Although most people who are diagnosed with borderline personality disorder (BPD) report having experienced childhood trauma, this is not invariably the case (although, of course, just because a person does not report having suffered childhood trauma does not mean s/he didn’t experience it. For example, s/he could be in denial, may have suppressed or repressed memory of the trauma or may have been too young to have stored the trauma in conscious memory).
However, it is also the case that not all of those who suffer childhood trauma go on to develop BPD. This means that there must exist individual differences which make some vulnerable to developing BPD whilst making others resilient.
In order to help cast light upon this, various diathesis-stress models have been proposed and below I summarize three of the most important ones. But, first, let’s define what is meant by a diathesis-stress model:
According to the APA Dictionary Of Psychology, a diathesis-stress model is: ‘a theory that mental and physical disorders develop from a genetic or biological predisposition for that illness (diathesis) combined with stressful conditions that play a precipitating or facilitating role. Also called a diathesis-stress hypothesis, or paradigm or theory’.
THREE IMPORTANT THEORIES ABOUT WHY CERTAIN INDIVIDUALS DEVELOP BPD (ALL BASED UPON THE DIATHESIS STRESS MODEL
- The Schema-Focused Therapy Model (Young et al., 2003):
According to this theory, dysfunctional family characteristics such as rejection and deprivation prevent the child from having his/her core emotional needs met which, in turn, leads to frustration.
These frustrations then lead to the child developing ‘maladaptive schema.’ Young defined ‘maladaptive schema’ as:
‘a broad pervasive theme or pattern regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.’
Information is then processed via the lens of these dysfunctional schemas and it is this distorted informational processing which lies at the heart the BPD sufferer’s maladaptive cognitions, behaviours and emotional reactions, according to Young’s theory.
Core emotional needs include :
- the development of autonomy
- the development of identity
- the development of competency
- the development of a sense of secure attachment to others
- the freedom to express valid needs and emotions
- realistic limits
- spontaneity and play (Young and Klosko, 2005).
An example of a dysfunctional schema that might result from childhood trauma (e.g. rejection and betrayal) is: ‘nobody can ever be trusted.’
Children who are most at risk of being significantly psychologically damaged by the behaviours of the dysfunctional family are those children who are emotionally temperamental due to pre-existing biological/genetic influences, according to this theory.
2. Dialectical Behavior Therapy Model (Linehan, 1993a):
According to Linehan’s theory, children are at risk of going on to develop BPD if they are temperamental, highly sensitive, emotionally vulnerable and predisposed to emotional dysregulation (diathesis) AND ALSO grow up in an environment which is invalidating and dismissive/undermining of the child’s personal experience (stress).
3. Transference Focused Therapy Model (Kernberg, 1984):
According to Kernberg, children who are highly prone to negative emotions, especially aggression (diathesis) and experience certain environmental factors such as emotional frustration (stress) may, as a consequence, develop the dysfunctional defence mechanism known as ‘splitting’ and it is this that underlies the development of BPD. According to the APA Dictionary Of Psychology, ‘splitting’ is defined as:
‘…a primitive defence mechanism used to protect oneself from conflict, in which objects [i.e. person’s] provoking anxiety and ambivalence are dichotomized into extreme representations (part-objects) with either positive or negative qualities, resulting in polarized viewpoints that fluctuate in extremes of seeing the self or others as either all good or all bad.’
THERAPIES RELATED TO THE ABOVE MODELS
You may wish to read my previously published articles about the therapies relating to each of the above models which I list below:
- Schema-Focused Therapy
- Dialectical Behavior Therapy
- Transference Focused Therapy
Kernberg, O. F. (1984). Severe personality disorders. New Haven, CT: Yale University Press.
Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press; 1993.
Young, J. E. , & Atkinson, T. (2003). The young atkinson mode inventory. New York, NY: Schema Therapy Institute.
Young. J.E.,Janet S. Klosko and Marjorie E. Schema Therapy: A Practitioner’s Guide Weishaar New York: Guilford Press, 2003.
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David Hosier BSc Hons; MSc; PGDE(FAHE).