What Causes Borderline Personality Disorder?

[David Baxter]

What Causes Borderline Personality Disorder?
Florida Borderline Personality Disorder Association
November 25, 2008

What causes borderline personality disorder? Almost 30 years ago, James Masterson, MD wrote in From Borderline Adolescent to Functioning Adult: The Test of Time:

The developmental cause of the fixation of the borderline ego is to be found in the mother’s withdrawal of her libidinal availability (that is, of her libidinal supplies of approval, affection and love) as the child makes efforts to separate-individuate during the rapprochement subphase (15-22 months).

But in the early 1990s, Marsha Linehan, PhD developed a treatment for borderline personality disorder called dialectical behavior therapy (DBT) and she had a different take on what “caused” BPD. She writes in Cognitive Behavioral Treatment of Borderline Personality Disorder:

DBT is based on a biosocial theory of personality functioning. The major premise is that BPD is primarily a dysfunction of the emotion regulation system; it results from biological irregularities combined with certain dysfunctional environments, as well as from their interaction and transaction over time. The characteristics associated with BPD are sequelae of, and thus secondary to, this fundamental emotional dysregulation. Moreover, these same patterns cause further deregulation. Invalidating environments during childhood contribute to the development of emotion dysregulation; they also fail to teach the child how to label and regulate arousal, how to tolerate emotional distress, and when to trust her own emotional responses as reflections of valid interpretations of events.

It’s important to remember that when someone receives a diagnosis of BPD, that there should be no reason to focus any blame on parents or other caregivers. It’s also vital not to blame the person with the diagnosis of BPD. Unfortunately, there’s often an overwhelming tendency to find fault when people may be frightened or angered by some of the symptoms of borderline personality disorder. Without a doubt, persons suffering from a severe mental illness deserve compassion and appropriate care—not only from professionals—but from family members and friends, too.

As in all mental illness, clinicians have to be very careful about casual attributions, negotiating between the dangerous shoals of blaming the family and blaming the patient. — Harriet Lefley PhD

[amastie]

Another article that especially touches my heart.

Having said in a separate thread that Hypochondria would be to me one of the hardest disorders to live with, it's a toss-up with BPD, and I think that BPD "wins" out because those with this disorder are so often self-injurious.

I had a particular avesion to the idea of BPD. It was once suggested that I might be "borderline" but I'm not sure if it was meant that I was BPD. After many years and many (most often excellent) psychiatrists, I've been told that it doesn't fit me at all. I was relieved because it carries such a heavy weight of prejudice among all the forms of mental illness - probably because the acting out of someone with BPD pushes others away so stroingly, a combination of great need and volatility.

Then I met my first BPD friend. Getting to know her, I learned how much courage it takes to bear each day when you have BPD. I learned very much from her. I even learned from her to better understand another person with whom I was (and am) estranged when she explained in her typically intelligent and inclusive way how someone can need to hold onto anger because it empowers them in their daily life. She was, and is, full of vibrancy, understanding and enormously creative skill.

My perception of BPD changed when I met my friend. Our lives rarely touch now. We live far apart and, anyway, our individual "issues" keep us both busy

I wish her well always.

Again, David, you have included an article that reaches out to those who are not often granted the priviledge of being truly heard and respected.

I don't mean in any way to say that other forms of mental illness are "easy" to live with. Far from it. And I speak only from my own experiences of these things, but I was so glad to see this article tonight as well.



amastie