Kathy Ewing

Borderline personality disorder is a variable, hard-to-pin-down phenomenon. “These patients…are a heterogeneous group…Even the same patient will present with a wide variety of problems at different times,” says Arthur Freeman, editor of Comparative Treatments for Borderline Personality Disorder. Another specialist, Robert G. Harper, describes patients as sometimes relatively pleasant, engaging, and responsive, while at other times depressed, sullen, confused, disorganized, angry, demanding, drug-seeking, or manipulative.

Sometimes people who know a little about the disorder (sometimes experts, too) sum it all up in simplistic terms — addiction, rage, childhood abuse, cutting — when not all (not even most) sufferers show all these symptoms. And no one shows them most of the time. It’s elusive, this disease, and often people with BPD don’t exhibit the symptoms much at all outside the home, outside of their closest relationships. It’s the significant others, along with the patient, who bear the brunt of this relationship disease.

Augusten Burroughs in his memoir A Wolf at the Table writes this about his dad: “I remembered thinking how, in the light of day out in the world, my father was just like anybody’s father. But as soon as I was alone with him again, Dad was gone and dead was there in his place. … I realized my father was two men – one he presented to the outside world, and one, far darker, that was always there, behind the face everybody else saw.” 

I always noted that my mother seemed cheerful around other people. When neighbors visited, she smiled and conversed and never betrayed her bitterness. At church, she was cordial, if distant, and in the nursing homes, the staff always told me and my sisters how pleasant and cooperative my mother was. We would exchange knowing and frustrated looks. Why did she save all of her bitterness and cutting remarks for us?

She behaved pleasantly and normally to outsiders and showed us her darker, sadder face.

Yesterday a friend and my sister and I attended an all-day seminar called Understanding 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 PowerPoint 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 are 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 time I paradoxically feel very confident in my new understanding of my mom. When I analyze carefully, I can make the case that the conventional thumbnail sketch of BPD — which includes 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.” 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 developed dialectical behavior therapy, argues that  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. That’s also a whole lot of people, maybe over half, and so maybe the offhand assumptions about abuse as a cause is misleading.

I’m reminded of 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. Friedel’s mother surmised that the anesthetic she had received during Denise’s birth (and not for her four other children) had somehow affected Denise’s brain.

Friedel himself absolves his mother of any responsibility for his sister’s illness. 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.” (page 22) 

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 intuition holds true, 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 neglect (and those cases might be the most difficult and hardest to treat), in other cases the sufferer comes from loving, if inevitably imperfect, parents.