The prevailing thought is that there is not a âcauseâ of BPD. Instead, there are a number of risk factors that create the likelihood that the disorder will develop. A risk factor is just what it sounds like: something that, when present, increases the risk that something else will happen. Risk factors can be both biological and environmental. The more risk factors that a person has for some type of physical or mental illness, the greater the chance he will develop that condition.
BPD opinions tend to reflect the occupation of the expert.. Sexual abuse counselors think sexual abuse causes it because that's their patient load. Psychiatrists focus on neurons and synapses. Attachment therapists see a poor child-mommy connection. Marsha Linehan sees an invalidating environment. Someone on another thread sees a head injury, and another the effects of artifical sweetener. A parent with one BP child and one undisordered child is sure it must be genetic, too. A severly abused BP who has a web site attracts many other BPs who have been sexually abused.
I spend three years investigating this issue. I spoke with the top experts at the National Education Alliance for Borderline Personality Disorder. My main source was Dr. Robert Friedel.
Genetics and the Brain
One gene alone is responsible for a rare, incurable disorder called Huntingtonâs disease. If you have the gene, youâll come down with Huntingtonâs eventually. But most inherited medical problems need several genes to converge before the disease develops.
For example, more than twenty genes can play a role in diabetes. Typically, someone who inherits four or five of them becomes diabetic. The different ways in which those genes combine can influence how severe a particular personâs diabetes is, how easily it can be treated, and so on.
BPD itself isnât passed from one generation to the next. What are inherited are two to four traits that define this complex disorder. Two parents, neither of whom have BPD, might still have some of the genes that can lead to traits associated with BPD, such as
â˘ quickness to anger
â˘ a susceptibility to addiction
â˘ cognitive (thinking, reasoning) impairments
Is genetics a form of destiny? Yes and no. Psychologist Pierce Howard sees genetics as a seed, and personality as something that develops from that seed in response to its environmentâsun, water, fertilizer, and so on. So genes play a role, but environment and lifestyle choices have a great impact as well.
OK, now let's talk about the environment and abuse:
Environmental Risk Factors
The following environmental factors play a role in the development of BPD.
Abuse: Myths and Realities
If youâve researched borderline personality disorder for any length of time, youâve read that abuse causes BPD. This belief partly comes from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which states that 75 percent of people with BPD have been abused.
The data, however, has a few flaws. First, if abuse causes BPD, than how do you explain the fact that one out of four BPs has not been abused? Second, a correlation is not necessarily a cause. Robert O. Friedel, MD, director of the BPD program at Virginia Commonwealth University, says, âNone of the environmental risk factors Iâve discussed [early separation or loss, trauma, ineffective parenting, and adverse social customs] has been show to cause borderline disorder. Many people who are exposed to the same abuse, separations, and bad parenting do not develop borderline disorder, and some borderline patients have not experienced any of these environmental risk factors.its association with BPD].
Family and Peer Influences
Many other environmental circumstances favor the development of BPD.
All of our personalities are shaped by the surroundings we grew up in. Some influences are positive, such as a caring older brother, a good school system, and a family with good financial resources.
Then there are negative influences: losing a grandfather, getting pneumonia, or living in a dangerous neighborhoodânot to mention the ânormal dysfunctionâ we all grow up in. Our cultureâits norms and expectationsâinfluence us, too.
Some life circumstances may present a higher risk for the development of BPD. Some doctors refer to these as âenvironmental burdensâ that can trigger the condition. They include
â˘ emotional, physical, or sexual abuse
â˘ ineffective parentingâor perceived ineffective parentingâof the borderline individual. This can mean anything from poor parental skills to a parentâs mental illness or substance abuse.
â˘ an unsafe and chaotic home situation
â˘ a poor match between the temperaments of parent and child
â˘ the sudden loss of a parent or a parentâs attention (sometimes perceived by the child as abandonment). This can arise from the death of a parent, a divorce, or even the birth of a new baby.
You might be thinking that this describes 99 percent of families. (About 50 percent of marriages end in divorce.) It probably does, so donât feel guilty if this looks familiar. Also keep in mind that many people who are exposed to the same abuse, separations, and ineffective parenting do not develop BPD.
Research is beginning to tell us that relationships with peers are crucial to the development of our personalityâinteresting, considering that most parents in the Welcome to Oz community say their child had a hard time making friends and lacked social skills. This could be because, compared to others seeking psychological help, people with BPD are especially likely to misinterpret or misremember social interactions. With their deep fear of abandonment, people with BPD may need and expect more from friendships, even at a young age.
Staying on the topic of the environment, let's take a look at Marsha Linehan's âInvalidating Environmentsâ as a Factor in BP. This is more from The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells .
Marsha Linehan, the creator of dialectical behavior therapy (DBT), a method us
ed to treat BPD and other disorders ) developed a âbiosocialâ model about the causes of BPD. The âbioâ refers to biology and the âsocialâ to the environment.
She agrees with research that shows that people with BPD are hardwired to react more intensely to stress. Their emotional peaks are more pronounced. Once the stress is over, they take a longer time than most to calm down. Linehan calls this tendency âemotional vulnerability.â BPD, she says, can develop when an emotionally vulnerable child is raised in an âinvalidating environment.â An invalidating environment is one in which caregivers
â˘ tell children that their feelings and experiences are wrong or untrue
â˘ find fault with children who fail to perform to the expected standard and caregivers make comments such as âyou werenât motivated enoughâ
Children raised in this environment learn not to trust their own gut reactions and look to others to tell them how to feel and to solve their problems for them.
But wait--there's more! Lots and lots of parents with BP kids are not bad parents. There may be a Poor Parent/Child Fit.
Perry Hoffman, president of the National Education Alliance for Borderline Personality Disorder, says that one risk factor for BPD is a poor match between a biologically vulnerable child and her caregivers who, for whatever reason, find it overwhelming to meet the childâs needs.
For example, perhaps the mother develops post-partum depression or the familyâs going through a crisis. Another example is a single mother who, for economic reasons, takes two jobs that limit the time she can spend with her child.
Now let's go back in history and tell you the story of a man who changed the way we think about the development of personality for all time. Once again, this is from The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells--a book I spent three years writing. Warning: this is a bit graphic. Think "CSI" here and shattered brain (not things like neurotransmitters, but the wrinkled grey stuff). Ignore the numbers, which are my footnotes.
The Physical Brain
Weâve known for more than a century that our wrinkled gray cells have a large role in shaping personality. This was demonstrated in the mid-1800s when an unfortunate railway worker named Phineas Gage was the victim of a freak accident thatâs still discussed in science books today. (Warning: the next paragraph is graphic.)
Gage was packing a load of explosives into the ground when the charge accidentally went off. The iron tamping rod he was using (4â long and 1Âźâ in diameter) was propelled though his left cheek and brain and exited through the top of his skull. Incredibly, he walked away from the accident and lived another thirteen years.
But the accident radically altered his personality. Gageâs physician, John Harlow, wrote:
Before his injury, Gage possessed a well-balanced mind and was looked upon by those who knew him as a smart businessman, energetic and persistent. After the accident, Gage was fitful, irreverent, indulging in the grossest profanity (which was not previously his custom), exhibiting little deference for his fellows, and at times impatient, obstinate, capricious, and vacillating. . . . His mind was so decidedly changed that his friends said he was âno longer Gage.
Yet MORE about the brain: this time the AMYGDALA (a physical structure inside the brain) and NEUROTRANSMITTER (problems which can be passed down genetically). This is from a NIMH website:
NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.10 The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion.
In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.11
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.