What causes BPD?

Borderline personality disorder (BPD) is a mental health condition that affects mood, behavior, and personal relationships. It often emerges in adolescence and is more often diagnosed in females than males. The causes of BPD are unclear, but risk factors for developing the mental health disorder include genetic, environmental, and biological factors.

Do genetics cause BPD?

Research suggests that genetics likely increase a person’s risk for developing BPD. The prevalence of BPD is higher in people with a family history of the condition, such as a parent or sibling. This suggests that it can be inherited ^[1][2].

However, the exact genetic cause of BPD is unknown, and it is likely that genetics also influence environmental factors. For instance, a child living with a parent with BPD might later develop the psychiatric disorder due to a genetic predisposition. It is also likely that the environment in which they were raised may have exposed them to factors that also increased this risk, such as hostile or stressful family dynamics ^[1][3].

Do environmental factors cause BPD?

Several environmental factors have been linked to an increased risk of developing BPD, particularly childhood adversity ^[4].

Among people with BPD, there is a high prevalence of trauma in childhood, such as neglect and physical, emotional, and sexual abuse. Studies indicate that between 30-90% of people with BPD have experienced childhood trauma or abuse. This suggests that these experiences significantly increase the likelihood of developing the condition ^[5][6].

Furthermore, individuals who experience more than one type of abuse in childhood are likely to develop more severe symptoms of BPD. Additionally, correlations have been found between the severity and duration of childhood abuse with the severity of BPD symptoms ^[5][6].

Childhood interpersonal relationships that cause distress are also linked to an increased risk of BPD. This includes bullying and difficulties with maternal relationships, such as inconsistent care, hostility, and early separation ^[1][6] Interpersonal distress can also be caused by exposure to maladaptive behavior in parents, such as hostile dynamics, violence, addictive behaviors, and criminal activity ^[1][3].

Childhood exposure to trauma, abuse, and distress is thought to influence the ability to regulate emotions, tolerate adversity, and develop self-esteem. As such, exposure to these childhood experiences can lead to the development of maladaptive coping strategies and emerging BPD symptoms ^[3][5].

These occurrences may also be a combination of environmental and genetic factors. For example, parents with addiction or mental health issues may expose their children to maladaptive behaviors. Therefore, the children may inherit a predisposition to mental illness, while also being exposed to traumatic experiences that increase their risk ^[1].

Other potential causes of BPD

Studies show that neurobiology may play a part in the development of BPD. For example, abnormalities in the size or activity of various brain areas have been found in individuals with BPD. This includes areas such as the amygdala, hippocampus, and orbitofrontal cortex, which influence emotion, impulse control, and behavior ^[2][5].

It may be that these changes occurred in infancy or childhood. Research shows that early exposure to traumatic events and abuse can alter brain development, thus potentially leading to the development of BPD ^[5][6]. Alternatively, it may be that BPD causes these brain changes. As such, this link needs to be clarified and requires further research and understanding ^[1].

Similarly, it is thought that there may be altered levels and activity of certain neurotransmitters in people with BPD. For example, altered serotonin levels can influence mood regulation. Again, further research is required to clarify this link ^[2][6].

Environmental, biological, and environmental risk factors are likely interlinked in how they influence the risk of developing BPD. As such, there is no clear cause of the condition, which develops due to a complex combination of factors ^[1][6].

Can borderline personality disorder be prevented?

BPD signs and symptoms typically emerge in childhood and adolescence, although the condition is not diagnosed until after age 18. It was previously thought that this delay in diagnosis was beneficial in preventing stigma and labeling. However, it is now being considered that this delay can increase or worsen the effects of BPD and cause challenges in treatment ^[7][8].

Research indicates that early intervention and treatment of children and adolescents at risk or showing signs of BPD can improve treatment outcomes and prevent worsening symptoms ^[1][8].

Studies have found that young people can receive similar therapeutic treatments given to adults with good results. This can help to educate the individual and their family members about the condition, allowing for a better understanding and management of emerging symptoms ^[1][8].

These effective treatment options can also teach young people how to develop tools to cope with emotional distress and adversity, helping to improve resilience and prevent maladaptive behaviors commonly seen in BPD. It may be possible to avoid the occurrence of severe BPD symptoms by managing harmful behaviors and emotion regulation before the condition fully develops ^[7][9].

It is important to note that preventing BPD development may not always be possible. There may be cases in which the individual’s environment, family dynamics, or support system are detrimental to improving their risk ^[1].

However, in all cases, to provide the best chance of prevention is to improve the self-esteem and resilience of the individual through evidence-based interventions. Additionally, it is vital for them to develop therapeutic relationships with professionals and for their family members to engage in treatment where appropriate ^[8][9].