We have seen from other articles I have published on this site that if we suffered significant and protracted childhood trauma we are, as adults, at increased risk of developing borderline personality disorder (BPD).

Many specialists in the field are of the view that of all psychiatric conditions, BPD causes its sufferers the greatest amount of mental pain and anguish – indeed, this is borne out by the generally accepted statistic that approximately 1 in 10 BPD sufferers will eventually kill themselves.

It is particularly tragic, therefore, that it seems that there still exists a great deal of prejudice towards BPD sufferers. And I don’t just mean amongst lay-people who lack understanding of, and education about, the condition, but also amongst those who should know better : namely those who work within the medical profession itself and are responsible for their care and safety.

This unfortunate state of affairs is exacerbated further when one considers that many BPD sufferers have been demonized throughout their lives (including, often, by one or both of their parents) and have come to internalize such demonization, seeing themselves as intrinsically and irredeemably ‘bad’ ; so to meet with similar disparaging attitudes amongst those to whom one turns, often in absolute desperation, for support can be devastating and can potentially tip BPD sufferers over the precipice (most BPD sufferers are perpetually living their lives on the edge of said precipice most, or all, of the time).

RESEARCH PROVIDING EVIDENCE OF STIGMATIZATION OF BPD SUFFERERS WITHIN THE MEDICAL PROFESSION :

STUDY 1 :

Reseachers (Black et al.) surveyed 706 clinicians who were responsible for treating BPD patients and found that a large minority expressed a preference not to work with such patients.

STUDY 2 :

An Italian study (Lanfredi et al.) investigated caring attitudes towards BPD sufferers amongst 860 mental health professionals (these included social workers, educators working in social health, nurses, psychiatrists and psychologists). It was found that :

• nurses and social workers scored significantly lower on caring attitudes towards BPD sufferers than psychologists, psychiatrists and social health educators.
• those mental health professionals who had more years experience in mental health and those who had had training in working with BPD patients, overall, scored higher in terms of their caring attitudes towards BPD sufferers compared to those with fewer years of experience / no training in working with BPD sufferers.

The researchers who conducted the above study concluded that training in working with BPD sufferers should be targeted at those clinicians who are less experienced and professional groups for whom such training is less accessible.

STUDY 3 :

A study carried out by Imbeau et al., looked at the attitude of General Physicians and Family Medicine Residents towards patients with a BPD diagnosis.

In total, the study involved 35 General Physicians and 40 Family Medicine Residents. Their attitudes towards their BPD patients was measured using the ATTITUDES TOWARD PEOPLE WITH BPD SCALE (ABPDS; Bouchard, 2001).

This scale is divided into 2 subcales :

SUBSCALE ONE : COMFORT WHEN INTERACTING WITH SOMEONE WHO HAS BPD.

SUBSCALE TWO : POSITIVE PERCEPTIONS ABOUT BPD.

It was found that the attitudes of General Physicians towards people with BPD was similar to the attitudes of mental health professionals towards people with BPD.

However, it was also found that Family Medicine Residents’ attitudes towards people with BPD were less positive than the attitudes displayed by General Physicians and mental health professionals.

Furthermore, and reinforcing the findings of Lanfredi et al’s study, it was found that less experienced clinicians had less positive attitudes towards BPD sufferers than their more experienced colleagues.

This also serves to emphasize the conclusion drawn from Lanfredi et al’s study, namely that training of clinicians dealing with people with BPD needs to be a key focus to help ensure these highly vulnerable and anguished patients receive the treatment they deserve.

STUDY 4 :

A Spanish study (Castell) also found negative attitudes within the medical profession and, like the studies cited above, also stressed the importance of training such mental health professionals so that the gain a better understanding of the causes of, nature of, and treatment for borderline personality disorder.

OTHER USEFUL ARTICLES :

You may also wish to read my previously published articles about dialectical behavior therapy, other treatment options for BPD , BPD and psychodynamic therapy and BPD and remission.

eBook :

Above eBook now available on Amazon for instant download : CLICK HERE.

David Hosier BSc Hons; MSc; PGDE(FAHE).

When I was young, my mother seemed to derive an odd sense of satisfaction (one hesitates to use the word ‘pleasure’) from my emotional distress. At such times, I see now, her fundamental motivation to comfort me (by talking to me, never in a tactile way by hugging etc.) was to make herself feel needed, of value, powerful, in control and superior to my own ‘inadequacy’.

