Borderline personality disorder is a serious mental health disorder that usually develops during adolescence. It affects the way that young people relate to themselves, other people, and the world around them. While BPD can make everyday life difficult to manage, BPD is treatable and with effective support, young people can manage and recover from symptoms.
Scientists still aren’t sure exactly how and why BPD develops, but our knowledge is always increasing. The most established models now follow a biopsychosocial approach. They explain BPD as the result of interactions between environmental factors (such as childhood trauma and early life experiences) and existing biological vulnerabilities (such as character traits or genetics).
Childhood trauma is one of the most critical risk factors for the development of BPD. Many instances of childhood trauma happen within the family environment through relationships and interactions between a child and their caregivers. These experiences can significantly impact a young person’s emotional and social development, affecting how they manage emotions and form relationships with others. Experts think these changes may underpin key traits and features of BPD.
This blog explores the relationship between childhood trauma in the family environment and borderline personality disorder. It looks at the interaction of trauma with existing character traits and some biological explanations for the connection.
What Is Borderline Personality Disorder?
While borderline personality disorder can look very different from one young person to another, it has certain core features and traits. Young people with BPD may:
- have an unstable sense of self with quickly changing interests
- have patterns of intense and unstable relationships
- engage in impulsive and dangerous behaviours
- experience very strong emotions, especially in response to relationships
- experience suicidal thoughts and ideations
- be afraid of abandonment by others
- hear voices or other visual and auditory delusions
While BPD is usually diagnosed during late adolescence or early adulthood, many younger adolescents also meet the criteria for BPD. Most young people experience sub-threshold BPD (where only one or a few criteria are met) in the years before they develop the full disorder.
In these cases, early intervention is important to prevent more symptoms from developing and protect against long-term harm to a young person’s development.
How Common Is Childhood Trauma Among Individuals with BPD?
Childhood trauma and early life adversity play a key role in the development of BPD. Research suggests that between 30% and 90% of individuals with BPD experienced some form of abuse or neglect during childhood. Significantly more people with BPD experience childhood trauma – and especially severe forms of trauma – than those without.
Some experts understand BPD features as a normal response to traumatic events and difficult circumstances. Young people growing up with these experiences may learn to respond in a way that protects them at the time but becomes harmful in other social environments.
For example, young people who have been abused by caregivers may become untrustworthy of others. While this behaviour may be a normal response to abuse, it makes it hard to form close relationships later on in life.
Trauma in the Family Environment and BPD Symptoms
Many forms of childhood trauma happen in the family environment. This may include childhood abuse by caregivers, including physical, sexual, and emotional abuse. It also includes neglect and circumstances where a child’s needs are not met.
Sometimes, this can be intentional, but sometimes, there are reasons why caregivers are unable to provide for their child as they would like. They may be living with mental health disorders, lack socio-economic resources, or be facing very stressful events.
During their early relationships with parents or caregivers, children learn about their identities, how to regulate their emotions, and how to behave in ways that maintain their relationships with others. When children experience abuse or neglect, these learning processes can be disrupted, preventing them from developing effective emotional and social skills and a balanced view of themselves and others.
Children who experience abuse or neglect may develop a negative view of themselves because of the way they are treated and blame themselves for their mistreatment while becoming untrusting of others. This may lead to low self-worth and a fear of abandonment – a core feature of BPD.
Family Mental Health and BPD
Research shows that when a mother has a mental health diagnosis, their child is more likely to develop BPD. Within the family, higher rates of psychiatric disorders in general are also associated with BPD. According to one review, having a family member with a psychiatric disorder like anxiety or depression was the biggest risk factor for a BPD diagnosis.
When caregivers are living with mental health disorders, it can be hard for them to be attentive and responsive to their child’s needs. As with experiences of abuse and neglect, this may disrupt emotional, social, and cognitive developmental processes and cause a young person to feel invaluable or fear abandonment.
Interactions with Biological Vulnerabilities
Not every young person who experiences trauma in the family environment develops BPD. Instead, scientists think that experiences of trauma interact with certain character and personality traits that make a child more vulnerable to the disorder.
Some of the traits that researchers have identified that may make someone more likely to develop BPD include:
- experiencing unstable emotions
- having distressing or difficult feelings
- experiencing inappropriate anger
- difficulties controlling emotions
- impulsivity
- aggression
Studies have also found that novelty seeking – a personality trait where someone pursues new experiences with intense emotions – and avoidance of harm are important predictors of a BPD diagnosis.
Biological Explanations: How Does Trauma Affect the Brain and Body?
In recent years, scientists have started to explore the biological explanations for the link between trauma and BPD symptoms. They’ve identified several ways that childhood trauma affects the development of a young person’s brain and body that underpin the character traits associated with BPD.
The Hypothalamic-Pituitary-Adrenal (HPA) Axis
The HPA axis is a system in the body involved in our response to stressful situations. It releases certain hormones in response to stress that affect important brain functions, such as making us more alert.
When someone experiences childhood trauma, it can affect the way the HPA functions. It can cause an over-active response to future stressful events or higher cortisol levels in general. High cortisol levels are associated with a range of mental health symptoms, including anxiety and depression.
One part of our stress response involves reducing cognitive functions (such as reasoning, learning, and memory) and directing attention to emotional-related events related to the perceived threat. However, reduced cognitive functions can affect a person’s ability to regulate their emotions, a core trait of BPD.
Neurotransmitters
Neurotransmitters (also known as hormones) are chemical messengers that communicate between different brain regions and other cells in the body. They’re involved in most functions of the brain and nerve system.
Research suggests that childhood trauma can affect the transmission of some of the body’s most important hormones, including serotonin and dopamine. Together, serotonin and dopamine are involved in key functions like mood, reward, and motivation that may be connected with BPD symptoms.
Childhood trauma can also impact the hormone glutamatergic, which plays an important role in brain cell development, learning, and memory. This may affect how young people’s brains look and function later in life. Interestingly, brain scans have shown people with BPD have fewer synapses (places where brain cells connect with each other) in areas of the brain associated with the regulation of negative emotional states and autobiographical memory.
Treating BPD in Young People
BPD is a serious mental health condition with pervasive consequences in the lives of young people. However, BPD is treatable and, with the right support, adolescents and adults with BPD can recover from symptoms and lead fulfilling lives.
There are several evidence-based treatments available for young people with BPD. These include:
- DBT or DBT-a (DBT for adolescents)
- Adolescent identity treatment
- Mentalisation-based treatment
Treatment for BPD usually involves more than just therapy. Typically, young people work with a community mental health team to provide day-to-day support with as much independence as possible. This may include a social worker, pharmacist, psychiatrist, and occupational therapist.
The Wave Clinic: Specialist Recovery Programs for Young People
The Wave Clinic offers residential and outpatient support dedicated to young people, delivered by a team of specialists in child and adolescent psychiatry.
Our programs aim at building life advantage in young people. We support individuals to recover from mental health conditions while developing the skills they need to lead fulfilling futures. Our residential space combines exceptional clinical care with education, enriching experiences, and an international gap year experience. We support young people to grow in self-confidence, discover new life paths, and form life-long relationships with others.
We take a trauma-focused approach in everything we do. We integrate trauma therapy from the first stages of treatment, emphasising the interactions between present and past experiences.
If you’re interested in finding out more about our programs, get in touch today. We’re here to help.
