Monthly Archives: December 2013

#5 – What to do if you are diagnosed with BPD

If you have recently been diagnosed with Borderline Personality Disorder, you are probably wondering what to do to start getting better. Or perhaps you’re wondering if it’s possible to recover at all.

Deep, lasting recovery from BPD takes a significant amount of time – in my opinion, at least 3-5 years to move far along the road to being emotionally well. However, it is possible to begin going in the right direction immediately. The early years of recovery for a borderline individual, while sometimes very challenging, can be rewarding and meaningful in the long run.

Step 1 – Educate Yourself about BPD

One of the most important things for someone diagnosed with Borderline Personality Disorder to do is to become informed about the disorder. In my opinion, three interrelated areas are useful to learn about:

1) What BPD is and how it “works” from different viewpoints.
2) Different treatment options.
3) Case studies of former borderlines who have now recovered.

For step one, the most basic, but limited way of understanding BPD is reading its definition in the DSM. After that, basic books like The Borderline Personality Disorder Survival Guide (Chapman), Stop Walking on Eggshells (Mason), and I Hate You, Don’t Leave Me (Kreisman) can give a basic overview of BPD’s characteristics.

While they can be useful initially, I no longer give much credence to these books, since they are superficial and give little guidance about how to recover. They tend to cater to friends and family, rather than to the individual diagnosed with BPD. Also, some of them hold the viewpoint that BPD is a disease to be struggled with for life, rather than a condition that can be fully recovered from. That is something that my experience has disproven.

Books that Helped Me Understand BPD And Have Optimism About It

To address steps one and three – how BPD works, and stories of people who recovered – I learned the most from two sources. First, from reading therapists’ case studies of borderlines who they successfully treated. These case studies usually  illustrate important facets of the disorder, including its developmental genesis, the use of splitting and projective identification, typical phases of treatment, how the attachment to bad relationships works, the fear of trust and dependence, and so on.  Second, I learned from reading material on the internet and in print by borderlines in recovery. These first-hand accounts of recovery written by former borderlines can be more powerful and direct than second-hand accounts of recovery seen through the eyes of a therapist. All of these books provide hope that lasting recovery from BPD is real and possible.

Realistic hope for BPD recovery is critical – hope that committed, hard work over a lengthy period will lead to a better life free from borderline symptoms. One of the lessons I’ve learned is that how one thinks and fantasizes about oneself in relation to Borderline Personality Disorder makes a big difference. At first, via my research and through therapy I worked on convincing myself that BPD could be deeply recovered from. Replacing my former pessimism and fear about BPD being a hopeless, life-long disorder with optimism about recovery helped me immeasurably. Later on, I came to question whether BPD was a valid diagnosis at all, which I no longer believe it is. But that is not so important initially as nurturing the simple belief that no matter what one’s problems are, they can get better.

At the bottom of this article, you can find listings of books by therapists about their successful treatment of BPD patients. They are mostly psychodynamic or psychoanalytic, since that is the viewpoint that was most useful in my own journey. I bought all these books used for low prices off Amazon. Also, some good online and print sources written by recovered borderlines are described.

Treatment Options – Psychotherapy

If one is diagnosed with BPD and can afford it, therapy can be one of the most important drivers of recovery. As a teenager, I was fortunate to have my therapy funded by my parents. Later on, I lived frugally while paying for treatment myself. Therapy can be expensive, but many therapists use a sliding scale of reduced fees correlating to ability to pay. If you want therapy but feel you cannot afford it, do not give up. Make sure you search around your area for different reduced rate or pro bono options. In large cities, there are hospital-based nonprofit clinics which offer low-rate or even free group and individual therapy.

What type of therapy is the best? Obviously, that is a question that cannot be answered objectively. In my view, the more important factors are the motivation of the person suffering with BPD, and the personal qualities of the therapist regardless of their orientation. However, with that caveat I believe that that the two best kinds of therapy for BPD are psychodynamic/psychoanalytic therapy and Dialectical Behavior Therapy (DBT). I am biased toward psychoanalytic treatment for BPD because it worked for me. I have no direct experience of DBT. However, it has worked for many others suffering from borderline symptoms, so I recommend it also.

Many uninformed therapists are pessimistic about BPD or do not know how to treat it. However, there are also many therapists out there who are skilled at treating BPD. They know from experience that lasting recovery from BPD is possible. If you seek treatment, it is obviously important to find the latter kind of provider.

