Borderline psychopathology in relationships

Features of BPD

The problems of BPD generally fall into four categories: (1) emotion instability, characterized by emotion sensitivity, emotion reactivity, and a slow return to emotional baseline; (2) behavioral impul-sivity (including suicide attempts or threats), particularly when emotionally dysregulated; (3) dichotomous thinking—as in viewing persons as all good or all bad or as holding self-views that are similarly extreme; and (4) problems in relationships, including fears of abandonment, high levels of dependence on others, and high levels of anger. Persons with BPD vary in the kinds of problems they have. Being very emotional describes a common shared characteristic, whereas other features of BPD may vary considerably from person to person. Other problems and psychiatric diagnoses commonly co-occur with BPD—including depression, anxiety disorders, substance abuse problems, post-traumatic stress disorder, and eating disorders.

The causes of BPD are not well established. Although BPD itself is not inherited, certain components of BPD (such as a tendency toward impulsiv-ity) do have a hereditary component. The best evidence seems to suggest that BPD results from a complicated interplay between a person's temperament as a child (e.g., high levels of emotion sensitivity, reactivity, and slow return to equilibrium) and how people in the family and social environment (e.g., peers, teachers) respond to the emotional child over time. In addition, persons with BPD are more likely than the norm to have been physically or sexually abused as children (although less than 10 percent of abused children go on to develop BPD).

Impact of BPD Problems in Close Relationships

There is more conflict in couples and families in which someone has BPD. Partners, parents, and other family members can be overwhelmed by having a loved one who is impulsive, has intense or unstable negative emotions, and often engages in dangerous behaviors (such as suicide attempts or other self-harm). Family members of someone with BPD report high levels of burden, depression, loss, and grief. Fears of abandonment, rejection sensitivity, and dependency in relationships contribute to demands for attention, commitment, and time together; simultaneously, high levels of impulsivity, shame, anger, depression, and suicidal behavior can push loved ones away. Interpersonal chaos and confusion are common results.

Not only do relationship difficulties result from problems associated with BPD, but also they may also contribute to those problems. For example, the quality of current relationships is a moderate predictor of prognosis. Specifically, invalidation of emotions, beliefs, desires or other expressions by parents, partners, and others can initiate (or exacerbate) emotion dysregulation, which may lead to destructive behaviors (self-harm, aggression, and other impulsive acts). Invalidating responses include criticizing, minimizing, or rejecting the valid feelings and desires of the individual. Moreover, disturbances in relationships (e.g., rejection, severe invalidation) may trigger suicide attempts and other self-harming or impulsive behaviors.

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