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 Genetics in Borderline Personality Disorder I was reading an article called “Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others” and noticed a line in the article that said this: “Thus, in addition to high heritability of BPD (Torgersen et al., 2008), these results argue that environmental factors (e.g., trauma) contribute to disturbed social cognition in BPD. In summary, for the current study we expected PTSD to be a negative predictor of social cognition.” That intrigued me on two levels. One was the “high heritability” part, because often I see comments about BPD and how many people believe that it is mainly caused by childhood trauma (and/or invalidation). In WHINE I state this: As I said earlier, one of the causes of BPD is the “invalidating environment.” Now, it could be that it is not an actual “cause” (and that all the real causes of BPD are biological), but more a reinforcer of BPD. So, the second part of the article that intrigued me was the idea that “we expected PTSD to be a negative predictor of social cognition” – and the discussion and methodology of comorbid PTSD with BPD. What they found was that people with BPD (with or without comorbid PTSD) are less able to understand the intent, thoughts and motivations of social interactions in others – in other words, people with BPD can’t mentalize as well as controls. They also found that this lack of ability is more marked in people with BPD who also have comorbid PTSD. The fact that they mention comorbid PTSD at all is something of a revelation – or perhaps should be to us nons. Many people come to support lists and do research on the Internet and begin their “introduction” of their BPD person with a long list of childhood traumas that explains why the person has BPD. This current research would indicate that PTSD and BPD are clearly two separate disorders and that, while PTSD is a contributor to poorer functioning that BPD alone, BPD is in itself a highly inheritable disorder and biological in nature, yet “reinforced” or made more severe (especially in a social functioning sense) when PTSD is present.
Anyway, this research led me to another scientific study called “Familial Resemblance of Borderline Personality Disorder Features: Genetic or Cultural Transmission?” In which the researchers studied twins, siblings and parents of borderlines to determine the genetic underpinning of BPD or whether the environment and/or cultural influences could have more of an influence on the development of BPD. They found this: “In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017) and their siblings (N = 1,266), parents (N = 3,064) and spouses (N = 939) from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects.” and this: “There was no effect of cultural transmission from parents to offspring.”
Recently, in the ATSTP group, we have been discussing the idea that shame/honor-based cultures and whether that environment could be explanatory in some sense of the development of BPD. It appears (at least based on this 2009 study) that the development and transmission of BPD is NOT cultural. It is essentially genetic (mainly “additive”, meaning it is more than one gene involved) and the environment has an effect, yet cultural transmission was not apparent.
They do go on to say this: “Gene by environment interaction implies that genes determine the degree to which an individual is sensitive to an environment. In the presence of gene-environment interaction, individuals with a ‘sensitive’ genotype will be at greater risk of developing BPD if an undesirable environment is present, than individuals with an ‘insensitive’ genotype.” So, basically, although this interaction has not been fully studied, it appears that some sort of “sensitive” genotype is required to develop BPD.
From Science Daily:
Possible Genetic Causes Of Borderline Personality Disorder Identified
ScienceDaily (Dec. 20, 2008) — According to the National Institute of Mental Health, borderline personality disorder (BPD) is more common than schizophrenia or bipolar disorder and is estimated to affect 2 percent of the population. In a new study, a University of Missouri researcher and Dutch team of research collaborators found that genetic material on chromosome nine was linked to BPD features, a disorder characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, and can lead to suicidal behavior, substance abuse and failed relationships.
“The results of this study hopefully will bring researchers closer to determining the genetic causes of BPD and may have important implications for treatment programs in the future,” said Timothy Trull, professor of psychology in the MU College of Arts and Science. “Localizing and identifying the genes that influence the development of BPD will not only be important for scientific purposes, but will also have clinical implications.”
