’s too stressful to deal with.

Even though Freud’s explanation on regression hasn’t received much direct research support, the belief of stress as a causal factor is accepted today. Some cognitive theorists believe that people with schizophrenia have a defect in the attention mechanism which filters out irrelevant stimuli, making them feel overwhelmed by both internal and external stimuli and in turn, causing sensory input to become a chaotic flood, resulting in irrelevant thoughts and images flashing into consciousness. The stimulus overload produces distractability, thought disorganisation, and a sense of being overwhelmed by disconnected thoughts and ideas.

As one schizophrenic noted, “Everything seems to come pouring in at once…I can’t seem to keep  anything out” (Carson). The recent MRI findings on thalamic abnormalities described earlier may help explain how the stimuli overload could occur through a malfunction of the brain's switchboard.

Environmental factors

Stressful life events seem to play an important role in the emergence of schizophrenic behaviour. Two to three weeks preceding a 'psychotic break', when acute signs of schizophrenia appear, these events tend to cluster. Stressful life events seem to interact with such a person's personality or biological vulnerability factors. A highly-vulnerable individual may require just a small stressful event to reach the breaking point. In a study, psychotic and non-psychotic individuals rated their emotional responses as they encountered stressful events in their daily lives. The psychotic individuals' reactions to their stresses were more intense with negative emotions, suggestive of emotional overactivity being a vulnerability factor.

Family dynamics have for long been a prime suspect in the origins of this disorder, but the search for characteristics of a parent or family causing the disorder has largely been unsuccessful. Significantly, children with biologically normal parents who are raised by adoptive parents with the schizophrenic disorder do not show an increased risk of developing the disorder. Although schizophrenic individuals often are from families with problems, the nature of the seriousness of such problems is not different from those of which non-schizophrenics are raised.

This does not mean that family dynamics are unimportant; it may just mean that a person must have a biological vulnerability factor in order to be affected by stressful family events to such a degree. There is indeed evidence that this vulnerability factor may appear early in life. In a study conducted by researchers, pre-schizophrenic children and their non-schizophrenic brothers and sisters were analysed using home movies of schizophrenic children. Even at these early ages, sometimes a child as young as two years old seem to show more odd and uncoordinated movements and less emotional expressiveness, especially for positive emotions. These odd behavioural patterns may not just reflect a vulnerability factor, but may also help create environmental stress by evoking negative reactions from others.

Although researchers have had difficulty pinpointing family factors contributing to the initial appearance of this disorder, one finding is consistent of previously-hospitalised schizophrenics being more likely to relapse when returned to a home environment that is high in a factor called 'Expressed Emotion'. Expressed emotion involves high levels of criticism, hostility, and over-involvement. One review of 26 studies showed that within 9-12 months of returning home, an average relapse of 48% in patients with  families who were high in expressed emotion, compared with a relapse rate of 21% with families that were low in this factor.

However, before we conclude on high expressed emotions causing relapses in patients, there is a finding from another study worth noting; which are videotapes of actual interactions between patients and their families. Analysis of the videotapes revealed that families who were high in expressed emotion did indeed make more negative comments to patients when they engaged in strange behaviours, but they also showed these patients behaving around four times as many strange behaviours, clouding the issue of what causes what. Thus, high expressed emotion may be a cause of a response to these patients' disordered behaviours; because people with this disorder can be overly sensitive to stress and even mildly negative family reactions could trigger underlying biological vulnerabilities, resulting in a relapse.

Sociocultural factors 

Sociocultural factors are undoubtedly linked to schizophrenia. According to many studies, the highest prevalence of schizophrenia is found in lower socioeconomic populations.Why is this? Is schizophrenia caused due to poverty, or is it an affect of the disorder? Two views tend to give opposite answers. The Social Causation Hypothesis attributes the higher prevalence of schizophrenia  to the higher levels of stress experienced by low-income people, particularly in urban environments.

In contrast, the Social Drift Hypothesis proposes that with the development of schizophrenic disorder, these individuals' personal and occupational functions tends to deteriorate, causing them to drift down the socioeconomic ladder into poverty and migrate to economically depressed urban environments. Perhaps both social causation and social drift maybe at work, for the factors linking poverty, social and environmental stressors, as well as schizophrenia, are undoubtedly complex.

