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BPD Causes, or, My First Use of the Word “Hypochondriasis”

A friend recently sent me an article called “Emotional Hypochondriasis, Hyperbole, and the Borderline Patient” about the etiology (causes) and symptoms of borderline personality disorder, especially relating to hypochondria. Despite their sometimes befuddling jargon, the authors clearly expressed empathy for patients, their families and doctors, and said some wise things about the syndrome. I differ, however, on the issue of causes.

This article cites three (only three) previous theories about causation, all of which particularly cite mothers. This article purports to take a contrasting view, but, in the end, also blames parents. The authors, Mary C. Zanarini, ED.D., and R. Frankenburg, M.D., write, “We also believe that such pathology develops in response to serious, chronic maladaptive behaviors on the part of immature and emotionally incompetent, but not necessarily deliberately malevolent caregivers.” Okay, so the parents aren’t horrible on purpose, but they’re still horrible.

As I’ve said in my book and elsewhere on this blog, I resist the notion that BPD is caused by mothers. I should also say that I have no professional expertise and have done no original research. I’m a well-read layperson with a fair share of real-world experience with people suffering from the disorder.

Scholars who blame bad parenting (and nearly always target mothers rather than fathers) never explain the evidence that many sufferers, maybe as many as 60%, had normal childhoods, or, at least, non-abusive ones. In my book Missing, I recount the story of Dr. Robert O. Friedel, author of Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, who writes movingly about his sister, Denise. 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.  

Friedel himself absolves his mother of any responsibility. He writes,

“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 family . . There was never any doubt: she loved us all deeply and unequivocally.”

Friedel’s mother was a warm presence who suffered with and for her daughter and did everything she could to help her.

In my life, the people I’ve known with the disorder had widely various sorts of parents. Maybe some were abusive. More often, though, I observe the mismatch problem that Dr. Marsh Linehan has proposed. She suggests that borderlines have some biological propensity toward heightened and labile emotions. If their parents tend toward emotional restraint, even within normal limits, this mismatch may trigger the disease. I find this explanation not only more generous to parents but also more congruent with what I see around me.

The blaming of parents harkens to obsolete views of schizophrenia and autism. Remember the bad old days when these conditions were the mother’s fault? As science has discovered more complex interactions between genetics and environment, the onus on parents has been lightened. I predict that will happen in relation to BPD as well.

One other knotty problem remains. I realize I’m on treacherous ground, but I’ll ask the question anyway. What evidence and testimony are substantiating the claims of abuse? I hate questioning anyone’s assertions about an abusive childhood. But any of us who have dealt with people with BPD know that their version of past events often differs from ours. A day after a conversation with my mom, she would confidently accuse me of having said outrageously offensive things: that I didn’t care about her, didn’t have to listen to anything she said, and felt I had a right to do whatever I wanted whenever I wanted.

Even if I believed those things, I would have the sense not to say them to my mother. I never said them, but my mother would insist, almost hysterically, that I had. So, I wonder, who’s checking the stories of abuse? People suffering from BPD often claim to feel, as the Zanarini and Frankenburg article says, “the worst pain anyone has felt since the history of the world began.”  They feel, recently, that their boss or their spouse or their doctor has abused them in some way. They aren’t lying. They feel as though these things are true. But no objective observer would see them as true.

So, I’d assert that people with BPD need to be affirmed and validated in their bitter and horrific feelings, because denying them is both cruel and non-productive. But accepting and reporting their childhood accounts of abuse as scientific fact, without any confirming evidence, is irresponsible.

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