How To Find A Therapist

My favorite source for finding therapists is the Psychology Today’s Therapist Finder. It can be accessed at:  http://therapists.psychologytoday.com/rms/

This site has the largest and most up-to-date listing of therapists currently available in the United States and Canada. Once you click on a region, you can search for therapist by orientation (psychodynamic, dialectical, etc.), by specialty (borderline personality disorder, eating disorders, anxiety, etc.), and so on. For example, I just searched in the large American city nearest me, and found over 70 therapists who specialize in treating Borderline Personality Disorder. You can also find therapists that are covered by different insurance providers, which is important because insurance can often cover a significant part of the cost of therapy. And you can directly email or call the therapists directly from the site.

My Therapist Interview Process

I used Psychology Today’s site to find a good therapist several years ago. What I did was to email and call all the therapists I was interested in, asking them a few brief questions. I introduced myself in a friendly way and asked them some version of the following:

– Do you have a lot of experience treating personality disorders, in particular Borderline Personality Disorder?
– Do you believe that individuals with Borderline Personality Disorder can be successfully treated? In particular, do you believe that a sufferer of BPD can become free of the disorder over the long term, i.e. come to live a healthy life free largely free of borderline symptoms?
– Are you willing to meet with me for a 15 minute free in-person consultation to see if we might be a good fit?

If the therapist answered no to any of these questions, I rejected them. For me, a therapist who won’t volunteer 15 minute of their time for a brief consultation is not worth your time. If the therapist had little past experience treating personality disorders, I discounted them. That might be arbitrary, but it made sense to me that I wanted someone with a lot of experience treating a difficult condition. And most important, if they were at all pessimistic or doubtful about recovery from BPD being possible, I moved on. I met two therapists in person who thought that BPD was a lifelong “disorder”, the symptoms of which could be managed but would always remain with the sufferer. These “therapists” were poorly educated charlatans who shouldn’t be given the time of day. I was happy to walk out of their offices and go on to find someone much better.

Alongside these kinds of questions, one might also ask if the therapist offers a sliding scale of fees based on income. Good therapists often do this, but they will not always advertise it up front, since of course they have to treat many patients at full price to make a good living.

For me, finding a good therapist for BPD was like shopping for a car or a house. It’s a big decision that requires careful consideration and research. In some cases, the buyer should beware.

Much more could be written about different types of therapy. Those will not be explored here, mainly because I am not an authority on different types of therapy for BPD (I only know a significant amount about psychodynamic-psychoanalytic approaches). However, I encourage you, if you are diagnosed with BPD, to research other types of therapy and come to the best understanding possible of your options.

Medication

I hesitate to include this part, because it is controversial. However, it is best to be honest about one’s views. For most people, I do not believe that psychiatric medication is a major long-term contributor to recovery from BPD.

Medication can play a role in the early phases of treatment. It can be useful because it controls symptoms in the short term, usually for a period of months. If a borderline individual is struggling with overwhelming suicidal impulses, or with terrible, unamanageable anxiety, medication can be useful to stabilize them. It can bring down the temperature and stop a person from “overheating” emotionally. I was prescribed anti-depressant medication for this reason myself in my late teens and early 20s. However, I then decided to taper off of it, and I have not used medication at all for the last six years.

However, beyond stabilizing short-term symptoms, I believe that medication is a waste of money and potentially dangerous. I recently read the books Anatomy of an Epidemic, by Robert Whitaker, and The Myth of the Chemical Cure, by Johanna Moncrief. These and many other books on the subject make clear that psychiatric medication carries with it the risk of severe long-term side effects that are currently poorly understood. In particular, there is the scary and very real possibility of tardive dyskinesia (uncontrollable, often irreversible movements of the mouth and other body parts) in those who take psychiatric medication long term.

For me, there are several problematic emotional aspects to using medication long-term in the treatment of BPD. Using medication long-term promotes the myth that taking a pill can magically solve one’s emotional problems. It implies that one does not have the ability to deal with long-standing issues interpersonally. And it suggests that the primary source of one’s problems is biochemical or genetic, which for me is pessimistic and false. As referenced in Whitaker’s book, disturbing long-term studies are now showing that if they take medication long term, patients with several types of psychiatric disorders do worse on most measures of recovery than those who never take them. Big Pharma companies are denying these results. But of course, they have billions of reasons to do so.

I recommend that people do their own research and come to their own conclusions about medication. My position is that therapy, self-help, and support from family and friends are the main drivers of recovery. If I were to start over with recovery, I would remain open to taking medication in the short term to provide relief from overwhelming symptoms. However, I am so glad to be off medication for the past six years. It gives me the empowering feeling that my own actions are responsible for my recovery, that I am a free agent.

