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: Introduction to BPD

Borderline Personality Disorder (BPD) has been the focus of intense interest among clinical researchers due to the chaotic effects it has on the individuals suffering from it, as well as their families and therapists. There may be an occurrence rate of 3 to 5 percent among the general population, and around two-thirds of those diagnosed are women.

Black and White Vision

Individuals suffering from Borderline Personality Disorder see the world as black and white, with no grey areas around. They tend to change the way they feel about a person from one moment to the next, making a person they once adored and respected someone they distrust and despise. Their views and values tend to change rapidly.

Before 1980, the term Borderline was referred to an intermediate level of disturbance between psychotic and neurotic symptoms. However, at present, BPD refers to a collection of symptoms characterised primarily due to serious instability in emotion, behaviour, identity, and interpersonal relationships.

Borderline individuals tend to have intense and unstable interpersonal relationships. They also experience chronic feelings of extreme anger, loneliness, emptiness, distrust (due to the irrational fear of not knowing a person’s intentions); as well as fear of abandonment and momentary loss of personal identity, such as feeling cut-off from oneself or seeing oneself out of their body. They tend to engage in impulsive behaviours, such as going on shopping sprees, running away, promiscuity, binge-eating, as well as drug and alcohol abuse. Their lives are often marked by repetitive self-destructive behaviours such as reckless driving, self- mutilation, and suicide attempts, calling forth saving responses from the people in their lives.

The following is an example of the complex nature of Borderline Personality Disorder:

A 27-year-old married woman with two small children, had undergone a stormy adolescence. She had been forced into sexual relations with a brother six years her senior; whom, at first, she idolised; and later, feared. Their relationship had continued until just before she left home for college, at which time she confessed to her parents about it. In the ensuing emotional turmoil, she made a gesture of suicide (overdose of aspirin) but was hospitalised. 

Outwardly flirtatious, although inwardly shy and ill at ease, she felt intensely lonely, causing her to go through a period of mild alcohol abuse and brief sexual affairs in order to cope with feelings of anxiety and a sense of inner emptiness, which was halted at the age of 19 when she married a classmate and dropped out of school.

For the first few years of marriage, she was fairly at ease. But with the birth of her second child, she became anxious, bored and got into fits of sadness and fearfulness. Her mood started fluctuating from hour to hour and day to day, but the negative feelings were greatly intensified on the 3 or 4 days before her period. As the family expanded, the husband had become less attentive towards her.

As a response, she became increasingly irritable, provocative, and even abusive at times (hurling insults and breaking plates). This resulted in her husband beginning an extramarital relationship, which she eventually discovered. This caused her to get seriously depressed, which caused her a loss of appetite and sleep. She then began abusing alcohol and sedatives and also made several gestures of suicide, including an instance where she cut her wrists. On two occasions, she hid for several nights in motels without informing anyone of her whereabouts (Stone).

Association with Other Disorders

BPD is highly associated with a number of other disorders, which include mood disorders, PTSD, and substance abuse disorders. In one study, BPD's symptoms of impulsivity and emotional instability had predicted recurrent problems in academic achievements and social relationships two years later (Bagge). In one intensive study of 57 individuals diagnosed with BPD, a total number of 42 suicide threats, 40 drug overdoses, 38 episodes of drug abuse, 36 instances of self-mutilation, 36 instances of promiscuity with near strangers, as well as 14 accidents mainly caused by reckless driving, were revealed.

The chaos that marks the lives of BPD patients extends to their relationships with their psychotherapists. These individuals are considered to be among the most difficult patients to treat, owing to their clinging dependency, irrational anger, and tendency to engage in manipulative suicidal gestures and threats as an effort of controlling the therapist (Linehan).

Every individual with Borderline Personality Disorder does not experience all these symptoms. Some may experience a few symptoms, while others experience the whole array of them. Symptoms can be triggered by ordinarily simple events; for example, individuals with BPD may feel angry and distressed due to minor separations from the people they are close to, even if it’s just a business trip. The severity and frequency of symptoms, as well as the lengths of the periods, may vary depending on the individual and their illness.

These behaviours and symptoms occur primarily during a period of elevated mood and energy. Therefore, If you know anyone like this, you may need to consider that they may not be suffering from Borderline Personality Disorder; instead, they may be signs of a mood disorder.

Borderline Personality Disorder, though historically viewed as a difficult disorder to treat; with new evidence-based treatment, many individuals with this disorder suffer fewer or less severe symptoms—and an improved quality of life.