Chapter Three

Roots of the Borderline Syndrome

All happy families resemble one another; every unhappy family is unhappy in its own fashion.

—From Anna Karenina, by Leo Tolstoy

 

 

 

Growing up was not easy for Dixie Anderson. Her father was rarely at home and when he was, he didn’t say much. For years, she didn’t even know what he did for a living, just that he was gone all the time. Margaret, Dixie’s mother, called him a “workaholic.” Throughout her childhood, Dixie sensed that her mother was hiding something, though Dixie was never quite sure what it was.

But when Dixie turned eleven, things changed. She was an “early developer,” her mother said, though Dixie really wasn’t sure what that meant. All she knew was that her father was suddenly home more than he had ever been, and he was also more attentive. Dixie enjoyed the new attention and the new feeling of power she had over him when he was finished touching her. After he was done, he would do whatever she asked him.

About this same time, Dixie suddenly became more popular in the family’s affluent suburban Chicago neighborhood. The kids began to offer her their secret stashes of pot and, a few years later, mushrooms and ecstasy.

Middle school was a drag. Halfway through a school day, she’d wind up fighting with some of the other kids, which did not rattle her at all: she was tough; she had friends and drugs; she was cool. Once, she even punched her science teacher, whom she felt was a real jerk. He didn’t take it well at all and went to the principal, who expelled her.

At age thirteen she saw her first psychiatrist, who diagnosed her as hyperactive and treated her with several medications that didn’t make her feel anywhere near as good as weed. She decided to run away. She packed an overnight bag, took a bus to the interstate, stuck out her thumb, and in a few minutes was on her way to Las Vegas.

The way Margaret saw it, no matter what she did, it always seemed to turn out the same with Dixie: her older daughter could not be pleased. Dixie had obviously inherited her dad’s genes, always criticizing the way Margaret looked and the way she kept the house. She had tried everything to lose weight—amphetamines, booze, even the stomach operation—yet nothing seemed to work. She’d always been fat, always would be.

She often wondered why Roger had married her. He was a handsome man; from the beginning she could not understand why he wanted her. After a while it was obvious he didn’t want her: he simply stopped coming home at night.

Dixie was the one bright spot in Margaret’s life. Her other daughter, Julie, was already obese at age five and seemed a lost cause. But Margaret would do anything for Dixie. She clung to her daughter like a lifeline. But the more Margaret clung, the more Dixie resented it. She became more demanding, throwing tantrums and screaming about her mother’s weight. The doctors could do nothing to help Margaret; they said she was manic-depressive and addicted to alcohol and amphetamines. The last time Margaret was in the hospital they gave her electroshock treatment. And now with Roger gone and Dixie always running away, the world was closing in.

After a few frantic months in Vegas, Dixie took off for Los Angeles, which was the same story as Vegas: she was promised cars and money and good times. Well, she had ridden in a lot of cars, but the good times were few and far between. Her friends were losers and sometimes she had to sleep with a guy to “borrow” a few bucks. Finally, with nothing but a few dollars in her jeans, she went back home.

Dixie arrived to find Roger gone and her mother in a thick fog of depression and drug-induced numbness. In all this bleakness at home, it wasn’t long before Dixie fell back into her alcohol and drug habits. At fifteen she had been hospitalized twice for chemical abuse and was treated by a number of therapists. At sixteen, she became pregnant by a man she had met only a few weeks before. She married him soon after the pregnancy tests.

Seven months later, when Kim was born, the marriage began to fall apart. Dixie’s husband was a weak and passive oaf who could not get his own life together, much less provide a solid home environment for their child.

By the time the baby was six months old, the marriage was over, and Dixie and Kim moved in with Margaret. It was then that Dixie became obsessed with her weight. She would go entire days without eating, and then eat frantically and voluminously only to vomit it all up in the toilet. What she couldn’t get rid of by vomiting she eliminated in other ways: she ate squares of Ex-Lax as if they were candy. She exercised until sweat drenched her clothes and she was too exhausted to move. The pounds dropped off—but so did her health and her mood. Her periods stopped; her energy waned; her capacity to concentrate weakened. She became very depressed about her life, and for the first time suicide seemed like a real alternative.