Other Sources of Support Early In Recovery – Family and Friends

On my recovery journey, learning about how the borderline disorder works, reading stories about how former borderlines recovered, and finding an effective therapist were key early steps.

Support from family and friends is also very important. If one’s family can come to understand BPD in a compassionate way and be supportive of one’s recovery, that can obviously be tremendously helpful. My mother never actually knew that I had BPD, but she nevertheless supported me  to go to therapy, gave me a place to live, and was available to talk for several years after I graduated from college. Without her financial and emotional support, I would not be where I am today.

Opening up to friends about BPD can also be valuable, although it can feel risky. Over the course of five years (between ages 17-22), I told four people I met about my history of physical abuse and the problems between my parents, who divorced when I was 18. Although they never knew that I had BPD, Gareth, Julian, Andrew and Helena did discover that I was severely depressed, occasionally sometimes suicidal, and that I had great difficulty trusting and opening up to other people. They became invaluable sources of support and helped me to feel less alone during the early period of my recovery.

I was very hesitant initially to confide in these people, since I had no real friends at the time and feared that they would reject me. The antidependent side of me did not want to risk asking anyone else for help. However, the healthier, dependent part of me correctly sensed that they were kind, mature people, and it eventually won out. Gareth was an older family man in his 40s that I met through tennis, Julian was a fellow high school student in the class above me, and Andrew and Helena were young people in their mid 20s who worked at a spiritual retreat center that my family went to every summer.

Where to Find Friends Who Support Your Recovery

If you don’t have friends like this yet, there are many people out there willing to help. Online web boards and forums can be useful places to find support, but nothing replaces meeting people in real life and talking face-to-face. For that reason, I believe that group therapy and 12-step groups are extremely valuable. I attended both in my late teens and in my 20s.

Many therapists listed on the Psychology Today site above run or make referrals to group therapy. To find such groups it is usually necessary to get referrals from therapists or local hospitals and social work clinics. I went to a group for emotionally troubled young people at the state college that I attended. The university hospital ran this group, and it was free.

Regarding 12-step groups, I met several great people at these meetings that became friends whom I could call or meet in person during difficult periods. Twelve-step groups exist for almost every possible emotional problem, including eating disorders, sex addiction, drug and alcohol addiction, gambling, self-harm, and many more.  Here is a list of 30 different 12-step groups, along with their websites:
http://www.12step.org/12-Step-Groups/

Also, Meetup (www.meetup.com) is a great way to make new friends in your local community. This worldwide online platform creates groups for specific interests that meet in real life. I met several of my current friends through Meetup groups in my area. This might not be the very first step to take in BPD recovery, but once the borderline individual is more confident and ready to leave behind past abusive relationships, Meetup provides access to a whole new world of people.

I hope this article has provided some useful ideas for those wondering where to start looking for help with BPD recovery (and please also see the books below). The central, overriding goal throughout my recovery from BPD was to learn to trust and develop satisfying relationships with other people. Good long-term psychotherapy can help a borderline individual come to trust and truly depend on another person for the first time. Therapy groups, 12 step programs, friends, and family can be invaluable sources of support, with or without individual therapy. Lastly, the individual’s own self-advocacy and motivation to get better are perhaps the most critical drivers of their recovery.

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Therapists’ Books About Borderlines Who Recovered

The Bad Object – By Jeffrey Seinfeld. Seinfeld’s successful cases of Kim, William, Justine, Diane, and Peggy are detailed 20-30 page “stories” of these borderline patients’ lives. Seinfeld tells how they went from severely borderline to learning to trust him and becoming increasingly functional and independent. Seinfeld, a New York-based social worker who recently passed away, is one of my heroes for how optimistically he writes about BPD.

Six Steps in the Treatment of Borderline Personality Organization – by Vamik Volkan. This internationally renowned psychoanalyst was a master at conceptualizing and treating BPD. In this book he illustrates his conceptual understanding of BPD, and outlines six phases of successful treatment that he used. His account of his treatment of Patti, the borderline patient whose history fills half this book, is a touching and ultimately triumphant story of how Patti became a mature adult over a period of several years.

