The Essential Family Guide to Borderline Personality Disorder Read online

  First, we’ll take a look at the biological risk factors: the physical brain itself, brain chemistry, and genetics. Even though we’ll be looking at them separately, they’re interwoven. We can’t separate them any more than we could separate the sugar, eggs, and flour from a piece of cake.

  Biological Risk Factors

  The following is a greatly simplified explanation of how the brain works.

  1. Our brain controls the way we think, feel, and act.

  2. BPD is characterized by impairments in thinking, feeling, and acting.

  3. To a large extent, these biological impairments in the brain contribute to the skewed thoughts, emotions, and behaviors characteristic of people with BPD.

  Even when we intellectually understand the chemical causes of BPD, it’s hard to accept that a three-pound organ and a complex chemical imbalance can cause a learned professor to become completely illogical or a child from a loving home to try to commit suicide. But once this notion truly settles in our bones, it becomes easier to empathize with a loved one, to depersonalize the behavior, and to use the power tools that make up the second half of this book.

  Our brains are divided into three sections: the primitive brain, the limbic system, and the cerebral cortex. Imagine an upside-down golf club: That’s the primitive brain (the clubhead) joined with the spine (the shaft). Now cover the clubhead with a sock. That’s the limbic system. Top it off with a bike helmet (the cerebral cortex). This is a model of the brain as it might appear in a Girl Scout project.

  Each part has a specialized job:

  • The primitive brain controls functions like breathing, digestion, and heart rate. When someone is labeled “brain dead,” this is the only part of the brain that is working.

  • The limbic system, which includes the powerful amygdala, has a hold over our emotions. This is the feeling brain.

  • The cerebral cortex is our thinking brain. It’s the part measured by an IQ test, or what you might glimpse during an autopsy in an episode of CSI.

  The Physical Brain

  We’ve known for more than a century that our wrinkled gray cells have a large role in shaping personality. This was demonstrated in the mid-1800s when an unfortunate railway worker named Phineas Gage was the victim of a freak accident that’s still discussed in science books today. (Warning: the next paragraph is graphic.)

  Gage was packing a load of explosives into the ground when the charge accidentally went off. The iron tamping rod he was using (4 feet long and 1¼ inches in diameter) was propelled though his left cheek and brain and exited through the top of his skull. Incredibly, he walked away from the accident and lived another thirteen years.

  But the accident radically altered his personality. Gage’s physician, John M. Harlow, wrote:

  Before his injury, Gage possessed a well-balanced mind and was looked upon by those who knew him as a smart businessman, energetic and persistent. After the accident, Gage was fitful, irreverent, indulging in the grossest profanity (which was not previously his custom), exhibiting little deference for his fellows, and at times impatient, obstinate, capricious, and vacillating. . . . His mind was so decidedly changed that his friends said he was “no longer Gage.”1

  To figure out why Gage’s personality changed so radically, in the 1990s scientists examined the accident’s impact on the brain using the latest technology. They discovered that the rod had damaged structures in Gage’s cerebral cortex, the thinking part of the brain.2

  So, specifically, what’s wrong with the brain that can lead to BPD? Part of the story lies in a horseshoe-shaped organ called the hippocampus. It’s associated with memory and emotional sensitivity. A glitch in how the hippocampus operates may explain why BPs can get so angry in a short time, why their memories can be so unreliable, and why simple events and innocuous statements trigger extreme rage.3

  The Feeling Brain

  Our amygdala, which lies within the limbic system (the sock), is the heart of our emotions. Although it’s only the size and shape of an almond, it packs a mighty punch. (By the way, even though we say the amygdala, there are actually two of them: one on the right temporal lobe, and one on the left. That’s also true of the hippocampus.)

  When a person experiences an event, her cerebral cortex tells her objectively what’s happening. (For example, “I just spied my old classmate Charlie Richards at my high school reunion. I see his hair is gone, and he’s gained a little weight. I hear his wife left him, too.”)

  But her amygdala helps produce the emotions that hit her as she watches Charlie belly up to the bar. If Charlie was a good friend, she may feel sympathetic. If he once deliberately tripped her in the hall, she might smirk. That’s the cognitive part of the brain connecting with the amygdala in twelve thousandths of a second.4

  The amygdala also controls the intensity of our emotions. If Charlie was a close confidant, her sadness may turn to sorrow. If he ditched her at the senior prom, her smirk might turn into a wide grin. Even a chuckle.

  Although we’d all like to think we base our decisions on logic, our emotions often hold a larger sway than we think. A striking example: A few decades ago, a television series featuring a family living in a small town ended its run on a sad note. The town’s citizens learn that a corrupt man is going to take over their community. Unable to stop this, they blow up their homes so he won’t get them.

  For years afterward, the actor who played the swindler had strangers come up to him on the street and scold him for being so evil. And that’s not even the unusual part. It’s that the series was Little House on the Prairie, starring Michael Landon, and the fictional event was supposed to have occurred in 1901.