Indeed, I can now see that she would deliberately induce states of distress in me so that she could then play the role of a nurturing mother ; she seemed to enjoy, and derive satisfaction from, toying with my emotions – repeatedly ‘breaking’ me in order to afford herself the opportunity of ‘fixing’ me – rather as a cat might enjoy and derive satisfaction from toying with a mouse by repeatedly catching it and letting it go only so it could catch it again…and so on…and so on…

This gave her complete control and absolute power over me ; once she had reduced me to a desperate and pleading display of tears by subjecting me to her unbounded rage and name-calling, and then left me to suffer for a while (often by giving me the silent treatment ),

I would be pathetically grateful, submissive and pliable when, at a time of her choosing, she deigned to ‘forgive’ me and play (for short while until the cycle repeated itself) the ‘magnanimous’ mother (on more than one occasion, it comes back to me now while writing this) by administering to me whisky in warm milk and half of one of her valium).

In short, playing the nurturing’ mother wasn’t about making me feel good – it was about making herself feel good about herself.

However, I have never mentioned this particular aspect of my mother’s behavior to anyone for fear of sounding ungrateful and cynical. After all, as many who have suffered childhood trauma will know all too well, even our most patently reasonable and self-evidently justifiable objections to our upbringing can be, and frequently are, invalidated by others (for myriad reasons – e,g. see my articles How Narcissistic Mothers Can Invalidate Us ; my article, BPD, Effects Of Biparental Dysfunction And Invalidation and also my article about gaslighting) compunding the effects of our trauma and intensifying our irrational feelings of shame.

I was heartened, therefore, to come across the work of Masterson and Rinsley (1975). They theorize that mothers can cause psychopathology in their children, later leading to the development of borderline personality disorder (BPD), by preventing them from undergoing the separation-individuation process (see also my article on ‘enmeshment’).

They prevent their children going through this process, according to Masterson and Riley, by encouraging them to be dependent. They encourage this dependency, according to the theory, as it gives them (i.e. the mothers) a sense of pride, satisfaction , gratification and self-esteem. It is further theorized that they achieve this by positively reinforcing the child’s ‘needy’ and ‘clingy‘ behavior whilst discouraging any signs of the child creating an independent, autonomous life for him/self. This then has the effect of preventing him/her from breaking away from her and forming his/her own idenity

Indeed, tangetially related to the idea of certain types of mothers (especially narcissistic mothers) not wanting their child to form his/her own sense of identity, I recall that my own mother would frequently take it as almost a personal affront if ever I tried to change the subject from talking about her life (normally her ‘boyfriend troubles’) to talk, even for a short while, about any of my own intersests (at the time these were meteorology and magic tricks ; I often think now that it is no co-incidence that the former involved trying to understand a chaotic and difficult to predict system, whilst the latter involved developing ‘special powers’ to make the ‘impossible’ happen, like making things ‘disappear’ – no prizes for guessing what these things almost certainly symbolized in my unconscious).

But back to Masterson and Risley. The researchers state that such maternal behavior (i.e. rewarding the child’s dependence whilst punishing him/her – or, at least, withdrawing approval – when s/he attempts to gain mastery, independence and self-sufficiency) is frequently most prevalent during the developmental stage of the child when psychological and social influences are at their most potent in relation to instilling in him/her a need to become independent, thus creating maximum conflict in the child’s mind.

David Hosier BSc Hons; MSc; PGDE(FAHE).

When a child is born into the world, s/he is utterly helpless and dependent upon his / her mother, and, in the early days of life, as long as his / her mother is present and sufficiently responsive to his / her needs, the baby is able to feel relatively safe, content and secure.

However, when the mother is absent, the baby quickly becomes panicked and distressed (as s/he has no way of knowing for certain that the mother will return.

As the baby develops, though, and continues to receive at least adequate nurturing from the mother, s/he becomes more able to tolerate periods of time when the mother is not present, especially if s/he is able to derive some compensatory comfort during such periods from objects such as soft toys and dummies. This is possible because s/he has managed to internalize the emotional nourishment s/he has previously received from the mother in such a way as to protect him/herself from developing overwhelming feelings of insecurity during temporary, maternal absences.

A metaphor that helps to elucidate this process is that of the ‘leaky cup,’ If an infant has received adequate ’emotional nourishment’ from the mother during the very early part of his/her life, s/he will have a good store of this nourishment in his/her (metaphorical) cup, and, during separations from the mother, the nourishment will only slowly ‘leak out of the cup.’ In other words, the infant is able to draw on this ‘nourishment’ during ephemeral periods of maternal absence as the store is reasonably voluminous and enduring.