Initially she felt safe and comfortable when she was readmitted to the hospital, but soon her old self returned. By the fourth day, she was trying to seduce her doctor; when he didn’t respond, she threatened him with all sorts of retaliation. She demanded extra privileges and special attention from the nurses and refused to participate in unit activities.

As abruptly as she had gone into the hospital, she pronounced herself cured and demanded discharge, days after admission. Over the next year, she would be readmitted to the hospital several times. She would also see several psychotherapists, none of whom seemed to understand or know how to treat her dramatic mood shifts, her depression, her loneliness, her impulsiveness with men and drugs. She began to doubt that she could ever be happy.

It wasn’t long before Margaret and Dixie were again fighting and screaming at each other. For Margaret it was like seeing herself growing up all over again and making the same mistakes. She couldn’t bear to watch it any longer.

Margaret’s father had been just like Roger, a lonely, unhappy man who had little to do with his family. Her mother ran the family much like Margaret ran hers. And just as Margaret clung to Dixie, so had her mother clung to Margaret, trying desperately to mold her every step of the way. Margaret was fed her mother’s ideas and feelings—and enough food for a battalion. By the age of sixteen, she was grossly obese and taking large amounts of amphetamines prescribed by the family doctor to suppress her appetite. By the age of twenty, she was drinking alcohol and taking Fiorinal to bring her down from the amphetamines.

Margaret was never able to please her mother even as the constant struggle for control between them raged on. Neither could Margaret please her own daughter or husband. She had never been able to make anyone happy, she realized, not even herself. Yet she persisted in trying to please people who would not be pleased.

Now, with Roger gone and Dixie so sick, Margaret’s life seemed to be falling apart. Dixie finally told her mother how Roger had sexually abused her. And before Roger left, he had bragged all about his women. Despite everything, Margaret still missed him. He was alone, she knew, just like she was.

It was time, Dixie recognized, to do something about the plight of this self-destructive family. Or at least herself anyway. A job would be the first priority, something to combat the relentless boredom. But she was nineteen years old with a two-year-old child and no husband, and she still hadn’t graduated high school.

With characteristic compulsiveness, she flung herself into a high school equivalency program and received her diploma in a matter of months. Within days of obtaining her diploma, she was applying for loans and grants to attend college.

Margaret had begun to take care of Kim, and in many ways the arrangement looked like it might work: raising Kim gave Margaret some meaning in her life, Kim had built-in child care, and Dixie had time for her new mission in life. But soon, the system showed cracks: Margaret sometimes got too drunk or depressed to be of any help. When this happened, Dixie had a simple solution: she would threaten to take Kim away from Margaret. Both the grandmother and granddaughter obviously needed each other desperately, so Dixie was able to totally control the household.

Through it all, Dixie still managed to find time for men, though her frequent liaisons were usually of short duration. She seemed to follow a pattern: whenever a man started to care for her, she became bored. Distant, older men—unavailable doctors, married acquaintances, professors—were her usual type, but she would drop them the instant they responded to her flirtations. The young men she did date were all members of a church that was strictly opposed to premarital sex.

Dixie avoided women and had no female friends. She thought women were weak and uninteresting. Men, at least, had some substance. They were fools if they responded to her flirtations and hypocrites if they did not.

As time went on, the more Dixie succeeded in her studies, the more frightened she became. She could pursue a particular interest—school, a certain man—relentlessly, almost obsessively, but each success spurred ever higher, and more unrealistic, demands. Despite good grades, she would explode in rage and threaten to kill herself when she performed below her expectations on an exam.

At times like these, her mother would try to console her, but Margaret was also becoming preoccupied with suicide, and the roles often reversed. Mother and daughter were again shuffling in and out of the hospital trying to overcome depression and chemical abuse.

Like her mother and grandmother, Kim didn’t know her father very well either. Sometimes he came to visit; sometimes she went to the house that he shared with his mother. He always seemed awkward around her.