In an ongoing study of the health and lifestyles of families with twins in the Netherlands, Trull and colleagues examined 711 pairs of siblings and 561 parents to identify the location of genetic traits that influences the manifestation of BPD. The researchers conducted a genetic linkage analysis of the families and identified chromosomal regions that could contain genes that influence the development of BPD. Trull found the strongest evidence for a genetic influence on BPD features on chromosome nine.
In a previous study, Trull and research colleagues examined data from 5,496 twins in the Netherlands, Belgium and Australia to assess the extent of genetic influence on the manifestation of BPD features. The research team found that 42 percent of variation in BPD features was attributable to genetic influences and 58 percent was attributable to environmental influences, and this was consistent across the three countries. In addition, Trull and colleagues found that there was no significant difference in heritability rates between men and women, and that young adults displayed more BPD features then older adults.
“We were able to provide precise estimates of the genetic influence on BPD features, test for differences between the sexes, and determine if our estimates were consistent across three different countries,” Trull said. “Our results suggest that genetic factors play a major role in individual differences of borderline personality disorder features in Western society.”
Here the text of a report on BPD in Malaysia…
Personality disorder common, says expert
By Brenda Lim
2008/10/12
IPOH: Stormy relationships, intense mood swings and suicide attempts are among the experiences faced by Malaysians with borderline personality disorders (BPD). For those living or working with them, the experience is like “walking on broken glass”.
“They consume you emotionally. They want to get under your skin and into your mind,” said psychotherapist associate professor Dr Brian Ho Kong Wai at his plenary talk at the Seventh Perak Mental Health Convention yesterday.
The usual reaction was to reject a person with BPD, which only reinforced their feelings of betrayal and abandonment.
BPD was a common psychiatric disorder, he said, estimating that one or two out of every 100 Malaysians had it, and that it was more common in women.
According to Ho, Susanna Kaysen, who wrote her memoir entitled Girl, Interrupted, had BPD, while other celebrities, including Marilyn Monroe and Princess Diana, were said to have many traits indicating that they had BPD.
Besides having difficulties in maintaining close relationships, those with BPD had feelings of emptiness and engaged in risk-taking behaviour which put them in circumstances which were inherently dangerous, he said.
They might also be confused about their identity, have brief transient psychotic or disassociative episodes, experience significant disruption to their relationships and work, and be sensitive to criticism and feared rejection, he added.
Are people with BPD manipulative?
“We are all manipulative. We don’t become what we are without being manipulative.
“If you are a businessman, you will network with others. Is that being manipulative?
“Someone who is truly manipulative will not be discovered as such. We are talking about those who are faulty in the skills and ways of dealing with people.”
Ho said that problem could have been caused by childhood BPD, a common disorder from neglect or abuse, or a traumatic event which led to a person failing to mature from seeing “black and white” such as good-looking heroes and ugly villains as described in fairy tales, to accepting “grey” areas.
“Everything is clearly right or clearly wrong to them. There is no middle ground. What they perceive as good is idolised and omnipotent.
“When they find that it is gone, it is hated and rejected. There is a lot of negativity.”
He said the main treatment of BPD was not medication but building trust and negotiating with patients, helping them accept changes, identify their emotional reactions and learn new skills like being mindful and adapting.
“You have to do a little re-parenting in helping them to grow and go. Remember that some of them had traumatic childhood experiences and lacked nurturing.”
While many improve as they grow older, those who recover more quickly are those who are likeable, honest, able to see the truth about themselves, willing to try to improve themselves and seek therapy, and have a supportive group of friends and family.
Well, well, well… I don’t know why but apparently I continue to be a subject at WTO. Weird. I posted about this a few days ago. I’ve been out of touch with the blog for a few days, while I do family stuff and take care of my email list. I really admire the people on my list; they do a great job of being both honest and validating with one another – while at the same time providing constructive advice to one another.
Boundaries… I’ve posted about boundaries many times before. I think boundaries are one of the most misunderstood concepts in the non-BP/BP relationship. While it is difficult to be a parent of anyone (much less someone with BPD) and provide no guidance to your child – I mean, it is natural to want to provide some advice and guidance to children – boundaries in the sense that many people on the Internet understand them are not effective in an emotional situation. Now, WAIT! Actually boundaries ARE effective… OK, how can I say they aren’t effective and are effective at the same time?
The major problem with boundaries is that most of the Nons out there believe that boundaries are something to “control” or “moderate” their BP’s behavior. This concept is absolutely ineffective and untrue. Boundaries created for other people (whether they have BPD or not) are not effective – especially when the other person has a general fear of judgment like those with BPD. Those types of boundaries are not really boundaries at all – they are RULES for the behavior of another person. They will not work in emotional situations.
Boundaries that DO work are those you set for yourself with respect to other people’s behavior. In other words, boundaries that guide your OWN behavior are effective ones. If you say to someone, “I will not go to a restaurant with you if you are drunk” (for example), what you are really doing is setting a boundary that limits/affects your OWN behavior given certain conditions. That type of boundary is effective because you, as a non-BP, have complete control over it. You can choose NOT to do something given a set of conditions.
I would encourage you to examine what you ”boundaries” you have in place and see if they are rules for other people’s behaviors or if they are actual personal boundaries that manage your own behavior and reactions. If they are the former, I expect you will end up being frustrated quickly. If they are the later, then you can find some peace when they are applied to a given situation. This statement isn’t meant to imply that someone with BPD will automatically accept your application of personal boundaries (to yourself). No, they might rage at you or try and convince you to do otherwise (i.e. go to the restaurant even if they are drunk), but you are the master of your own behavior and you can always be firm and say, “No.”
Here’s a good site about invalidation:
http://eqi.org/invalid.htm
A quote:
“Invalidation is to reject, ignore, mock, tease, judge, or diminish
someone’s feelings. Constant invalidation may be one of the most
significant reasons a person with high innate emotional intelligence
suffers from unmet emotional needs later in life.(1) A sensitive child
who is repeatedly invalidated becomes confused and begins to distrust
his own emotions. He fails to develop confidence in and healthy use of
his emotional brain– one of nature’s most basic survival tools. To
adapt to this unhealthy and dysfunctional environment, the working
relationship between his thoughts and feelings becomes twisted. His
emotional responses, emotional management, and emotional development
will likely be seriously, and perhaps permanently, impaired. The
emotional processes which worked for him as a child may begin to work
against him as an adult. In fact, one defintion of the so-
called “borderline personality disorder” is “the normal response of a
sensitive person to an invalidating environment” (2) ”
And another quote:
“Telling a person she shouldn’t feel the way she does feel is akin to
telling water it shouldn’t be wet, grass it shouldn’t be green, or
rocks they shouldn’t be hard. Each persons’s feelings are real.
Whether we like or understand someone’s feelings, they are still real.
Rejecting feelings is rejecting reality; it is to fight nature and may
be called a crime against nature, “psychological murder”, or “soul
murder.” Considering that trying to fight feelings, rather than accept
them, is trying to fight all of nature, you can see why it is so
frustrating, draining and futile. A good guideline is:
First accept the feelings, then address the behavior.
One the great leaders in education, Haim Ginott, said this:
Primum non nocere- First do no harm. Do not deny your teenager’s
perception. Do not argue with his experience. Do not disown his
feelings.
We regularly invalidate others because we ourselves were, and are
often invalidated, so it has become habitual. Below are a few of the
many ways we are invalidated:
We are told we shouldn’t feel the way we feel
We are dictated not to feel the way we feel
We are told we are too sensitive, too “dramatic”
We are ignored
We are judged
We are led to believe there is something wrong with us for feeling how
we feel”
Main Assumption: BPD is an emotional disorder in which the sufferer experiences extremely intense emotions and has more trouble than “normal” people do returning to “baseline” (they have a long “refractory period”). Notice I didn’t say “moods” – it is not a mood disorder (like bipolar) because moods last a long time. Emotions are short lasting and can spur other emotions. Ever notice how your BP can swing from sadness to anger to shame to elation all in about an hour (or less)?
If that is accepted then the next step is: what does one do about that? The best answer I can come up with is to use validation. If you feel something emotionally, you usually don’t have a “choice” not to feel it. Emotions are very valuable to us – they can save our life (as evidenced by the automatic fear reaction when a car swerves in front of you). So, some form of the emotion is valid, even if you think it isn’t “right” in these circumstances.
So, how does one validate an emotional state? You must identify it first. So, if your BP looks angry, you say “It seems like you are angry. What happened?” Usually the “trigger” is something that just happened, even if it relates to some long-standing fear/disagreement. The trigger will be something that JUST HAPPENED – that is the nature of emotion (not mood) – it is immediate. These triggers may not be what you think they are at all – they may seem trivial to you, but to the BP, they are a BIG DEAL.
When they tell you want happened, VALIDATE IT. What I mean is don’t say it is “right” or “wrong” to feel that way, just that they do feel that way, because they do. In other words, if my wife says, “You called me this morning and didn’t say anything about how I got up and took care of the baby last night, I am so pissed!” I would say,”Wow, I can see that you’re so pissed, feeling that someone doesn’t acknowledge your hard work must really upset you. Anyone would be upset if they didn’t feel appreciated.” This does two things: it validates that they feel that way and it normalizes the feeling. It also does NOT admit that you did anything wrong. In other words, it validates the feeling, but not the circumstances that triggered it.
OK, so I’m done for a while more. If you do decide to try this technique, be careful NOT to make it about you. It is about how they feel, not about how you feel. This is the most difficult skill to learn because when they are yelling at you about something YOU have done, it is hard to remember it is not about you. You want to jump in there are deny or reframe the argument to defend yourself and make it about you. I would suggest not doing this. It may feel “right” at the time to do that, but it will not be “effective” to dealing with the emotional state in the BP.
Also, don’t try and solve their problem (don’t try and make it better), don’t apologize, don’t judge. I know it’s hard and really, please don’t take me wrong, I am not trying in any way to invalidate the pain and struggle you guys go through as nons – really, I go through it too. I am not criticizing what you have been doing so far or what is working for you. I am not saying, “you’re doing it all wrong.” If what you are doing works, by all means keep it up. If what you have been doing so far doesn’t work, try this out and see if things get better. If it doesn’t help, try something else.
This is a link to site positing that adopted children are often mis-diagnosed with Borderline Personality Disorder (BPD). Sometimes, BPD is characterized by an “”inability to connect”" with parents. In the case of adopted persons, the initial invalidation of being “”rejected”" by one’s birth parents can be a life-long struggle. I have found that in Family Support groups close to 40% of the children diagnosed with BPD were adopted. However, there is another theory that has been overlooked by this author. That is that the birth parents of these children may have exposed them to biological impulsivity. If the mothers of the adopted children are impulsive – having sex and getting pregnant when it is not possible to keep a child – is it likely that the impulsivity has been passed down to the child? Meaning, the parents (who may have BPD tendencies, since they are often young and impulsive and engaging in unsafe behaviors themselves) may biologically pre-dispose those children to emotional dysregulation and BPD. It is impossible to know whether these children would develop BPD if they had stayed with their birth parents, but, going back to the biosocial model, they may have biological factors from their parents that are furthered by the initial rejection. This is just a theory and not based on scientific evidence at all. I would agree that, given my experience with families of diagnosed borderlines, a large portion of the children are adopted. Certainly, more study is needed. I would just suggest that perhaps the unsafe and impulsive behaviors of their birth parents might also play a role in their development of emotional dysregulation. It is not necessarily all the “”inability to connect”" with the adopted parents.http://borderlinebyproxy.blogspot.com/2006/04/bpd-adopted-important.html
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