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.