With her mother detached and her grandmother ineffectual or preoccupied with her own problems, Kim took control of the household by the time she was four. She ignored Dixie, who responded by ignoring her. If Kim threw a tantrum, Margaret would cave in to her wishes.

The household was in an almost constant state of chaos. Sometimes both Margaret and Dixie would be in the hospital at the same time, Margaret for her drinking, Dixie for her bulimia. Kim would then go to her father’s house, although he was unable to care for her and would have his own mother tend to her.

On the surface, Kim seemed oddly mature for a six-year-old, despite the chaos around her. To her, other kids were “just kids,” without her experience. She didn’t think her particular type of maturity was unusual at all: she had seen old photographs of her mother and grandmother when they were her age, and in the snapshots they all had the same look.

Across Generations

In many respects, the Andersons’ saga is typical of borderline cases: the factors contributing to the borderline syndrome often transcend generations. The genealogy of BPD is often rife with deep and long-lasting problems, including suicide, incest, drug abuse, violence, losses, and loneliness.

It has been observed that borderlines often have borderline mothers, who, in turn, have borderline mothers. This hereditary predisposition to BPD prompts a number of questions, such as: How do borderline traits develop? How are they passed down through families? Are they, indeed, passed down at all?

In examining the roots of this illness, these questions resurrect the traditional “nature versus nurture” (or, temperament versus character) question. The two major theories on the causes of BPD—one emphasizing developmental (psychological) roots, the other constitutional (biological and genetic) origins—reflect the dilemma.

A third theoretical category, which focuses on environmental and sociocultural factors, such as our fast-paced, fragmented societal structure, destruction of the nuclear family, increased divorce rates, increased reliance on nonparental day care, greater geographical mobility, and changing patterns of gender roles, is also important (see chapter 4). Though empirical research on these environmental elements is limited, some professionals speculate that these factors would tend to increase the prevalence of BPD.

The available evidence points to no one definitive cause—or even type of cause—of BPD. Rather, a combination of genetic, developmental, neurobiological, and social factors contribute to the development of the illness.

Genetic and Neurobiological Roots

Family studies suggest that first-degree relatives of borderlines are several times more likely to show signs of a personality disorder, especially BPD, than the general public. These close family members are also significantly more likely to exhibit mood, impulse, and substance abuse disorders.¹ It is unlikely that one gene contributes to BPD; instead, like most medical disorders, many chromosomal loci are activated or subdued—probably influenced by environmental factors—in the development of what we label BPD.

Biological and anatomical correlations with BPD have been demonstrated. In our book Sometimes I Act Crazy, we discuss in more detail how specific genes affect neurotransmitters (brain hormones, which relay messages between brain cells).² Dysfunction in some of these neurotransmitters, such as serotonin, norepinephrine, dopamine, and others, are associated with impulsivity, mood disorders, and other characteristics of BPD. These neurotransmitters also affect the balance of adrenaline and steroid production in the body. Some of the genes affecting these neurotransmitters have been associated with several psychiatric illnesses. However, studies with variable results demonstrate that multiple genes (intersecting with environmental stressors) contribute to the expression of most medical and psychiatric disorders.

The borderline’s frequent abuse of food, alcohol, and other drugs—typically interpreted as self-destructive behavior—may also be seen as an attempt to self-medicate inner emotional turmoil. Borderlines frequently report the calming effects of self-mutilation; rather than feeling pain, they experience soothing relief or distraction from internal psychological pain. Self-mutilation, like any other physical trauma or stress, may result in the release of endorphins—the body’s natural narcotic-like substances that provide relief during childbirth, physical traumas, long-distance running, and other physically stressful activities.

Changes in brain metabolism and morphology (or structure) are also associated with BPD. Borderline patients express hyperactivity in the part of the brain associated with emotionality and impulsivity (limbic areas), and decreased activity in the section that controls rational thought and regulation of emotions (the prefrontal cortex). (Similar imbalances are observed in patients suffering from depression and anxiety.) Additionally, volume changes in these parts of the brain are also associated with BPD and are correlated with these physiological changes.³

These alterations in the brain may be related to brain injury or disease. A significant percentage of borderline patients have a history of brain trauma, encephalitis, epilepsy, learning disabilities, ADHD, and pregnancy complications.⁴ These abnormalities are reflected in brain wave (EEG, or electroencephalogram) irregularities, metabolic dysfunction, and white and gray matter volume reductions.

