Borderline Personality Disorder (BPD) is a life-changing mental disorder that affects up to 2% of adults (Psychology Today, 2017). Its most common and visible symptoms include frequent mood changes, injurious and suicidal tendencies, problematic interpersonal relationships and unstable behavioral patterns (Psychology Today, 2017). Other symptoms include unjustified feelings of abandonment, careless, impulsive and dangerous behavior (e.g. substance abuse, unsafe sex, uncontrollable eating, spending sprees etc.), extreme mood changes with each episode lasting up to several days, inability to control one’s anger, distorted self-image and intense emotional responses to apparently minor events.
For example, people who suffer from BPD may get extremely angry and / or anxious over brief separations from their close friends, family members and partners, i.e. anyone to whom they feel close. From a theoretical perspective, the causes and symptoms of BPD can be interpreted in many different ways, depending on which personality theory one chooses to embrace. Psychoanalytical theory, for example, places special emphasis on people’s childhood experiences. Social cognitive theory, on the other hand, rests on the assumption that behavior is influenced by people’s expectations about the world and other people.
Borderline Personality Disorder (BPD) is a life-changing mental disorder that affects up to 2% of adults (Psychology Today, 2017). Its most common and visible symptoms include frequent mood changes, injurious and suicidal tendencies, problematic interpersonal relationships and unstable behavioral patterns (Psychology Today, 2017). Other symptoms include unjustified feelings of abandonment, careless, impulsive and dangerous behavior (e.g. substance abuse, unsafe sex, uncontrollable eating, spending sprees etc.), extreme mood changes with each episode lasting up to several days, inability to control one’s anger, distorted self-image and intense emotional responses to apparently minor events.
For example, people who suffer from BPD may get extremely angry and / or anxious over brief separations from their close friends, family members and partners, i.e. anyone to whom they feel close. Being BPD a pervasive mental disorder that makes it nearly impossible for patients to regulate their emotions, its impact on their everyday life, career, sense of identity, family members and long-term plans is usually enormous. In addition to that, people with BPD display high rates of self-harmful behavior (especially cutting), co-occurring mental disorders (especially eating disorders, anxiety-related disorders and substance abuse) and, last but not least, suicide attempts (Psychology Today, 2017). Interestingly, BPD is more common among women than men and its most devastating symptoms tend to weaken as patients get older.
From an etiological point of view, BPD is believed to stem from a combination of environmental and biological / genetic factors – even though its exact causes are yet to be unveiled. Research has revealed that a significant percentage of people with BPD have experienced neglect, separation and / or abuse as children, and that 40% to 70% of patients have been sexually abused, in most cases by a non-caregiver (Psychology Today, 2017). In other words, early traumatic experiences and environmental stress play a key role in triggering BPD by activating certain neurological mechanisms which are known to promote aggressive behavior, impulsivity, severe mood swings, anger and negative emotional states.
Interestingly, research has revealed that a significant percentage of people with BPD have a close family member who also suffers from the disorder, which clearly suggests that similarly to other psychiatric disorders, BPD is also hereditary (NIMH, 2016). In an attempt to determine whether and to what extent biological factors contribute to the onset of BPD, Lis et al. (2007) reviewed a wide range of previous studies on the matter. The researchers identified a particular study which revealed that patients with BPD have slightly smaller neurological structures than people who do suffer from BPD.
This is especially true for the amygdala, a section of the brain that plays a crucial role in regulating individuals’ emotional behavior and motivation. According to them, the reason behind these structures’ abnormal size could be because they have lost essential inhibitory neurons, and this lost inhibition could be what triggers extreme mood swings and impulsive behavior in people with BPD (Lis et al., 2007). With that being said, it is important to keep in mind that while changes in the areas of the brain that control impulses and emotional responses are likely to play a role in triggering BPD, many individuals with similar neurological changes do not have BPD, which means that more research is needed to unveil the relationship between the brain and BPD.
As Selby (2014) observed, sleep quality is another key factor that needs to be taken into consideration when investigating the causes and effects of BPD. With available data suggesting that there exists a strong correlation between poor sleep and BPD, Selby (2014) believes that chronic sleep disturbances such as difficulty falling asleep, difficult staying asleep, insomnia and waking earlier than desires contribute greatly to aggravating BPD symptoms, thus resulting in higher levels of daytime functional and psychological impairment. In view of these considerations, a growing number of scholars and practitioners are starting to realize that a deeper understanding of sleep disturbances in patients with BPD is needed in order for treatment to bring substantial benefits in the long term. As far as substance abuse is concerned, patients’ inability to cope with their fears and emotional pain may prompt them to resort to alcohol and drugs in order to numb the pain and / or overcome their fear of being abandoned by those around them. Unfortunately, available data indicates that people with BPD who have been diagnosed with substance dependence are more likely to engage in self-destructive behavior and even attempt suicide.
Treating individuals with BPD can be extremely challenging due to their manipulative tendencies and distinctively “needy” nature. When patients’ unrealistic demands are not met, they may turn against their care providers, acting hostile and paranoid. Over the years, practitioners have tested a vast array of conventional and unconventional treatment solutions, none of which has emerged as a universally-effective method. With that being said, Dialectical Behavior Therapy (DBT) has been found to be particularly effective when treating both BPD and substance abuse. This is because DBT helps patients address the environmental and social factors that trigger undesirable emotional responses, while teaching them the importance of accepting themselves and pursuing meaningful life goals. As a form of meditation that prompts individuals to focus on the present and being aware of what is happening around them, mindfulness meditation is often employed to treat BPD.
When people with BPD experience intense negative emotions, they tend to focus exclusively on their negative feelings, judging both their emotions and themselves. These judgmental thoughts are likely to trigger even more undesirable emotions, thus making it extremely challenging for patients to feel better about themselves. Mindfulness meditation helps people build coping skills so that when they experience pain, anger or anxiety, they can analyze their own emotions and avoid acting on them. Transference-focused psychotherapy (TFP) is another approach that helps patients understand their own emotions and interpersonal challenges as they develop a solid relationship with their therapists.
As for the impact of BPD on memory processes, research has showed that while people with BPD are perfectly capable of storing, encoding and retrieving emotional information, they find it remarkably difficult to forget negative information (Winter et al., 2014). This could stem from specific temporo-prefrontal changes which cause patients to experience strong emotional responses to negative memories (Winter et al., 2014). From a theoretical perspective, the causes and symptoms of BPD can be interpreted in many different ways, depending on which personality theory one chooses to embrace. Psychoanalytical theory, for example, places special emphasis on people’s childhood experiences, which play an essential role in shaping their personality and triggering a wide range of psychiatric disorders, including BPD.
Social cognitive theory, on the other hand, rests on the assumption that behavior is influenced by people’s expectations about the world and other people. Since human beings are naturally inclined to observe and imitate others, human behavior is usually the result of observation and environmental phenomena, rather than innate traits. This would explain why individuals who suffer from mental disorders tend to exhibit abnormal social behavior. When applying social cognitive theory to BPD, one should try to determine how patients perceive those who are close to them as well as society at large, examining their social expectations and needs in such a way to determine whether and to what extent environmental factors are responsible for their symptoms.
