What is the cause of Borderline Personality Disorder?

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GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Up Out of It]

I just found a great article on borderlinepersonalitydisorder.com called "Etiology of BPD by John G. Gunderson, MD".  It helps explain how both genetics and environment contribute to BPD.

http://www.borderlinepersonalitydisorder.com/notes-gunderson.shtml

[Mollyd]

It's also important to remember that not all people with bpd have a history of abuse/neglect/abandonment.  That's hard to remember, because the persepctive of bpd is often one of victimization (e.g. they perceive they've been victimized all the time - current and past).  Personality disorders, in general, are a condition where there isn't a clear path of "disease" like:  a + b = personality disorder.  Maybe someday, as brain research gets better.

After reviewing lots of current research on this topic, and speaking with several researcher, my personal opinion based on the research is there is a biological component (meaning there is some genetic pathway - increase in likelihood if bio relatives have it), however, abuse/abandonment is not the cause, it's, at times, a factor. 

Molly

[ian]

So, one of the new and interesting developments in recent science is the field of Epigenetics. What researchers have discovered that environment influences gene expression. This means that there are alot of genes that are more like switches, with two or more positions and that they can be switched on and off by environmental factors. This is may be why some abused people and up ok and others end up with a personality disorder.

So it appears that environment and genetics are two interdependant factors, that may even be flexible throughout life.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Bitzee]

BPD results from the combination of a sensitive emotional nature (inborn) along with an invalidating environment.  The environment does not have to be abusive in order to be invalidating.  The parent and child may simply be a poor fit.

My niece, for instance, was diagnosed with BPD.  There was some sort of trauma at her birth... a lack of oxygen.  She was developmentally slow, but the doctors did not really acknowledge it.  Anyway, I'm saying she was 'different' and it was difficult to be validating for her.  Just your normal, run of the mill environment was invalidating for her... because she was different from the get go and this was never appropriately addressed and compensated for.

[speed of dark]

I have read to much on this subject. Genetics (genotype) does effect character and constitution (phenotype)of the individual, but it does not DETERMINE IT. It is always, an interaction between  potentials and experience that produces an individual.  Cultural traditions are behaviors learned from parents, imitated by children (primary phenotype transmission). 

The genetic message is comprised of shadows of long forgotten ancestors.  Depending on your religious  affiliation the number of ancestors could vary greatly.  In any event the number of genetic contributions become fugitive simply because the number is hugh even if you believe the world is only 4000 years old.  I personally think our world is considerably older.

 The lessons we learn (1st) from our parents and (2nd) institutions are likely to be more crucial.  This debate still rages on.

[JoannaK]

This has been alluded to in this thread, but I'm not sure it has been stated outright.  Environment affects physiology.  Children brought up in more stressful situations, with abuse, war, violence around them, actually produce different (or different amounts of) neurotransmitters and hormones.  Those neurotransmitters and hormones do affect their bodies physiologically and usually permanently.

It's everything...  genetic predisposition, problems or differences in utero, problems or differences at or immediately after birth, differences in environment throughout childhood and adolescence.   

[Unreal]

http://www.ncbi.nlm.nih.gov/pubmed/17988414

Heritability of borderline personality disorder features is similar across three countries.
Distel MA, Trull TJ, Derom CA, Thiery EW, Grimmer MA, Martin NG, Willemsen G, Boomsma DI.

Department of Biological Psychology, VU University, Amsterdam, The Netherlands. ma.distel@psy.vu.nl

BACKGROUND: Most of our knowledge about borderline personality disorder features has been obtained through the study of clinical samples. Although these studies are important in their own right, they are limited in their ability to address certain important epidemiological and aetiological questions such as the degree to which there is a genetic influence on the manifestation of borderline personality disorder features. Though family history studies of borderline personality disorder indicate genetic influences, there have been very few twin studies and the degree of genetic influence on borderline personality disorder remains unclear.

METHOD: Data were drawn from twin samples from The Netherlands (n=3918), Belgium (n=904) and Australia (n=674). In total, data were available on 5496 twins between the ages of 18 and 86 years from 3644 families who participated in the study by completion of a mailed self-report questionnaire on borderline personality disorder features.

