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.

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.