However, in the case of an infant who has received inadequate nurturing from his mother during his/her early life, his/her ‘cup of emotional nourishment’ will be far less full than the relatively secure infant’s cup, and, what’s more, far ‘leakier’. Such a poorly cared for infant, then, will have an insufficient supply of previously stored emotional nourishment upon which to draw and is liable to become highly distressed as a result of even very brief periods of maternal absence (in terms of Bowlby’s theory, the infant is ‘insecurely attached’ to the mother).

Putting it simply, then, the nurtured infant can be viewed as adequately ‘full’ in terms of ’emotional nourishment’, whereas the neglected infant can be viewed as nearly ’empty’ in terms of such maternal nourishment.

As the neglected / empty child grows (assuming this lack of emotional nourishment is not somehow corrected, s/he will then, of course, eventually become an adult who also feels a pervasive sense of emptiness, especially if the extent of his/her childhood neglect has led him/her to develop borderline personality disorder (BPD) or complex posttraumatic stress disorder (complex PTSD).

In such cases, this feeling of ’emptiness’ can lead to severe and chronic psychological suffering and anguish.

It has been hypothesized, therefore, that these feelings of emptiness (one hallmarks of BPD, as alluded to above) are intimately connected to another frequent symptom of the disorder, namely that of impulsive thrill-seeking and risk-taking.

In short, in a desperate (and, ultimately, of course, futile) attempt to rid him/herself of intolerably painful feelings of emptiness,the BPD is exquisitely vulnerable to developing an array of risky, self-destructive addictions, including drug-taking, alcoholism, chain-smoking, gambling and self-harm.

Currently, one of the most effective treatments for BPD available is dialectical behavior therapy.

David Hosier BSc Hons; MSc; PGDE(FAHE).

GENES, ENVIRONMENT AND BORDERLINE PERSONALITY DISORDER (BPD) :

Studies have been conducted that suggest that parents suffering from borderline personality disorder (BPD) may pass on certain genes to their children that predispose them to impulsive behavior and emotional volatility.

For example, a study conducted by Distel et al. (2007) suggested that the genetic component (heritability) of BPD is about 42%, whilst a study conducted by Torgersen (2000) put them figure even higher, at 69%.

Of course, this does not mean there is a ‘gene for BPD’, but, rather, the findings suggest that certain temperamental features of an individual that are passed on genetically may increase a person’s RISK of developing BPD in later life. However, whether or not this person does develop it will depend upon the QUALITY OF THE ENVIRONMENT, WITH PARTICULAR REFERENCE TO TREATMENT BY PRIMARY CARERS, IN WHICH S/HE GROWS UP and how this INTERACTS with any genetic vulnerability to the disorder s/he has inherited.

Clearly, too, it should be noted that, as the disparity between the two percentages shows (42% and 69%), trying to quantify the heritability of disorders like BPD is a far cry from being an exact science.

MOTHERS WITH BPD :

Of course, if the mother of a child has been diagnosed with BPD, not only may her child have inherited certain temperamental characteristics (see above) that predispose him/her to developing the same disorder in later life, but, additionally, the mother may also create an environment for the developing child that compounds any genetically inherited propensity s/he may be harbouring for later being diagnosed with BPD him/herself.

Dysfunctional maternal behaviors towards the child that may increase his/her risk of developing psychopathology in later life include rejection, inconsistency (e.g oscillating between idealizing and demonizing the child) , hostility, invalidation, ’emotional incest’ and other forms of emotional abuse.

And, if the child is, by temperament, emotionally labile, his/her responses to the BPD mother’s unstable and unpredictable behavior may serve to create a vicious-cycle of mother-child interaction.

As a result of this, the child may start displaying severe problems relating to mood (e.g. depression and anxiety) and behavior (e.g. aggression, self-harm and hypervigilance).

PROTECTIVE FACTORS :

Children who may have inherited personality traits which increase their risk of developing BPD in later life may be protected from this most undesirable fate by consistently receiving affectionate, loving and accepting nurturing. If this is not forthcoming, therapeutic intervention (e.g. family therapy or dialectical behavior therapy) can be of substantial benefit.

David Hosier BSc Hons; MSc; PGDE(FAHE).