Borderline Psychopathology and its Treatment – by Gerald Adler. In this book, Adler defined specific phases in the successful treatment of BPD and reviews the treatment course for several borderlines with whom he worked. Adler, a Boston-based psychiatrist, uses a deficit model of BPD which is different from some other psychodynamic writers. He focuses on the relative absence of positive introjections and the inability to regulate emotions, rather than on the attachment to bad objects. I met Adler in Boston in 2008 to discuss BPD, and he is still very optimistic about treating the disorder, while not being unrealistic about the major challenges involved. Adler is such a kind man, and he is another one of my “idols of BPD” 🙂

Psychotherapy of the Borderline Adult – by James Masterson. Masterson describes his theory of BPD treatment, which is focused on working through negative feelings and encouraging independence in the patient. He tells the stories of several young and middle-age adult patients who had strong outcomes, becoming able to love and work. I’m not a big fan of Masterson’s theories, since for me they overemphasize autonomy at the expense of dependence and closeness, but I respect his success in treating BPD. Until he recently passed away, Masterson practiced therapy in New York where he developed an institute which trained other therapists in how to treat personality disorders including BPD.

The Difficult Borderline Patient, Not So Difficult to Treat – by Helen Albanese. This book has a strange title, but it’s a great book! It was written in 2012, by a Texas-based university therapist who has worked with borderlines for decades and is very optimistic about BPD. In this short volume, she describes her understanding of how borderlines repeat and cling to past traumatic experience. She describes how therapists can help separate the borderline from bad external relationships and promote the development of an authentic self.

The Angry Heart: Overcoming Borderline and Addictive Disorders – by Santoro and Cohen. This was one of my first introductions to BPD. It is a very empathic and informed view of BPD and how to recover from it, from a mainly cognitive-behavioral viewpoint. However, it does not have the lengthy case studies of some of the other titles above.

Listening Perspectives in Psychotherapy and Interpreting the Countertransference – Lawrence Hedges. I hesitate to recommend these books because they is quite technical. However, they moved me toward my current viewpoint about BPD being more useful as a metaphorical term than as a mental health diagnosis. In this work, California psychoanalyst Hedges explicates his theories about Borderline Personality Disorder, as well as about psychosis, narcissism, and neurotic conditions. He explains how these conditions are formed in past childhood trauma and perpetuated by adult relational patterns and defenses. However, Hedges also believes that these disorders do not exist as distinct medical entities,  and he explains why. When I went to Los Angeles last year, I got a chance to meet Hedges in person. He is still very optimistic about borderline-spectrum conditions. He told me how he, his colleagues, and his supervisees had treated dozens of people with severe borderline conditions over the past several decades, often with significant success.

Online and Print Accounts of Recovery by Borderlines, in their own words

Borderline Personality From the Inside Out – by A.J. Mahari

You can find A.J.’s website at http://www.borderlinepersonality.ca
In my opinion, A.J.’s website is the best online source of information about BPD. A Canadian blogger who was diagnosed as borderline many years ago, A.J. writes with great wisdom and experience about every aspect of the borderline experience. By the mid 1990’s, A.J. had meaningfully recovered from BPD, and she has spent the last 15+ years encouraging others to do the same. She also offers “recovery coaching” services to current borderlines. If I had known about her 10 years ago, I would not have hesitated to get coaching from her (well, being honest about myself 10 years ago, I might have hesitated, but that’s another story! 🙂

Healing from BPD – by Debbie Corso.
Debbie’s website is – http://www.my-borderline-personality-disorder.com/
Debbie is a young woman from California who tells the story of her journey to recover from Borderline Personality Disorder using DBT. Over the past few years, Debbie has progressed to the point where is no longer diagnosable with BPD, and she is a great example of how motivation and hard work can lead to successful recovery. I highly recommend her website and blog.

Get Me Out Of Here: My Recovery From Borderline Personality Disorder – By Rachel Reiland.

Rachel Reiland, a young mother and wife, suffered from severe BPD which manifested itself in symptoms including anorexia, promiscuity, and suicide attempts. In this book, she tells the story of how she faced these challenges using intensive psychotherapy and the support of her family and friends. By 2004, when she published this book, she had meaningfully recovered from BPD, and her recovery has been stable and lasting for the past 10 years. Today, Reiland does radio interviews, blog postings, and generally spreads the message that recovery from BPD is real and possible. More information about her can be found at http://www.getmeoutofherebook.com

The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating – by Kiera Van Gelder

This is another moving account of long-term recovery from BPD. Van Gelder honestly describes her traumatic family history and the resulting behaviors it led to including drug addiction, suicidal thinking, and severe mood swings. She courageously sought help via group therapy – the book contains interesting accounts of how DBT works in groups – and via the unconventional methods of Buddhist spirituality and online dating.  These unusual things that helped Van Gelder are reminders that every recovery process is different, and that what works for some people may not work for others. I would not use online dating, but I’m glad it helped her!

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes

#4 – Is Borderline Personality Disorder Caused by Faulty Genes?

