Borderline personality disorder may affect around 3% of young people. It’s characterised by an unstable sense of self and relationships with others that can make daily life difficult to manage. While BPD is a serious mental health disorder, it is treatable and with the right support, young people with BPD can live fulfilling, productive lives.
Researchers are not sure exactly why and how BPD develops, but they think it usually results from a complex interaction of biological, environmental, and psychosocial factors. The developmental journey looks different in every individual and may take a wide range of different paths.
In recent years, researchers have started to explore the links between BPD and attachment styles. Shaped by the way young child attaches to their parents, secure, insecure, and fearful attachment styles describe the way we form and maintain relationships with others. Some researchers have proposed that:
- People with borderline personality disorder may be more likely to have insecure or disorganised attachment styles
- Some of the main features of BPD may be related to a hyperactive attachment system, causing young people to quickly and intensely bond with others
This blog offers some information about attachment theory and how it may explain some of the symptoms of BPD. It also provides an outline of treatment for the condition and how it can help young people to manage symptoms and build fulfilling futures.
What Are Attachment Styles?
Attachment styles are formed by the early interactions between a parent and their child. These first relationships have a huge impact on the emotional and social development of an infant, affecting the neurobiology of their brains and shaping the way they attach to others throughout the rest of childhood, adolescence, and into their adult lives.
For a young child, attachment is fundamental to their survival. Infants are dependent on their parents or guardians to fulfil their every need, from feeding to shelter to protection. In secure attachments, a sensitive and caring caregiver responds to their child’s needs while the child seeks to stay close to them.
Insecure attachment happens when a parent cannot adequately fulfil a young child’s needs. The child may become anxious, clinging to a parent and showing signs of intense desperation if they leave. In other cases, children tend towards avoidance, detaching from their parents and showing little attachment towards them.
Some children also show a fearful (or disorganised) attachment style – an unstable pattern of behaviours that may fluctuate between anxious and avoidance tendencies. Fearful attachment may happen when a child is frightened of their parent or sees their parent as frightened, possibly interpreting themselves as the cause. They may experience a paradox of a caregiver who at times fulfils their needs, and others harms them, leading to a state of confusion and instability that seriously damages the healthy development of the attachment system.
In many cases, these attachment styles continue into adolescence and adulthood. Young people with avoidant attachment styles may be reluctant to form close relationships and avoid intimacy with others. Those with anxious styles may become controlling over another person, seeking to ensure that they do not leave. Teenagers and adolescents with disorganised attachment may rapidly switch between anxious and avoidant traits, sometimes clinging to another and at other times detaching.
While insecure attachments can have a huge impact on a young person’s life, change is possible. With therapeutic interventions and the formation of other, secure relationships, young people can start to understand the roots of their feelings towards others and learn how to develop secure attachments in the future.
BPD, Attachment Activation, and Mentalisation
In 2011, a group of researchers published a paper that explores the activation of the attachment system among people with BPD.
They suggest that people living with the disorder often have a hyperactive attachment system that may have developed as a result of insecure attachments or the experience of traumatic events. Individuals with hyperactive attachment systems may quickly and intensely attach to another as though they are dependent on them for their survival. This may lead to some of the interpersonal difficulties associated with BPD, such as:
- Intense fear of abandonment by the other person, which may cause people with BPD to suddenly and pre-emptively end relationships
- Quickly escalating relationships that move from acquaintance to great intimacy over a short period
- Unstable relationships rooted in intense feelings of anxiety or avoidance attachment to the other person
The paper also explores the idea of mentalisation and how this may relate to attachment. Mentalisation is the ability to imagine the mental states of yourself or others that underlie actions and behaviours. It’s the skill of ‘thinking about thinking’ – reflecting on why you (or others) might feel a certain way or do a certain thing. Mentalisation is an important part of maintaining healthy relationships, allowing you to empathise with the feelings of others and understand the reasons that people act in certain ways.
Young people with borderline personality disorder often have difficulty mentalising. They may think that if a person leaves for a short amount of time, they have left them forever and not consider that they have an intention to return. They may also be quick to act according to a certain feeling without considering that the feeling may be rooted in other factors and not present the best course of action.
The authors suggest that a hyperactive attachment system may be one of the reasons that people with BPD can struggle with mentalisation. When a person attaches strongly to another, experiencing very intense urges to be close to – or sometimes avoid – them, it may leave little space to take a step back and consider the mental patterns that underlie these feelings.
Instead, they may feel overwhelmed by their affection, desires, and fears, and act following these emotions. They also suggest that, in some cases, this lack of mentalisation could be rooted in experiences of mistreatment as a child, who may be reluctant to consider the destructive thoughts and feelings a caregiver has towards them.
The Relationship Between Insecure Attachment and BPD
BPD can look very different from one young person to another. This means that it can be hard to generalise both the symptoms and underlying causes of the disorder. However, despite these difficulties, researchers have noticed certain core features that many people living with BPD experience.
One of these observations is that many people living with BPD show patterns of anxious and disorganised attachment. They may have a painful intolerance of aloneness, an expectation of hostility from those around them, fewer positive memories of social interactions, and a hypersensitivity to their social environment. These traits, which cluster around insecure attachments, often seem to constitute some of the most significant characteristics of individuals living with the disorder.
Other studies have explored the role attachment styles may play in the development of BPD. One study found that children with insecure attachment and separation anxiety were more likely to show traits of the disorder. Another study found that teenagers who were overly close with their friends or untrusting of the world around them were more likely to show features of BPD.
Understanding the significance of insecure attachment among young people with BPD may help therapists and other mental health professionals treat the disorder. By working with young people to understand the roots of their attachment styles and developing the skills to form more secure attachments with others, young people may be able to manage and overcome many of the interpersonal difficulties associated with the condition.
Treating Borderline Personality Disorder
Borderline personality disorder is a serious condition that often affects many aspects of a young person’s life. It may affect their relationships with friends, family members, and partners, their performance at school, and their ability to care for themselves. As a result, treatment for the disorder usually involves a combination of different types of care from a range of professionals. These may include:
- Social workers
- Occupational therapists
This team will focus on providing a young person with psychotherapy, as well as any other support that they require.
Psychotherapy for BPD
There are several different kinds of therapy that can effectively treat BPD, helping young people understand and accept their emotions while learning skills that promote positive change. Treatment for BPD often involves group therapy sessions, providing the space for young people to develop meaningful and secure relationships with both their therapists and other people living with BPD.
Psychotherapy for BPD may include:
- Dialectical behavioural therapy, a type of therapy specially developed to treat BPD
- Mentalisation-based therapy
- Psychodynamic therapy
- Therapeutic communities
- Art therapy
While BPD can make daily life feel difficult – or almost impossible – for young people, they can get better. With effective treatment and secure care, they can learn to manage and overcome BPD symptoms and build fulfilling, hopeful futures.
The Wave Clinic – A Safe-Haven for Learning
The Wave Clinic offers specialist mental health support for young people, guiding them through a transformative process of personal growth and positive change. Our whole-person approach combines clinical care with education, social responsibility, and a gap-year experience, offering young people the chance to rediscover themselves and their love of life.
We understand that young people have unique needs. Our team includes adolescent and teenage mental health specialists worldwide, ensuring each young person receives the very best treatment for them. Our clinic offers a safe haven of support, care, and attention that offers the space to introspect, grow, and overcome. Our programs aim at more than just recovery: we support young people to leave our centre ready to plan and build the futures they dream of.
If you have any questions for our team or would like to start the admissions process, contact us today. We’re here to help.