Borderline Personality Disorder: Answering the 'Why'

By Wasim Kakroo

BORDERLINE personality disorder (BPD) is a serious mental illness marked by erratic moods and emotions, as well as relationships and behavior. An in depth description of BPD as a mental health issue has been given in last Friday’s article in Mindful Fridays column.

BPD, like many other illnesses, is caused by a combination of factors. Actually BPD is caused by an interaction between nature and nurture. While there are three basic causes of BPD — genes, brain abnormalities, and environmental variables — they all interact to generate the condition. Let's take a closer look at each one.

Genetics: A person's genetics play a significant role in whether or not he or she develops BPD. Earlier, two or three decades ago, experts felt that adverse childhood experiences were the main cause. Though bad parenting experiences can obviously impact the development of BPD, however, genetic roots are of BPD are more powerful than most people realize.

It's self-evident that everyone is born differently. We all experience emotions at certain levels, however, some people, are born with more sensitive or emotionally fragile personalities. These people may experience emotions more intensely than others. However, just because someone is "sensitive" does not mean they will have BPD. The environment also plays a role.

Brain abnormalities: A person with BPD Abnormalities may be born with a brain that has distinct characteristics. Research has found that some parts of the brain of the people with BPD respond to emotional situations differently than other people. Your brain is on high alert if you have BPD. Things scare and stress you much more than they do other people.

The amygdala (the brain's emotional centre) and the frontal lobes (the brain’s rational centre) interact with each other to regulate behavior of a person. People with BPD have exaggerated emotional response, while the frontal lobe that governs rationality remains underactive and hijacked by amygdala especially during emotionally charged situations. Your fight-or-flight switch operated by amygdala is easily tripped, and once activated; it takes control of your reasoning brain, triggering primordial survival instincts that aren't necessarily appropriate for the situation. Thus when compared to healthy people, their brains are programmed to respond differently that is often outside of social norms.

Furthermore, people with BPD have a reduced capacity to recognize other people's facial expressions, which may contribute to social and relationship issues. Research has shown that growing up in a dysfunctional home environment where one does not learn to manage one's emotions reinforces the brain patterns and emotional responses specific to BPD.

Environmental determinants: An invalidating atmosphere is the tipping point for the development of BPD. Invalidation happens when parents or caregivers ignore or punish the child’s emotional experiences.  Consider the following scenario: When someone cries while watching a movie, friends and family may ask, 'What are you crying about?' "I don't see what the big issue is." They may have grown up with persistent criticism and dismissal. Thus a chronically invalidating environment can become a strong factor in the development of BPD.

A temperamentally sensitive child can annoy a family that is already under stress. If a child says they are hungry, they may be told that they are not. Or the child may voice their dissatisfaction with something at school, to which their parents may respond by telling them to shut up and get over it. The temperamentally sensitive child may start to feel horrible about himself and may feel unwell, mentally ill, or incapable. As such children become older, they become more self-critical and look for methods to cope, which can lead to maladaptive behaviors including eating disorders and self-injury.

Traumatic experiences, such as emotional/sexual abuse, early separation from caregivers, parental insensitivity, emotional neglect and abandonment, especially during early childhood, are the ultimate examples of an invalidating environment. As a victim, one's needs and safety are overlooked when they go through these experiences. They aren't being protected by the people around them.  These more serious situations are often the "trigger point" for the onset of BPD.

An individual's surroundings may respond to — and hence reward — emotionally driven and emotionally charged behaviors, which can reinforce difficulties. E.g., a client may observe that the only time their parents told her they loved her was when she was in the hospital after she attempted a suicide.

If you don't have the genetic makeup that makes you more prone to BPD, you might still get it if you live in a familial environment that is extremely invalidating. Similarly, some people are inherently hypersensitive but do not have BPD. It all comes down to how genes, brain activity, and the family environment interact.

The whole discussion we had today in this article may give the impression that there is nothing you can do. After all, what can you do if your brain isn't the same as everyone else's? However, the truth is that you have the ability to change your brain. You create new brain connections every time you exercise a new coping response or self-soothing approach. Some therapeutic treatments, such as mindfulness meditation, that we will discuss in the next article, next Friday, can even increase the amount of brain matter in your brain. And the more you practice, the more these routes will get stronger and more automatic.

  • The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar). He works at Kashmir Life Line, a free mental health counseling service. Author can be reached at [email protected]

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