This site aims to consider contentious questions about BPD head on. In that light, I will address the “broken brain” theory of borderline personality disorder. What is this theory?

The Broken Brain / Genetic Causation Theory of BPD

The broken brain theory states that children who grow up to become borderline are born with a specific constitutional weakness based on unfortunate genes passed down to them by their parents. Supposedly these children, unlike healthy individuals, are constitutionally unable to regulate their emotions from birth. Their severe emotional problems therefore have little to do with environmental influences, and are instead a consequence of bad genes which prevent their limbic system from functioning properly. This idea is discussed on many online forums about BPD. Although I find it difficult to take seriously, I will discuss this notion at length because many borderlines and their family members believe it.

Cui Bono?

It is useful to first consider the possible benefits of this belief before contesting it. “Cui bono?’ is a Latin phrase meaning “Who benefits?”, and in its idiomatic form it implies the existence of a hidden motive. Understanding how pharmaceutical companies, psychiatrists, and family members benefit financially and emotionally from the promotion of such a belief system is important in understanding how the belief system develops.

The benefits of promoting a genetic basis for BPD include:

1) Simplification – Viewing the often-difficult person with BPD as having a broken brain relieves that person’s therapists and/or family members from having to consider them as a complex human being with a unique history that has contributed to their condition. The simple idea that their brain doesn’t work replaces an in-depth understanding of the borderline as an individual. This way of thinking crucially eliminates the possibility that a broken brain might be partially or wholly the result, rather than the cause, of their past and present emotional problems. In other words, it seeks to minimize the role of the environment and past interpersonal relationships.

2) Relief of Guilt and Shame – The broken brain theory relieves family members from feelings of guilt or shame about how they related to the borderline individual in the past. If the borderline’s problem is genetic, nothing different could have been done to stop them turning out this way. For a formerly abusive and/or neglectful parent, it might be a great relief to think that their child’s problems are due to genetic bad luck, rather than to physical abuse and lack of love. For an ineffective therapist, it might be comforting to feel that the patient’s continued suffering and seeming inability to change is due to misfiring neurons, rather than the therapist’s own lack of knowledge about how to treat BPD.

This is not to blame the parents. Parents who mistreat and neglect their children, as parents of borderline-children-to-be often do, usually have their own severe emotional problems passed down to them from their own parents. They cannot be held morally responsible for continuing a generational legacy of poor parenting that often began before they were born.

3) Financial Benefit – Pharmaceutical companies make billions of dollars by over-medicalizing BPD and hundreds of other “disorders.”  It is well known that the Diagnostic and Statistical Manual of Mental Disorders continually expands to encompass dozens of new mental health “disorders.” In the last few decades, these companies have made massive gains in sales of their products, developing pills for patients with almost every emotional problem imaginable.

In this light, promoting the idea that Borderline Personality Disorder is caused primarily by genetic and biological factors, and thus requires long-term medication to treat its symptoms, makes financial sense for drug companies and psychiatrists. It is part of a long-term movement in the US and global mental health industry. Pharmaceutical companies make tens of billions of dollars annually by promoting the pharmaceutical treatment of hundreds of supposed emotional disorders. Psychiatrists make hundreds of thousands of dollars annually for prescribing pills which have dangerous side effects and often do not work.

It is no surprise then that these companies and psychiatrists are heavily invested in promoting the genetic/biological-causation viewpoint, since it supports their income and continued existence. Even if the validity of certain diagnoses and treatments are doubtful, Big Pharma attempts to profit from them anyway. If one doubts that Big Pharma companies would distort the truth to protect their profits, one should look at how Big Tobacco companies lied on a massive scale about the true harm of tobacco during the 1970s and 1980s.

(Aside: I was recently entertained to read about the new disorders in DSM V. Do you have Hypoactive Sexual Desire Disorder, Caffeine-Induced Sleep Disorder, or Disruptive Mood Disregulation Disorder? Do you think that your psychiatrist can reliably diagnose these disorders, and prescribe you the appropriate pills to treat them? If yes, then you should be a supporter of DSM V!)

Evidence for the Genetic Basis of BPD – The Problem of Diagnostic Validity and Reliability

So, is there good evidence that Borderline Personality Disorder is caused by a broken brain, i.e. by genetic and hereditary factors?

To begin addressing the genetic argument, it is useful to note that in scientific research, the burden for proving a theory is placed on the person who proposes it. In other words, a theory is not accepted until it can be proven via repeated, observable experiments that it has validity and reliability. Validity means that a given result is true, accurate, and meaningful, and reliability refers to the notion that a process can be consistently repeated and yield the same result.

