What causes borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Most theories about the cause or pathogenesis of BPD include the notion of a biologic predisposition [14] along with psychological and environmental factors. One theory posits that neurobiologic development is affected by a combination of disruption of early attachments and subsequent trauma leading to hyperresponsiveness of the attachment system. During emotional arousal, images of self and object are affected, and the individual begins to use primitive defense mechanisms.

A history of abuse is very common, and Michael Stone has postulated that childhood abuse can lead to the development of BPD. Several researchers have proposed the existence of a constitutional incapacity to tolerate stress. Kernberg has hypothesized that patients with borderline pathology have a constitutional inability to regulate their affect, which predisposes them to psychic disorganization or deterioration under early adverse environmental conditions. [11]

Persons with BPD are at higher risk for depression, panic disorder, and agoraphobia. Studies commonly reveal that patients with BPD are anxious, dependent, and acutely sensitive to rejection and loss; these observations suggest that the condition might be specifically related to attachment bond regulation.

Mahler hypothesized unpredictable and prolonged separation from their maternal figure during the separation-individuation process of development (18 and 36 months) places children at risk. [15] The unavailability of the maternal figure might make the child forever vulnerable to disorganization brought on by separation experiences.

Kernberg suggested that patients with BPD internalize early pathologic object relations. [11] The use of primitive defense mechanisms (which individuals without BPD outgrow during normal development) maintains these early pathologic object relations. Kernberg hypothesized that in the early stages of development, the infant experiences the maternal figure in 2 contradictory ways, as follows:

  • The good mother, who provides for, loves, and remains close to the child

  • The hateful, depriving mother, who unpredictably punishes and abandons the child

These contradictory experiences result in intense anxiety, which leads to the borderline defense of splitting. In splitting, an individual is unable to combine positive and negative feelings about another individual into a realistic picture of the other person, and stable feelings about the other person, that can withstand normal life frustrations and disappointments. As a result, the individual rapidly shifts between having very positive to very negative feelings about others.


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