RESULTS: In all countries, females scored higher than males and there was a general tendency for younger adults to endorse more borderline personality disorder features than older adults. Model-fitting results showed that additive genetic influences explain 42% of the variation in borderline personality disorder features in both men and women and that this heritability estimate is similar across The Netherlands, Belgium and Australia. Unique environmental influences explain the remaining 58% of the variance.

CONCLUSION: Genetic factors play a role in individual differences in borderline personality disorder features in Western society.

[Randi Kreger]

I am going to reprint something here from my new book (not the final edition though, so please don't use this elsewhere). I researched this topic for three years to come up with a cogent analysis of this very topic. What I'm pasting here is from various places in the book. Please ignore all the footnotes and such. You can find out more about the book from the link


FROM THE ESSENTIAL FAMILY GUIDE TO BORDERLINE PERSONALITY DISORDER: NEW TIPS AND TECHNIQUES TO STOP WALKING ON EGGSHELLS
Http://www.bpdcentral.com/bpdbook/



Risk Factors of BPD

The prevailing thought is that there is not a “cause” 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.

As an example, consider heart disease. Imagine a man whose grandmother and uncle died of a heart attack. His parents own a bakery, so he grows up appreciating the buttery taste of croissants and chocolate-covered cream puffs. As an adult, he eats high-fat, high-cholesterol meals and doesn’t have time to exercise.
Suddenly, on his sixtieth birthday, he dies of a heart attack while shoveling a heavy, wet snow. What caused his death? Was it his genetic history? The high-fat diet? The lack of exercise? The shoveling? The answer is all four factors (and perhaps others) working together.

Now let’s extend that example as it applies to developing BPD. Let’s take four people: Julius and Nelson, two brothers, ages thirty and thirty-two, and Terri and Sherri, identical twins separated at birth and adopted by different families.

Terri and Sherri are both biologically vulnerable to BPD. However, they grew up in different environments. Terri grew up in a high-conflict household. At ten years old, she was sexually abused by a neighbor. She develops BPD. Sherri was luckier. Her home life was stable and with no major trauma. She never develops the condition.
Julius and Nelson grew up in a reasonably stable and pleasant environment, just like Sheri. In Julius, the mix of genes is such that, even with good parenting, he still develops BPD. His brother Nelson doesn’t, because his genetic heritage is just different enough.

In the rest of this chapter, we’re going to look at the two kinds of risk factors that lead to the development of BPD: biology and environment. The argument about which is dominant has been going on for decades. One might as well debate about which came first: the chicken or the egg. Increasingly, research is finding that it’s not one or the other. It’s both.
That’s not to say that the two are always equal. If many biological risk factors are present, only a few environmental aspects are needed to develop BPD. The fewer the biological factors, the more the environmental factors. Whichever dominates, the result is the same: lots of splattered eggs and a while lot of crunched eggshells.

First, we’ll take a look at the biological risk factors: the physical brain itself, brain chemistry, and genetics. Even though we’ll be looking at them separately, they’re interwoven. We can’t separate them any more than we could separate the sugar, eggs, and flour from a piece of cake.

<a>Biological Risk Factors
The following is a greatly simplified explanation of how the brain works.

1.   Our brain controls the way we think, feel, and act.
2.   BPD is characterized by impairments in thinking, feeling, and acting.
3.   To a large extent, these biological impairments in the brain contribute to the skewed thoughts, emotions, and behaviors characteristic of people with BPD.


Genetics and the Brain
One gene alone is responsible for a rare, incurable disorder called Huntington’s disease. If you have the gene, you’ll come down with Huntington’s 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 person’s diabetes is, how easily it can be treated, and so on.
BPD itself isn’t 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 ssociated with BPD, such as

•   aggressiveness
•   depression
•   excitability
•   quickness to anger
•   impulsivity
•   a susceptibility to addiction
•   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 environment—sun, water, fertilizer, and so on. So genes play a role, but environment and lifestyle choices have a great impact as well.[7]

[Abigail]

Randi,
   Thanks for the great post.  I loved your comparisons with heart problems and riskfactors.  You said it so well.  From all my research and experience, I wholeheartedly concur with your analysis.  But you convey it much better than I ever could. 

   The current thinking regarding the development of many mental disorders is based on a stress-diathesis model.  Just as you described, a combination of risk factors involving genetic, biological factors and environmental stressors eventually reach a "tipping" point where the development of a mental disorder occurs.  As you mentioned, one can have a lot of biological factors and not need many environmental stressors to develop and another individual might have a lot of environmental stressors without quite as many biological factors and still develop the disorder. 

