Causes and Treatment of BPD

(From Stop Walking on Eggshells, 1998, New Harbinger, Randi Kreger and Paul T Mason, MS)


According to John M. Oldham (1997), BPD, like many mental disorders, is caused by a combination of genetic influences and environmental  circumstances. Yet many clinicians, and many of their patients, believe that BPD almost always stems from a childhood of physical or sexual abuse. So pervasive is this myth that one BPD treatment program diagnoses patients with BPD only if they come from abusive backgrounds.

Trying to diagnose BPD by the presence of childhood trauma flies in the face of current research. John D. Preston (1997) notes that 20-25 percent of borderline patients come from intact families without evidence of severe early stress or trauma. And, according to prominent BPD psychiatrist Kenneth R. Silk (1997), preliminary research suggests that BPD behavior may be influenced by neurotransmitter disturbances.

Neurotransmitters

Neurotransmitters carry the signals between all the nerve cells in the brain. According to Madeleine Nash (1997), they are "the most mind-bending chemicals nature has ever concocted." They underlie every thought and emotion, as well as memory and learning. About fifty different neurotransmitters have been discovered thus far. 

The neurotransmitter dopamine involves thinking. Impulsivity and aggression are associated with serotonin, mood stability with acetylcholine, and sensitivity to the environment with norepine-phrine. People with BPD may have difficulties in all of these areas.

However, physicians cannot at this point simply prescribe medications to "correct" each of these neurotransmitters. Silk writes, "Neurotransmitters work in subtle ways and the level of one may directly or indirectly effect the level of another, and thus what is true in the lab does not translate directly into what is true, wise, or useful in a person."

Medications

Medications are often successfully used to help people with BPD by reducing depression, dampening their emotional ups and downs, and putting the brakes on excessive impulsivity. According to Larry J. Siever (1997) antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake  Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Tegretol may be helpful for controlling excessive anger and irritability. 

These medications must be carefully titrated; that is, the right dose must be found for each person so that it helps relieve distressing symptoms without causing troubling side effects.