If you have a close family member who is dealing with borderline personality disorder (BPD) — a psychiatric illness in which a person struggles with regulating his or her emotions, and may engage in maladaptive coping mechanisms like substance abuse, cutting, and suicidal behavior — you may be at risk, too. (1)
BPD affects an estimated 1.6 percent of American adults, but the numbers may be even higher, affecting nearly 6 percent of this population segment, notes the National Alliance on Mental Illness (NAMI). (2)
One strong predictor of the disorder is family history. In fact, having a first-degree relative (parent, sibling, child) with BPD puts you at a 5 times greater risk of developing it yourself, according to NAMI. (2) With a first-degree relative, you share an average of 50 percent of your genes.
Research on the family link comes to a similar conclusion. One study found that having a first-degree family member increases your own odds of BPD by three- to four-fold. The study also concluded that this increased risk of developing BPD within families is most likely due to genetic influences rather than the shared family environment. (3) Additional research has found that personality disorders in addition to BPD have a similar degree of genetic influence. (4)
“Just like you can be born with a sensitive digestive system, people with BPD are born with emotional sensitivities,” says Jeff Riggenbach, PhD, a personality disorder expert based in Tulsa, Oklahoma,?and the author of Borderline Personality Disorder Toolbox: A Practical Evidence-Based Guide to Regulating Intense Emotions.
But just because you have a strong family tie to BPD doesn’t guarantee you’ll develop it. A sensitive disposition can differ among siblings.
“If we could go back and watch a video of what happened in the childhood of someone with BPD, you may see drastically different things,” Dr.?Riggenbach says. “Regardless, as an adult or teen, everyone with BPD would describe feeling invalidated when younger. That is their experience. You can interview sisters in the same family. One may say she has no clue what her sibling is talking about. There’s enough of a difference between the two biologically that their experience is interpreted differently, even though they’re siblings.”
Invalidation at home means that your experience (regarding anything from your emotions to whether or not you’re hungry) is chronically disregarded as not being real or true.
Why There’s More to Borderline Personality Disorder Risk Than Just Genes
Even though there are strong genetic ties in the development of?BPD, that’s not the entire story. John Oldham, MD, a professor emeritus of psychiatry at Baylor College of Medicine in Houston and the author of the classic personality-type guidebook The New Personality Self-Portrait, talks to families about the interplay between genes and the environment. Think of two men who both have family histories of type 2 diabetes and have exactly the same genetic risk, he says. One is highly active and watches his diet and never develops diabetes. The other never exercises, becomes overweight, and thus develops diabetes. “The predisposing risk is not enough alone, but the right environment will turn on those genes and lead to the disease,” he says. This is also true of BPD.
“There are some eventual results of a genetic predisposition to develop the condition. Once it’s been turned on by repetitive or continued stress because of bad luck or an?unsupportive environment, it’s hard to get back on track,” continues Dr. Oldham. While this can be chronic invalidation at home, it’s often a traumatic event — physical abuse, sexual abuse, neglect — that pulls the trigger. One systematic review of 10 studies in 2018 found that maltreatment during childhood was a risk factor for developing BPD symptoms. (5) Another scientific review in 2018 linked childhood sexual abuse to BPD. (6)
Unfortunately, nearly 85 percent of those with BPD also have a co-occurring mental health condition. The National Institute of Mental Health notes that 60.5 percent of those with BPD also have an anxiety disorder, 34.3 percent have a mood disorder, 49 percent have impulse control disorder, and 38.2 percent have a substance abuse disorder. The right treatment will not only involve therapy for BPD but also appropriate treatment for the associated mental health problems.
How to Find Help for a Loved One Who’s Been Diagnosed With Borderline Personality Disorder
While BPD symptoms are often present during adolescence, the disorder frequently remains undiagnosed until adulthood, perhaps because personality traits fluctuate during adolescent years, according to one study. (7)
Having a child evaluated early can be invaluable in getting them on the path toward wellness sooner by identifying symptoms in childhood that may predict a personality disorder diagnosis. (8) This early intervention can help kids learn to manage their emotions in effective, healthy ways rather than self-destructive ones, and can assist caregivers in providing a supportive environment.
No matter their age, when a loved one has BPD, it’s common for others to feel that their loved one is out of control. “They may seem unreasonable, irrational, or that they’re deliberately and willfully behaving in a way just to try to get a rise out of you,” says Dr. Oldham. But the wrong response is to tell them to just knock it off or get a grip — as if that’s easy.