    I am waiting for your book to arrive.  It should be coming shortly.  I can't wait to read it.  Thanks so much for all your research into the borderline disorder.  You have helped a lot of people.  I've given out several copies of your first book. 

  Abigail

[Skip]

Wanted to add this recent information to the discussion:

Possible Genetic Causes Of Borderline Personality Disorder Identified

ScienceDaily (Dec. 20, 2008) — According to the National Institute of Mental Health, borderline personality disorder (BPD) is more common than schizophrenia or bipolar disorder and is estimated to affect 2 percent of the population. In a new study, a University of Missouri researcher and Dutch team of research collaborators found that genetic material on chromosome nine was linked to BPD features, a disorder characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, and can lead to suicidal behavior, substance abuse and failed relationships.

“The results of this study hopefully will bring researchers closer to determining the genetic causes of BPD and may have important implications for treatment programs in the future,” said Timothy Trull, professor of psychology in the MU College of Arts and Science. “Localizing and identifying the genes that influence the development of BPD will not only be important for scientific purposes, but will also have clinical implications.”

In an ongoing study of the health and lifestyles of families with twins in the Netherlands, Trull and colleagues examined 711 pairs of siblings and 561 parents to identify the location of genetic traits that influences the manifestation of BPD. The researchers conducted a genetic linkage analysis of the families and identified chromosomal regions that could contain genes that influence the development of BPD. Trull found the strongest evidence for a genetic influence on BPD features on chromosome nine.

In a previous study, Trull and research colleagues examined data from 5,496 twins in the Netherlands, Belgium and Australia to assess the extent of genetic influence on the manifestation of BPD features. The research team found that 42 percent of variation in BPD features was attributable to genetic influences and 58 percent was attributable to environmental influences, and this was consistent across the three countries. In addition, Trull and colleagues found that there was no significant difference in heritability rates between men and women, and that young adults displayed more BPD features then older adults.

“We were able to provide precise estimates of the genetic influence on BPD features, test for differences between the sexes, and determine if our estimates were consistent across three different countries,” Trull said. “Our results suggest that genetic factors play a major role in individual differences of borderline personality disorder features in Western society.”

Journal references:

   1. Distel et al. Chromosome 9: linkage for borderline personality disorder features. Psychiatric Genetics, 2008; 18 (6): 302 DOI: 10.1097/YPG.0b013e3283118468
   2. Distel et al. Heritability of borderline personality disorder features is similar across three countries. Psychological Medicine, 2008; 38 (9): DOI: 10.1017/S0033291707002024

[TheCleverCowboy]

Great information Skip. Thanks!

[Peaceful.]

Very helpful Skip!  Is there research data that has measured the prevalance of BPD in children born to BPD mothers?

Of course there are individual cases of BPD children with BPD mothers, but I was wondering if there was national data that provides a % number.

[arjay]

... Canadian Journal Of Psychiatry...

http://ww1.cpa-apc.org:8080/Publications/Archives/PDF/1996/June/WEISS.PDF

[stpmom]

Interesting study, Skip,  I often wonder given the distortions of facts by those with BPD if the trauma that they were exposed to as children is real or imaginary.  I suppose that imaginary trauma can be damaging also.  My stpD was given to her father by her mother when she was two.  She had visitation with her through her life but they had a strained relationship.  In the end she turned out to be a lot like her.  Very self centered.  She said to me one time I was driving and I asked her to dig the directions I had for where we were going out of a bag.  She couldn't find it and began getting agitated.  She said why are you so calm, why aren't you yelling at me?  My mom would be yelling at me right now.  I said, how would that help anything, don't worry we will find it, everything will be fine.

We don't know if she experienced trauma at her mothers house or if her mothers rejection has caused it.  We do know that she received a lot of love and support also.  It is very frustraiting that we are the ones she "can't be around" now.  Would a could a should a, she is an adult now and responsible for her choices regardless of the wounds of her childhood...just like all of us.

