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Origins of Borderline Personality Disorder (BPD)
Biological factors
The majority may have emotionally intense, labile temperament. This hypothesized temperament may serve as a biological predisposition to developing the disorder. Three-fourths of patients diagnosed with BPD are female. This could be the intense temperament, or the gender difference may be that women are most often the victims of sexual abuse that is a frequent feature of the childhood history of patients with BPD. Girls are more often subjugated and discouraged from expressing anger. It is also possible that men with BPD are an underdiagnosed group. They are more often diagnosed with narcissistic, or antisocial personality disorders, even when the underlying modes and schemas are similar. Men may have a higher likeliness of aggressive temperaments that are more likely to act out against others in a domineering way and less likely to act out against self.
Environmental Factors
1. The family environment is unsafe and unstable.
2. The family environment is depriving.
3. The family environment is harshly punitive and rejecting.
4. The family environment is subjugating.
Schema Modes in Patients living with BPD
1. Abandoned Child
A version of Vulnerable Child common to patients with BPD. Specifically, characterized by the patients focus on abandonment. In this mode patients appear fragile and childlike. They seem sorrowful, frantic, frightened, unloved, lost. The feel helpless and utterly alone and are obsessed with finding a parent figure who will take care of them. They engage in desperate efforts to prevent caretakers from abandoning them, and at times their perceptions of abandonment approach delusional proportions. The very young age at which the patient’s Vulnerable Child typically functions explains much about these patients’ cognitive styles. Healthier patients have Vulnerable Child modes that are older (typically 4 years or older), whereas patients with BPD have Vulnerable Child modes that are younger (usually less than 3 years old). In the Abandoned Child mode patients with BPD usually lack object permanence. They cannot summon a soothing mental image of the caretaker unless the caretaker is present. The Abandoned Child lives in the eternal present, without clean concepts of past and future, increasing the patient’s sense of urgency and impulsivity. What is happening now is all that there is, was, or ever will be. The Abandoned Child mode is largely preverbal and expresses emotions through actions rather than words. Emotions are unmodulated and pure. The four individual modes can function at different ages in patients with BPD. The Detached Protector is often an adult, whereas the Vulnerable Child and Angry Child modes are childlike. The patient often attributes to the Punitive Parent, the power and knowledge young children ascribe to their parents and not a mode. The Abandoned Child mode “carries” the patient’s core schemas. The therapist comforts the child in the grip of these schemas and provides a partial antidote through the limited reparenting of the therapy relationship. When patients with BPD are in the Abandoned Child mode, the therapist’s broad strategy is to help them identify, accept, and satisfy their basic emotional needs for secure attachment, love, empathy, genuine self-expression, and spontaneity.
2. Angry and Impulsive Child
3. Punitive Parent
4. Detached Protector
5. Healthy Adult