Borderline personality disorder causes great suffering to the person with the diagnosis and those around them. Dysregulated behaviours, affect and cognition result in suicide attempts, self-harm, fractured relationships, and ‘walking on eggshells’ by those who are close. While there has been some progress in relation to treatment and is no longer viewed as a lifelong condition, better understanding of causative factors is important for clinicians working with children and families.
What do we know?
Crowell (2016) explored the interpersonal causes, correlates, and consequences of borderline personality disorder. She notes there is no single causal process but there are identifiable precursors and risk factors contributing to both appearance and maintenance of the disorder. The characteristic instability in self-concept, emotions, behaviours, and relationships, has been hypothesised to stem from inconsistency in early attachment relationships resulting in a lack of trust in caregivers as co-regulators. Physical and sexual abuse appear to be associated, especially with suicidality and self-harm, however a simple mismatch between parenting style and a child’s temperament can also increase risk if the child has hereditable vulnerabilities that render them sensitive to the care giver environments. Impulsivity and emotional sensitivity are partially hereditable, suggesting early intervention may benefit parents and reduce intergenerational transmission of distress.
She notes that while there is a growing literature exploring interpersonal correlates for both adults and adolescents there are no randomized controlled trials testing the effectiveness of couple’s therapy or clearly articulated protocols for the involvement of parents and families. She speaks to an ‘urgent need’ to understand dynamic interaction patterns between those with BPD and those who love them, to clarify actions which are experienced as supportive and soothing and skills and strategies to protect relationships. She recognizes that most research targets the individual which ‘communicates a powerful message of blame, when in fact many problems may exist within dynamic interaction patterns between persons rather than within any one person.’ While BPD traits are painful for family and friends and may fuel social isolation, relationship conflict and interpersonal distress, she also acknowledges that, research is skewed towards identification of dysfunction and no exploration of adaptive features.
Where to for clinicians?
While there is much scope for researchers the information available is invaluable to practitioners, especially those who work with children, couples, and families. We know that early childhood experiences and match between children and parenting style are worthy of attention. Assuming difficulties in one person will have consequences for the social group should encourage exploration of the patterns which connect with a view to addressing destructive guilt and blame and encouraging more effective parenting and family dynamics. Without exception, the recognition and addressing of abuse and violence is always important both now and for future generations.
Crowell SE. Biting the hand that feeds: current opinion on the interpersonal causes, correlates, and consequences of borderline personality disorder [version 1; referees: 2 approved] F1000Research 2016, 5(F1000 Faculty Rev):2796 (doi: 10.12688/f1000research.9392.1)