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Borderline personality disorder (BPD) is a psychological disorder that causes disturbance in the personality functioning of an individual.
In most cases, it has been reported in people aged eighteen and above. However, there have also been some reported instances in teenagers and adolescents. The main characteristic of this psychological disorder is extreme and variable moods. Patients of this disorder usually exhibit extra ordinary instability in moods.
In addition, Siegle (2007) points out that the disorder is characterized by “idealization and devaluation episodes” (p.1). Unstable and disordered relationships with other people, erratic self image and in extreme instances dissociation form other characteristics of this disorder.
Although much has been written concerning causes of borderline personality disorder, childhood abuse remains one of the most mentioned causes. A plethora of literature has pointed out that childhood abuse, especially sexual abuse plays a great role in the development of borderline personality disorder.
In most cases of this disorder, there have been evidence of neglect and maltreatment during early years as a child. The patients tend to have experienced emotional, physical or sexual abuse at some point in their lives. In other cases, the patients have reported having had no caregivers or having caregivers who never put in consideration their feelings and opinions.
This paper intends to highlight the arguments and discussions that prove that childhood abuse and neglect contribute to the development of borderline disorder personality. It will also highlight brain mechanisms and how they are affected in the case of borderline personality disorder.
Borderline Personality Disorder and Childhood Abuse
Meyer-Lindenberg clearly points out that of all the psychiatric care patients, 10% of them are suffering from borderline personality disorder. Of those hospitalized from psychological disorders, 20% of them are suffering from that disorder. Given this great number of patients, it is important to identify the main causes so that the number can be abridged.
The National Institute of Mental Health (2011) purports that while there are genetic and environmental causes of borderline personality disorder, a larger percentage of patients report abuse and neglect and some forms of separation during childhood. The institute further argues that 40% to 71% of patients of BPD have, at some point in their life been sexually abused. In most of these cases, the abuser was not the caregiver.
In the same line, Winston (2000) points out that 87% of all borderline personality disorder patients have had instances of abuse and neglect in their childhood years. Other than the 40-71% of those abused sexually, he indicates that physical abuse accounts for 25% to 71%.
One clear argument put forward by Winston (2000) is that there are great disparities in the degree of damage in relation to the age at which the abuse or neglect was done. If the abuse is carried out in an early stage of development, it carries greater damage as compared to abuse or neglect in later stages of development.
He attributes this to the child’s likely cognitive immaturity and the fact that the child does not have the ability to understand or derive any sense in the experiences that lead to trauma. As mentioned earlier, separation or neglect can lead to BPD.
This argument is evidenced by Winston who argues that sexual abuse can only be experienced if a family (and in most cases the parent) fails to offer adequate protection to the child. This is a form of neglect which will automatically lead to borderline personality disorder.
Emotional modulation is a hurdle for borderline personality disorder patients. Researchers have tended to associate this complication with the patients earlier experience with traumatic incidences.
Kernberg and Michels (2009) argue that mutilation of the self as a characteristic of BPD sets in as a result of early stage sexual abuse. They argue that an extreme case of this leads to dissociation and hence self cutting which at that point is carried out by the patient as a painless activity. This is a characteristic of dissociation.
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Furthermore, it was also ascertained that BPD characteristics were positively related to rejection sensitivity while they negatively related to emotional control. This is a clear indication that patients suffering from BPD have a problem with emotional control and hence the main characteristic of unstable and varying moods.
Brain Mechanisms and Borderline Personality Disorder
How, then, does borderline personality disorder affect the brain? Meyer-Lindenberg (2008) attributes the characteristics of aggression, negativity in emotions and unstable moods of BPD patients to “…impaired regulation of the neural circuits that modulate emotions” (p. 2).
The center of this problem of unstable moods and negative feelings is the amygdala. According to science, this almond shaped feature located in within human brain acts as part of the circuit whose role is ensuring that negative emotions are well controlled.
Other features in the brain that assist in emotion regulation and stabilization include the orbitofrontal and subgenual cingulated cortices. There are also other chemicals produced in the brain that help in the stabilization of moods.
These include On the other hand, the pre-frontal area of the brain plays a counter role. It tries to suppress the activities performed by the circuit.
BPD hence affects the emotion regulating features and chemicals of the brain. Inhibition of the limbic region of the brain leads to less ability to control emotions. Normal people have the ability to regulate the emotions by an increase in the activity of the parts of the brain that play the role of emotional regulation whenever the other parts of the brain report instances worth triggering fear or uncertainty.
On the other hand, the patients suffering from borderline personality behavior do not increase the activities of those parts in the event of stimulus. A scan of the brain of BPD patient indicates that their brains do not show increased activities of the parts of the brain that deal with emotional arousal.
As a result, the emotions cannot be put under control as the parts and chemicals responsible for this activity have been inhibited. Therefore, BPD affects the brain by inhibiting the production of necessary chemicals and also suppresses the parts of the brain like the amygdala, orbitofrontal and subgenual cingulated cortices.
Management of Borderline Personal Disorder
Given the mentioned effects of BPD on the brain and how these effects affect the patient’s moods and personal view of himself and others, it can be possible to identify the most appropriate approach.
For instance, it would be necessary for researchers and medical practitioners to ensure that they come up with strategies that would ensure that the parts of the brain that play the role of emotion control are not suppressed.
This means that the functional roles of the brain are restored. This includes reactivating parts like the amygdala and the orbitofrontal parts of the brain which would eventually restore the functional capacity of the brain.
The management of borderline personality disorder has therefore factored in the trauma issue and the scientific and functional activity of the brain. To enhance the functional ability of the brain, the use of medication has been recommended.
After having understood that borderline personality disorder affects the production of chemicals like serotonin, norepinephrine and acetylecholin which play an axial role in the circuits that work systematically to regulate emotion, it became necessary to develop artificial chemicals that would therefore assist the brain which has problems in the process of production of these chemicals.
Therefore, to ensure that a BPD patient maintains a stable mood that he is able to control involves use of drugs that would stimulate the production of the mentioned chemicals within the brain (Lyon & Martin, 2009).
Having also been established that a bigger percentage of BPD patients are created by a traumatic childhood, it becomes necessary that a psychotherapeutic approach is developed. Research also points out that psychotherapeutic approaches have been efficient and successful in some cases.
For instance, dialectic behavior therapy has been a very effective approach to borderline personality disorder patients. This approach has been efficient especially to those patients that had suicidal tendencies and affect dysregulation. Other than the one mentioned above, there are several other therapeutic approaches that have proved efficient and functional.
In conclusion, it is clear that childhood trauma can have great impacts on the development of a child. If neglected and abused, the child might end up with borderline personality disorder due to the effect it has on the brain. However, it is possible to control the effects through therapy and medical approaches. These work towards restoration of normal functioning of the brain in relation to emotion regulation.
Kernberg, F. & Michels, R. (2009). Borderline personality disorder. American Journal of Psychiatry, 166, 505-508.
Lyon, C. & Martin, B. (2009). Abnormal Psychology: Clinical and Scientific Perspectives. 3rd Ed. CA: McGraw Hill. Print.
Meyer-Lindenberg, A. (2008). Borderline personality disorder: No man is an island. Scientific American. Web.
National Institute of Mental Health. (2011). Borderline personality disorder: Raising questions, finding answers. Web.
Siegle, G. (2007). Brain mechanisms of borderline personality disorder at the intersection of cognition, emotion and the clinic. The American Journal of Psychiatr, 164, 1776-1779.
Winston, A. (2000). Recent developments in borderline personality disorder. Advances in Psychiatric Treatment, 6, 211-217.