Since failure to achieve healthy parent-child attachment may result in later character pathology, cognitive impairment on the part of the child and/or the parent may hinder the relationship. As the latest research strongly suggests that BPD may be at least partly inherited, parent and child may both experience dysfunction in cognitive and/or emotional connection. A poor communication fit may perpetuate the insecurities and impulse and affective defects that result in BPD.

Developmental Roots

Developmental theories on the causes of BPD focus on the delicate interactions between child and caregivers, especially during the first few years of life. The ages between eighteen and thirty months, when the child begins the struggle to gain autonomy, are particularly crucial. Some parents actively resist the child’s progression toward separation and insist instead on a controlled, exclusive, often suffocating symbiosis. At the other extreme, other parents offer only erratic parenting (or are absent) during much of the child-raising period and so fail to provide sufficient attention to, and validation for, the child’s feelings and experiences. Either extreme of parental behavior—behavioral over-control and/or emotional under-involvement—can result in the child’s failure to develop a positive, stable sense of self and may lead to a constant, intense need for attachment and chronic fears of abandonment.

In many cases the broken parent-child relationship takes the more severe form of early parental loss or prolonged, traumatic separation, or both. As with Dixie, many borderlines have an absent or psychologically disturbed father. Primary mother figures (who may sometimes be the father) tend to be erratic and depressed and have significant psychopathology themselves, often BPD. The borderline’s family background is frequently marked by incest, violence, and/or alcoholism. Many cases show an ongoing hostile or combative relationship between mother and pre-borderline child.

Object Relations Theory and Separation-Individuation in Infancy

Object relations theory, a model of infant development, emphasizes the significance of the child’s interactions with his environment, as opposed to internal psychic instincts and biological drives unconnected to sensations outside himself. According to this theory, the child’s relationships with “objects” (people and things) in his environment determines his later functioning.

The primary object relations model for the early phases of infant development was created by Margaret Mahler and colleagues. ⁵ They postulated that the infant’s first one to two months of life were characterized by an obliviousness to everything except himself (the autistic phase). During the next four or five months, designated the symbiotic phase, he begins to recognize others in his universe, not as separate beings, but as extensions of himself.

In the following separation-individuation period, extending through ages two to three years, the child begins to separate and disengage from the primary caregiver and begins to establish a separate sense of self. Mahler and others consider the child’s ability to navigate through this phase of development successfully to be crucial for later mental health.

During the entire separation-individuation period, the developing child begins to sketch out boundaries between self and others, a task complicated by two central conflicts—the desire for autonomy versus closeness and dependency needs, and fear of engulfment versus fear of abandonment.

A further complicating factor during this time is that the developing infant tends to perceive each individual in the environment as two separate personae. For example, when mother is comforting and sensitive, she is seen as “all-good.” When she is unavailable or unable to comfort and soothe, she is perceived as a separate, “all-bad” mother. When she leaves his sight, the infant perceives her as annihilated, gone forever, and cries for her return to relieve the despair and panic. As the child develops, this normal “splitting” is replaced by a healthier integration of mother’s good and bad traits, and separation anxiety is replaced by the knowledge that mother exists even when she is not physically present and will, in time, return—a phenomenon commonly known as object constancy (see page 67). Prevailing over these developmental milestones is the child’s developing brain, which can sabotage normal adaptation.

Mahler divides separation-individuation into four overlapping subphases.

DIFFERENTIATION PHASE (5-8 MONTHS). In this phase of development, the infant becomes aware of a world separate from mother. “Social smiling” begins—a reaction to the environment, but directed mostly at mother. Near the end of this phase, the infant displays the opposite side of this same response—“stranger anxiety”—the recognition of unfamiliar people in the environment.