[Esmerelda]

In reading through a lot of this board, I'm finding that most BPD folks have had some sort of background of abuse or neglect.  I'm pretty sure my sister is BPD (one of her many therapists diagnosed her as this, and others have diagnosed as Dependent Personality Disorder) but I'm only 14 months older than her and we did NOT have an abusive family (dysfunctional, for sure, but not physical or mental abuse).  I can remember from when we were very small that she always had a temper, got really mad at strange things that seemed to have no basis in reality, etc., fought with literally everyone around her.

Couldn't a big part of this disorder be genetic-based with very little environment basis?  We had a great-aunt that our grandmother described as a lovely person with lots of issues who committed suicide while in a hospital -- probably in the 1920s era.

I've finally decided to get some counseling for myself after all these years just to learn some better coping skills when dealing with her and the family situation (parents view her as a person who gets a lot of bad breaks in life, rather than having bad breaks from the fallout of her actions).  I am feeling badly that she always seems so unhappy in life...

[Bitzee]

There does not have to be abuse...  It is said that BPD develops as the result of a combination of an Inborn Sensitive Nature and an Invalidating Environment.  Not an abusive environment, an Invalidating one.

It can be fairly subtle... perhaps the family is merely stressed during crucial stages of the child's early development (especially infancy).  Perhaps the mother has an extended illness, or one of the other children become seriously ill, or there are financial hardships.  If the family system becomes too stressed, the child's needs are not met.  BPD is especially associated with early separations.  If the mother may have had to give the infant to someone else to care for for an extended period while she was having a difficult time.  That sort of thing.

There are many scenarios.  And many are unintentional.  Sometimes it is a poor fit between the temperament of the mother and the child.

[canttakeitanymore23]

my two cents on this is that ANY disorder is usually a combination of nature and nurture,i.e.,genetics and enviromental influences:some combination thereof is at play.someone genetically predisposed toward a certain disorder is far more likely to develop it/and/or develop it to a greater degree if external factors are conducive thereto...as far as individuals raised in the same family...i have seen wide variances.birth order,parental rejection/approval all play a part.
just an example from my personal experience...
i was raised in a family of ten children.both my parents were teachers so they were supposedly very conscientious about the ways in which children should be raised...in retrospect i feel they were excessively cold,controlling,and frugal...five of the aforementioned children were adopted;whereas five were biological.the five eldest were adoptees.fast forward to all of us kids being adults...we were all raised with the same parents/environment.the five adopted kids have all either been married/divorced multiple times-four or more times in some instance-whereas the five that weren't adopted have all only been married once.seeing as relational stability can oft be a significant indicator of overall mental health and coping mechanisms...there seeems to be a discrepancy amongst the family members based upon genetic basis alone.
sorry for overlong post...but it is a topic in which I am very much interested...

[tiree]

I have this same question and I am looking into neurological studies. My daughter, who is 13, and has BPD has had no major upsets in her life. My husband and I don't fight, abuse drugs or alcohol, we are educated...our other children are straight A students, good kids that are loved by their friends, teachers, family. We have a hard time understanding where this could have come from...what the 'onset' could have been. We have mulled over the past, our parenting styles etc...so many times - we are done trying to look for a 'trigger' or a 'reason'. She is ill, we didn't cause it. We are loving, fun, outgoing, invested parents. She has never been molested, abused, etc. yet her symptoms started showing up when she was a toddler, and I can even trace some things to infancy. For example, she could never entertain herself, if you left a room she screamed. As a toddler she would play fine with the cat, for example, then cut his ear with scissors. We rationalized these behaviors as a little one finding her way...not realizing that it hurt the cat, or whatever and deal with the behaviors as any good parents would. (there were a lot more things, those are only two examples) We would take the scissors, set her in a time out, then give her a hug, explain how it hurt the cat and bring her to the cat to pet it and be nice. If she cried as an infant because we left the room, we would go back and pick her up and love her (can't spoil a baby).
By the time she was in grade school the splitting had started. She would come home with stories of teachers slapping her, I would act on these stories and they would turn out to be false. She would make a friend, I would have a sleep over for the girls or she would stay at one of their houses and she would steal the girl's belongings, or threaten to kill her with a kitchen knife...whatever it would be the girls would never come back and angry parents would call. I stayed on top of it, supervised, but she was very manipulative...we started counseling etc. when by the time she was seven.
Now she is 13. Has falsely accused us of abuse twice, cuts her face, arms, legs, neck...embeds glass in her hand, goes to the bathroom in cups, the splitting is horrible - it's the only way she knows how to be, she is 'empty' and cold - emotionless or outraged - one or the other extreme...she takes huge risks...climbing on an icy roof wanting to jump, jumping into one of the Great Lakes on a stormy day and getting caught up in undertow, accused another teacher of abuse, the list goes on and on. Meanwhile our other children are getting student of the month awards, in math club, soccer, they have good friends that come from good families.
I cannot explain my daughter's behavior other than she has a mental illness and that she was most likely born with it. Puberty made it explode, but it was always there. We love her, support her, praise her talents (she is an incredible artist and writer), we signed her up for ballet when she was 3, she got kicked out, basketball in grade school, she got kicked out..., we attend school functions even though every teacher there is whispering about us - we just hold our heads up high. It is not our fault that our daughter is sick, and we will continue to fight for her, advocate for her and help her learn to cope, understand and function with her disease.