To start with, a valid, reliable theory about a mental health disorder should involve a disorder which can be reliably diagnosed. On this measure, the broken brain theory of BPD is a failure. The problem is that BPD itself, along with most other mental health “disorders”, is not a a valid or reliable diagnostic entity. Rather, the entire notion of BPD is built upon a fragile foundation, involving subjectively assessed traits which no brain scan, blood test, or gene test can reliably diagnose.

Since there is no physical test which can reliably diagnose BPD, therapists must use their subjective judgment about whether or not a person meets at least 5 out of 9 DSM criteria. As noted in the books listed below, different therapists often disagree as to whether the same individual has a given mental health disorder, and this certainly applies to BPD. Where does one draw a line before which one is non-borderline or even healthy, and beyond which one suddenly has BPD?

When I began to consider this question, BPD’s weak position as a scientific diagnosis became apparent. Are there great therapists who can reliably detect when someone has just enough fear of abandonment, or just enough evidence of black and white thinking, or just enough self-destructive acting-out, for these traits to collectively qualify them for the clinical picture needed with a BPD diagnosis? Who decides exactly what degree of poor self-esteem, how severe of an identity disturbance, or how much splitting, counts as a trait contributing toward a BPD diagnosis? How does one scientifically and reliably include or discount such symptoms in all their different degrees and presentations?

If these questions cannot be reliably answered, the whole notion of establishing a genetic basis for BPD is undermined. If mental health professionals cannot reliably diagnose who has BPD at a given time, how can researchers reliably test what causes it? How can one be sure that the people one chooses for testing do have BPD, and they they continue to have it throughout one’s experiment? It makes little sense to test a theory based upon a condition which has not been proven to exist as a discrete entity, and which cannot be reliably diagnosed.

This argument might strike some as outrageous, crazy, or outside the norm. If so, that is fine, since I am merely stating my opinion. My view of BPD is unconventional, but that is not a bad thing. Rather, it is something that has helped me. I do not think that BPD is a useless concept. Instead , I view BPD as a developmental metaphor – one that symbolizes the lower part of a continuum of human functioning stretching between emotional health and psychotic illness, rather than a scientifically valid, reliable diagnosis. I understand why some people simplistically believe that BPD exists as a discrete disorder that one “has” just like one has diabetes or cancer. But that is not my viewpoint.

Can Brain Scans Prove a Genetic Basis for BPD?

Back to the issue of whether the genetic basis for BPD has been proven. Let us assume for the sake of argument that BPD is a valid diagnosis that can be tested scientifically. One possible way of proving a genetic basis for BPD might be to identify the existence of long-term abnormalities in the brains of those diagnosed with BPD when compared with healthy controls. Both groups – those who grew up to become borderline, and those who grew up to become healthy adults – would have to be studied from a young age, with their brains scanned repeatedly to detect changes in structure and function over time. Such a study would have to be massive in scale and timeframe, relying on repeated, costly brain scans over many years. To my knowledge, no one has yet attempted such a study for BPD.

Even if such a study were made, it would face the thorny challenge of conclusively proving that differences in observable brain function between borderlines and healthy control subjects were the cause of past and current emotional problems, rather than the result of past environmental problems. It would have to demonstrate that similar environmental  conditions (i.e. a similar amount of traumatic childhood experience) existed both for those who became borderline and those who remained healthy. Otherwise, the presence of environmental trauma could be a confounding factor, as the greater contributor in the cases of those who became borderline.

One might say that it is enough to simply scan the brains of borderlines versus non-borderlines, and identify differences that prove a genetic basis. This is scientifically baseless. Identifying present-day differences in the brains of borderlines and non-borderlines does nothing to prove the degree to which genes and/or past environmental influence caused these differences. This would be a circular argument.

Twin Studies

Several recent studies have indicated that a genetic basis for BPD has been established based on studies of identical versus fraternal twins. These studies usually find a higher concordance (diagnosis rate) for BPD among identical twins, who share 100% of their genetic material, versus fraternal twins, who share 50% of their genetic material.

However, such studies have come under severe criticism, with detractors asserting that they suffer from faulty assumptions and research methods. The most serious issue is the Equal Environment Assumption (EEA). The EEA, which is crucial to the twin study method, means that researchers assume the environments of identical twins and fraternal twins to be extremely similar, or at least not different enough to influence a study’s outcome. The problem with this is that in-depth observational analysis of twins’ home environments have undermined this assumption, a fact many twin researches have already admitted. It is clear that identical twins are often treated more similarly, pushed to engage in more similar activities, and experience a closer psychological bond with each other compared to fraternal twins. This environmental difference could easily confound studies,  accounting for the variation in rates of diagnosis for disorders including BPD.

