What causes Borderline personality disorder exactly?
Borderline personality disorder facts.
Like with any other mental disorder it’s unclear what causes borderline personality disorder exactly. It’s very likely that there is more than one factor contributing to its development. One of the borderline personality disorder causes is childhood abuse or neglect ,, but also genetics and brain abnormalities are considered to be borderline personality disorder causes.
Next to BPD causes there are also risk factors which may increase the chance of developing borderline personality disorder. Think of being a current age or living in rural areas.
This page discusses borderline personality disorder causes and risk factors, and explains why or how they may cause BPD to develop.
At Barends Psychology Practice we offer (online) therapy for borderline personality disorder. Contact usto schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).
Borderline personality disorder causes.
Childhood abuse or neglect: There is a strong link between the development of borderline personality disorder and childhood sexual abuse. Study  found that 73.9% of the people with borderline personality disorder had experienced childhood sexual abuse (non-genital), and 60.3% genital compared to 5.5% and 2.5% of the people who did not suffer BPD. The total duration of these sexual abuse periods was 40.7 months (3.39 years), and in 30.3% of the cases it was either the father, grandfather, brother, uncle or mother. According to study  91% of the people with BPD experienced some type of childhood abuse. 60% reported childhood sexual or physical abuse.
Apart from the childhood sexual abuse childhood neglect is also one of the strong borderline personality disorder causes. Examples of childhood neglect (that are associated with developing BPD) are: punishments by parents (inappropriate and frequent), having strict parents, a dominant or short tempered father, or when one or both parents have a weak character. Interestingly, receiving sufficient love and attention from mother, father or care-giver has a strong link with people who do not have borderline personality disorder. Those with BPD reported significantly less about receiving sufficient love from parents compared to people without BPD. According to study  92% of the people with BPD reported some sort of childhood neglect. 75% of the people with BPD reported childhood emotional abuse (e.g. being shamed or humiliated) or verbal abuse. 70% reported a caretaker’s denial of their feelings and thoughts and reported they lacked a relationship with their caretaker.
Childhood (sexual) abuse can be a predictor for the development of borderline personality disorder, because childhood abuse negatively affects the development of self-esteem, self-image, emotion, and perhaps even more importantly: childhood (sexual) abuse usually takes place in an unsafe environment in which sufficient love and attention from (a) parent(s) is absent. A child needs its parent’s love and attention to develop a healthy self-image, self-esteem, and so on.
Brain abnormalities & chemistry: In people with borderline personality disorder those areas of the brains that control and regulate emotions have a low metabolic rate and the activation of the limbic areas is excessive. This suggests that rational thought fails to control emotional thought and that causes emotional instability in people with BPD. The same study  reports findings of other changes in the brains that link BPD to excessive activation of limbic areas, and a reduced blood flow in areas associated with impulsiveness. And another interesting find suggests that lower levels of serotonin and greater impulsive aggression is associated BPD as well.
Abnormalities in the brain is one of the borderline personality disorder causes that seems to affect behaviour in a direct way (emotional instability and impulsiveness). It’s still unclear whether these brain abnormalities are caused by genetics, experiences in childhood or something completely different (food perhaps?), but they seem to contribute to the development of BPD. I think that childhood abuse and neglect causes the child’s brain to develop in an abnormal way causing these behavioural problems, and perhaps these behavioural problems affect the development of the brain in return.
Genetics: The development of borderline personality disorder may be affected by genes involved in the production of mono-amine oxidase-A (MAOA). The MAOA gene encodes the MAOA enzyme and this enzyme affects the effectiveness of the neurotransmitters norepinepherine, serotonin, and dopamine. Study  demonstrated that people with a MAOA deficiency who are abused as children are more likely to show criminal behaviour than those who are abused but had normal MAOA levels. This suggests that MAOA protects against the negative outcomes of childhood abuse, but more research on this topic is needed to confirm.
The heritability of borderline personality disorder ranges from moderate to high, but because BPD is such a complex disorder (BPD often comes with other mental disorders) it is difficult to tell which genes cause BPD. Instead researchers nowadays focus on its symptoms and found proof of the highly inheritable traits associated with BPD: aggression and impulsiveness. Another study  showed that a combination of high neuroticism and low agreeableness best predicts BPD. Borderline personality shares all genetic variation with neuroticism, agreeableness, conscientiousness, and extraversion. The specific pattern of personality traits in combination with unique environmental influences (childhood neglect or abuse) may cause people to develop borderline personality disorder.
Borderline personality disorder risk factors.
Although childhood sexual abuse is one of the borderline personality disorder causes, it could also be seen as a risk factor. However, the borderline personality disorder causes have not been added to this BPD risk factor list.
One major risk factor for developing borderline personality disorder is having a first degree relative with a mental disorder in the neurotic spectrum. According to study  people who have a mom, dad, sibling etc. with a mental disorder in the neurotic spectrum are 22 times to as likely to develop BPD compared to those people without a first degree relative with a mental disorder in the neurotic spectrum.
People living outside the city are more likely to have BPD. It’s unclear whether these people always lived outside the city or moved there later on in life.
People in the age group 30-39 are more likely to have borderline personality disorder.
BPD is more common among people with an income in the range of 0,000-19,999 US$ compared to higher incomes.
BPD is more common among people who are separated, divorced or widowed.
People with BPD more often reported major illnesses during childhood than healthy controls did.
Being separated from both parents during childhood also increases the chance of developing BPD.
 Grant, B. F., et al., 2009. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry, 69, 533-545.