What is Borderline Personality Disorder (BPD)? Part 1: The Science & Development Part 2: Presentation & Treatment
- Lisa Shouldice
- 2 days ago
- 4 min read
I am a trauma specialized psychotherapist of over 20 years experience. Psychotherapists do not diagnosis, but can be trained and educated to support the treatment and management, as well as facilitate the healing of abuse &/or relational trauma, related to the BPD experience.
I have learned that BPD is, at least in part, an attachment disorder that begins to develop in childhood and formative years. Is Attachment new for you? Attachment Theory Attachment Series Blog
Borderline Personality Disorder (BPD) also has a physiological, genetic component that is really important in understanding and treating/managing it.
What is Borderline Personality Disorder (BPD)? Part 1:
Borderline Personality Disorder: Definition
The Diagnostic and Statistical Manual (DSM) that is used to diagnosis mental health concerns defines Borderline Personality Disorder as:
The 9 Diagnostic Criteria
Fear of Abandonment: Frantic efforts to avoid real or imagined abandonment.
Unstable Relationships: A pattern of intense, turbulent relationships that shift between extremes of idealization and devaluation (often called "splitting).
Identity Disturbance: A markedly and persistently unstable self-image or sense of self.
Impulsive Behavior: Engaging in self-damaging acts in at least two areas, such as reckless driving, unsafe sex, substance abuse, binge eating, or overspending
Self-Harm or Suicidality: Recurrent suicidal behavior, threats, gestures, or self-mutilating behavior.
Affective Instability: Rapid and intense mood swings or emotional reactivity, with episodes typically lasting a few hours and rarely more than a few days.
Chronic Emptiness: Persistent, deep feelings of emptiness or worthlessness.
Intense Anger: Inappropriate, intense anger or trouble controlling temper, including frequent physical fights or constant bitterness.
Stress-Related Paranoia or Dissociation: Transient, stress-induced paranoid thoughts or severe feelings of unreality and detachment.
What stands out for me, as a clinician, is affect regulation and abandonment fears, including how abandonment fears impact relationships. We will talk more about presentation or how BPD shows up in Part 2.
For those of you who have read about Attachment Styles, this may sound similar to Anxious Attachment Style and there certainly is overlap. However, think of BPD as far further along on the continuum, abandonment fears more extreme as well as only one of the other symptoms, seen above.
Borderline Personality Disorder: Causes
I am a big believer in the Diathesis Stress Model. This relates to the Nature-Nurture debate. Are we born with the genetic vulnerability for BPD? Or is it one of many possible responses to a personal trauma history?
The Diathesis Stress Model says, Yes, there is a genetic component to BPD (40-60% of those diagnosed) and this vulnerability is triggered and characteristics develop due to extreme stressful factors in a person’s environment. Trauma is reported by up to 90% of those diagnosed.
The tricky part? Not everyone responds to trauma the same way. There are myriad of ways we respond to trauma. Trauma Series Blog
Why? Temperament and related neurobiology. An independent introvert vs. an extrovert with high social/connection needs (Myers-Briggs) will respond very differently to relational trauma. Which precedes the other? Is there really a way to know?
Whatever the cause, brain function is a big part of this experience. This is due to neuroplasticity. Whether trauma causes the brain to wire so these symptoms develop and are expressed, or genetics cause this brain structure, the result is:
1. an overactive amygdala, the memory/feelings part of our brain. This means huge feelings come up and linger often.
2. an underactive neocortex, the logic part of the brain. This means our Wise Mind is offline when having a huge feeling.
3. a smaller hippocampus, the memory creating part of the brain. This means stressful and emotional memories are not properly processed or contextualized. Check Out the Research
The brain can be rewired and even change structurally through trauma treatment. This will be discussed in Part 2.
Borderline Personality Disorder: Development, Attachment and Trauma
Most people who develop the symptoms/characteristics of BPD report a personal trauma history. They are more likely to have family members that have mental health issues as well.
This usually includes sexual, physical &/or emotional abuse. This can also include neglect and unstable, inconsistent or even dangerous primary attachment figures.
Why does trauma cause the mental health symptom cluster we call Borderline Personality Disorder?
This is due to changes trauma causes in the brain and body, referred to above in the Causes part.
Trauma causes Central Nervous System overload that overtaxes its capacity. Not once, but continuously, overtime. This causes CNS activation often. The fight/flight/faun response that activates when we are in danger helps cause affect regulation struggles. A child cannot learn healthy affect regulation in a home they are simply not safe in.
When trauma happens under extreme emotional situations while we are developing in childhood, it results in brain structure differences.
The main pieces include an overactive danger response within the amygdala and an underdeveloped hippocampus so memories are not properly processed.
This results in unprocessed trauma, resulting in trauma symptoms Trauma Series Blog. It means the child is set up to struggle with huge, overwhelming feelings that do not get properly processed throughout their adult life, compounding trauma symptoms.
BPD symptoms frequently begin showing up in the teenage years, often with high-risk behaviour and poor affect regulation. This is really hard so this teenage experience can include self-harm, a highly addictive and unhealthy coping practice.
Why the teenage years? The development of the emotional parts of the brain is faster in a teenage brain than the neocortex or logical part (develops by age 25). So being a teenager is emotionally intense, even more so when we add a personal trauma history or unsafe family life into the mix.
Stay tuned for Part 2: Personal presentation or how BPD shows up and how to get Treatment.
Lisa S.
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