In contrast to most disorders, schizophrenia may be a culture-free disorder. According to a worldwide epidemiological study sponsored by the World Health Organisation, the prevalence of schizophrenia  is not dramatically different throughout the world. Researchers have, however, found that the likelihood of recovery is greater in developing countries than in the developed nations, such as North America and Western Europe. This may be due to stronger community orientation and greater social support extended to disturbed individuals in developing countries.

Schizophrenia reflects complex interactions among psychological, biological, and environmental factors and presents prominent causal factors identified by analysis. Some patients do well with treatment and live productive lives, while others continue to be symptomatic. As this disorder starts in early adulthood, these individuals can benefit from rehabilitation and help them develop management skills, complete education or vocational training, and hold onto a job. This helps with self-sufficiency in people afflicted with schizophrenia.

There is no cure for schizophrenia, but management of symptoms with medication, cognitive behavioural therapy, and supportive psychotherapy. Substance abuse is high in schizophrenic patients, owing to the misuse of drugs, which can make diagnosis harder.

Causal Factors of Mood Disorders

Mood disorders, much like anxiety disorders, are a product of interacting biological, psychological, and environmental factors.

Biological factors

Both neurological and genetic factors have been linked to depression; genetic factors surface in both twin and adoption studies. In identical twins, there is a higher concordance rate of experiencing clinical depression compared to fraternal twins. Among adopted people who develop depression, biological relatives have a higher chance of suffering from depression than adoptive relatives and a predisposition to depressive disorders is more likely to be inherited given certain kinds of environmental factors such as a significant loss, or low social support.

Influential Theory

Considering biological research, the focus has increased on the role of brain chemistry in depression. According to Influential Theory, depression is a disorder of motivational underactivity of a family of neurotransmitters, including dopamine, serotonin, and norepinephrine. These transmitters play important roles in several regions of the brain involved in reward and pleasure.

When neural transmissions in these brain regions decrease, it results in lack of pleasure, and motivational loss, which are characteristics of depression. In support of this theory, several effective antidepressants operate by increasing the activity of these neurotransmitters, further stimulating the neural system which underlies positive mood and goal-directed behaviour.

A study headed by Lescia Tremblay tested the amount of reward experienced by depressed patients when a stimulant drug was used to activate these centres, and individuals who were in severe depression showed a much stronger level of pleasure response to the drug, supporting the hypothesis of a deficit of pleasure in the brain.

Genetic Basis

Later research by Ian Gotlib with the use of fMRI (functional Magnetic Resonance Imaging) readings of emotion areas of the brain showed low neuron responsiveness to happy and sad scenes alike, as if the emotional response system had shut down. This may account for lack of positive emotionality and the empty feelings of depressive emotional experience.

Bipolar Disorder, in which depression alternates with less frequent manic periods, has been studied primarily at a biological level because it tends to have a stronger genetic basis than unipolar depression. Around 50% of patients with the disorder have parents, grandparents, or a child with bipolar disorder as well. Identical twins have a higher chance of developing bipolar disorder than fraternal twins, which suggests a genetic cause.

Manic disorders may stem from an overproduction of the same transmissions which are underactive in depression. Lithium chloride, which is most frequently used to calm manic disorders, is used to decrease the activity of these transmitters in the brain's motivational and pleasure activation system.

Psychological factors

Biological factors can cause a person to be more vulnerable to certain types of psychological and environmental events that can trigger such disorders.

Personality-based Vulnerability

According to the beliefs of psychoanalysts Sigmund Freud and Karl Abraham, early traumatic losses or rejection create vulnerability for later depression by creating a grieving and rage process which becomes part of the individual's personality. Subsequent losses and rejections cause the reactivation of the original loss, causing a reaction not just about the current event, but unresolved losses from the past, too.

British sociologists George Brown and Terrill Harris support Freud's theory of early loss. According to Brown and Harris, out of the women they interviewed in London, the rate of depression was three times higher among those who lost their mothers under the age of 11 and experienced severe recent losses than the women who had similar recent losses but no such previous loss. Experiencing the death of a parent in early childhood can cause an increased risk of depression later in life.

