Borderline personality disorder (BPD) is a Cluster B personality disorder, characterized by instability in relationships, emotion, self-image and behavior. Those with borderline personality disorder are prone to losing drip on reality and are vulnerable to take their inner world as reality. This chapter will outline the Diagnostic and Statistical Manual classification of BPD, before moving on to a discussion of the origins of BPD, emphasizing the family environment and attachment.
For a DSM-IV-TR classification of BPD, the person must exhibit at least 5 of the follow behaviors in more than one context:
The diathesis-stress model proposes that genes provide a vulnerability factor, but this will only be triggered and shaped by environmental factors. One particular diathesis stress theory predicts that BPD will develop when two influences are at play:
An invalidating family environment means that the person’s emotions and efforts at communication are disregarded. At the extreme end of invalidation is abuse, but it can also be seemingly minor things such as insulting comments, especially when these occur frequently. Emotional dis-regulation and invalidation interact with each other to form a vicious cycle which can escalate into BPD.
Attachment theory proposes that children with adequate parenting are likely to develop a secure bond. Secure attachments are characterized by warm, loving, attentive caregivers who respond quickly to infant’s distress, and in return, infants develop a trust that caregivers will respond to their needs. However, individuals with borderline personality disorder are likely to have had an insecure attachment relationship with primary caregivers during infancy and childhood.
Insecure resistant (ambivalent) attachments are characterized by inconsistent caregivers (sometimes warm and caring and sometimes neglectful). As a result, infants do not develop an implicit trust in their caregivers, but are confused and unsure by such inconsistency. Insecure avoidant attachments are characterized by distant and inattentive caregivers and infants do not develop a trust in caregivers but instead come to expect neglect.
The insecure disorganized attachment type is the most severe and is characterized by caregivers who are inconsistent and possibly abusive. It is more severe than the resistant type, but with the common feature of inconsistency. Such inconsistency prevents the child from forming an adequate protection device, and the infant is likely confused and fearful of caregivers.
Parents of individuals who grow up to have borderline personality disorder are often insensitive to their infants needs due to a preoccupation with their own needs. As a result, these parents are emotionally unavailable and unable to regulate their infants’ emotions. This inability to sooth and regulate is likely to result in high levels of stress in these parents who find it very difficult to deal with the situation of having a child. In extreme cases, such frustration and self-preoccupation can lead to abuse.
Children with these parents are likely to have a disorganized style of attachment, in which fear is a likely experience, perhaps because inconsistent care is potentially life threatening in itself. Such extreme inconsistency makes it impossible for the infant to develop a coherent plan of action (i.e. withdrawal is a common strategy in avoidant children but without a predictive structure to a relationship, disorganized children are unable to form a coherent strategy). The instability in BPD patients may be explained by such great levels of inconsistency during infancy.
Psychologists have argued that disorganized attachment as being at the extreme end of emotional dis-regulation. As we know, emotional dis-regulation is a common part of the BPD experience. This makes sense because the child has not been taught to manage their feelings, and this can result in a desperate state of helplessness.
In conclusion, this chapter has briefly outlined 8 criteria considered to be a common part of the BPD experience; 5 of which must be present for a diagnosis to occur. We then moved on to a lengthy discussion of why a person might develop borderline personality disorder in the first place, paying close attention to the role of the attachment relationship with the primary caregiver.