[oneflewover]

I have two theories:

Definitely yes to the idea of a spiritual malady.  No doubt in my mind that many who are afflicted with this disorder is a direct link to their shameful and sinful patterns and choices.  Because of their impulsive behaviors they are often full of regret later and are embarrassed internally.  That embarrassment is the motivation for so much of what we see in them, anger, anxiety, odd thinking, unusual perceptions, substance abuse, sexual deviance.  A masking of sorts to numb and dull the shame and guilt.      

I also feel that bpd is also an emotional developmental issue.  I think that a borderline suffers from a lack of growing up emotionally, hence why we see such child-like behaviors from them.  For whatever reasons (i.e. environmental, dysfunctional parents, trauma, abuse, etc.) they were never able to bridge that gap into adulthood which allows them to have healthy interpersonal skills.  My interactions with my ex feels like I am dealing with a child.  Two examples of this is their ability to split and their ability in magical thinking.

Let's look at splitting (a person or thing is seen as all good or all bad).  Just like a child tells their parent "I hate you" one moment and "I love you" the next.  Why the flip in sentiments?  The child is either being scolded or not given into their demands.  So their parent is either all good or all bad in their little minds.  This is never more true than with a borderline.  They read each action of people in their lives as if there were no prior context or history.

With the magical thinking (beliefs that thoughts can cause events), a child is representative of what they are doing at the time and their mood illustrates it.  If a parent leaves the child with a babysitter and that child has been left countless times before but continues to cry that is because they are unskilled at looking at the fact that their parent will and does return.  In their mind they feel scared that they won't return and so they react accordingly.  Or if a child is hungry and told that they will be eating within the hour, they don't care, they obsess over eating right then and there, cause they are hungry now.  They are in the mood, just like a borderline.  A borderline is so completely in each mood, they can't conceptualize and remembering what it's like to be in another mood.  And so the borderline projects unpleasant characteristics in the self onto others.

Because a borderline reacts "more intensely to lower levels of stress than others and to take longer to recover" is every indication to me that they lack maturity in their emotions.  They have failed to grow up and cross over into adulthood in which they are uncertain of the truth of their own feelings and their failure to master what is taught in DBT: vulnerability vs invalidation; active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart); unremitting crises vs inhibited grief.  They are children really just trapped in an adult body.

I don't know waybird, I think it really is a combination of things that are mixed together in a borderlines life that contributes to this disorder in them.

OFO

[Neal]

In my opinion it is not a spiritual problem since personality is formed before the age of accountability. I also don't think that genetics play as important of a role. Genetics would put more of the emphasis on neurotransmitters, development of the brain, etc.

In my experience, no expert either; ASPD, NPD, and BPD have always had an environmental factor. That factor might not be the parents or even anyone within their FOO. IMHO, it only takes the right circumstance at a critical moment in development and the child to continue in that pattern of response (internally) to allow it to become part of their coping mechanisms and later personality.

From my own personal life, I can identify many early developmental points at which (by happenstance, providence, or whatever) my reaction and subsequent reactions to similar lead away from PD instead of towards it. Very easily I could have reacted differently and if repeated over time it could have lead to the maladaptive behavior that we label as a personality disorder.

Nobody can follow each second a child experiences from birth to teen years. Even if we could, every individual's perception of a specific event can be different.

At least that is my take on it.


(Now I will read the replies.  )