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What causes Borderline Personality Disorder?
Here to answer that question is leading clinical psychologist, Dr. Ramani.
Everybody wants to know — in such a complicated, clinical condition,
like Borderline Personality Disorder (BPD) —
How did this happen?
That's always the million dollar question, with any mental illness, frankly.
And, if you look at the work of Dr. Marsha Linehan, who's done a lot of the research in this area,
a lot of her work, and other people's work, highlights this idea
that it's two things coming together:
a biological vulnerability
and coming from an invalidating early environment.
So, the biological vulnerability part?
That part, we're not entirely clear what that's about.
Is it genetic? Is it a neurotransmitter issue?
But something biologically about that person
has resulted in them being more hyper-reactive
— They sort of overreact with emotion, with sadness, with anger
That couples with coming from an early environment, usually a family environment,
that's very invalidating, -Mhm
where people are downright hostile, abusive, negating, critical, in a chronic way.
Listen, no parent gets it right every time; this is the majority of the time.
That environment is invalidating, and you can see how that becomes a set-up
for assuming all environments are gonna be invalidating,
so there's this sort of hyper over-reaction in the face of that.
Now, where this work gets interesting is that not everybody who comes from an invalidating environment
develops BPD, -That was my next question.
and not everyone who has that biological vulnerability develops BPD.
Obviously if you have both, the probability goes way up.
Now, an example of some of the most extreme, invalidating, early environment
is sexual abuse. Childhood sexual abuse, right? -Mhm
That is an example where the child's trust is betrayed.
They're confused. No one's keeping the child safe.
However, the majority of people who experience childhood sexual abuse
do not go on to develop BPD,
and a lot of people with BPD did not experience sexual abuse as a child. -Right.
So, there's no absolutes here.
And I think that frustrates people, 'cause everyone wants a slam dunk.
-I was just about to say that. I am frustrated just listening to that.
-It is. So, when we uncoil, un-spool the history of someone with BPD,
we definitely see that something wasn't quite right in that early environment in most cases,
But I gotta tell ya:
the longer I'm in this field, the more I hear tales of people who have borderline personalities as adults;
I've worked with the parents; and they'll say, "Listen,"
"we have wracked our brains." — and this is multiple people,
so it's not like one person could be deceiving and hiding this. And there's just no story there.
There's no neglect. There's no abuse. There's no bullying.
Like: there's no smoking gun.
So, it really then comes down to — in those cases — it probably was all biological vulnerability.
The research right now is focusing on uncovering what that biological vulnerability is.
Remember, as with all mental illnesses:
the earlier we can intervene, the better the work we can do.
So, if we can identify some of these early soft signs
we might be able to work with people to give them better coping skills, particularly around managing emotion.
-Yes, and that is a common thread with
all of the mental health issues we've been talking about. -Yes, yes.
Early intervention and intense intervention is the key to almost anything. -Yes, especially
we often miss these things in childhood. That's where it gets tricky.
For a lot of people, these patterns were apparent even in late childhood/early adolescence,
but nobody really jumped on it
until they were well into adulthood. -Or they say, "Well yeah, he's sixteen."
"So, of course. He'll grow out of it." -Yeah, sixteen — That time — It is true, yeah.
But, if we don't know the biological component that could be causing this,
the only way we're coming to that conclusion is by...
By saying that everything else can't be the cause.
So, it must be a biological... -If there's no other
historical kind of an issue that comes up. I mean, listen:
we are born with a temperament. -Yeah
Every, ask any parent out there, especially a parent who has multiple children, they'll say,
One kid was a really easy baby, and they went on to become an easy grown up.
And a kid who was clenched up from the day they were born, they were clenched up as adults.
We do have temperaments, and there may be more vulnerable temperaments,
which I believe to be biological in origin, too.
Until we can really unravel this,
we're not gonna know until, again, these behavioral patterns emerge.
But what this also speaks to, though,
is what we can do is hedge our bets.
This means things like teaching people to parent.
That — they're sometimes under a lot of stress.
Parenting is hard. This is not meant at all to blame parents,
but it's really about ensuring that we have supports in place for parents.
Whether that's daycare. Whether that's parent training. -Mhm
Whether that's pediatricians and other medical professionals that work with parents
so they can be the best parents possible.
We put a lot of pressure on parents as individuals,
when really as communities we can be drawing together and supporting parents,
especially parents who are in more vulnerable situations:
high stress, um — job insecurity, other mental health issues
We should be supporting parents, 'cause that allows them to support kids.
-Well, we put a lot of pressure on them, and then no tools. -Yeah, and no tools.
So, that's one of the reasons that I love what we're doing here,
because parents, or anybody, can go to medcircle.com,
get on a free digest — it doesn't cost them any money — and start to get
The lessons, the knowledge, the resource -Yes.
The actionable steps to take to say, "Alright, maybe my kid's goin' through a phase,"
"or maybe there's something more going on here, but either way"
"I'm gonna do everything that I can to move forward." -Exactly.
And the importance of creating very validating early environments for children.
At home. At school. That children need to hear, day and day out:
You're okay. You're not just okay, you're terrific.
Pay attention to them. However you can do all of that
You can do all of that, and a person could still develop BPD. -True.
So that's where this gets tricky.
-And you know what, I also like to hear that and I'm not three years old either.
I like to hear I'm terrific, too, so -Yeah. Amen. That's right.
I mean that just – -That's right, yeah.
We— It's— There— It can't be understated of being a good person. -Yup.
Be a good person and that will always help.
Uh, Dr. Ramani, thank you for being here talking about this fascinating topic.
We'll have more videos from you, I'm sure of it. -Thank you.
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