  The Teenage Physical Brain

  Although parents have instinctively known this since the Ice Age, research has confirmed that the parts of the brain that weigh risks, make judgments, and control impulsive behavior are still developing through the teen years and don’t fully mature until about age twenty-five.5

  Young people process emotions differently, which makes talking about feelings more difficult for them. In one experiment, researchers scanned a subject’s brain activity with an MRI while the person identified the emotions of faces on a screen. Researchers found out that adults use the frontal lobes (the reasoning part of the brain) to perform this task, while young teens used the amygdala.6

  The Chemical Brain

  Most people have a vague notion that BPs have some kind of chemical imbalance in their brain. While this is true, it’s an oversimplification. You might as well say that buses work because the wheels go ’round and ’round.

  To better understand the complexity, imagine a dense forest with flowering maple trees, leaves shimmering in the summer sun. The maple trees “talk” to one another by emitting clouds of pollen that waft through the air on puffs of wind. Pollen is a chemical messenger of sorts that helps one tree interact with another despite the air gaps between the branches.

  The mass of neurons tangled in our brain is like a forest. Like trees, neurons have branchlike shapes to help them reach out to catch chemical messages called neurotransmitters. Neurotransmitters, like pollen, carry information across the synapse from one neuron to the next—or sometimes even to neurons that are very far away.

  Little pulses of voltage, like wind, help waft neurotransmitters off one neuron so they can float to the next. In this way, different parts of the brain set up a conversation with one another.

  So far, scientists have identified about fifty neurotransmitters. Each carries different messages. For example, norepinephrine involves memory and the fight-or-flight response. Dopamine is linked to feelings of being rewarded. And serotonin is associated with both impulsivity and mood. Neurotransmitters can combine together in different ways to carry still more messages.

  Problems arise when there are too many or too few neurotransmitters, or when changes in the neurotransmitter system happen too quickly or slowly. The neurons can have trouble “talking” to one another. This can then build
on other difficulties in a person’s neurological makeup, and the mental and physical health consequences can be severe.

  For example, very low levels of dopamine in the motor areas of the brain are known to produce Parkinson’s disease, with its symptoms of muscle rigidity and loss of coordination. An imbalance of serotonin is associated with depression, chronic fatigue, and social withdrawal. Frequent, uncontrollable panic attacks are associated with quirks in the amount of norepinephrine.

  Glitches in neurotransmitter systems help underpin the three core dimensions of BPD: faulty thinking (cognitive abilities), feeling (emotional dysregulation), and acting (impulsivity). It would be marvelous if we could describe exactly how that happens. But the reality is that the neuroscience involved is so complex that researchers are just beginning to understand what’s going on.

  So why do some people have problems with their neurotransmitters and other parts of their brains, like the hippocampus and amygdala, while other people don’t? The answer lies partly in genetics.

  Genetics and the Brain

  One gene alone is responsible for a rare, incurable disorder called Huntington’s disease. If you have the gene, you’ll come down with Huntington’s eventually. But most inherited medical problems need several genes to converge before the disease develops.

  For example, more than twenty genes can play a role in diabetes. Typically, someone who inherits four or five of them becomes diabetic. The different ways in which those genes combine can influence how severe a particular person’s diabetes is, how easily it can be treated, and so on.

  BPD itself isn’t passed from one generation to the next. What are inherited are two to four traits that define this complex disorder. Two parents, neither of whom have BPD, might still have some of the genes that can lead to traits associated with BPD, such as

  • aggressiveness

  • depression

  • excitability

  • quickness to anger

  • impulsivity

  • a susceptibility to addiction

  • cognitive (thinking, reasoning) impairments

  Is genetics a form of destiny? Yes and no. Psychologist Pierce Howard sees genetics as a seed, and personality as something that develops from that seed in response to its environment—sun, water, fertilizer, and so on. So genes play a role, but environment and lifestyle choices have a great impact as well.7

  Environmental Risk Factors

  The following environmental factors play a role in the development of BPD.

  Abuse: Myths and Realities

  If you’ve researched borderline personality disorder for any length of time, you’ve read that abuse causes BPD. This belief partly comes from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which states that 75 percent of people with BPD have been abused.

  The data, however, have a few flaws. First, if abuse causes BPD, then how do you explain the fact that one out of four BPs has not been abused? Second, a correlation is not necessarily a cause. Robert O. Friedel, MD, director of the BPD program at Virginia Commonwealth University, says, “None of the environmental risk factors I’ve discussed [early separation or loss, trauma, ineffective parenting, and adverse social customs] has been shown to cause borderline disorder. Many people who are exposed to the same abuse, separations, and bad parenting do not develop borderline disorder, and some borderline patients have not experienced any of these environmental risk factors.”8

  Third, the 75 percent figure is based on self-reporting, meaning that it was compiled by asking adult patients if they have a history of abuse. The assumption is that the responses are 100 percent accurate, and that there is a consensus of what, exactly, constitutes “abuse,” be it emotional, sexual, or physical.