If the relationship with mother is supportive and comforting, reactions to strangers are mainly characterized by curious wonder. If the relationship is unsupportive, anxiety is more prominent; the child begins to divide positive and negative emotions toward other individuals, relying on splitting to cope with these conflicting emotions.

PRACTICING PHASE (8-16 MONTHS). The practicing phase is marked by the infant’s increasing ability to move away from mother, first by crawling, then by walking. These short separations are punctuated by frequent reunions to “check in” and “refuel,” behavior that demonstrates the child’s first ambivalence toward his developing autonomy.

RAPPROCHEMENT PHASE (16-25 MONTHS). In the rapprochement phase, the child’s expanding world sparks the recognition that he possesses an identity separate from those around him. Reunions with mother and the need for her approval shape the deepening realization that she and others are separate, real people. It is in the rapprochement phase, however, that both child and mother confront conflicts that will determine future vulnerability to the borderline syndrome.

The mother’s role during this time is to encourage the child’s experiments with individuation, yet simultaneously provide a constant, supportive, refueling reservoir. The normal two-year-old not only develops a strong bond with parents but also learns to separate temporarily from them with sadness rather than with rage or tantrum. When reunited with the parent, the child is likely to feel happy as well as angry over the separation. The nurturing mother empathizes with the child and accepts the anger without retaliation. After many separations and reunions, the child develops an enduring sense of self, love and trust for parents, and a healthy ambivalence toward others.

The mother of a pre-borderline, however, tends to respond to her child in a different way—either by pushing her child away prematurely and discouraging reunion (perhaps due to her own fear of closeness) or by insisting on a clinging symbiosis (perhaps due to her own fear of abandonment and need for intimacy). In either case, the child becomes burdened by intense fears of abandonment and/or engulfment that are mirrored back to him by mother’s own fears.

As a result, the child never grows into an emotionally separate human being. Later in life, the borderline’s inability to achieve intimacy in personal relationships reflects this infant stage. When an adult borderline confronts closeness, she may resurrect from childhood either the devastating feelings of abandonment that always followed her futile attempts at intimacy or the feeling of suffocation from mother’s constant smothering. Defying such controls risks losing mother’s love; satisfying her risks losing oneself.

This fear of engulfment is well illustrated by T. E. Lawrence (Lawrence of Arabia), who at age thirty-eight writes about his fear of closeness to his overbearing mother: “I have a terror of her knowing anything about my feelings, or convictions, or way of life. If she knew, they would be damaged; violated; no longer mine.”⁶

OBJECT CONSTANCY PHASE (25-36 MONTHS). By the end of the second year of life, assuming the previous levels of development have progressed satisfactorily, the child enters the object constancy phase, wherein the child recognizes that the absence of mother (and other primary caregivers) does not automatically mean her annihilation. The child learns to tolerate ambivalence and frustration. The temporary nature of mother’s anger is recognized. The child also begins to understand that his own rage will not destroy mother. He begins to appreciate the concept of unconditional love and acceptance and develops the capacity to share and to empathize. The child becomes more responsive to father and others in the environment. Self-image becomes more positive, despite the self-critical aspects of an emerging conscience.

Aiding the child in all these tasks are transitional objects—the familiar comforts (teddy bears, dolls, blankets) that represent mother and are carried everywhere by the child to help ease separations. The object’s form, smell, and texture are physical representations of the comforting mother. Transitional objects are one of the first compromises made by the developing child in negotiating the conflict between the need to establish autonomy and the need for dependency. Eventually, in normal development, the transitional object is abandoned when the child is able to internalize a permanent image of a soothing, protective mother figure.

Developmental theories propose that the borderline is never able to progress to this object constancy stage. Instead, the borderline is fixated at an earlier developmental phase, in which splitting and other defense mechanisms remain prominent.

Because they are locked into a continual struggle to achieve object constancy, trust, and a separate identity, adult borderlines continue to rely on transitional objects for soothing. One woman, for example, always carried in her purse a newspaper article that contained quotes from her psychiatrist. When she was under stress, she would take it out, calling it her “security blanket.” Seeing her doctor’s name in print reinforced his existence and his continued interest and concern for her.