Recently, twin researchers have attempted to take the position that identical twins’ genes cause or elicit more similar treatment from the environment, and that genes therefore explain the more similar environment of identical as compared to fraternal twins. In this way, the researchers maintain that the EEA is still valid, since genes are supposedly still the cause of observed environmental differences in how identical twins are treated, rather than these differences stemming from any choice by people in the external environment.

To me, and many other critics, this position relies on circular reasoning and is extremely weak. It is circular reasoning because it brazenly asserts that its conclusion proves its premise – i.e. it assumes to begin with that genes are the cause of the more similar treatment of identical twins versus fraternal twins. It then states that therefore the environment itself is not the cause of the more similar treatment of identical as compared to fraternal twins. In fact, without such circular reasoning, that “fact” has not yet been proven. For some people, this might be hard to wrap one’s mind around, but it is important to understand in order to undermine the basis of twin researchers. Without the Equal Environment Assumption, the whole foundation of twin research collapses.

There are many other problems with twin research, including small sample sizes, unreliable diagnoses of disorders under study, and investigator bias. Anyone seriously considering twin studies as indicative of a genetic basis for BPD should read the work of Jay Joseph, the preeminent critic of twin studies worldwide. Josephs’s books, The Missing Gene and The Gene Illusion, mercilessly expose the weaknesses of twin studies. Joseph’s work is notable for its meticulous attention to detail and to the importance of the scientific process.

Of course, even if twin studies themselves were to be valid, they would still face the problem, with Borderline Personality Disorder, of studying a diagnosis that has not been demonstrated to be scientifically valid or reliable. Therefore, twin studies of BPD face the Scylla and Charybdis of the severe methodological problems of twin research on the one hand, and the inherent unreliability of the BPD diagnosis on the other.

Views of Present Day Psychiatrists, Therapists, and Family Members

Psychiatrists and family members of borderlines often promote the idea that Borderline Personality Disorder is caused by a broken brain, without relying on any experimental evidence that proves that notion. In my view, the more plausible reality is that the symptoms collectively called BPD arise from a complicated, long-term interaction between the individual and their environment. In this view, constitution and genes are not unimportant. A person’s genetic endowment affects their level of vulnerability to stress and trauma, and therefore their vulnerability to developing “borderline” symptoms. But genetic endowment has not been proven to be the primary force that causes these symptoms, as in the broken brain theory of BPD.

Many more evolved psychiatrists and therapists actually subscribe to this dynamic or broader view, in which both environment and genetic endowment are important. Such therapists believe that the relationship between nature and nurture is complex, and therefore the proportional influence of each varies from case to case. In my experience, the therapists who have worked the most extensively with borderline individuals give a heavy weighting to the influence of environment trauma versus genetic contributions, while still acknowledging the importance of both. In my personal opinion, the environment is usually more important than genetic endowment in causing severe emotional problems. Everyone has a bias, and that is mine. Without the severe physical abuse and emotional deprivation that I endured over many years as a child, I highly doubt that I would have been diagnosed with BPD at age 18.

Many psychiatrists without in-depth therapy training, who do not understand the psychodynamic and/or psychoanalytic viewpoints on emotional illness and how to treat it, believe that “it is all biological”, regarding the environment as relatively important. Genetic researchers in universities and foundations sometimes subscribe to an almost entirely genetic viewpoint on mental illness. These researchers rarely work with or even encounter mentally ill people in person like therapists do. To me, their position is difficult to take seriously. However, given that their academic funding for research often depends on their promoting a genetic basis for emotional problems, with Big Pharma companies expecting them to find genes that cause the conditions under study, it is easy to see why they might cling to flimsy evidence for genetic causation.

The extremists who promote purely or mostly genetic theories of BPD need to be called out and discredited. They should not be given serious attention until they provide proof that BPD can be reliably diagnosed, along with experiments that clearly separate the causes and effects of brain-based biological differences.

The Tragic Effect of Genetic Theories of Mental Illness and BPD

The worst effect of genetic theories of BPD is to promote a sense of hopelessness in the person diagnosed with the disorder and their family. If the borderline has problems that are caused by a broken brain and bad genes, problems that can only be managed but not cured with medication, then they are doomed to suffer for life with a severe set of emotional problems from which deep recovery is not possible. This is often the underlying belief of biologically-based psychiatrists who treat BPD primarily using medication. As I have said elsewhere on this site, nothing could be further from the truth.

