We can say, with a very considerable degree of confidence indeed, that there exists a strong link between borderline personality disorder and childhood trauma; a large body of research has shown that individuals who have suffered childhood trauma and/or neglect are far more likely to develop borderline personality disorder (BPD) as adults than those who were fortunate enough to have experienced a relatively stable childhood.
Before we look at how borderline personality disorder and childhood trauma are linked, it is first useful to briefly describe the main symptoms of this most serious psychological disorder.
WHAT IS BORDERLINE PERSONALITY DISORDER (BPD)?
Borderline personality disorder experience a range of symptoms which are split into 9 categories. These are:
1) Extreme swings in emotions
2) Explosive anger
3) Intense fear of rejection/ abandonment sometimes leading to frantic efforts to maintain a relationship
6) Unstable self-concept (not really knowing ‘who one is’)
7) Chronic feelings of ’emptiness’ (often leading to excessive drinking/eating etc ‘to fill the vacuum’)
8) Dissociation ( a feeling of being ‘disconnected from reality’)
9) Intense and highly volatile relationships
For a diagnosis of BPD to be given, the individual needs to meet at least 5 of the above borderline personality disorder criteria.
A person’s childhood experiences have an enormous effect on his/her mental health in adult life. How parents treat their children is, therefore, of paramount importance.
A borderline personality disorder is an even more likely outcome, if, as well as suffering trauma through dysfunctional parenting, the individual also has a BIOLOGICAL VULNERABILITY.
In relation to an individual’s childhood, research suggests that the 3 major risk factors are:
– trauma / abuse
– damaging parenting styles
– early separation or loss (e.g due to parental divorce or the death of the parent)
Of course, more than one of these can befall the child. Indeed, in my own case, I was unlucky enough to be affected by all three. And, given my mother was highly unstable, it is very likely I also inherited a biological/genetic vulnerability.
EXAMPLES OF DAMAGING PARENTING STYLES:
1) Dysfunctional and disorganized – this can occur when there is a high level of marital discord or conflict. It is important, here, to point out that even if parents attempt to hide their disharmony, children are still likely to be adversely affected as they tend to pick up on subtle signs of tension.
Chaotic environments can also impact very badly on children. Examples are:
– constant house moves
– parental alcoholism/illicit drug use
– parental mental illness and instability/verbal aggression
2) Emotional invalidation. Examples include:
– a parent telling their child they wish he/she could be more like his or her brother/sister/ cousin etc.
– a parent telling the child he is ‘just like his father’ (meant disparagingly). This invalidates the child’s unique identity.
– telling a child she or he shouldn’t be upset over something, therefore invalidating the child’s reaction and implying the child’s having such feelings is inappropriate.
– telling the child he or she is exaggerating about how bad something is. Again, this invalidates the child’s perception of how something is adversely affecting him or her.
– a parent telling a child to stop feeling sorry for him or herself and think about good things instead. Again, this invalidates the child’s sadness and encourages him/her to suppress emotions.
Invalidation of a child’s emotions, and undermining the authenticity of their feelings, can lead the child to start demonstrating his/her emotions in a very extreme way in order to gain the recognition he/she previously failed to elicit.
3) Child trauma and child abuse:
People with BPD have very frequently been abused. However, not all children who are abused develop borderline personality disorder due to having a biological/genetic RESILIENCE and/or having good emotional support and validation in other areas of their lives (e.g. at school or through a counsellor).
The trauma inflicted by a family member has been shown by research to have a greater adverse impact on the child than abuse by a stranger. Also, as would be expected, the longer the traumatic situation lasts, the more likely it is that the child will develop borderline personality disorder in adult life.
4) Separation and loss:
Here, the trauma is caused, in large part, due to the child’s bonding process development being disrupted. Children who suffer this are much more likely to become anxious and develop ATTACHMENT DISORDERS as adults which can disrupt adult relationships and cause the sufferer to have an intense fear of abandonment in adult life. They may, too, become very ‘clingy’, fearful of relationships, or a distressing mixture of the two.
Borderline Personality Disorder (BPD) Statistics, Facts and Figures :
– about three-quarters of those who suffer from BPD have a history of self-harm
– about 10% of those who suffer from BPD eventually commit suicide
– the majority of those who suffer from BPD improve over time (over 70% go into long-term remission).
– about 50 -60% of those with BPD have a history of having been sexually abused
– one of the main hallmarks of BPD is severe dissociation
– a diagnosis of BPD does not define the person nor detract from their positive qualities
– psychotherapy, especially Dialectical Behaviour Therapy (DBT), has been shown by studies to be the most effective treatment
– if a person suffers from BPD, s/he is likely to have other mental health issues that run alongside it (known as co-morbidities). Often, these other conditions include depression, psychotic symptoms and bipolar disorder
– about half of those who suffer from BPD have experienced a history of having been the victim of violence
– about 1% of the population suffers from BPD; whilst it is just as likely to affect men as women, the condition is under-diagnosed in men who are more likely to become caught up in the justice system or to use substance abuse services instead of having their BPD directly addressed.
Neuroimaging And Borderline Personality Disorder (BPD) :
Are the brains of people with borderline personality disorder (BPD) physically different from the brains of those without BPD? Neuroimaging techniques can help to answer this question.
What Is Neuroimaging?
Neuroimaging incorporates various techniques which take images of the brain’s structure and functioning. However, there is controversy surrounding just how accurately such images may be interpreted.
Neuroimaging techniques include :
- Magnetic resonance imaging, or MRI (this technique uses magnetic fields and radio waves to produce two or three-dimensional images of the brain).
- Positron emission tomography, or PET (this technique also produces two or three-dimensional images by measuring emissions from radioactive chemicals that have been injected into the bloodstream)
- Magnetoencephalography (this technique measures the magnetic fields produced by electrical activity in the brain).
Meta-analysis Of Neuroimaging Studies Relating To Borderline Personality Disorder (BPD) :
Researchers at the University of Freiburg (2006) conducted a meta-analysis (an overarching analysis of relevant, previously published studies) of all the research to date (i.e. 2006, see above) relating to BPD and neuroimaging.
They found that all of these studies found abnormalities in :
- the limbic system (a region of the brain involved in generating emotions including fear, anger and those connected with sexual behaviour, the formation of memories, especially memories connected with intense emotions)
- the frontal lobes (a region of the brain involved in functions including understanding the consequences of actions, decision making, the regulation (control) of emotions and the suppression of unacceptable social impulses (including impulsive aggression).
These abnormalities in these two regions of the brain, given the functions of those regions, are consistent with symptoms found in individuals suffering from BPD. It can, therefore, be inferred that the limbic system and frontal lobes are involved with the disorder.
However, research (at the time of writing) is not advanced enough to enable actual diagnosis of BPD using neuroimaging techniques.
Common Misunderstandings About Borderline Personality Disorder :
Due to the fact that borderline personality disorder (BPD) is a highly complex condition, there are, notoriously, many misunderstandings and misconceptions surrounding the true nature of this extremely serious psychiatric illness; they include the following :
1) The condition is untreatable – unfortunately until relatively recently, many of those working in the field of mental health regarded BPD as essentially untreatable. It is very sad that this meant a lot of individuals were left to suffer extreme distress which could, with proper treatment, have been alleviated.
Fortunately, there is now much research showing that, in fact, treatment can be very effective for those suffering from BPD. Other therapies for BPD, include :
- Mentalization-Based Therapy (MBT)
- Intensive Short-Term Dynamic Therapy
- Dynamic Deconstructive Therapy (DDT).
Indeed, approximately three-quarters of those who receive proper treatment will improve so significantly that they no longer meet the criteria to be diagnosed with BPD.
2) Stigmatization – It is true that there is still a significant stigma surrounding the diagnosis of BPD, but things are improving.
It used to be the case that many mental health professionals even refused to work with BPD sufferers because they were regarded as too difficult and challenging. This situation has greatly improved due to the much better understanding that now exists surrounding what compels BPD sufferers to behave the way they do and how this behaviour is very often linked to intense feelings of distress and having suffered a deeply painful childhood.
3) Diagnosis – In the past, psychiatrists frequently did not even like to diagnose their patients with BPD because they did not wish to stigmatize them. Again, now, with the accruing of much greater understanding and knowledge about both the causes and true nature of the condition, psychiatrists are not so likely to be deterred from diagnosing the illness.
There is, in fact, a great value in receiving a correct diagnosis of BPD, as it allows the sufferer to understand the source of his/her difficulties and what may have caused them (click here to read my post about the link between childhood trauma and the subsequent development of BPD,) therefore making it far more likely that these difficulties can be effectively addressed. Learning about one’s illness and its likely causes means that an individual no longer needs to fight it with ‘one hand tied behind their back’
4) The misconception that those who suffer from BPD are deliberately manipulative – it used to be claimed by some that individuals with BPD had a tendency to be deliberately manipulative. In fact, however, when BPD sufferers become intensely angry, for example, or otherwise ‘act out’. it is generally the case that such behaviour is impulsive, spontaneous and completely unplanned.
Indeed, because one of the symptoms of BPD is an impaired understanding of how social interaction operates, they are unlikely to have the necessary skills to plan out the intricacies of how to approach others in a manipulative and self-serving way.
5) The misconception of ‘attention-seeking’ suicide attempts – the fact of the matter is, an absolutely astounding ten per cent of individuals with BPD ultimately end their lives by suicide. THIS SUICIDE RATE IS ONE THOUSAND TIMES GREATER THAN IN THE GENERAL POPULATION IN THE UK! That statistic speaks most eloquently for itself, I think. Given this horrendous figure, one is left wondering, and deeply bewildered, as to why those with BPD do not demand MUCH MORE ATTENTION, LEFT AS THEY ARE, SO OFTEN, TO FEND FOR THEMSELVES WITH NO PROPER MEDICAL INTERVENTION.
Study Shows 73% Recover from Borderline Personality Disorder (BPD):
Until recently, it was frequently suggested that borderline personality disorder (BPD) was very difficult, if not impossible, to treat. During my research for this article, I have been disturbed to discover, also, that in the recent past some clinicians did not regard BPD as an illness at all – instead, they put forward the view that those diagnosed with BPD were not mentally disordered, but, rather, simply ‘bad’ and ‘manipulative’ people!
This reminds me of a time I made a very serious and determined suicide attempt and the psychiatrist I saw afterwards (who knew very little about me) tried to make the case that I had not really intended to kill myself but was seeking attention and sympathy. When I protested and tried to explain the attempt had been made very much in earnest (one might even say, ‘deadly earnest), he responded (and I quote him verbatim: ‘It sounds like you’re talking bullshit to me!’
In connection with the cynical and deeply insulting attitude that my psychiatrist displayed, I would also point out that, in my own personal view, some individuals (in my case, certain family members and former friends) like to take the view the BPD sufferer is not really ill as this, in their minds, absolves them of any responsibility to provide help and support.
Despite such pessimism, a study funded by Columbia University found that 73.5% of the participants who took part in their study recovered from BPD within 6 years. Even more encouragingly, it was found in the same study that more than half actually recovered within just 2 years.
Another encouraging finding of the study was that only 6% of those who had recovered relapsed (and, even if they did, this was mainly due to the effects of an extremely stressful event/s).
FURTHER RESULTS FROM THE STUDY :
– 1.4% of the participants committed suicide in the first 2 years of the study
– 1.7% of the participants committed suicide in the next 2 years of the study
– 0.7% of the participants committed suicide in the final 2 years of the study
(This gives a total of 3.8%, or about 1 in 25, who committed suicide during the study).
– 65.9% achieved good psychological functioning by the end of the study (32.4% after 2 years, 48.3% after 4 years, 65.9% by end of study).
SPECIFIC SYMPTOMS THAT IMPROVED IN THE INDIVIDUALS IN THE STUDY :
– Impulsiveness (this symptom improved best of all)
– Mood/affect (although this improved least well)
– Interpersonal functioning
– Suicidal behaviours
– Psychotic symptoms
The study also showed that the two factors which most helped the individuals to recover were :
1) Ending a destructive relationship
2) Determination to get well.
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David Hosier BSc Hons; MSc; PGDE(FAHE).