Princess Diana also took comfort in transitional objects, keeping a menagerie of twenty stuffed animals—“my family,” she called them—at the foot of her bed . . . As her lover James Hewitt observed, they “lay in a line, about thirty cuddly animals—animals that had been with her in her childhood, which she had tucked up in her bed at Park House and which had comforted her and represented a certain security.” When she went on trips, Diana took a favorite teddy bear with her.⁷ Ritualized, superstitious acts, when done in extremes, may represent borderline utilization of transitional objects. The ballplayer who wears the same socks or refuses to shave while in the midst of a hitting streak, for example, may simply be prone to the superstitions that prevail in sports; only when such behaviors are repeated compulsively and inflexibly and interfere with routine functioning does the person cross the border into the borderline syndrome.

Childhood Conflicts

The child’s evolving sense of object constancy is consistently challenged as he progresses through developmental milestones. The toddler, entranced by fairy tales filled with all-good and all-bad characters, encounters numerous situations in which he uses splitting as a primary coping strategy. (Snow White, for example, can only be conceptualized as all-good and the evil queen as all-bad; the fairy tale does not elicit sympathy for a queen who may be a product of a chaotic upbringing or criticism of the heroine’s cohabitation with the seven short guys!) Though now trusting mother’s permanent presence, the growing child must still contend with the fear of losing her love. The four-year-old who is scolded for being “bad” may feel threatened with the withdrawal of mother’s love; he cannot yet conceive of the possibility that mother may be expressing her own frustrations quite apart from his own behavior, nor has he learned that mother can be angry and yet love him just as much at the same time.

Eventually, children are confronted with the separation anxiety of starting school. “School phobia” is neither a real phobia nor related exclusively to school itself, but instead represents the subtle interplay between the child’s anxiety and the reactions of parents who may reinforce the child’s clinging with their own ambivalence about the separation.

Adolescent Conflicts

Separation-individuation issues are repeated during adolescence, when questions of identity and closeness to others once again become vital concerns. During both the rapprochement phase of infancy and adolescence, the child’s primary mode of relating is less acting than reacting to others, especially parents. While the two-year-old tries to elicit approval and admiration from parents by molding his identity to emulate caregivers, the adolescent tries to emulate peers or adopts behaviors that are consciously different—even opposite—from those of parents. In both stages, the child’s behavior is based less on independently determined internal needs than on reacting to the significant people in the immediate environment. Behavior then becomes a quest to discover identity rather than to reinforce an established one.

An insecure teenager may ruminate endlessly about her boyfriend in a “he loves me, he loves me not” fashion. Failure to integrate these positive and negative emotions and to establish a firm, consistent perception of others leads to continued splitting as a defense mechanism. The adolescent’s failure to maintain object constancy results in later problems with sustaining consistent, trusting relationships, establishing a core sense of identity, and tolerating anxiety and frustration.

Often, entire families adopt a borderline system of interaction, with the family members’ undifferentiated identities alternately merging with and separating from each other. Melanie, the adolescent daughter in one such family, closely identified with her chronically depressed mother, who felt abandoned by her philandering husband. With her husband often away from home and her other children of much younger age, the mother fastened onto her teenage daughter, relating intimate details of the unhappy marriage and invading the teenager’s privacy with intrusive questions about her friends and activities. Melanie’s feelings of responsibility for her mother’s happiness interfered to the point where she could not attend to her own needs. She even selected a college nearby so she could continue to live at home. Eventually, Melanie developed anorexia nervosa, which became her primary mechanism for feeling in control, independent, and comforted.

Similarly, Melanie’s mother felt responsible and guilty for her daughter’s illness. The mother sought relief in extravagant spending sprees (which she concealed from her husband) and then covered the bills by stealing money from her daughter’s bank account. Mother, father, and daughter were trapped in a dysfunctional family swamp, which they were unwilling to confront and from which they were unable to escape. In such cases, treatment of the borderline may require treatment of the entire family (see chapter 7).