There are many great books that carefully consider the proof or lack thereof for gene-based theories of the etiology of mental health problems.  Some of my favorites are listed at the bottom of this page. My favorite author in this regard is Jay Joseph, the California psychologist who was noted above.

My Own Experience as a Refutation of Genetic Theories

Several years ago, my therapist told me that you can only truly know something if you experience it for yourself. At the time, this was a new idea for me, since I did not trust my own thoughts and feelings.  This statement came in the context of my starting to feel much better in several areas of my life, but having trouble believing in that feeling. I had trouble trusting my own progress partly because of my fear that if BPD were a hopeless, genetically-based condition, then my experience could not be real or would not last. My therapist encouraged me that if I felt better, that was real. Over time I came to trust my own experience more.

My own experience has been the best guide informing me about the validity of biological, genetically-based explanations of mental illness. The severe physical beatings that I received from my father, along with my mother and father’s inability to communicate love and make me feel secure, were massive factors in my development. They destabilized me emotionally as a young child and teenager, causing me to develop the symptoms that comprise Borderline Personality Disorder. I simply never had the chance to develop a secure sense of identity, self-esteem, and healthy, intimate relationships with my parents and peers. In its place, I was forced to use the primitive defenses of denial, avoidance, projection, splitting, acting out, etc. to defend against overwhelming fear, rage, and grief. The use of these defenses and my inability to trust others to help me as a teenager led me to develop all nine of the symptoms of BPD to varying degrees.

To me, it is obvious that genes and biology – while they are not unimportant – are not the primary causative factor for borderline symptoms and Borderline Personality Disorder. I understand why that might be hard to understand for those who have not experienced the symptoms and history of BPD. Although it is controversial, I believe that family members of borderlines are sometimes motivated by the oversimplification and the avoidance of guilt and shame that genetic theories of BPD allow for. If anyone has experienced a genuinely happy, secure childhood, and then gone on to inexplicably develop chronic, long-term BPD (and not just normal teenage angst), I would be morbidly fascinated to hear about that. However, I doubt that I will be hearing from too many people with that history, given the statistics on how frequently neglect and abuse are associated with the disorder.

In sum, I am proud to reject the idea that Big Pharma and many psychiatrists promote about BPD – the notion that it is caused primarily by biology and bad genes. My childhood experience of abuse, along with my successful recovery from BPD over the last 10 years, is all the evidence I personally need to conclude that the genetic theories are faulty and do not universally apply. Beyond my personal experience, the analysis above, which questions the validity of BPD itself and of the associated twin and gene studies, are more evidence that the issue of causation is not settled.

When it comes to those who promote genetic theories of the cause of BPD, people like me are their reckoning, here to end the borrowed time their theories have been living on.

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Further Reading

If you would like to learn more about the problems surrounding modern psychiatry, here are a few relevant texts. I bought these books used at Amazon for very low prices, often only $5-10 including shipping.

Saving Normal, – by Allen Frances – In this book, the former chair of the DSM Task Force fiercely criticizes the new DSM-V. Frances asserts that the DSM V, without any scientific proof, turns every possible aspect of normal emotional struggle into a new mental health diagnosis.

Mad Science: Psychiatric Coercion, Diagnosis, and Drugs – By Stuart Kirk and David Cohen. In this book, the authors assert that American psychiatry’s claims about mental health diagnoses are riddled with unscientific claims, faulty reasoning, and missing evidence.

Bias in Psychiatry Diagnosis – By Paula Caplan. Caplan cogently illustrates how therapists frequently make unreliable psychiatric diagnoses. Caplan shows how therapists often misdiagnose individuals based on gender and race, and how this can have serious adverse effects in the courtroom and workplace.

The Heroic Client – by Barry Duncan. While this book is mainly about a positive vision of the therapist-patient relationship, it contains a large section critiquing current methods of diagnosis and treatment based on the DSM and psychiatry.

Warning: Psychiatry Can Be Hazardous To Your Mental Health – by William Glasser. A brutal indictment of modern psychiatry, which lays bare its unscientific assertions and points the way toward a better, client-focused form of treatment.

The Missing Gene – By Jay Joseph. A fantastically-detailed exposition of twin research and all the unfounded assumptions it is based on.

The Gene Illusion – by Jay Joseph. Another devastating critique of twin research. Joseph’s books focus on schizophrenia, but his methods of reasoning are easily transferable to twin research which addresses BPD.

Some of Jay Joseph’s articles on twin research from 2013 and before are available for free here – http://jayjoseph.net/publications

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes