Biological Aspects of Borderline Personality Disorder

Borderline Personality Disorder is a diagnosis having many different meanings, depending on the tradition or discipline from which you view it. In the biological sense, the disorder is treated with medications directed at a chemical imbalance, using Antidepressants and Mood Stabilizers, much like the treatment of Bipolar Disorder.

Psychopharmacologists tend to understand patients with Borderline Personality Disorder in terms of Atypical Affective Disorders, or Impulse-Related Disorders, and to treat them according to these target symptom areas.

Psychoanalysts tend to understand patients with Borderline Personality Disorder in terms of their psychological symptoms, such as “splitting” (seeing everything as “all good” or “all bad”) and self-injury, and in terms of disturbances in their interpersonal relationships; thus, recommending psychotherapy as the first-line treatment for the disorder.

The two hallmark biological predispositions are impulse aggression and affective instability. The person who has Borderline Personality Disorder is especially sensitive to shifts in his/her environment, particularly in his/her interpersonal space, so that he/she will overreact with feelings of despair, humiliation, and even rage, at a setback at work, for example.

It is likely that this highly sensitive reaction to a shift in the person’s environment has a genetic as well as environmental basis that may have been present from a very early age. This affective sensitivity during the course of early development may prove to be a challenge to the successful mastery of the developmental tasks of childhood (adolescence). For instance, an infant who is very sensitive to separation or bodily pain might cry more frequently and persistently and be more difficult to soothe when its mother or other caregiver leaves. For a depressed or affectively sensitive parent, this type of child can present a particularly formidable challenge.

Then as this child grows older, these crying spells might turn into temper tantrums. For the parent, there may be a temptation to respond to the child’s tantrums with one of two extremes: either excessive indulgence, or inattention or neglect. The responses become inconsistent and unpredictable, and, for the child, these inconsistent responses might then constitute a sort of "intermittent reinforcement," making their temper tantrums more likely.

Later, this cycle is continued, when the child becomes an adult and these temper tantrums become emotional “storms” when the (now adult) patient with Borderline Personality Disorder is threatened by a potential loss of a relationship or has feelings of abandonment.

There are some suggestions of a biologic basis to this affective sensitivity or instability, according to Dr. Larry J. Siever, as published in the Journal of the California Alliance for the Mentally Ill, who reported that patients with Borderline Personality Disorder tended to show greater responses to pharmacologic agents which induce affective changes. For instance, his work suggested that borderline patients with affective instability responded to administration of physostigmine – a cholinesterase inhibitor that prevents the breakdown of acetylcholine – with marked feelings of negative mood (or dysphoria). This response was not observed in patients with other personality disorders or with a normal comparison group. His research suggests that the cholinergic system may play a role in the dysphoric effects of patients with Borderline Personality Disorder.

Impulsive aggression is also a characteristic of Borderline Personality Disorder. Patients with this disorder often engage in self-destructive acts such as self-mutilation and suicide attempts, which can be considered as instances of self-directed aggression. These people are also prone to angry outbursts of aggression that interfere with the stability of their interpersonal relationships, and this, too, may have a biological basis, according to Dr. Siever, who believes that the tendency to impulsive aggression may have a biological basis in the serotonin system.

Dr. Siever states that the serotonin system is a behavioral suppressive system that is involved in modulation of mood, appetite, and a variety of other functions, and that reductions in serotonergic activity are associated with impulsive aggressive behavior such as impulsivity, angry outbursts, and self-damaging acts.

While we are only beginning to understand the biologic aspects of Borderline Personality Disorder, it is clear that more research and a greater understanding of these aspects can lead to improved treatment of the disorder.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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