Cognitive process

According to Aron Beck, depressed individuals tend to victimize themselves with the beliefs that they are defective, inadequate and worthless. They feel that everything that happens to them is bad and that bad things will continually happen to them because of their personal defectiveness.

This depressive cognitive triad of negative thoughts concerning the world, oneself, and the future tends to pop up into the conscience automatically. Many depressed people are unable to control or suppress negative thoughts. Depressed individuals recall their failures more often than their successes and tend to focus more on their perceived inadequacies. They detect pictures of sad faces at times of lower exposure times and remember them better than individuals with no depressive disorders, which indicates a perpetual and memory sensitivity to the negative.

Most people take personal credit for the good outcomes in their lives, blaming their misfortunes on outside factors; thereby maintaining and enhancing their self-esteem. This is the opposite of what depressed people do, according to Beck. These individuals exhibit a depressive attributional pattern, which is attributing success or other positive events to factors outside oneself, while attributing negative outcomes to personal factors. According to Beck, not taking credit for success but in addition, blaming themselves for failures helps depressed individuals maintain low self-esteem and beliefs that they are failures.

Learned Helplessness

Another prominent cognitive account of depression referred to as Learned Helplessness Theory holds that depression occurs when people expect the occurrence of bad events and feeling unable to do anything to prevent or cope with them. Even though the depressive attributional pattern plays a central role in the learned helplessness, model learned helplessness theorists have taken it a step further by specifying what the negative attributions for failures are like.

According to them, chronic and intense depression is a result of negative attributions for personal failures. These people, who attribute negative events in their lives to factors such as low levels of intelligence, physical repulsiveness, or an unlovable personality tend to believe that their personal defects will render them helpless, making them unable to avoid negative future events This sense of hopelessness places them at a significantly higher risk of depression.

Behavioural Perspective

The behavioural perspective also has important things to say about depression. According to Peter Livingston, depression is usually triggered by a loss, punishing event, or by a drastic decrease in the amount of positive reinforcement received by an individual's environment. When depression takes hold, people stop performing behaviours that provided them with reinforcement, such as hobbies and socialising.

Depressed individuals, at times, tend to make others anxious. Those persons may lose patience due to their failure to understand why this individual doesn't break the cycle. This can further diminish social support and may cause depressed individuals to be abandoned by those most important to them. According to longitudinal studies, reduction in social support is a good predictor for subsequent depression.

Positive Reinforcement

According to behavioural theorists, for depressed individuals to feel better, they need to break this vicious cycle by forcing themselves to engage in behaviours that would provide them with some degree of pleasure. Eventually, positive reinforcement produced by the process of behavioural activation will begin counteracting the depressive affects undermining the feelings if hopelessness that characterise depression and thereby increasing feelings of personal control over the environment.

Environmental factors may help explain the reason depression tends to run in families. Constance Hammen studied family histories of depressed individuals; his conclusion was that children of depressed parents often experience poor parenting and many stressful experiences growing up. This may result in poor coping skills and a negative self-concept, making them more vulnerable later in life to stressful events, which may trigger depressive reactions. This conclusion is supported by findings that children of depressed parents exhibit a significantly higher incidence of depression and other disorders as adolescents and young adults.

Sociocultural factors

Depression exists virtually in all cultures; but its prevalence, symptom patterns, and causes reflect cultural variations. For example, Hong Kong and Taiwan have a far lesser prevalence rate of depressive disorders compared to Western countries. Individuals in these societies tend to have strong social support from family and other groups, and this helps them through the occurrence of negative impacts of loss and disappointment.

Cultural factors, too, can affect the way depression manifests. For example, in Western European countries and North America, there is a predisposition to feelings of guilt and personal inadequacy. On the other hand, people of Latin, Chinese, and African cultures more often tend to suffer from somatic symptoms of fatigue, loss of appetite, and sleep difficulties.

Finally, according to cultural factors in technologically-advanced countries such as Canada and the United States, women have been reported to be twice as depressed than men. Yet, this sex difference is not evident in developing countries.