The Lifecourse of Borderline Personality Disorder
Borderline Personality Disorder (BPD) is one of the personality disorders. What is a personality disorder?
Personality disorders are generally considered to be the result of early experience and resistant to change. They are thought to be deeply embedded ways of thinking about and responding to the world, and other people. Treating personality disorders is often thought to be very difficult, because the patterns are so ingrained. Some professionals even say you can’t “cure” personality disorders; rather, you treat people who “work around” their ineffective natural tendencies.
The truth is much more complicated.
Personality development is a very complex process. Genetic and biological factors are important, because they shape our earliest responses. Is a baby fussy, and easily overstimulated? Are they quick to smile and laugh at others? Are they calm and easy to soothe, or do they demand extra attention? These early behaviors in turn shape how other interact with us.
After biological factors, we consider the early environment. Children’s early behaviors interact with their parent’s personalities. A demanding child may frustrate some parents, and not others. Some parents are patient, empathetic, and loving, and they nurture independence and teach self-soothing skills.
Any kind of abuse or neglect is especially damaging, though some persons are resilient. Many resilient persons probably have some biological, temperamental advantage. Some people find positive adult figures outside the home, and are able to avoid internalize the abuse and neglect they experience and develop in a healthy way.
Other persons are greatly affected by abusive, neglectful, or distant parents, but they “work-through” their issues in an organic way during their adolescence. Such change happens through relationships. This often occurs through a series of progressively more fulfilling intimate relationships and friendships. Support from non-abusive family members, teachers, coaches, and other role models can also be very beneficial.
Others work on their issues in a more systemic way, through therapy. In the therapeutic relationship, the therapist draws upon their training and experience to interact with the client in a particular way, with the shared goal of self-improvement and symptom reduction. This can occur with one effective therapist, or a string of therapists over time of varying skill.
With borderline personality disorder, the central personality issue is thought to be a deficit of emotion regulation. Everyone has bad things happen to them, and everyone feels upset sometimes. However, most people learn over time to develop skills to help themselves calm down, and to avoid becoming overwhelmed in the first place.
How does this develop? Again, the dynamics involved are very complicated. One key factor seems to be invalidating parenting. Invalidation is when someone fails to acknowledge the reality or validity of someone else’s emotions. In some families, emotional expression is not tolerated. In others, one child may be the target of the invalidating behavior. It includes comments such as:
Stop crying, you have no reason to feel sad.
Just get over it.
You are overreacting.
You’re not sad, you’re just tired.
Given all the factors that go into shaping personality, it makes sense that the course of personality disorders, such as BPD, can also be very complex. A recent article examined the life course of borderline personality disorder. The findings? The lifecourse is much more variable than many therapists assume. Symptom presentation varies and changes over time more than one might expect. In younger persons, life stressors have the ability to influence to course of the condition for the worse. However, as one gets older, the condition seems to have “intertia” of its own, and it is less influenced by life events.
Personalities change, but they are more easily shaped by life events when younger. This presumably includes the effects of relationships, and the effects of therapy.