Traumas

Major traumas—parental loss, neglect, rejection, physical or sexual abuse—during the early years of development can increase the probability of BPD in adolescence and adulthood. Indeed, case histories of borderline patients are typically desolate battlefields, scarred by broken homes, chronic abuse, and emotional deprivation.

Norman Mailer described the effect of an absent parent on Marilyn Monroe, who never knew her father. Though his absence would contribute to her emotional instability in later life, it would also ironically be one of the motivating forces in her career:

Great actors usually discover they have a talent by first searching in desperation for an identity. It is no ordinary identity that will suit them, and no ordinary desperation can drive them. The force that propels a great actor in his youth is insane ambition. Illegitimacy and insanity are the godparents of the great actor. A child who is missing either parent is a study in the search for identity and quickly becomes a candidate for actor (since the most creative way to discover a new and possible identity is through the close fit of a role).⁸

Similarly, Princess Diana, rejected by her mother and reared by a cold, withdrawn father, exhibited similar characteristics. “I always used to think that Diana would make a very good actress because she would play out any role she chose,” said her former nanny, Mary Clarke.⁹

Raised in an orphanage during many years of her early childhood, Marilyn had to learn to survive with a minimum of love and attention. It was her self-image that suffered the most and led to her manipulative behavior with lovers later in life. For Diana, her “deep feelings of unworthiness” (in the eulogizing words of her brother, Charles) hindered her relationships with men. “I’d always kept [boyfriends] away, thought they were all trouble—and I couldn’t handle it emotionally. I was very screwed up, I thought.”¹⁰

Not all children who are traumatized or abused become borderline adults, of course; nor do all borderline adults have a history of trauma or abuse. Further, most studies on the effects of childhood trauma are based on inferences from adult reports and not on longitudinal studies that follow young children through to adulthood. Finally, other studies have demonstrated less extreme forms of abuse in the histories of borderlines, particularly neglect (sometimes from the father) and a rigid, tight marital bond that excludes adequate protection and support for the child.^11,12,13 Nevertheless, the large amount of anecdotal and statistical evidence demonstrates a link between various forms of abuse, neglect, and BPD.

Nature Versus Nurture

The “nature-nurture” question is, of course, a long-standing and controversial one that applies to many aspects of human behavior. Is one afflicted with BPD because of a biological destiny inherited from parents—or because of the way parents handled—or mishandled—upbringing? Do the biochemical and neurological signs of the disorder cause the illness—or are they caused by the illness? Why do some people develop BPD in spite of an apparently healthy upbringing? Why do others, burdened with a background filled with trauma and abuse, not develop it?

These “chicken-or-egg” dilemmas can lead to false assumptions. For example, one might conclude, based on developmental theories, that the causal direction is strictly downward; that is, an aloof, detached mother would produce an insecure borderline child. But the relationship might be more complex, more interactive than that: a colicky, unresponsive, unattractive infant may generate disappointment and detachment in the mother. Regardless of which comes first, both continue to interact and perpetuate interpersonal patterns, which may endure over many years and extend to other relationships The mitigating effects of other factors—a supportive father, accepting family and friends, superior education, physical and mental abilities—will help determine the ultimate emotional health of the individual.

Though no evidence supports a specific BPD gene, humans may inherit chromosomal vulnerabilities that are later expressed as a particular illness, depending on a variety of contributing factors—childhood frustrations and traumas, specific stress events in life, healthy nutrition, access to health care, and so on. Just as some have postulated that heritable biological defects in the body’s metabolism of alcohol may be associated with an individual’s propensity to develop alcoholism, so there may exist a genetic predisposition for BPD, involving a biological weakness in stabilizing mood and impulses.

As many borderlines learn that they must reject the either-or, black-or-white ways of thinking, researchers are beginning to appreciate that the most likely model for BPD (and for most medical and psychiatric illnesses) recognizes multiple contributing factors—nature and nurture—working and interacting simultaneously. Borderline personality is a complex tapestry, richly embroidered with innumerable, intersecting threads.