In a recent post I looked at the role that parenting plays in the onset of Borderline Personality Disorder (BPD). I wanted to draw attention away from what most people who don’t live with this illness experience – the behaviours – and look at the causes, because hopefully if we understand the causes we can minimise the occurrence of this illness and develop compassion for those who experience it.
But parenting is only half the story. How does neglect and abuse develop into an illness as severe as BPD? What predisposes some people to succumb to the illness and others to avoid it, because clearly not everyone with a poor childhood goes onto develop this illness? And how come 30% of us with BPD had healthy upbringings with no neglect or abuse?
The answer lies in the uniqueness of our creation and the development of our brains.
Our Organic Nature
A few years ago I decided to study horticulture. I learned so much during the course.
Firstly, that it was so important to select healthy plants for cultivation. Some cuttings and seeds from plants that were weak produced weak offspring that didn’t perform well, and sometimes just barely survived.
Other young plants that didn’t receive the right care in their first season would also often perform poorly – failing to become established, flower or in the worst cases dying.
But more than this, some young plants that appeared healthy just didn’t thrive in spite of coming from good stock and receiving really good care.
Counselling theory brought it home to me that as organic creatures we are no different.
It’s all the in the head…the brain to be exact
Firstly, at birth, no two brains are alike – no two people have exactly the same structure or chemical composition. Why should they? We all look different externally so why should we look the same internally? It just doesn’t make sense. This could be genetics, or it could be just the randomness of the natural world, but the effect is the same – we are all created unique – and this means that naturally some of us are more vulnerable to mental illness than others.
We know that whilst 70% of adults with BPD had a troubled childhood, 30% did not. And scientists have suggested that BPD has a 55% chance of being genetically inherited. So some people seem to be born with a predisposition to the illness.
Then, as our brains develop in childhood, their growth is affected by the environment in which they live. To use an extreme example, the brain of a child raised with lots of nurturing and structure in a loving home will develop differently from one raised in a violent, abusive home.
Not that it’s that simple. Researchers are also unsure as to whether childhoods were difficult because of parental neglect and trauma, or if the unhelpful behaviour of the child made parenting that much more difficult.
Whichever, the end result is that different pathways are created, different neurons formed, and different levels of chemical transmitters produced in the brain and body.
Now for the science bit.
There are four important areas of the brain which researchers have identified as being affected in people living with BPD.
The amygdala regulates the emotions, in particular the ‘negative’ emotions such as fear and anxiety, anger and aggression, and sadness and depression. It performs a vital role in daily living.
Brain scans have shown that people with BPD not only have smaller amygdalae than the general population, but these can waste away over time. A smaller amygdala is an overactive amygdala, leading to a heightened sense of the negative emotions – people with BPD experience fear, anger and depression much more frequently and intensely than the average person.
The hippocampus is the body’s data processor – it is associated with long and short term memory, spacial orientation and, most importantly, emotional reaction.
When an event is registered, it decides how we respond – if it interprets the event as safe, it relaxes, but if not, it kicks off the fight or flight response.
For people with Borderline Personality Disorder, the hippocampus is in a state of continuous over arousal. Uncoordinated and dysfunctional, it consistently misinterprets threats, and relays faulty messages back to the amygdala.
For people with BPD the world can be a threatening place, as can relationships with others. You feel constantly on edge and find it almost impossible to really relax. Unfortunately this inability to relax over a lifetime causes further damage to the brain and the rest of the body, creating a vicious cycle of reinforcement.
The Orbitofrontal Cortex
In terms of human evolution, this is the most recently developed part of the brain, and is responsible for reasoning, rationality and decision making…..but most importantly it inhibits our animal nature which is still present in the primitive parts of the brain.
Those of us with BPD have under-active and inefficient orbitofrontal cortexes, which goes some way to explaining the impulsivity of BPD, the failure of the reward/pain response to moderate actions and inform decisions, the development of unrealistic expectations, and difficulties in learning from past experiences. In short, many of the symptoms of BPD are as result of a weakness in this area.
A chemical attraction
The hypothalamic – pituitary – adrenal (HPA) axis
The HPA axis is a network of three glands which work together to control reactions to stress and regulate many body processes including digestion, the immune system, mood and emotions, sexuality and energy storage and consumption.
One of the functions of the HPA axis is to produce and manage important chemicals which communicate between these organs, the three that are important in BPD being cortisol, adrenaline and noradrenaline.
Cortisol is a natural chemical released during times of stress. Studies have shown that people with BPD have abnormal levels of cortisol in their bloodstream.
Too much Cortisol production means stress levels in daily life are always overwhelming. Psychologically, resilience and coping skills are undermined, chemically, the body is overwhelmed. Long term excessive cortisol literally acts as an acid, eroding organs like the brain and heart causing further illness.
Adrenaline is another chemical produced in the adrenal glands and brain. It plays an important role in the fight or flight response by increasing blood flow to muscles and the output of the heart, pupil dilation, and regulating blood sugar. Again, we know that individuals with BPD not only have excessive adrenaline in their system, but become addicted to its release thus priming them for high risk activities.
I’ll be looking more at the chemical aspects of BPD in a later blog. What’s that? You can’t wait?!
The causes and risk factors for developing BPD are complex. We know that having a family member with a mental illness or a neglectful or abusive childhood, along with stressful life events, increase the chances of developing the illness.
However, we have no control over the circumstances of our birth and upbringing, the structure of our brain, or the chemicals that flow through our body.
Severe mental illness is therefore not a sign of weakness, a spiritual sickness, evil or badness, although it may manifest itself in behaviours and emotional expression to which we attach those labels. No, mental illness has a physical basis over which the sufferer is powerless.
In fact, those with severe mental illness face an ongoing, daily battle to try to function in society and enjoy life in the way that so many people take for granted, things like loving relationships with others, the feeling of being loved and valued, the ability to hold down meaningful work, and create a comfortable home. Where you see someone with a mental illness doing any of these to any extent, you are truly witnessing a miracle, not a failure.
If you don’t have a mental illness, it’s worth considering that only by the grace of God, and through no choice of your own, you are well and don’t have to carry that heavy burden. In short, compassion, not judgment or a desire to criticise, blame or ‘fix’, is the only appropriate response to those who suffer from mental illness.
And if you do have a mental illness this is the relationship you need to build with yourself – one of compassion for yourself in the face of your struggles and forgiveness where you have failed.
So now I am giving you a new commandment: Love each other. Just as I have loved you, you should love each other.
As he went along, he saw a man blind from birth. His disciples asked him, ‘Rabbi, who sinned, this man or his parents, that he was born blind?’ ‘Neither this man nor his parents sinned,’ said Jesus, ‘but this happened so that the works of God might be displayed in him.
Lord, open our eyes
that we may see you in our brothers and sisters.
Lord, open our ears
that we may hear the cries of the hungry,
the cold, the frightened, the oppressed.
Lord, open our hearts
that we may love each other as you love us.
Renew in us your spirit.
Lord, free us and make us one.