Yesterday a friend and my sister and I attended an all-day seminarÂ called UnderstandingÂ Personality Disorders presented by Dr. Dennis A. Marikis and sponsored by the Institute for Brain Potential. I was amazed, being a teacher myself, at how well Dr. Marikis was able to hold our attention through six hours. He used PowerPointÂ adroitly (which many people don’t…have you noticed?) and interspersed movie clips illustrating the various disorders. He was funny and engaging and compassionate.
Being inclined to worry, though, I take note of things that might undermine the thesis of my book, that is, that my mom suffered from borderline personality disorder (BPD). My mom never cut or injured herself, she never tried suicide, she wasn’t abused (as far as we know), and she was not an addict. Sometimes, these very characteristics areÂ cited as clear “markers” of the disorder. Coincidentally, I met up with an old high-school friend tonight who now works as a psychiatric nurse. When I told her about my theories about my mom, she immediately began describing young people with BPD cutting themselves and attempting suicide and suffering abuse.
It doesn’t take much to make me feel insecure, even though at the same timeÂ I paradoxically feel very confident in my new understanding of my mom. When I analyze carefully, I can make the case thatÂ the conventionalÂ thumbnail sketch of BPD — which includesÂ abuse, rage, addiction, and self-harm — is inaccurate or incomplete.
In this post, I’ll address the “cause” issue — the often-made connection with childhood abuse as a cause of BPD. I’ll address the other issues in later posts.
“There is evidence that people with BPD are more likely to report a history of child abuse or other distressing childhood experiences,” says Dr. Kristalyn Salters-Pedneault. “But, many people who have experienced child abuse do not have BPD, and many people with BPD were not abused or maltreated as children.”Â As Dr. Marikis made clear in his presentation, recent studies indicate that brain chemistry and genetics play a large part in BPD; it correlates with a heritable variation in how the brain uses serotonin.
Dr. Marsha Linehan, who developedÂ dialectical behavior therapy,Â argues thatÂ biology interacts with the environment. If someone has a strong genetic inclination toward BPD, it may be triggered by parents who are merely undemonstrative, not abusive or neglectful.
Research shows that 40%-70% of BPD sufferers report childhood abuse. That’s a lot, of course, and it makes sense that abuse and neglect would contribute to BPD symptoms such as fear of abandonment and difficulty in relationships. But look at the issue another way: 30% to 60% of BPD sufferers do not report abuse.Â That’s also a whole lot of people, maybe over half, and soÂ maybe the offhand assumptions about abuse as a cause is misleading.
I’m reminded ofÂ Dr. Robert O. Friedel, who in Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD writes movingly about his sister Denise, who suffered from BPD. Denise had emotional difficulties literally from birth; she cried more than her siblings and was difficult to soothe. In childhood, she would attack her sisters and brothers in violent rages and break their belongings. She seemed to have begun life with a strong biological disposition to BPD. Friedelâ€™s mother surmised that the anesthetic she had received during Deniseâ€™s birth (and not for her four other children) had somehow affected Deniseâ€™s brain.
Friedel himself absolves his mother of any responsibility for his sister’s illness. He writes,Â
“One of my most vivid memories of my mother was the way her face would light up whenever she saw one of the family. It made me feel good to my core to be caught in the radiance of her smile and the warmth of her embrace. I would watch her bestow the same love on every member of our familyâ€¦There was never any doubt: she loved us all deeply and unequivocally.” (pageÂ 22)Â
Dr. Friedel’s sister seems to have been born with BPD or so inclined to develop it that a stimulus like an anesthetic, if her mother’s intuitionÂ holds true,Â triggered her disorder. In Missing I predict that at some future date, parents (often meaning “mothers”) will be let off the hook, as they have finally been in respect to autism and schizophrenia.
That is, though BPD is in many cases probably triggered by trauma, violence, or neglectÂ (and those cases might be the most difficult and hardest to treat), in other cases the sufferer comes from loving, if inevitably imperfect, parents.
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After more than 30 years of working with/on behalf of people who have significant disabilities – physical, developmental, emotional, psychiatric – I have come to understand that there is no rigid all-or-nothing set of descriptors that must apply to “fit” a diagnosis. Everything is on a spectrum. Nothing is black-and-white. There are many shades of gray in between. So your Mom didn’t do some of the things that others with BPD do and she didn’t have the same history as some. She “fits” in with around 50% of people with the diagnosis – right in the middle of the spectrum. These diagnoses are handy tools to have – they help us think about, talk about, and give us something to grab on to when we consider and try to “come to terms with” people with differences and certain difficulties. (And by the way, they – the diagnoses – help the professionals get insurance to pay for treatment…) They shouldn’t be more than tools.