  However, as a method of data collection, self-reporting is considered to be unreliable. Dieters are notorious for underestimating their food intake, and food is a pretty simple thing to measure compared to “abuse.” Plus, the subjects have a disorder that, by definition, is characterized by faulty perception and reasoning. These cognitive defects, added to the vagueness of the term abuse and the limits of the methodology, mean that the 75 percent abuse statistic should come with a disclaimer.

  There is a middle ground here. Clinician Harriet Lefley, PhD, explains, “People biologically predisposed to develop BPD are hypersensitive to, and more intensely experience, the slights, criticisms, and punishments endured by most children in the process of growing up. And if parents are raising an exceptionally difficult child, these criticisms and punishments are likely to be frequent and generate tension in family dynamics—and later be recalled as abusive.”9

  Sharon is a mother of a child with BPD and maintains an online support group for parents of children with this disorder. Her group is called NUTS (parents Needing Understanding, Tenderness, and Support to help their child with borderline personality disorder). She says:

  Throughout my ten-plus years of running NUTS, I have seen very few families pass through where abuse, neglect, trauma, etc., have been an issue. I realize that abusive parents probably won’t be joining a group and talking about it. Still, our little sampling of the world of BPD does indicate that there are many of us out here struggling with BPD where there isn’t the trauma/abuse cause involved.

  In addition, about 70 percent of our children in NUTS have falsely accused someone of abuse; my own daughter accused me, and we were under investigation. My other daughter denied that we were abusive.10

  Perry Hoffman, cofounder of the Family Connections program of the National Education Alliance for Borderline Personality Disorder, is concerned about the same issue. She says:

  We have to educate clinicians not to fingerpoint family members. Certainly we know there’s abuse that goes on. But I certainly know that the family members I interface with or who have come through our Family Connections program are not the parents who have abused their children. And these are the families who are feeling so terrible when they read about abuse and [its association with BPD].11

  Family and Peer Influences

  Many other environmental circumstances favor the development of BPD.

  All our personalities are shaped by the surroundings we grew up in. Some influences are positive, such as a caring older brother, a good school system, and a family with good financial resources.

  Then there are negative influences: losing a grandfather, getting pneumonia, or living in a dangerous neighborhood—not to mention the “normal dysfunction” we all grow up in. Our culture—its norms and expectations—influence us, too.

  Some life circumstances may present a higher risk for the development of BPD. Some doctors refer to these as “environmental burdens” that can trigger the condition. They include

  • emotional, physical, or sexual abuse.

  • ineffective parenting—or perceived ineffective parenting—of the borderline individual. This can mean anything from poor parental skills to a parent’s mental illness or substance abuse.

  • an unsafe and chaotic home situation.

  • a poor match between the temperaments of parent and child.

  • the sudden loss of a parent or a parent’s attention (sometimes perceived by the child as abandonment). This can arise from the death of a parent, a divorce, or even the birth of a new baby.

  You might be thinking that this describes 99 percent of families. (About 50 percent of marriages end in divorce.) It probably does, so don’t feel guilty if this looks familiar. Also keep in mind that many people who are exposed to the same abuse, separations, and ineffective parenting do not develop BPD.

  Research is beginning to tell us that relationships with peers are crucial to the development of our personality—interesting, considering that most parents in the Welcome to Oz community say their child had a hard time making friends and lacked social skills. This could be because, compared to others seeking psychological help, people with BPD are especially likely to misinterpret or misremember social interactions.12 With their deep fea
r of abandonment, people with BPD may need and expect more from friendships, even at a young age.

  “Invalidating Environments” as a Factor in BPD

  Marsha M. Linehan, the creator of dialectical behavior therapy (DBT), a method used to treat BPD and other disorders (see page 87) developed a “biosocial” model about the causes of BPD. The “bio” refers to biology and the “social” to the environment.

  She agrees with research that shows that people with BPD are hardwired to react more intensely to stress. Their emotional peaks are more pronounced. Once the stress is over, they take a longer time than most to calm down. Linehan calls this tendency “emotional vulnerability.” BPD, she says, can develop when an emotionally vulnerable child is raised in an “invalidating environment.” An invalidating environment is one in which caregivers

  • tell children that their feelings and experiences are wrong or untrue

  • find fault with children who fail to perform to the expected standard, and make comments such as “you weren’t motivated enough”

  Children raised in this environment learn not to trust their own gut reactions and look to others to tell them how to feel and to solve their problems for them.

  A Poor Parent/Child Fit

  Perry Hoffman, who is also the president of the National Education Alliance for Borderline Personality Disorder, says that one risk factor for BPD is a poor match between a biologically vulnerable child and her caregivers, who, for whatever reason, find it overwhelming to meet the child’s needs.

  For example, perhaps the mother develops post-partum depression or the family’s going through a crisis. Another example is a single mother who, for economic reasons, takes two jobs that limit the time she can spend with her child.

  All of this helps us to realize an important point. We may believe that people with BPD are consciously choosing to act the way they do—and in a sense, they are. But in another sense, if we had the same genes and environmental influences as a person with BPD, we might be surprised to find ourselves acting in precisely the same way.