Borderline Personality Disorder

Etiology
Borderline Personality Disorder (BPD), as is the case with several psychiatric disorders, is viewed widely as a consequence of the complex interaction of many factors such as psychological, neuroanatomical, neurochemical, and genetic factors.
a) Genetic factors: There is growing evidence that BPD is genetic and can run in some families. A study of people with BPD has shown that the prevalence of BPD among the relatives of people suffering from the condition can be up to 20 times higher than the prevalence among people who don’t have a blood relative suffering from the condition. In Monozygotic twins, the concordance rate was 35% relative to a rate of 7% in dizygotic twins. This research was done by Torgersen and colleagues. This high concordance rate is linked to the role played by genetics in BPD etiology.
b) Neurochemical factors: Serotonin has been linked to impulsivity and aggression. If there is a drop in the levels of serotonin, there is a corresponding increase in impulsive and aggressive behavior. Therefore, professionals have made the suggestion that the impulsive and aggressive behavior often witnessed among people with BPD is usually caused by low serotonin levels in the brain. Also, norepinephrine has been liked to aggression among people with BPD.
c) Neuroanatomical factors: Amygdale hyperactivity has been recorded among BPD patients. Further, a decrease in the functioning of the preorbital and prefrontal cortex in BPD patients has been associated with decrease in personal capacity.
d) Traumatic experiences: People who have been diagnosed with the disorder report instances of adversity and trauma as a consistent feature of their existence. The trauma is relatively different from that reported by people with various mental health issues, or people with mood and personality disorders. It is also different from those reported by people who have suffered abuse such as childhood neglect, sexual abuse, or physical abuse. Further, people with the disorder have higher instances of paternal and maternal abandonment as well as higher probabilities of being raised under foster care.
e) Attachment: interpersonal and emotional instability that is usually seen among people with BPD can be linked to their inability to create strong attachments when they are young. Infants benefit a great deal from creating strong attachments to their caregivers which gives them a sense of security and also creates affection between them and the people offering them care. Given the comforting responses that a caregiver affords an infant whenever the infant cries or alerts the caregiver to a discomfort, they grow to expect that the important people in their lives are great sources of comfort and security. This helps with the emotional development of the infant. Infants with BPD fail to adequately develop this capacity as their emotional development is impaired by the disorder.
Treatment Modalities
The most significant treatment protocol for people suffering from Borderline Personality Disorder is psychotherapy. The treatment helps reduce the symptoms over time. The benefits of psychotherapy treatments are as follows:
a) Dialectical behavior therapy: there is more evidence supporting the effectiveness of dialectical behavior therapy than other techniques in the treatment and management of BPD. The therapy makes use of eastern philosophy and cognitive behavioral therapy to achieve desirable results. One of the areas that the therapist has to consider is how to balance between the promotion of change and the validation of the patient’s experiences. The treatment includes individual sessions that are held weekly and group sessions that are also held weekly to teach various life skills such as emotional regulation, interpersonal effectiveness, mindfulness, and stress management and tolerance.
b) Mentalization-based treatment: this treatment process was developed to specifically treat Borderline Personality Disorder. It draws its roots from attachment theory and aims at improving the ability of patients to comprehend the mental state of others as well as their own mental state – the capacity to “mentalize”.
c) Transference-focused psychotherapy: The therapy is informed by a theory that was proposed first by Dr. Otto Kernberg. He theorized that BDP develops in a person because of “identity diffusion.” The idea is that one loses the capability to integrate negative and positive images of others and of themselves. The problems begin in childhood but continue into adulthood thereby creating a lot of internal conflict. The therapy works by helping the patient and the clinician understand past relationship dynamics and the emotions the patient has attached to those relationships that may affect their current state. The therapy’s aim is assisting patients integrate the views of other people and the views of themselves better.
Bibliography
Bateman, A., & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry, 166, 1355–64.
Biskin, R. S., & Paris, J. (2012). Management of borderline personality disorder. CMAJ, 184(17), 1897-1902. doi: 10.1503/cmaj.112055
Harvard University. (2019). Treating borderline personality disorder. Retrieved from https://www.health.harvard.edu/newsletter_article/treating-borderline-personality-disorder
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York (NY): Guilford Press.