“For the person in the overemotional state, their ‘emotional brakes’ don’t work. And it’s very distressing for them. This is illness-driven behavior, they’re not just being a jerk,” Oldham adds. It’s a key thing for family and friends to keep in mind, particularly when you’re trying your best to get them help.
There are certain types of treatment that are more appropriate than others for those with BPD. Treatment tends to focus on psychotherapy — specifically dialectical behavior therapy (DBT) — not medication. DBT is an evidence-based treatment where people learn skills to regulate their emotions and handle stress, explains Adam Carmel, PhD, a clinical professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. The treatment involves team classes, phone coaching, group skill coaching, and individual therapy.
To date, there are 36 randomized controlled trials of DBT, Dr. Carmel points out. “It’s the most researched treatment for BPD,” he says. Other evidence-based treatments for BPD include transference-focused psychotherapy (TFP) and mentalization-based treatment (MBT), as well as a general approach called good psychiatric management (GPM). (9)
Because one of the causes of BPD is thought to be brain changes (people with the diagnosis have different brain structure and function that impairs the ability to control emotions and impulses, as well as make decisions), therapy aims to rebuild those neural connections that allow people to develop social smarts.
And research suggests that’s one way it works. A 2017 study on females?found that after 12 weeks of DBT, patients had increased volume in brain regions that regulate emotions compared with those who underwent the control therapy. (10)?
One problem is that those with BPD have deep-seated trust issues. “They will fire their friends, they will fire their therapists,” Carmel says. As their loved one, you’ll have to offer continuous support so they can stay the course. It’s also common for them to assume they’re not the one with the problem: you are. Unfortunately, BPD is severely undertreated. As NIMH points out, only 42.4 percent of people with the illness report having received any treatment over the past year.
To get them in the door, employ a little strategy when talking to them about therapy. “You have to respond to someone with BPD neutrally. As a therapist, we know that they’ll try to do something to get us angry,” says Gladys Frankel, PhD, a clinical psychologist in New York City. Respond to them neutrally, factually, and respectfully, she advises. If the conversation gets out of control, you can respond with “I don’t think this conversation is productive, maybe we should stop right now and come back in a few minutes,” says Dr. Frankel.
Not every therapist specializes in or has experience with DBT. “The vast majority of health professionals do not,” says Riggenbach. That’s why it’s critical to do research about which professionals those with BPD should seek out. Seeing the wrong health professional is one reason many people with BPD are in treatment for years without getting much better, he says.
To find a therapist qualified in DBT, you can look on the Psychology Today directory, advises Frankel. You may also call a local mental health clinic to ask if they treat BPD. If not, ask for a recommendation, says?Riggenbach.
Editorial Sources and Fact-Checking
- Borderline Personality Disorder. National Institute of Mental Health. April 2022.
- Borderline Personality Disorder [PDF]. National Alliance on Mental Health. March 2015.
- Gunderson JG, Zanarini MC, Choi-Kain LW, et al. Family Study of Borderline Personality Disorder and Its Sectors of Psychopathology. JAMA Psychiatry. July 2011.
- Czajkowski N, Aggen SH, Krueger RF, et al. A Twin Study of Normative Personality and DSM-IV Personality Disorder Criterion Counts: Evidence for Separate Genetic Influences. The American Journal of Psychiatry. July 1, 2018.
- Ibrahim J, Cosgrave N, Woolgar M. Childhood Maltreatment and Its Link to Borderline Personality Disorder Features in Children: A Systematic Review Approach. Clinical Child Psychology and Psychiatry. January 2018.
- Ferreira LFA, Pereira FHQ, Benevides AMLN, Melo MCA. Borderline Personality Disorder and Sexual Abuse: A Systematic Review. Psychiatry Research. April 2018.
- Sharp C, Wall K. Personality Pathology Grows Up: Adolescence as a Sensitive Period. Current Opinion in Psychology. June 2018.
- What Is Borderline Personality Disorder? Child Mind Institute. August 10, 2022.
- Choi-Kain LW, Finch EF, Masland SR, et al. What Works in the Treatment of Borderline Personality Disorder. Current Behavioral Neuroscience Reports. March 2017.
- Mancke F, Schmitt R, Winter D, et al. Assessing the Marks of Change: How Psychotherapy Alters the Brain Structure in Women With Borderline Personality Disorder.?Journal of Psychiatry & Neuroscience. May 1, 2018.
- Personality Disorders. National Institute of Mental Health.
- Find a Therapist. Psychology Today.